Is Video Game Addiction Really an Addiction?

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Ask the parent who watches their child retreat into the world of video games for hours every day, who neglects their friends and family, and who loses interest in anything but their game console, and they will say that yes, video game addiction is as real as addiction to alcohol or cocaine. But do they really know what they are evaluating? Surely the alcoholic who drinks himself to death, or the drug addict who overdoses, are more sick than a kid who spends too long in front of a computer screen?

Latest Developments

Video game addiction was not included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), although video game playing has become much more widespread since its publication in 1994. Since then, the video game addiction concept has been controversial, with the American Medical Association first supporting, then withdrawing support from a proposal for it to be included in the next edition, the DSM-V, in 2012. Video game addiction has also been proposed for the DSM-V as a sub-type of internet addiction, along with sexual preoccupations and e-mail/text messaging.

Asian countries, such as South Korea, are recognizing video game addiction as an urgent public health matter, with several deaths having occurred in internet cafes, apparently as a result of blood clots occurring during prolonged sitting at computers. In the United States, estimates of video game addiction and related problems are more difficult, with computers being accessed at home rather than in shared public places.

However, case studies show similar patterns of behavior across cultures, and it is argued that they are the same phenomenon.

When free from the constraints of school, many kids simply want to be entertained as easily as possible. And many parent want this for their kids too, as the shift to single parent families and two-income families leaves many parents with little time to focus on interaction with their kids.

Giving their child the latest video game serves two purposes: It alleviates parental guilt about not spending enough time with the child, and it keeps the child happily occupied. This kind of lifestyle can quickly settle into a pattern which makes lengthy periods in front of computer games rewarding for everyone concerned.

Yet there is currently no clear or consistent message to parents about whether computer game addiction is a real risk. Video games may also have positive effects, and game developers are making efforts to incorporate health benefits, such as exercise, into games. So how are parents supposed to know how to respond?

Background

Video games themselves are a relatively recent phenomenon, and widespread video game ownership and play has only occurred in the past few years. Video games certainly did not exist in their current, highly sophisticated form 15 years ago when the DSM-IV was published. So although there is no recognition of video game addiction in the DSM-IV, that is no indication that it does not exist now.

The idea of video game addiction has rapidly grown out of an industry geared specifically at getting kids to buy as many games as possible. Halfway between toys and TV, video games are targeted at naïve youngsters who are unable to set their own limits on play, or to make well-thought out decisions about how to spend their time -- with some game manufacturers even boasting in their advertising about the "addictive" experience of their games. Proper recognition of the risk of video game over-use or addiction provides a rationale for setting standards of guidance for parents and gamers regarding appropriate limits to gaming.

Video game addiction is being increasingly recognized by researchers and other professionals. The American Medical Association (AMA) took a lead role in compiling research supporting the idea of video game addiction in 2007, concluding that the "AMA strongly encourages the consideration and inclusion of 'internet/video game addiction' as a formal diagnostic disorder in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders-IV."

However, both the AMA and the American Society of Addiction Medicine (ASAM) backed off from this decisive position later in 2007, saying more research was needed before video game addiction could be recognized as an addiction. A release by the American Psychiatric Association around the same time stated:

"Since the current edition, DSM-IV-TR, does not list “video game addiction,” the APA does not consider “video game addiction” to be a mental disorder at this time. If the science warrants it, this proposed disorder will be considered for inclusion in DSM-V, which is due to be published in 2012. Revising DSM requires a years-long, rigorous process – one that is transparent and open to suggestions from our colleagues in the medical and mental health communities and the public. All changes to DSM will be based on the latest and best science."

Case For

Several research studies have been conducted that indicate video game addiction is real in around 10% of gamers who meet criteria for video game addiction. Grüsser et al (2007) found that pathological gamers differed from regular gamers in terms of daily time spent playing, and had higher "expected relief of withdrawal symptoms when gaming," and higher "craving due to the expectation of a positive outcome of gaming." These are all characteristics which mirror those of of substance dependence.

Skoric et al (2009) showed that video game addiction is independent of simply how much time is spent playing, and how engaged children are with the game. In their study, addiction tendencies were negatively related to scholastic performance, while no such relationship was found for either time spent playing games or for video game engagement. A similar pattern of video game addiction being negatively related to scholastic performance was previously found in a separate study by Chiu et al (2004).

