Tuesday, September 14, 2010

Video Game Addiction: Is it Real?

In this article I aim to take a modestly comprehensive look at the notion of video game addiction, and try to get to the bottom of the hype. Is video game addiction real, or not? Is it fact, or fiction? Truth, or Lie? Is it a reality facing gamers today, or a total myth? Is it a symptom of some other problem (perhaps an impulse control disorder), a condemnation of 'too much time' spent on a hobby unbecoming of an older teenager or even adult (as judged by a non gamer, usually issued forth through the cavernous maw that is a generation gap), a cultural phenomenon, perhaps the manifestation of an attempted escape from too much educational pressure put on the youth, or something else?
And if it is indeed real, are the video games an outlet for an addicted personality, or are they a causal factor? Does that distinction even matter? And, lastly, if it is indeed real, if there are people out there who seem to be addicted to video games, what does the research say regarding incidence rates, severity, and treatment outcomes? Is the media reporting this fairly, not taking it seriously enough, or blowing it way out of proportion?

These questions and more are going to be addressed as I tackle the issue of video game addiction. Is it fact or fiction?

What is Addiction?

Addiction, as defined by the American Society of Addiction Medicine, is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviours. Addiction is characterized by impairment in behavioural control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviours and interpersonal relationships. Like other chronic diseases, addiction involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Traditionally, addiction has been defined solely in the context of psychoactive substance (ab)use (drug addiction). However, this may possibly be changing in the future, as there is a large push for recognition of addictive behaviours with respect to behaviours (behavioural addiction), including, but not limited to, gambling, eating, sex, watching pornography, using computers, playing video games, surfing the internet, working, exercising, watching TV or certain types of non-pornographic videos, inflicting/sustaining pain, and shopping.

As it stands, however, the classification of these sorts of things as addictions is debated, and has, as of yet, been unsuccessful if the standard of classification used is the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Specifically, the latest version, DSM-IV). The DSM-IV is the gold standard of sorts within the field of psychology when it comes to classification/diagnostic criteria of/for mental disorders, and, as of yet, the only things classified as engendering addictions are drugs (and alcohol, of course, but it's a drug and I class it as such). The compulsive engagement in certain behaviours (like shopping, sex, pornography, computer, video game and internet use) is classified as an impulse control disorder.

Impulse Control Disorders

An impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder (hot-hotheadedness), kleptomania (stealing), pathological gambling, pyromania (fire-starting), and three Body-
focused repetitive or compulsive behaviours of trichotillomania (a compulsion to pull one's hair out), onychophagia (compulsive nail biting) and dermatillomania (compulsive skin picking). The onset of these disorders usually occurs between the ages of 7 and 15. Impulsivity, the key feature of these disorders, can be thought of as seeking a small, short term gain at the expense of a large, long term loss. Those with the disorder repeatedly demonstrate failure to resist their behavioural impetuosity. Impulse control disorders are considered to be part of the obsessive-compulsive disorder spectrum.

Behavioural addictions is proposed as a new class of disorder in the upcoming (2013) DSM-V, although the only category included is gambling addiction (although internet and sex addiction are included in the appendix). Notable of course, is the absence of video game addiction, among other things. I will return to this momentarily, but I would first like to remain on the issue of classification by comparing impulse control disorders with the classical definition of addiction, as it pertains to psychoactive substances.

So, what's the deal? Are behavioural addictions just that? Addictions? Or are they more aptly listed as impulse control disorders? Does this distinction even matter? Or is this just a worldwide debate over what amounts to semantics? In order for one to figure that out, I suppose the best route to take would be to compare the definitions of addiction and impulse control disorders, and see where, if at all, they differ. Upon doing that, the other most important issue as I view it would be the end result of the issue/behaviour/disorder: Is the person's life being negatively impacted? Apart from obvious things like physical withdrawl, if engaging in a given behaviour is driven by compulsion, and other factors are present (such as a desire to stop and an inability to do so) then I see the debate as being largely pointless. It would seemingly come down to semantics, if this were true.

