What You Need To Know about Gaming Addiction
This section of the website is aimed at mental health clinicians looking to understand a bit more about gaming addiction. If you're reading this, the assumption is that you're probably familiar with working with other psychological issues and addictions, and so my focus here will be on highlighting some of the important ways in which gaming addiction differs from other addictions and the implications that this has for treatment.
What Makes It Different
While all addictions share many common features - a loss of control, the development of tolerance, the presence of withdrawal symptoms and so on - there are a number of features of gaming addiction that make it very different from many other addictions.
Invisibility
Compared to many other addictions, gaming addiction can be very invisible. To start with, it is not formally recognised under any current system of diagnosis, meaning that patients will generally not be screened for gaming addiction or asked questions about their gaming through all the normal channels that might identify other addictions such as GP visits, psychiatric assessments etc. There are exceptions as many clinicians are becoming more aware of it as a potential problem, but this is still the exception rather than the rule.
Furthermore, unlike other addictions gaming addiction tends to be something that can be conducted with minimal impacts on others outside the immediate family, meaning that often it is not noticed until it starts to have severe impacts. Unlike drug or alcohol addictions, gaming addiction does not lead to the sort of public behaviour that might help it be identified. Unlike gambling addictions, gamers are unlikely to steal or commit fraud to fund their addiction, again meaning that it can go undetected for a long time. People who are not close to a gaming addict may just see them as isolated, withdrawn and will typically not notice their absence, so it is very easy for gaming addicts to maintain their behaviours in secrecy.
Lastly, because gaming addiction is not broadly recognised as a disorder, gaming addicts may be less likely to view their behaviour as problematic, even in the face of obvious issues that it is creating for them. For this reason, clients may at times be likely to minimise their gaming or downplay its affects on their lives.
For this reason, clinicians need to be particularly alert and curious about their client's gaming and computer use. Rather than taking a negative stance towards gaming, it is helpful for clinicians to be able to invite clients into an open discussion about their gaming and computer use, and to think together about how it fits into the client's life and what effects, positive and negative, it might have. Just as many people can use drugs and alcohol in a responsible manner, similarly so can many people game in healthy ways. You may find it useful to include some basic screening questions around gaming and computer use during first sessions with clients in order to assess their level of usage, and their thoughts and attitudes about gaming. Even simple questions around "How often do you play games?", or "What is it that you enjoy about playing games?" can start to give you a sense of where gaming fits in a person's life and whether it might contribute to other problems they are having.
Lack of Self-Limiting Factors
Unlike other addictions, gaming addiction has very few self-limiting factors. An alcoholic or drug addict will eventually reach the point where they cannot consume any more or black out, a gambler will eventually run out of money. By contrast, unless someone is playing a game that requires large financial investment (which some do), they would theoretically be able to continue gaming indefinitely. This is at least in part why we have seen a number of deaths from players who have gamed non-stop for 48-72 hours, as apart from the body's own limiting factors there is nothing else to stop gamers gaming. This can mean that gaming addictions can develop much more rapidly than some other addictions, as there is little or no downtime between 'binges'.
A second consequence of this, combined with the invisibility of gaming addiction is the fact that gamers will typically not seek treatment or help for gaming addiction until it is very firmly entrenched and has caused substantial damage to significant areas of their life. Until this point, since their behaviour is sustainable, most gamers will not see it as a significant issue.
Clinicians need to be aware that somebody could have a quite significant gaming problem but present in a very functional way. Although somebody might be able to maintain a job and a relationship, they could still be playing games overnight or at work, since games do not have the same immediate health impacts as drugs or alcohol, or the financial impacts of gambling. Again, this makes it all the more important that clinicians ask clients about their gaming (where relevant) in order to assess these things.
Psychological Drivers
Other factors that separate gaming addiction from other addictions are the psychological drivers behind it. While again there are some similarities, some aspects of gaming addiction are quite unique. The sense of meaning and purpose that gaming can create, or of achievement and success are rarely experienced in the same way with other addictions. Similarly, while people with other addictions often develop social circles built around those addictions, these are qualitatively different from those developed while gaming, since players have to co-operate and build alliances in very different ways.
The psychological drivers behind gaming are discussed further in the 'Why Do People Game' section of this website, and I suggest this as an important starting point for understanding the motivating factors that contribute to and can sustain a gaming addiction. It is important for clinicians to be aware of these drivers, as what often shifts gaming from being an engaging or enjoyable hobby into a problem or an addiction is the tendency for games to become the only way in which a person is meeting certain psychological needs. When that happens, it becomes very difficult for a person to give up gaming, as it means that a major psychological need then becomes unmet.
One of the most important things we can do as clinicians working with people with gaming addictions is to help them identify the psychological needs that gaming is meeting for them, and help them discover for themselves other ways in which these needs can be met. In particular, one of the things that games offer very powerfully is a sense of control, and so early on in treatment with gaming addiction it is important to recognise that without gaming clients may feel overwhelmed or out of control. Depending on the client, skills which allow them to experience a sense of control or mastery may be particularly valuable, such as DBT skills, emotional regulation and relaxation skills etc.
Conclusions
What these differences mean for treatment is that gaming addiction needs to be approached somewhat differently from other addictions. Due to its invisibility, clinicians need to be curious and open to exploring with their clients the way in which they game (if they do!) and the psychological needs that this may be meeting for them. With other addictions, clients may be quick and readily able to identify their behaviours as a problem due to wide social acknowledgement of drug, alcohol and gambling addictions. By contrast, people with gaming addictions are less likely to name this as a presenting problem and so exploration of this as a possibility by the clinician becomes more crucial.
Alongside this, due to the lack of awareness and general access to information about gaming addiction, clinicians are likely to need to provide more education to clients around the mechanisms of addiction and the way that gaming fits in with this if clients do report experiencing problems due to their gaming. In my own practice, many clients have expressed that they found it very helpful to gain some understanding as to why they might feel depressed or irritable when they stopped gaming and to recognise that these were a predictable part of the process.