Charlton's (2002) factor analysis provided support for computer addiction as a unique concept. This research demonstrated the importance of recognizing the specific characteristics of computer addiction, rather than simply adapting measures of pathological gambling, which are likely to overestimate the occurrence of computer addiction.

Recognition of video game addiction would allow support services to be integrated into community addiction settings, and specific training to be provided to staff.

This is particularly important given the high incidence of concurrent disorders among those with video game addiction.

Case Against

Video game playing may have several advantages. Proficiency in video games can develop the self esteem of the player. It can develop eye-hand coordination, and can have other educational features.

More sophisticated games can help players to develop other skills, and recent developments have built in aspects of physical exercise -- although this may have limited appeal to gamers.

The reality of popular culture is that we are more and more dependent on technology. A generation ago, computers were complicated and difficult to use, but modern computers are more user-friendly, and are relatively easy and enjoyable for the majority of people to use. Video games allow people to have positive experiences of using computers, that can provide transferable skills for using computers for a variety of purposes.

Bearing in mind the potential positive effects of video game playing, to label the activity an addiction without sufficient evidence and interpretive guidelines about what constitutes addiction (as opposed to benign or positive game playing) could deter many children and their parents who could possibly benefit from video games. This would be a mistake.

There is wide variation in video games, and although some appear to have harmful effects, particularly through the promotion of violence and other anti-social behaviors, this is a function of the content of specific games, rather than a characteristic of video games per se.

Video games as a medium have equal potential to develop positive social skills, or to provide benign forms of entertainment -- although these may not be as easily marketable to kids.

As with other addictions, there is a risk that a label like video game addiction could be used too liberally, without paying attention to other concurrent or underlying conditions, such as attentional problems, autism spectrum disorders, depression and anxiety disorders. These conditions have different treatments which might more effectively help the excessive game player.

And video game addiction is vulnerable to the same criticism that all behavioral addictions are -- that addictions are a chemical problem resulting from the intake of addictive substances, not a pattern of behavior.

Where It Stands

The APA is not saying that video game addiction does not exist, nor that it is not addiction, but simply that they are looking at the issue and won't make a decision until the next edition of the DSM comes out in 2013.

In the same release in which they withdrew their recommendation that video game addiction be recognized, the APA expressed serious concern about the consequences of excessive video game playing in children, stating:

"Psychiatrists are concerned about the wellbeing of children who spend so much time with video games that they fail to develop friendships, get appropriate outdoor exercise or suffer in their schoolwork. Certainly a child who spends an excessive amount of time playing video games may be exposed to violence and may be at higher risks for behavioral and other health problems."

Therefore, whether or not video game addiction is acknowledged as a real addiction, or even as a mental health problem in and of itself, the APA is clear that excessive video game playing in children can be unhealthy, and can lead to other problems.

Sources

American Psychiatric Association, News Release: Statement of the American Psychiatric Association on "Video Game Addiction". Release No. 07-47. June 21, 2007.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th Edition – Text Revision), Washington DC, American Psychiatric Association. 1994.

Block, M.D., Jerald J., "Issues for DSM-V: Internet Addiction." Am J Psychiatry 165:3. 2008.

Charlton, J. P. "A factor-analytic investigation of computer addiction and engagement." British Journal of Psychology 93:329–344. 2002.

Chiu, Ed.D., S., Lee, M.A., J. & Huang, Ph.D., D. "Video Game Addiction in Children and Teenagers in Taiwan." Cyberpsychology & Behavior 7:571-581. 2004.

Entertainment Software Association. "2008 Essential Facts about the Computer and Video Game Industry." Accessed 10 Feb 2009.

Grüsser, Ph.D, S.M.., Thalemann, Ph.D., R. & Griffiths, Ph.D., M. "Excessive computer game playing: evidence for addiction and aggression?" Cyberpsychology & Behavior 10:290-292. 2007.

Khan, MD, PhD, Mohamed K. “Emotional and Behavioral Effects, Including Addictive Potential, of Video Games.” Report Of The Council On Science And Public Health. CSAPH Report 12-A-07. 2007. Accessed 10 Feb 2009.

Skoric, M., Lay Ching Teo, L. & Lijie Neo, L. "Children and Video Games: Addiction, Engagement, and Scholastic Achievement." CyberPsychology & Behavior. 12:567-572. 2009.

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