Regardless of what you call it, dependence, compulsion, impulse control, or addiction, if you have someone compulsively and/or impulsively engaging in an activity to the detriment of themselves and/or others around them, and against their (and others') desires, then you have a problem that requires attention. I'm not saying that classification is unimportant, or mere semantics, of course. All I am saying is, if the outcome and subsequent treatment is the same, then whether or not they are classed as behavioural addictions or impulse disorders seems irrelevant to me. If Y (outcome) and Z (treatment) are Y and Z independent of X (classification), then X is an irrelevant label in terms of whether it is X or a slightly variation on X with no bearing on Y/Z.

So, what's the answer? Well, if you compare the two definitions, they seem similar but with definite distinctions, and these distinctions go above and beyond those attributed to the fact that addiction is currently defined within the framework of application to drugs. Hence, I suppose, from my layman's understanding of it, the confusion.

So, fine. Let's let the experts hash that out, and deal with the central thesis of this piece:

Is Video Game Addiction Real?

Well, see, on the face of it, that question itself seems to be driving at the issue I just covered. Addiction vs. expression of an impulse control problem. And, looking at the two definitions, I see things in both that are applicable to those cases which the media, various organizations, and even the individuals themselves, would term 'video game addiction.' In fact, some of the criteria are the same. So, let's get past that issue and focus on what I think the real central question is here:

Are there people who play video games so much that it is causing them harm, others around them harm, and, more importantly, is this occurring despite their best efforts to stop?

As much as large segments of both the video game industry and the gaming community at large want to say no, I think the answer is quite clear: Yes. In some cases, this is definitely true.

HOWEVER, I also think that the majority of people who throw the word addiction around in the context of video game playing are wrong, and also hypocritical. I think what they are really talking about is hours spent per time period (day/week/month etc) and how it exceeds their arbitrary, built in notion of what is acceptable and what is not.

Bias, Generation Gap, Hypocrisy?

Think about it: Johnny (why is it always Johnny?) is 22 years old. He works 10 hours a week and is in school for 30 hours a week, attaining a Bachelors degree. He spends 20 hours a week playing video games. Let's say on average, 2 hours a day on weekdays and 5 hours every Saturday and Sunday. His parents complain that he plays too much and is 'addicted.' Well, let me pose to you this question: If he has completed all of his homework, and met all other commitments for the day/week, including those social in nature (actually, gaming itself can and often is a social activity, despite the common misconception that it is a solitary activity, but I digress) is he addicted or merely enjoying a time filling hobby? If he accepted his parents' assessment and say, took up TV watching, or reading, or card collecting...whatever, and spent the same amount of time doing said activities, would his parents then accuse him of being 'addicted' to those as well?

Must one split their time up into several different activities to appease those around them and avoid being labelled an addict? What's the difference if those 20 hours are spent doing one thing or 4? Hell, if he is addicted to anything (and this goes for most of us) why not say he's addicted to distraction? Johnny has an aversion to inactivity, and is addicted to activity! Sure, that might sound silly, but how many people are content to do nothing in their free time? Exactly. So if those 20 hours are spent playing a board game, video game, watching TV, doing pottery, playing guitar, etc, is whatever activity engaged in an addiction? Or is it that some activities are deemed to be 'okay' by the majority, and others are not, leading to 20 hours of one not having an eye batted at and 20 hours of the other raising eyebrows and concern?

Is it that so many gamers out there are addicted to gaming, or is there a generation gap, hypocrisy, bias, and arbitrary assessments at work here?

Now, keep in mind, I set up a specific example to pose this question. If Johnny was gaming and not doing his school work, skipping work shifts, neglecting social and other extracurricular activities, etc, then I would absolutely consider his gaming to be a problem, and in need of attention. At that point, the docs would have to get into the whole classification issue, and another question:

Outlet Or Cause?

Is the gaming the issue or is gaming an outlet for the person's proclivity to compulsion? Is it that there is something inherently addicting about gaming, or is it that some people are predisposed to compulsive/impulsive behaviours (addiction, if you will....again, up to the doctors) and they happen to like gaming, which becomes the outlet for it?

