Dr Simon Adamson

Computer and video gaming is huge. As well as the home PC there are a range of dedicated gaming consoles with serious computing grunt. Game development companies boast budgets rivalling those of the big movie studios, producing games with very high production values and sophisticated back stories. This level of investment reflects the money that gamers are prepared to pay for good products, and the large number of gamers that are out there. Along with all the excitement generated by the emergence of a new entertainment medium is growing concern that for some gaming is getting out of control. Gaming addiction is increasingly recognised as a genuine phenomenon.

How common is it? Well that all depends on what you mean by “it” and what definition is used. Because there is no widely agreed definition and no well recognised measure, we are in the situation of wildly varying estimates, from virtually no one up to around half of all gamers, depending on which study you look at. The manual used by the American Psychiatric Association (sometimes referred to as the “bible” of psychiatry) released its fifth edition in 2013, 19 years after the release of the 4th edition. Whilst the only behavioural addiction formally recognised is Gambling Disorder, the manual has a final section to list conditions that warrant further study, where there is enough evidence to justify the research that would be necessary to include the condition in the 6th edition.

One such new condition is Internet Gaming Disorder, which is characterised by a pre-occupation with internet games, symptoms of irritability, anxiety or sadness when unable to game, need to spend increasing amounts of time gaming, and deceiving others about the extent of this, difficulty controlling use, loss of interest in other activities, continued use despite knowledge of psychosocial problems, using gaming to escape or relieve negative moods, and significant impact on relationships, work or education. A person would need to meet most, but not all of these criteria. Readers won’t be surprised to learn that this problem is most common amongst males, in the 12-20 age range. It is certainly not exclusive to males and heavy internet gaming does occur in older age groups, and this may prove to be increasingly the case as a generation exposed to modern games, and less focussed on the passive experience of TV viewing continues to age.

It is this generational change that may underlie much of the conflict within homes and uncertainty that surrounds the emergence of computer games as a major focus of adolescent and young adult entertainment time. Like it or not gaming is a legitimate hobby for millions of people. Older generations are not familiar with these games. Whilst very heavy TV watching will often be seen as an unhealthy choice, it is seldom thought of as an addiction or compulsion. What is it about computer games that makes them more prone to compulsive use, as captured by the concept of Internet Gaming Disorder? Unlike watching TV or reading a book, gaming is an interactive experience and it appears that the more interactive a game is the more popular it is and the more likely it is to become problematic. Acronyms such as MMO and MOBA refer to games that are online, involve large numbers of people, sometimes interacting with a small group of people and sometimes in an environment or world with hundreds or even thousands of other players. Games may be played as one off battles or ongoing campaigns. Players usually have the ability to achieve higher status levels that provide them with the opportunity to purchase better equipment.

The global nature of these games means a New Zealand player could be interacting with people from anywhere in the world. As a result usual circadian rhythms and conventional sleep patterns can become blurred. As well as finding these games exciting, players are attracted by the ability to compete, challenge themselves, acquire online possessions, achieve status and the experience of group membership. Like all entertainment, computer gaming can be a way to relax and unwind, but also has the potential to become an escape from worries and can lead to avoidance of responsibilities. They can also be seriously expensive, with more committed players spending thousands on equipment, games, upgrades and other optional content.

How much time is too much? A person who is identified as having internet gaming disorder typically spends 8 or more hours a day gaming when possible, with a least 30 hours accumulated per week. By their nature these games make it very easy for players to lose track of time. Amount of time gaming on its own isn’t a good way to identify problematic use however. More important is the impact this is having on a person’s life. Probably the most pronounced impacts of gaming addiction are social isolation, family conflict, neglect of sleep and diet, and neglect of work/study responsibilities. Social isolation is difficult to evaluate in this group however as gaming is often very interactive. A person can spend a lot of time engaging with others, either random strangers or a regular group of people they will team up with. At one level this does constitute social interaction, but if it is occurring at the expense of at least some contact with family and face to face contact with friends then this would be a concern.

As a newly emerging problem, treatment options are poorly evaluated, however the general approaches taken with other addictive behaviours are likely to be relevant. These include enhancing motivation, dealing with underlying mood and anxiety difficulties, agreeing on whether significant reduction or complete abstinence is required, environmental change, social support, and encouragement to engage in alterative activities.