This is what gaming addiction actually looks like

The best games have always kept players hooked: from Space Invaders guzzling down billions of quarters in the early ​’80s, through to League of Legends clocking 125 million hours in Twitch views last month. If a new release is branded ​“addictive” in a review, it’s a form of high praise – its gameplay making it impossible to put the controller down.

But for some unfortunate gamers, they experience addiction in the clinical sense. Gaming disorder is now classed as a mental health condition by the World Health Organization. Sufferers experience impaired control over their gaming to the extent that they prioritise it over everything else – badly impacting their personal, social, school, work or family life.

Its symptoms mirror that of other, more notorious addictions. ​“Hardcore addicted gamers experience withdrawal,” explains Dr Mark Griffiths, director of the International Gaming Research Unit at Nottingham Trent University. ​“They’ll be moody, irritable, frustrated and anxious. On a physiological level, they’ll have the shakes, nausea and stomach cramps.”

Adolescent males are at the greatest risk. That’s not just down to gamer demographics (in fact, the number of girl gamers is steadily rising and there’s a widening age range). Rather, it’s men who tend to experience greater social isolation, and then turn to self-medication: be it alcohol; drugs; or, nowadays, gaming. If you’re under 25, neuroscience comes into play, too. The prefrontal cortex – the self-monitoring, decision-making part of the brain – is still developing. It means Mother Nature condemns adolescents to seek out risky but rewarding experiences.

And it turns out that video games, with their immersive designs and escapist storylines, are one of those experiences. If you’re enjoying a game of Mario Kart, there’s a reason why it’s so hard to quit: feel-good hormones and pleasure chemicals are flooding the brain. Among them is dopamine – a key neurotransmitter in the brain’s reward system. It’s present in all enjoyable activities – including addictive substances and behaviours. Its impact upon the developing adolescent brain, however, is far more intense.

Whereas addictive substances tend to be (legally) off-limits for children – who are biologically hardwired to have weaker impulse control – video games effectively offer 24-hour access to people of all ages. ​“A seven-year-old, with a lot less developed psychology, can still experience the reinforcement and rewarding behaviour of gaming,” says Griffiths.

That behaviour is heightened by loot boxes now being everywhere: from Fortnite llamas to Fifa packs, the lines between gaming and gambling are becoming increasingly blurred. In Belgium and the Netherlands, loot boxes have been outlawed. Other nations have also taken a hard line on gaming addiction: Korean children have long been banned from accessing online games between midnight and 6am; in China, a new curfew restricts anyone under 18 to just 90 minutes of gaming on weekdays.

On these shores, the response has been more measured. In September, the Department for Digital, Culture, Media and Sport published a report recommending the regulation of loot boxes under the Gambling Act. Then, in October, the NHS announced its first specialist clinic tackling gaming disorder. Based in west London, it’s now open and accepting referrals nationwide from anyone aged 13 – 25, with consultations available over Skype.

“Gaming disorder is a mental health condition which can have a hugely debilitating effect on people’s lives, both for patients and their families who can be left feeling utterly helpless in the wake of their loved one’s addiction,” said Henrietta Bowden-Jones, director of the new Centre for Internet and Gaming Disorder. ​“It’s not a mental illness to be taken lightly. We are talking about instances where someone may spend up to 12 hours a day playing computer games, and can end up becoming socially isolated and lose their job as a result.”

Although it’s the first free service, gaming addiction has actually been treated for years – at private centres like The Priory. Treatment closely follows rehab for alcoholism and drug abuse: behavioural therapy, self-help groups, in-patient care and the 12-step programme. ​“There’s very little difference in treating any addiction,” explains Pamela Roberts, addictions programme manager at The Priory’s Woking hospital. ​“The main difference is establishing abstinence.”

Residential care can last weeks. For the first seven days, all gadgets – including phones – are banned. Roberts says some patients become ​“agitated, angry and at a loss of what to do” when deprived of technology. In extreme digital detox cases, they need help joining in and adjusting to face-to-face communication. ​“Unlike alcohol, there’s no medication for withdrawal symptoms from a behavioural addiction,” she adds. ​“So, the use of the therapy sessions becomes even more vital.”

