Video game addiction is real, rare, and poorly understood

It’s great to do things you enjoy. But can you go too far with a hobby? And at what point does it become an addiction? That’s the question experts are trying to answer about playing video games.

Game addiction

In 2018, the World Health Organization (WHO) first recognized “gaming disorder”  in the 11th Revision of the International Classification of Diseases (ICD-11).

This choice of whos was particularly quick to attract skepticism from gamers, experts, and gaming and tech websites. For many gamers it was a personal problem: they felt that their hobby was being blackened as a social problem. After experiencing nothing themselves that did not make them feel addicted, they found that the WHO’s admission of addiction was made without good evidence.

Gaming addiction

Those who support WHO’s choice, however, note that the majority of gamers would not experience anything close to addiction. As with most other addictive activities and substances, the vast majority of people who play games do not intend to be addicted.

But some people really struggle with gaming addiction – a legitimate medical condition, the WHO argues. The idea behind the designation is to recognize that this group needs health care and other resources for help.

In addition, there are aspects of games that can make them particularly prone to addiction, including their unique immersion skills, the easy access to them, and the gambling-like mechanics that have cropped up in games in recent years.

Video games are now mainstream – and that comes with some risks

It was only a few decades ago when video games were seen as a niche activity, gamers were geeks.

With the rise of phenomenon like Pokémon, World of Warcraft, Call of Duty, and Fortnite, games are now mainstream. The vast majority of these people will not become addicted to video games. Based on some of the best research, 1 to 3 percent of gamers are at risk.

This is true of other forms of addiction, even drugs that are considered highly addictive. For example, some studies estimate that about 8 percent of opioid pain reliever patients become addicted — still a significant amount, but certainly not a majority.

But when billions of people around the world play games, even a small percent can lead to a large population – literally tens of millions – with problems.

The WHO designation aims to stay ahead of this problem. It creates a foundation for the health care system to build a response around. It allows for more research into the condition. And health insurers will be pushed to pay for the treatment if it is recognized as a genuine medical condition.

Joël Billieux, a professor from the University of Luxembourg involved in clinical and research into gambling disorders, argued that is why the WHO designation is necessary.

“It will enable the systemization of education and prevention,” Billieux, who sat on the who’s gaming disorder committee, told me. “There will also be more resources to do research and better understand the condition.”

“But on the other hand,” Billieux added, “it is legitimate to be concerned about the risks of pathologizing normal behavior or unnecessary treatment.”

That last concern is what has fueled much of the opposition to the WHO’s designation. Hailing from researching video games and violence, Stetson University psychologist Christopher Ferguson is particularly concerned about a moral panic — a type of negative overreaction that often follows new trends and technologies.

“Often there are these kinds of visceral, negative reactions to new technologies that in some cases lead to pretty extreme claims. “It’s not hard to see that in the video game addiction realm, where you see headlines that video games are ‘digital heroin. ‘ “


Just think: President Donald Trump suggested that video games could be to blame for mass shootings. There is simply no conclusive evidence to support this claim. But it’s the kind of thing we’ve seen consistently, from parents calling rock and roll “the devil’s music” to comic book censorship to fears about violent movies.

What exactly is addiction?

There is still a big gap between the public understanding of addiction and the expert view. It’s common to hear people casually refer to an activity as “addictive” just because it’s fun. Some people continue to see addiction not as a medical condition, but as a moral failure, contrary to what major public health and medical organizations say. There are still misconceptions that addiction requires some sort of physical component — for example, physical dependence that causes withdrawal — or that physical dependence is compelling evidence of addiction.

Experts, however, have long renounced these old conceptions of addiction. According to experts, addiction does not require a physical dependence component.

How Gambling Disorder Is Defined

Looking at WHO’s explanation of pulpitis, gaming fits into the modern understanding of addiction:

Gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior (“digital gaming” or “video gaming”), which may be online (i.e., over the Internet) or offline, manifested by: 1) decreased control over gaming (e.g., onset, frequency , intensity, duration, termination, context); 2) increasing the priority given to gaming to the extent that gambling takes precedence over other life interests and daily activities; and 3) continuation or escalation of gaming despite the occurrence of negative consequences. The pattern of behavior is of sufficient severity to result in significant disability in personal, family, social, educational, occupational, or other important areas of functioning. The pattern of gaming behavior can be continuous or episodic and recurrent. Play behavior and other functions are normally apparent over a period of at least 12 months to receive a diagnosis, although the duration required may be shortened if all diagnostic requirements are met and symptoms are severe.