Is that shopaholic wired to shop? Or is it that they are wired to seek out rewards and appease feelings of self worth and success (and maybe mask/deal with negative feelings like low self worth) and they took to shopping to fulfill those needs, when in fact, while shopping fits the bill quite nicely, there are other avenues of expression that would have worked just as well? It's sort of like the whole drug gateway thing. Some people believe that marijuana is a gateway drug, whereas I think that is abject nonsense, and the real issue is that certain people are predisposed to seeking out certain types of experiences, and when they discover that they like getting high, weed is cheap, popular, easily accessible, and considered a safe option. Once that person who is predisposed to such behaviours finds out that getting high fills their need, they seek out other similar (and possibly better) experiences.

Also, as a quick, one note aside, notice how, for example, most people who try marijuana also drink? Why is alcohol never considered the gateway? Huh? HUH? Exactly....

That digression aside, I think that the whole gateway thing fits nicely with my logic on the addiction thing. The mode of expression is not the focus of the need/drive, but the expression of it, and it's possible that something else would fit the bill as well. For example, I have had the “you're addicted to video games” thing levied at me a couple of times in my life, and I can say that, not only is it not true, but if video games were taken away from me in those periods of my life (even now, actually, although I play FAR, FAR less than I used to, due to life circumstances) I simply would have replaced them.

The reason I played games so much was because I LIKED THEM. If they were not an option, then I would have replaced them with movies, most likely. So what is it? Am I addicted to video games and movies? Am I addicted to sitting in front of a TV? Or do I enjoy a certain type of hobby, as most people do, and my particular choices tend to be more commonly frowned upon?

It's important that we aren't throwing the word addicted around to describe something that is not even remotely so. Addictions are not that “you do too much of that.” Addictions are “I am driven to do this despite my attempts to stop, and this compulsive behaviour is ruining my social life, my career, my marriage, my education, my finances, etc. It's not “oh, dude, you play way too many video games (for my liking) and therefore you are addicted. Uh, dude? For every hour I am playing a video game, you're engaged in whatever it is that you do (TV, poker, whatever). Are you addicted as well? Are we all addicted to killing time?

According to the APA....

Well, let's get past my conjecture and get to some research findings. First off, what does the American Psychological Association (APA) have to say on this issue? Well, in 2007, they ruled that there is not enough evidence to make video game addiction a disorder.

Research: Incidence Rates, Treatment, Terms

What about some numbers? Well, there is a clinic in Amsterdam that deals with what they call gaming addiction. The clinic opened in 2006. Two years later, the clinic released a statement saying that they were changing their treatment as they realized that 'compulsive gaming is a social rather than psychological problem.' Their findings over two years? 90% of the patients they saw were not addicted. Even those who played four hours a day or more playing video games had little to no trouble abstaining from video game play- 90% of them, that is. The head of the clinic, Dr. Bakker, stated that they no longer think addiction counselling is the way to treat the gamers they were seeing in their clinic:

"These kids come in showing some kind of symptoms that are similar to other addictions and chemical dependencies. But the more we work with these kids the less I believe we can call this addiction. What many of these kids need is their parents and their school teachers - this is a social problem."
In response the clinic has changed its treatment programme for gamers to focus more on developing activity-based social and communications skills to help them rejoin society.

In most cases of compulsive gaming, it is not addiction and in that case, the solution lies elsewhere.
"This gaming problem is a result of the society we live in today," Dr. Bakker told BBC News. "Eighty per cent of the young people we see have been bullied at school and feel isolated. Many of the symptoms they have can be solved by going back to good old fashioned communication."
By offering compulsive gamers a place where they feel accepted and where their voice will be heard, the clinic has found that the vast majority have been able to leave gaming behind and rebuild their lives. Another BBC report quoted a researcher who described gamers with true addictions as being “few and far between.”

