Have you ever felt like you truly couldn’t put a game down? Pulled a gaming all-nighter? Needed to play just one more turn… or fifty more turns? Games are designed to keep you engaged and playing. Often a sign of a good interactive experience is when the hours melt away as we play because we’re enjoying the experience that much. As games grow more complex and keep enticing us with new content, their addictive qualities have been thrust into the spotlight, making it a hot topic with exhausting debates about its prevalence, how to treat it, and if video game addiction is indeed a modern psychological disorder.
Truth be told, researchers and psychological professionals still don’t have great data to say for certain what we’re dealing with when people can’t power down. And yet, it’s impossible to ignore the news stories or personal accounts of those who have had games negatively impact their lives, from Fortnite being cited in divorce filings to professional sports teams like the Vancouver Canucks banning it and other games during the season. On the other side of the coin, you can’t dismiss the positive power of games, either. They bring people together and have been used as an outlet for those who struggle with everything from intense stress to major depression and anxiety. Games are now being used as a learning tool in many classrooms, as well.
We talked to various researchers and psychological experts to discover what is currently known about video games and addiction. As with many things in life, this is a highly complex and murky issue. Here’s a look inside the challenges facing gamers, experts, and advocacy groups.
PUBG is a battle royale game that has attracted both positive and negative attention
Where We’re At
You’ve probably seen news stories pop up talking about video game addiction. Everyone seems to have an opinion on the matter. Even Britain’s Prince Harry recently said Fortnite should be banned, proclaiming he believes it’s more addictive than drugs or alcohol. Countries like Iraq went one step further and outlawed battle royale games like Fortnite and PUBG Mobile due to their addictive nature. As more stories like these make their way into the news, the pressure is on researchers to find answers about what’s truly going on.
Currently, The Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook published by the American Psychiatric Association to classify mental health disorders, lists internet gaming disorder as an area requiring more research, which means it’s not ruling it out and it will be discussed in 2020 for inclusion in the DSM-6. The DSM is considered an authoritative guide for diagnosis used by a wide array of healthcare professionals, such as clinicians, researchers, health insurance companies, policy makers, and more. Since the DSM’s last publication, The World Health Organization (WHO) recently listed gaming disorder as a disease in its draft for the 11th revision of the International Classification of Diseases, which is comparable to the DSM but isn’t exclusive to psychiatric disorders. It voted for final inclusion just this past month at the agency’s 72nd World Health Assembly in Geneva, Switzerland, deciding to officially classify “gaming disorder” as a behavioral addiction. The new revision goes into effect on Jan. 1, 2022. Its current definition lists that “the pattern of gaming behavior must be characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” To be diagnosed, this must go on for at least 12 months and cause a significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
The ESA Fights Back
The ESA (Electronic Software Association) took a strong stance against the World Health Organization’s proposed disorder classification, immediately issuing a statement urging them to reverse their decision, saying: “The World Health Organization knows that common sense and objective research prove video games are not addictive.” When asked about why it was important to respond, ESA president and CEO Stanley Pierre-Louis reiterated there is no medical consensus regarding the term “gaming disorder.” “From our perspective, anyone who feels they need help should get the help they need,” he says. “I think our concern becomes when video games become the blame, as opposed to really addressing whatever that underlying problem might be.”
Some think the ESA’s outspoken approach hasn’t been helpful and might be turning a blind eye to a real issue. “The gaming industry itself, especially around the violence of video games conversation, has just always been very defensive,” says Game Quitters founder Cam Adair. “You could say maybe rightfully, and so I think that they’ve shown a lot of resistance to this idea that some people in the community are struggling. For me, that’s always been kind of ironic, because as someone who was a hardcore gamer, it’s not like people gaming too much was a big secret in the community.”
The WHO classification decision was met with both support and criticism, leading to passionate conversations within the scientific community. “I think it’s a difficult time with lots of very strong opinions on both sides,” says Patrick M. Markey, professor and director of the IR Laboratory at Villanova University. “It’s almost the new violent video games.”
