treatment processWhen a behavior stimulates the reward centers of the brain, it can become addictive for some people.
 
Although many Americans of all ages play video games, a small percentage of people who play video or online games become addicted to the adventure and rewards involved.

There is a difference between playing a video game for a long period of time – as the culture around video games becomes more socially acceptable and widespread, “marathon” gaming sessions are becoming more common – and becoming addicted to video games. The current diagnostic manual, DSM-5, offers a footnote stating that more research must be done before gaming addiction can truly be added to the manual, but several gamers have self-reported in studies that they have symptoms that fulfill the definition of addiction.

Common symptoms of gaming addiction include:

  • Consistent or compulsive reliving of gaming experiences and planning the next gaming session
  • Increased irritability, aggression, depression, or mood changes when the game ends, gaming is inaccessible, or a person is forcibly removed from access to games
  • Anger or lashing out when gaming is interrupted
  • Taking increasing amounts of time away from work, school, or social engagements specifically to play a video game
  • Losing sleep or neglecting grooming activities, such as bathing, in order to play video games
  • Inability to set appropriate limits around gaming, failing to follow self-imposed guidelines around time spent gaming, or even uninstalling and then compulsively reinstalling a game in order to keep playing
  • Playing a video game in order to avoid anxiety, depression, or grief
  • Guilt and shame around gaming activities, which sometimes leads to lying about gaming habits
  • Video games replacing other enjoyable activities or hobbies

According to the American Psychological Association, there are nine criteria regarding addiction, which apply to video game addiction. When five or more of these criteria are met for at least 12 months, the person can be considered addicted to video games. These criteria are:

  1. Preoccupation with games
  2. Withdrawal symptoms when gaming is taken away or inaccessible
  3. Tolerance to gaming, such that an increasing amount of time must be spent to achieve the same “high”
  4. Attempts at controlling urges to game or time spent on gaming without success
  5. Loss of interest in hobbies, social events, or other sources of enjoyment
  6. Knowledge of psychological and social problems caused by gaming, but inability to stop
  7. Lying to or deceiving loved ones about gaming habits
  8. Escaping negative moods or life experiences with gaming
  9. Loss of job, education opportunities, or a significant relationship due to video game habits

Risk Factors for Developing Gaming Addiction

While much more research must be conducted into causes or comorbidities of gaming addiction, there seem to be two basic underlying reasons for people to turn to video games. The first is the need to escape. When an individual goes through a tough life situation and experiences uncomfortable feelings, such as grief or depression, gaming offers a controlled world that can be an outlet. Gamers often report that video games offer a situation in which, through a combination of skill and luck, they can win, and receive tangible rewards for doing so. Leveling up, finding rare items (like weapons), or developing new character skills can all cause a surge of serotonin and dopamine in the brain, which feels like a reward. While the brain is rewarding the development of a skill, using games as a way to avoid a difficult reality is unhealthy and can create larger problems, which makes the person suffering video game addiction feel the need to continue to escape into games. This cycle is also common to gambling and shopping addiction: The financial stress caused by these addictions causes individuals to spiral further into the addiction, even when individuals understand that spending or betting will add to their deteriorating finances.

The need for the reward “high” is another reason gamers become addicted to video games. While this fuels escapism, even people who do not need or want to escape from their lives sometimes become addicted to activities that stimulate the reward system in the brain, releasing dopamine. Unlike gambling, video games rely on a gamer’s skill to get to the next level, although many games such as World of Warcraft also offer random “rare items” like magical weapons, so the gamer also needs luck to receive these rewards. These types of random drops could stimulate the same pleasure centers as gambling addiction, skewing the ability to understand risk versus reward.

Certain types of games may encourage addiction more than others. For example, online games that offer large, endless worlds might encourage players to spend more time playing the game, with no end to the story. As mentioned previously, randomly generated items that help the players “level up” can also lead to addictive behaviors. However, this relationship is little understood, and many people suffering from gaming addiction play a wide variety of games compulsively and constantly.

One study, conducted using self-reporting, showed that 41 percent of the 119 respondents played games to escape reality, while 7 percent could be classified as “dependent” based on the nine diagnostic criteria.

Being young, white, and male might also increase an individual’s chances of developing an addiction to video games, but this link is little understood and based on self-reporting.

Gaming Addiction’s Relationship to Substance Abuse

Both addictive substances and behaviors stimulate the pleasure centers of the brain, releasing endorphins, serotonin, and dopamine. Pre-existing psychological conditions like depression, anxiety, and post-traumatic stress disorder can lead to addictions to substances, and they can also lead to addictive behaviors, including video game addiction. While this connection is little understood for gaming addiction, it is documented for gambling, sex, and shopping addictions, as well as substance abuse.

A study published in 2011 by the National Institutes of Health examined whether substance abuse and video game addiction reinforced each other. There is some link between alcohol addiction and gambling addiction, but the researchers found that alcohol, marijuana, caffeine, and tobacco use was not enhanced, increased, or reinforced by video game addiction. Although adults who play video games, including those with video game addictions, certainly use these or other addictive substances, the addictions were not causally related enough to find an underlying cause. Dual diagnosis might be appropriate if both a substance addiction and a video game addiction exist together.

However, video game addiction does seem to be similar to other impulse control disorders, which can increase an individual’s risk of concurrent substance use disorders.

Treatment for Gaming Addiction

Because gaming addiction is a newer diagnosis for medical professionals, treatment success is not well understood yet. However, with behavioral addictions like gambling or sexual addiction, Cognitive Behavioral Therapy (CBT) has worked well. Sometimes, a combination of mood-stabilizing prescription medications and talk therapy can help an individual overcome addictive behaviors and examine the underlying causes of these problems. This might work for video game addiction as well.

The most recommended steps at the moment are for individuals to admit they have a problem and seek help from a mental health professional. If an addictive behavior is severe, inpatient rehabilitation can be most helpful. This type of treatment removes an individual from triggers and outlets for the addictive behavior, teaches new coping mechanisms, and creates a social network that can provide support when re-entering the world.