One place where video game addiction is supposed to be rampant is in Asian countries. There have been media reports of what were obviously true addiction cases that set off the alarm for the panic police, and now everyone thinks Asia is full of young people dropping like flies due to video game addiction (as a few severe cases have actually resulted in death due to players not eating or sleeping in order to play). Well, what does the research say?

In 2007, Michael Cai, director of broadband and gaming for Parks Associates (a media/technology research and analysis company), said that:

"Video game addiction is a particularly severe problem in Asian countries such as China and Korea."


So what numbers have been suggested in terms of incidence rates?

Well, results of a 2006 survey, funded by the South Korean federal government suggested that 2.4% of S. Koreans aged 9 to 39 suffer from game addiction, with another 10.2% at risk of addiction (what exactly they consider 'at risk' is beyond me, however).

Okay, 2.4% doesn't exactly merit the sounding of the alarms, does it? Maybe we could turn those off, but we should definitely keep an eye on the problem, as, despite many of my gaming brethrens' protestations, there does seem to be a problem. A small one, unlike what many media outlets have tried to portray (which is likely the source of most of the protestations in the first place, since media hit pieces on game addiction have been almost as bad as the ridiculous media hit pieces on “roid rage”) but one nonetheless.

Okay, digression over. Back to the discussion of the research findings.

So how was video game addiction described in this government funded study? Addiction was described as “an obsession with playing electronic games to the point of sleep deprivation, disruption of daily life and a loosening grip on reality.” According to the study, such feelings are typically coupled with depression, and even a sense of withdrawl (although it's imperative to note the assumed distinction between physical withdrawl and a 'sense of withdrawl'....I say assumed because, from what I could gather, 'sense' was not qualified/quantified in any way by the authors) as it applied to (gaming) withdrawl.

It is interesting to note that their definition of addicted basically fits the definition of classical addiction as applied to psychoactive drugs, including even craving and withdrawl, which does lend credence to this notion of video game addiction being legitimate. Also fulfilling that role is the following statistic: 10 South Koreans -- mostly teenagers and people in their twenties -- died in 2005 from game addiction-related causes, up from only two known deaths from 2001 to 2004, according to government officials. Most of the deaths were attributed to a disruption in blood circulation caused by sitting in a single, cramped position for too long (just like what has been seen on airplanes).


So what's the deal with S. Korea? Why is the problem distinctly worse there? If gaming is the issue, why the stark cultural divide? Could it be something else as opposed to gaming? Perhaps....culture?

According to the Washington Post, in an article about the research into this coming out of South Korea:
“Sociologists and psychiatrists have identified South Korea as the epicentre of the problem. That is in part because young people there suffer from acute stress as they face educational pressures said to far exceed those endured by their peers in other countries. It is not uncommon, for instance, for South Korean students to be forced by their parents into four to five hours of daily after-school tutoring. With drug abuse and teenage sex considered rare in the socially conservative country, escape through electronic games can be a hugely attractive outlet.”
Interesting. This fits with my feeling that the cultural differences were probably at work. However,  it is also important to note that the amount of time spent playing massive multiplayer online games (MMORPG's) as opposed to more traditional games is much higher there than it is here.  I have a suspicion that MMO's have a role to play in this as well. Whether they happen to be the outlet of choice, a causal factor, or both, remains to be seen, but clearly they are seen as a problem by some, and in fact, steps have been taken to mitigate their purported damage, although not in S. Korea, but in China.
Government Action in China

In 2006, the Chinese government instituted play time laws, limiting online playtime to 3 hours. This rule was changed a year later to affect only those under the age of 18. It was again changed in 2007, this time halving the experience earned by a player's character after the three hour mark, and reducing it to zero after the five hour mark. The hope is of course to make the player feel as though they are wasting their time, and in effect, having them banish themselves for the game for the day rather than directly kicking them out.

Potential For Video Games as a Causal Factor

As for what it is about video games themselves that may attract/cause this addictive behaviour, there does not seem to be an answer yet, although there are some theories, revolving mostly around in game rewards, freedom to do much more than one could do in real life (so a boost to personal ability and/or an escape from consequences), the establishment of friendships (online), etc.