Even with diverging opinions and concerns over incomplete data, there could be other reasons for it making its way into the International Classifications for Diseases. It’s almost a catch-22; listing it as a disorder carries some heavy connotations, but for those who need help it’s almost a necessary evil to ensure insurance coverage. “If you don’t make it a disorder, then people can’t get reimbursed for treatment,” says psychologist and University of Wisconsin Madison professor C. Shawn Green. “But if you do make it a disorder, there’s all kinds of stigmas associated with mental disorders, and those stigmas can have consequences.”
Some feel the WHO taking this first step will open the doors for more awareness and better research funding, hopefully leading to better treatments and insurance assistance. Many professionals feel the guidelines provide a good starting point and mirror what they’ve seen in their own research and personal lives. “I think it’s really sensible,” says BYU human development professor Sarah Coyne, who just completed the longest longitudinal study on video game addiction (see “New Research Has Interesting Findings” sidebar). “It’s based on the criteria for other types of substance use disorders. The individuals that I’ve seen personally, who I would say, ‘You’ve got a problem with video games,’ I see a lot of those same symptoms. They can’t cope with the real world so they just turn to games, and then just get kind of sucked in.”
However, others feel like the research is still inconclusive and the WHO’s criteria is too broad, causing concern that it makes premature claims without sufficient evidence. “There’s a lot of concern about the diagnostic criteria that is super vague, and that you can replace basically gaming with anything, playing soccer, reading books, whatever, and it would still kind of hold no matter where you place it,” says Rachel Kowert, research director of Take This, a non-profit whose mission is to decrease the stigma for mental health discussions in the game industry.
Right now, specific addictions like “exercise,” “food,” or “being a workaholic” aren’t their own entities, so it brings into question what would make video games require a special classification. Add in that data still doesn’t show that playing video games has any substantial impact on our brains. “We have decades and decades of research into the effects of video games,” Kowert explains. “And if you take the broad perspective, the effects of it is neutral at best. It’s going to have some good effects, and maybe in some extreme cases, you could link it to some sort of adverse effects. But generally, the effect of media on an individual in relation to any particular outcome is not significant.”
Loot Box Complications
Loot boxes are a whole other can of worms, but also come into the conversation about addiction, especially due to their comparisons to gambling. Lootboxes are a virtual Skinner Box, training players that they should derive positive feelings from opening them, even if the contents become less valuable. Countries like Belgium and the Netherlands have flat-out banned games from using them. This is another area that’s still being debated, with many calling for legislation and being concerned about ethics. “I think loot boxes and anything dealing with a random generator, that’s where more researchers are split right now, even more than video game addiction,” says Anthony Bean, a clinical psychologist and executive director at The Telos Project.
“There’s been a little bit of literature on loot boxes, but there’s not much yet,” says Chris Ferguson, a professor and co-chair of psychology at Stetson University in Florida. “It’s hard to say what real impact they have.” Ferguson spoke to some early work citing people with gambling issues being more likely to spend money on them, which isn’t unexpected, but there still is a lot that’s uncertain. He says it’s important games don’t put “unreasonable burdens” on players when using loot boxes.
Kelli Dunlap of iThrive Games spoke about humans being poor estimators when it comes to money spent, and thinks extra things like parental controls, showing total purchases, or even money caps could go a long way. “It’s not about being authoritarian and dictating players to do certain things or trying to legislate how players engage, but rather giving them the most tools possible to make the most informed decisions that they can,” she says. “I do think that is on the games industry, largely, to do, especially if they want to avoid future issues with government legislation, rules, fines, things like that.”
But are loot boxes any different from opening a pack of Pokémon cards in hopes of getting an ultra-rare, or having the surprise of not knowing which toy is in a blindbox? You’re walking away with something – unlike gambling, which can leave you empty handed. Even so, the awareness has picked up with recently proposed legislation from Senator Josh Hawley (R-MO) that would fine publishers that include them in games targeted toward children. It’s unlikely Hawley’s push will be the last we see from governments, meaning all eyes are on publishers to ensure they’re not being used in predatory ways.