The main consideration here is not some sort of physical symptom. No physical symptoms are mentioned. It is, again, about compulsive use despite negative consequences. This fits with how other addictions are viewed by experts.

This is not an easy diagnosis. You can’t say someone is addicted just because he plays games for more than a certain number of hours a week. In fact, experts like Billieux strongly warned against that kind of interpretation.

“We shouldn’t combine high engagement with problematic involvement,” Billieux said. You can have a high involvement in gaming, if gaming is your main hobby, but you have to do it in a fully controlled way that will not negatively affect your daily life.

An often cited example is severe sleep deprivation. If someone is consistently losing a lot of sleep to video games, there’s a good chance something bad is going on there.

That doesn’t mean that everyone who loses a little sleep to play games or another hobby is addicted. But it’s a sign that can be used to try and diagnose if someone has a problem.

A good doctor brings together these kinds of data points and anecdotes to gauge whether someone is addicted to games. Do they lose sleep? Are they failing to meet major responsibilities such as school and work? Do they neglect family and friends? If you put all this together, and it seems like someone is consistently putting games above all else despite negative consequences, that’s an indication of an addiction.

This also applies to other drugs. It is not enough to simply use alcohol, marijuana, opioids, or other drugs to become addicted. Even using them a lot is not a sign of addiction (although it can be unhealthy for other reasons). Addiction is when a person uses these drugs compulsively, despite the harm that follows.

Some people are more prone to addiction than others

So what makes the minority of people with substance abuse problems different from the majority? Researchers don’t have a conclusive answer to the question, but they say it likely involves a host of factors.

For some, it can be due to psychological problems. Video games give an outlet and put negative feelings aside for a while. Other psychological problems, such as anxiety, can also play a role. It can also be genetic. Some people simply experience less temptation, or have more willpower, than others.

A person’s environment can also play a role. Perhaps someone will be forced to move to a place where they have no friends, family, or previous hobbies, so games will soon be the only thing that gives her joy, and soon enough it’s all she does. It could be that, for some people, games are uniquely accessible, making them easy to play too much.

And it could be all these things combined or something completely different. No one knows for sure, whether for gaming addiction or other forms of addiction.

Video games pose unique risks for addiction

There are also factors that can make games uniquely risky compared to other activities, making it more likely that someone will become addicted to them and play way too much.

One is easy access.

Billieux quoted a patient as saying that the rush he gets playing Fortnite, a very popular online multiplayer game, compared it to the experience of skydiving.

Think about what that means for this person. In the past, he would have had to take several steps, from booking a plane to physical travel, to get the adrenaline of skydiving. Now all he needs to do is turn on whatever device he plays Fortnite on and get the same rush right away.

And Fortnite is on every gaming device, including phones. So someone can play Fortnite literally all the time, certainly way more than they can go skydiving.

Another problem is the possibility of immersion. In games, you don’t just follow the stories and actions of certain characters; you are the characters. In roleplaying games like World of Warcraft, you spend hundreds, if not thousands, of hours building a character – going through a story you feel like you’re a part of, taking on challenges, and building a reputation for yourself among other gamers. This can be further exacerbated if a game, such as World of Warcraft, has an online multiplayer element, compounding the immersion with socialization with other players.

Increasingly, some other games are also adopting gambling mechanics, introducing a whole new layer of addiction. An example is loot boxes, which players buy in games with in-game currency or real money for a chance at exclusive or powerful items.

Video games can also do a lot of good

Part of the concern here is that stifling video games can harm people substantively. But Games are also used in education. In some places, such as the Games for Emotional and Mental Health Lab at Radboud University in the Netherlands, research is now being conducted into the use of video games for therapy.

But outside of a medical setting, video games entertain people. They can make people relax after a hard day. They can provide an escape. These are all real benefits that help people on a daily basis.

For the vast majority of the billions of people who play games, gaming is a form of entertainment, not a problem to solve.