I suspect that the escapism is a big factor, and those at the highest risk for the drastic and severe addictions are probably those to whom escapism is most appealing, ie, social misfits (man that sounds antiquated), for lack of a better phrase. I myself was bullied and outcasted/alienated as a youth, and I spent a LOT of time gaming. I thought I was mostly gaming for fun, but I am sure escapism likely played a role. Then again, I also, and actually consciously, escaped into alternate realities by reading. A lot. And no one seems to think that was an issue- quite the opposite, in fact.

So.....Is Video Game Addiction Real Or Not?

It appears to be real, yes.

Uh huh....Here Comes The Butt...

Cute. Real Caveat, Though?

Correct, at least in my estimation. And I estimate that I am indeed correct! (haha). In all seriousness, video game addiction does seem to be real. At least in the sense that there are people who compulsively play them to their detriment (social, financial, health, educational, etc) and are seemingly unable or unwilling to stop. And as I touched upon earlier, there have been at least 15 cases worldwide of people who have died directly as a result of their gaming habit.

There are, however, many factors at play, and the research is far from over. I still suspect that in many cases video game 'addiction' is a symptom, not a source, of the problem, and in most cases of video game addiction, there IS NO addiction. I think there's a lot of bias involved, much misunderstanding of what gaming actually entails (it's not necessarily isolating, for one), cultural differences, and a generation gap at the heart of a lot of the hype surrounding this issue. I think the media has been largely irresponsible, and has blown this out of proportion, as they so wonderfully do, but I also readily agree that for some, THERE IS A PROBLEM, and whether or not video games are the outlet or the cause, help is definitely needed for these people.

I certainly do not want to see anyone else drop dead after 50 straight hours of StarCraft.

Game on people, but do it responsibly.


Note: The following text can be skipped with no detriment to the understanding of my take on this subject. What follows is some advice for fellow gamers and then discussion of an upcoming blog series of mine (currently in progress) that details my life as a gamer. You can stop reading now and you will have read the entirety of the pertinent information. The rest of the text is lighthearted stuff aimed at friends. Read on at your own peril!


If you're not married and/or have no kids, and have your health, ENJOY IT WHILE IT LASTS!!! I can tell you that marriage changes things, at least to some degree. A baby, however, changes them in a BIG way, as do illnesses. There were times where I gamed 20, 30, even 40 hours a week. Now? HA! On average, maybe 3 hours. Some weeks will see a spike in activity, and I might get 10 hours in, but then I might not play for the next 10-14 days. It all depends, but those 40 hour weeks (I think I definitely went way over that even, a few times) are loong before me.

And you know what? I sucks. It really does. I think there are a lot of positives to gaming. Fun, escape, actual, tangible cognitive benefits (reaction times, decision making, puzzle solving, etc), social cohesion, etc, and really, I just enjoy the HELL out of it. I really, really, really love (and miss) gaming, and I cherish almost every hour I have ever spent doing it. Just remember, if you love it too, to do it in moderation. I don't think a few 50 hour weeks will kill you, but I don't think I'd suggest that as a norm.

Hit the gym, spend time with family, friends, significant others, play an instrument, whatever. In short, do other things, and game on! I know I will be doing it for as long as I am physically and mentally able.

P.S.S. (For those bored enough to care about my doings with respect to this blog)

For those who care to read it, I am currently working on a blog series that details my gaming 'career' if you will, from the very beginning to the present. It details the trials, triumphs, and tribulations that constitute my time with a controller in hand, sitting in front of a TV, either alone or with friends/family/my wife (yes, she's a gamer as well (kickass, I know!) (she mostly plays RPG's and puzzle games, two genres I love as well) and playing games. A vast array of games. A multiple decade long laundry list of many, many games, too great in number to ever try counting.