Another area of contention is the theories on the cause of excessive video gaming. Researchers’ hypotheses ran the gamut. Some support it being treated like substance abuse, while others view it as a behavioral addiction like gambling or hoarding. Most people I consulted believe when people game at problematic levels it is most likely an underlying symptom of a deeper issue, such as depression or anxiety. The WHO’s classification of gaming disorder also doesn’t offer much clarity on when someone should be diagnosed with it, lacking specific symptoms.
The world doesn’t have concrete answers on whether video game addiction is real, how many people have it if so, and how to actually treat it. The research also isn’t the greatest, relying on self-reports, convenience samples, and small test groups. “The research base right now is relatively young, relatively new, so there’s also lots of problems with it,” says Kelli Dunlap, director of mental health research and design at iThriveGames. “The way the studies are carried out, the way they select their participants, the way the information is analyzed, and the way the information is presented – it is really problematic. That goes for people who have found that games don’t have addictive qualities as well as people who have found that games are addictive.”
It’s important to remember that research takes time, and technology evolves at such a rapid rate that it’s difficult for studies and science to keep pace. Scientists are often measuring different things and carrying out their studies in different ways as well, which is why one day we can see a news story on coffee being good for your health, while another says the opposite. With science taking some time to catch up, at the very least we are watching video games and other technology get more thoroughly researched, which can only help us learn more about their potential impact.
What To Do If You Have A Problem
Getting away from the focus on science and research, it’s impossible to deny that people may need help with their gaming habits. But doing a quick Google search does not exactly yield much information or treatment options. “If you feel like your gaming is becoming problematic, you should definitely go talk to somebody like a therapist, “ says Kelli Dunlap, director of mental health research and design at iThriveGames. Experts believe it’s a bonus if you can find one who has some experience with games, so they can better evaluate what’s cause for concern, but seek a professional first and foremost if you’ve noticed gaming negatively impacting your life.
If you’re looking for support and suggestions of ways to improve your gaming habits, Cam Adair, who once considered himself addicted to games, formed Game Quitters out of his own frustration with the lack of resources out there for those struggling. The program has everything from personal accounts to tips on helpful alternatives. “The people who are actually struggling with it, I think so often they’re the ones who are lost in the conversation,” he explains. “We missed the fact that there are thousands of people coming forward just asking for help, and we need to figure out some way of helping them.” Adair recommends trying to break away from gaming for 90 days, not forever, just as a test run.
For those concerned about their loved ones or selves, beware: Plenty of programs out there can take advantage of your fears and wallets. “A lot of people are getting advice in the guise of being coaches and running camps with no empirical scientific evidence at all to support their programs,” says director of the IR Laboratory at Villanova University Patrick M. Markey. While this problem isn’t exclusive to video game addiction, it’s one of the bigger targets lately. “There are really good, licensed therapists that are helping people out using scientifically based practices and so forth.” Markey notes the prevalence of clinics and detoxes being sold online and cautions: “They’re charlatans, and they’re just making money off of issues that don’t exist, or they’re giving you bad therapy or advice.” To ensure you get the best help possible, check accreditation, credentials, and reviews. If you get overwhelmed, The American Psychological Association even has a locator you can find on its webpage (https://locator.apa.org/) to assist with the search and ensure you get matched with a professional. You can also contact your insurance company for recommendations.
What We Can Agree On
The discussions and debates on video game addiction might sound like a mess, but we do have some clarity on the topic. To be clear, nobody I talked to denies problematic gaming habits exist, but based on findings, they believe it’s only a small portion of the population, estimated between one to three percent, who actually have trouble powering down.
The vast majority of people play games without developing behavioral problems, but that small percentage who struggle with addiction isn’t anything to scoff at. “It’s a small percentage, but still a substantial number, given how widespread gaming is, of people who seem to be taking serious damage to their lives because of the way in which they’re doing it,” says Iowa State University developmental psychology professor Douglas Gentile. “It’s not just a fad they go through when the newest Black Ops comes out.”
Gentile is one of the leading researchers in the US on the positive and negative effects of media, with 30 years under his belt and various awards to show for it. Based on current data, he says when somebody has a problem, they rarely get better on their own and require some sort of intervention. Once they have guidance, they do improve. He also wasn’t shy about his frustrations with how dismissive many have been about the issue, especially within the games industry. “If we could at least have a proper public education campaign that says it is a real legitimate problem for some players and this is what it looks like, we might actually see the prevalence go way down, because parents start noticing it and people start noticing within themselves before it becomes a problem,” he says.
