Why video game 'disorder' can be a real addiction
If you're a parent of school-age kids, you might have had the same occasional thought I have: "Is that all you do all day -- play video games?"
Clearly, I don't remember "gaming" nearly as often when I was their age. But back then, video games weren't as intense, immersive and social as they are today. We enjoyed Nintendo! And we definitely didn't feel we had a disorder, or were addicted, to playing these games.
The World Health Organization recently declared video gaming "disorder" a mental health condition. As someone in the addiction treatment field, this declaration gave me pause to consider the seriousness of video gaming disorders.
What does it mean exactly when an organization like WHO makes a statement like this about gaming, and what does it reflect about addiction, and perhaps society, in general?
Most people play video games -- and smartphone app-based games as well -- without any notable negative consequences. So, for the majority of people, it might be difficult to understand why some others simply can't put the controller down.
But that's no different from other sources of addiction. Many people can drink alcohol, for example, without consequence, but a significant minority cannot.
Addiction is not so much about how many drinks you have, how many drugs you use, or how many video games you play. It's not even about drugs or games, per se. It's about people and health. It's about our brain's reward system and how some are genetically and environmentally conditioned to pursue reward more compulsively than others.
The real marker for addiction is continued use or behavior in spite of negative consequences -- compulsions that hold people back from the things they really value.
From that perspective, it's easier to see the WHO's rationale in declaring gaming a mental health condition. And in countries outside the U.S., the problem may indeed be more palpable.
While some scoff at the notion of gaming as an addiction, my colleague, Dr. Joseph Lee, says the dialogue actually reveals how hard-wired our society is to look at addiction in moralistic terms.
"We tend to see drug addiction in a moralistic light -- good versus bad, or weak versus strong," says Lee, the medical director for the Hazelden Betty Ford Foundation's Youth Continuum. "Addictions are addictions not because of morality but because the compulsive behaviors take over a person's life and prevent them from prioritizing the things they know are really important, like work, family and relationships.
"Through this lens, I think people can better understand how things like gambling and video games can be addictive. If anything, the dialogue about gaming disorder, in general, reveals more about how stigmatized addiction is in the first place."
We don't need research to see the negative impact of gaming in some people's lives. Many of us see it in our families, where young kids might isolate themselves at the expense of almost everything else life has to offer.
We see intersections between gaming and substance use in the patients we treat, too.
Gaming by design -- like social media -- preys on some of the same thinking we see in young people with substance use disorder: fatalism, impulsivity and the desire for instant gratification -- and much more so than in the past.
Someone who grew up with "Super Mario Bros." on the original Nintendo can't really comprehend how immersive and alluring video games are today. The graphics, the social media interface and the realism all provide a kind of escape that wasn't there in the '80s and '90s.
A small percentage of video gamers buy most of the video games. Companies know this, and in a competitive field, they are constantly "enhancing" games to get those who play the most to play even more.
So, we are likely to hear more about gaming disorder and addictions to certain kinds of technologies as time goes on.
Whether we call it addiction, a mental health disorder or anything else, gaming problems are real for some people, and we should be helping them.
We need to move beyond the stigma of our diagnostic labels and talk about people and their whole health. When family members take a loved one to the hospital for a mental health condition, they're often sent to the back annex. They often have trouble using insurance to pay for the help they need. And most don't even get that far -- failing to see why their loved one won't simply stop drinking, cheer up, chill out or put the controller down.
Stigma runs deep when it comes to problems of the mind. But we need to have this dialogue in our society.