I am detailing my experiences with these games. You will read about those that were great, those that sucked, some that were easy, many that were hard, a few that were WAY TOO HARD, those that made me think, some that made me laugh, one or two that actually made me cry (or got me close to it at least), the rare few that made me jump, and even scream, the MANY that made me swear and scream, even throw controllers (and even one time an ottoman.....) but most of all, the ones that made me smile. Which is basically all of them, except for the really sucky ones. Yes, even the ones that made me rage. Hell, the ottoman throwing incident came while playing my absolute favourite game.

I will discuss consoles, and our (brother and I, mostly) attaining of them. I will discuss our first console, which was given to us as a Christmas gift (best Christmas ever!) and I will discuss friendships made, rivalries forged and broken (some to be forged again), practise (including thumb pushups, thumb calisthenics and thumb steroid injections), tournaments, competition, jealousy, sweet deals, ripoffs, games whose asses we kicked, games which kicked our asses, what game actually got my dad to quit scoffing at the idea of “those stupid video toys” and actually try it (and like it and play again and again and again), what game(s) did the same for my mother, who actually got hooked on two of them, who in my household moved the controller around as though the character needed the player to move the controller upwards to convince them to jump, and, while holding it straight out, lean over as far right as possible while straining your face in order to get a said character to run to the right, and more.

All of this is being detailed in a several part, expansive series, of which the first 3 parts are complete. I expect the entire thing to be done within a month or two. Look for it here on The Thoughtful Gamers, if you're bored enough (then again, if you're that bored you should be playing a game, not reading about me playing them....FOR SHAME!). If I see you back, I hope you enjoy, and drop me a comment letting me know if you do (or if you hated it and didn't buy the thumb steroids bit). If I don't, well, fine, but no cookies for you.

To the one or two of you masochistic enough to have read the postscript stuff, thanks for reading. Also, seek help. :)

You know I love you guys. My loyal readers are some of my favourite people on earth. I mean, if they can put up with my incessant rambling, they must be awesome (or certifiable). Seriously, thanks for all of the support, guys. As I used to say on GT, Science Bless You ;)


  1. Man that was a great blog on video game addiction. As I was reading it I kept thinking of points you missed and would file it away for my comment just to have you cover it later in the blog.

    As usual we see eye to eye on a subject. The thing I always find interesting is that it is only an addiction/impulse if it is perceived as a bad thing. Isn't it an impulse to be the best that keeps athletes practicing their sport for hours on end? Seriously if a basketball player didn't have a chance to make millions wouldn't people think he needed help because he shoots a thousand baskets a day? When you think about it the only difference between that basketball player and a gamer is the perception of others of what they are doing.

    You are also right about the fact that it is our preferred option for our entertainment. You take away my games and I will mow through books at an alarming rate. They both have that one more level/chapter aspect to them when they are good. Funny how one of those is thought of as a good quality ant the other a bad one.

    I also learned from this blog that I likely have dermatillomania. I pick at everything with out even thinking about it.

    My friend I was staying at has three kid's including his infant twins and we were still playing twenty hours a week. On top of that we were playing Frisbee at least seven hours a week. I think that means that you just aren't trying hard enough.

    Sounds like you are doing quite the comprehensive look back at your gaming history. I'll guess I'll have to try and remember my own history to share my own stories in the comments. So try and inspire them in me.

    Lastly the fact that I read the whole thing makes me certifiably awesome, as well you know.

  2. "My friend I was staying at has three kid's including his infant twins and we were still playing twenty hours a week. On top of that we were playing Frisbee at least seven hours a week. I think that means that you just aren't trying hard enough."

    My illnesses are a huge factor.

    "Sounds like you are doing quite the comprehensive look back at your gaming history. I'll guess I'll have to try and remember my own history to share my own stories in the comments. So try and inspire them in me."

    Will do.

    "Lastly the fact that I read the whole thing makes me certifiably awesome, as well you know."


  3. Yeah I should have realized that. At least I wasn't being completely serious. It still was slightly out of line though. So I apologize.

    It shouldn't be hard since nostalgia is such a powerful thing. Just hit some similar games and we be cruising.

  4. Dude, I knew that comment was in jest, it's all good.


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