At the very least, there seems to be a general consensus on when gaming becomes a problem and you should seek help. Most gamers can attest to times they’ve overdone it, but that doesn’t necessarily indicate a serious problem. “Doing something a lot, it’s not an addiction,” Gentile explains. “An addiction means doing something in such a way that it damages your life. And it can’t just damage your life in one area, because with anything you love, you will sacrifice some other part of your life [for it]. It has to damage it in lots of areas, and [be] so far out of balance that you’re not able to succeed in any other areas of your life because of it.”
Parental Guidance On Gaming Habits
Parents are often the first ones to spot when something is off with their children’s behavior. With gaming addiction making more headlines, it’s only natural to have concern. If this is the case, almost all professionals discussed consulting a therapist as a family. Nowadays, technology is so ingrained in our everyday lives, and gaming has increasingly become a social activity among children, that it can be hard to determine what’s problematic versus normal engagement for many parents.
Many experts say keeping lines of communication open with children about their gaming is key to understanding it and knowing when something is awry. “I would definitely encourage parents to talk to their children first,” says Kelli Dunlap, director of mental health research and design at iThriveGames, a non-profit that studies the issue. “Don’t just automatically assume ‘My kid is playing Fortnite, therefore, he or she is addicted.’ Some guidance that I like to give parents is that if your child was using the time they spend gaming to read a book or play a sport, would you still be concerned?” Dunlap said if you’re on the outside of the gaming world, sitting down with your child and having them teach you about the game and explain what they love about it and why they play can be very helpful.
Parents can also monitor their children’s gaming to make sure things are on a healthy level. The ESA provides game ratings to give parents and consumers more information on games, but it also encourages tapping into the parental controls. “One of the things that we do to empower consumers and especially parents is the ability to limit screen time with use of parental controls,” says the ESA’s president and CEO Stanley Pierre-Louis. Pierre-Louis spoke positively about the Nintendo Switch allowing you to activate parental controls in real time with the app, which will give you updates about your children’s activity. All major consoles currently have some form of parental controls that allow you to put extra efforts into ensuring your child is gaming safely.
Another good indicator of an issue is whether you’re really enjoying the time you’re gaming. If you’re doing it in spite of that or even when it puts you in a worse mood, it could be a sign something isn’t right. We all have moments of frustration with games, but addiction goes beyond that. You’re playing out of obligation for that one more turn in Sid Meier’s Civilization, or overnight PUBG gauntlets consistently leave you weary and unprepared for the next day, and yet you can’t stop.
No magic number of hours played can determine whether or not you’re addicted and need help. Some people can game a lot and not have it negatively impact their lives. Others can’t. This goes for any addiction, but people seem even more focused on numbers when it comes to gaming. “Lots of people think that just because someone plays a lot, they’re addicted and consider it an addiction,” Kowert says, regarding common misconceptions. “It has to have detrimental effects in every single area of an individual’s life.”
The effect gaming is having on your life has to be pretty drastic before you need to be concerned, but many people have continued to game in spite of losing everything around them. Gaming is no longer a coping mechanism for the things going poorly in their life, but instead becomes the cause of failing out school, losing a job, or drifting away from a significant other.
New Research Has Interesting Findings
New research surrounding game addiction is coming out rapidly, and experts have expressed wanting more longitudinal data that studies participants’ habits over time. BYU human development professor Sarah Coyne just published interesting findings in her lab, as her team tracked players over a six-year period, making it the longest longitudinal study to date. Coyne measured pathological gaming levels by using proposed criteria set forth in the DSM-5 for internet gaming disorder. To be considered addicted, you must have at least five of these traits: a preoccupation with gaming, experience withdrawal symptoms (sadness, anxiety, irritability), formed a tolerance where you need to spend more time gaming to satisfy the urge, have the inability to reduce playing time, abandon or lose interest in activities previously enjoyed, continue to game despite problems, deceive friends or family members on actual time spent gaming, use gaming to reduce negative moods, and have jeopardized or lost a job or relationship due to it.