Although phones are reintegrated, strict conditions remain in place. Screen use is monitored – with only one app open at a time – for fixed, agreed times only. An ongoing ban on video games remains in place. It’s not lifted for a minimum of 30 days – but the ideal is for three months. Aside from that, abstinence is assessed on case-by-case basis. ​“Abstinence from addictive gaming doesn’t mean never using technology – that would be unreasonable,” Roberts explains. ​“As clients continue through treatment, we begin to establish what abstinence needs to be. Whilst there are similarities for everyone, it can also be quite personal, too.”

The new NHS clinic, however, focuses on cognitive behavioural therapy. In other words, talking therapy. It’s typically done in short, sharp bursts – once a week, over a number of weeks. But Griffiths has some doubts. ​“CBT isn’t necessarily going to help everybody. It works better for adults – those who have fully matured with their cognitive functioning. The adolescent brain is still developing.”

There are approximately 2.5 billion gamers in the world. Some surveys suggest that more than two per cent of the gaming population might suffer from gaming disorder – equal to 50 million people worldwide. That there’s only one clinic in England providing free treatment highlights a wider trend: gaming addiction probably isn’t that prevalent.

Only a psychiatrist or clinical psychologist can diagnose gaming disorder, and the pattern of behaviour has to typically last for at least a year. Aside from that though, there’s no universal method of diagnosis. There’s also the definition of gaming disorder itself – it differs depending on who you ask. A gamer may be a sufferer under WHO criteria, yet fall short of a diagnosis if a clinician follows the American Psychiatric Association’s more stringent guidelines. It partly explains why disorder rates wildly fluctuate around the world: in some parts of Asia, it’s as high as 15 per cent.

There’s also the danger of over-diagnosis. ​“Every week I get emails from concerned parents saying their child is addicted to Fifa,” says Griffiths. ​“When I ask them why, they say they’re playing for fours hours a day, every day. I reply, ​‘We psychologists have a word for that: normal.’” With gaming addiction, context is everything. ​“It’s not to do with the amount of time you play – it’s all to do with the negative consequences as a result of playing,” argues Griffiths.

In 2010, Griffiths studied two gamers each playing a MMORPG up to 14 hours a day. ​“One was absolutely hooked and would be diagnosed as having gaming disorder; the other suffered little-to-no detrimental effects on his life.” Griffiths explains that the latter gamer, playing World Of Warcraft, met his future wife in the game. ​“At that point in his life he chose to spend all day, every day playing WoW – he was lauded and revered by everyone in the game, and he loved the affirmation.”

However, there are some definite cases of gaming disorder. ​“Every month, I’ll get a real, true sorry case of an adolescent who has dropped out of their studies,” Griffiths says. ​“Their parents can’t get them out of their bedroom. Gaming has become the be-all and end-all of their life.” He adds that underlying problems can exist, too. ​“A university drop-out could be homesick – rather than gaming disorder, the gaming is symptomatic of other problems. There could be comorbidities like depression and anxiety, too. Therapeutically, when you sort out those problems, the disorder should disappear.”

So, where do we draw the line between fun, healthy – if at times, excessive – gaming and addiction? ​“The rule of thumb is that while the former adds to life, the latter takes away,” says Griffiths. He lists the six criteria of all addictions: salience, mood modification, conflict, withdrawal, tolerance, relapse. ​“On a diagnostic level, gaming has to be the single most important thing in their life. They’ll have withdrawal symptoms if they can’t play, they’ll play to get a high or to numb, they’ll feel unable to stop playing. And it’ll compromise their relationships, education or occupation.”

Though not a clinician himself, Griffiths has developed treatment for gaming disorder in Barcelona. It’s a 22-week programme, and features a wide range of therapeutic techniques. On average, there’s one new patient a week, with a 13 – 17 age range. For Griffiths, it reinforces the true numbers of sufferers, and the demographic.

But not all gaming disorder sufferers are necessarily teens – the average gamer age is 33 years old. ​“Suggesting that gaming disorder is a problem predominantly affecting children can make it harder for those in their twenties, thirties, forties and beyond to seek support,” argues Roberts. ​“It creates a stigma that it’s a child’s problem.” It’s certainly not a condition to be taken lightly, either. ​“It definitely exists and, for those who suffer from it, it takes over their life,” adds Griffiths. ​“It’s as destructive as any kind of addiction.”

There may not be a consensus on its diagnosis, its treatment or even its definition. But gaming disorder is a definite, worrying part of gaming’s future.

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