The study found a small group of people stayed addicted to games over the course of the time, while others, who didn’t show any addiction at the beginning, would grow eventually addicted. Then another group who started addicted weren’t by the end of the study. “Yes, [they’re] very different trajectories, with the vast majority of people who play video games with no symptoms at all,” Coyne notes.
However, one thing she found really interesting is that whether your addiction increased, decreased, or remained stable, just having a video game addiction at any point tended to be related to a negative outcome. “We didn’t find any evidence that it was ever a good thing to be addicted,” Coyne says. “The biggest [negative outcome] was subjects were far less likely to be going to college or employed. They also had lower levels of empathy, higher aggression, and more financial distress.”
What The Future Holds
For now, the conversation continues to heat up in the aftermath of the WHO recognizing gaming disorder as a disease. In the past, the DSM has tended to follow its lead, and in 2020 it will be decided if the DSM will define and classify internet gaming disorder, an area it previously said required more research. “I won’t be surprised [if it’s included],” Coyne says. “We’re kind of moving toward that direction, and I think that with more research coming out, we’re recognizing that, yeah, this can be a significant problem for a small number of people.”
However, there are concerns that including it without substantive, conclusive research could cause more harm than good. Once something is classified and defined in the DSM and The International Manual for Diseases, it’s difficult to reverse course. “It’s super rare for a diagnosis to be taken out; that’s the concern,” says Anthony Bean, a clinical psychologist and executive director at The Telos Project, a nonprofit mental health clinic focused on video gamers and their families. “With the World Health Organization, we have seen reclassifications of things that have had to be reversed, but only after several decades,” adds ESA president and CEO Stanley Pierre-Louis. Pierre-Louis points to mischaracterizations of ADHD, gender identity, and homosexuality, which took decades to overturn. He doesn’t want to see that happen again.
Cam Adair struggled with his own gaming addiction, making it his mission to help others and bring awareness to the issue
At the very least, through the recent potential classifications, media attention, and debates within the scientific community, more awareness is being brought to the value of research and where things need to improve. “For any organization like the WHO to recognize a new addiction like this, those are 10-to-15-year cycles,” Adair explains. “Decades of research goes into it … and based on what’s in those manuals, that certainly impacts the public conversation. In the last year two years, the pace at which this issue is coming forward is very rapid and a big part of that is the World Health Organization recognizing it. It has shifted the public conversation around the topic.”
Not only has the conversation picked up in the public eye, but it’s also forced scientists to reevaluate the current research we have, opening a larger discussion about where the shortcomings are. “We need to change the culture of research to take the time to create really high-quality, standardized, pre-registered, open science that can be much more informative than what we have now,” Ferguson says.
Markley agrees in seeing studies on the rise and appreciates the benefits, but also has some concerns. “I think we’re learning a lot as a field. I think one of my bigger worries is sometimes the public gets ahead of our research, or sometimes it takes the research and molds it into a story they want to tell.”
Another question that’s still in flux: if this is a problem, how exactly should it be treated? It’s not like an infection, where you can take an antibiotic and get better. Even different therapies are more successful than others, depending on the person. Psychological experts admit they’re still figuring this out.
Some players of popular MMOs like World of Warcraft have detailed how hard it is for them to step away from their virtual worlds
“I’d like there to be better treatment out there,” Coyne says. “But we’re kind of floundering a little bit, and just trying a bunch of different things. Some kind of work. We’re still trying to figure that out.”
While we still don’t have a lot of answers, one thing all psychologists reiterated is that moderation is key. This isn’t about taking away video games, which many said they don’t believe is the answer. Instead, it’s about enjoying your hobby in a healthy way. Perhaps Coyne said it best: “[It’s about] finding that balance and that sweet spot of where you are able to play video games and have them work for you. You’re having a wonderful experience, you’re engaged, and it’s a positive thing in your life as opposed to when it really takes over and you’re working for the game at that point.”
If you or someone you know struggles with video game addiction, you can find valuable resources and help online.
This article originally appeared in the July 2019 issue of Game Informer.
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