Educational and helpful tool to learn about video game addiction, the controversial diagnosis and some treatment options.

Do you struggle with gaming, trying to fit your life around game time? Do you arrive late to meetings, events, miss appointments, or miss family events?  Or perhaps you struggle feeling that gaming is becoming another job?  Currently, medicine does not recognize video gaming as an addiction but there are many who meet many of the criteria for addiction that would disagree.  Doctors collect histories, gather facts, perform physical exams and order needed tests all to come up with the most likely diagnosis and a differential list of alternative potential diagnoses.  The United States adopted our most recent list of currently accepted diagnoses, the International Classification of DIseases-10 (ICD-10) on October 1, 2015.  This list, which originated in 1992, has been used throughout the world to categorize diseases, and to guide public health, research and  treatments.  As noted, Gaming Disorder did not make that list of approved diagnoses.  However, the World Health Organization announced this week that Gaming Disorder will be an official diagnosis within ICD-11.  Gaming Disorder will be listed as a “pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.  For gaming disorder to be diagnosed, the behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.”  This new diagnosis may allow people to get the help they need, or it may label countless others who game regularly but may not meet the criteria.  Either way, if it took over twenty years for the us to adapt to the ICD-10, we have a while before just imagine how long it will take us to adopt ICD-11. 

Like many labels, calling oneself a Gamer means something different than when someone else refers to you as a Gamer.  It is difficult to understand the allure, the lifestyle, the community, or the meaning, when you are looking in from the outside.  I have been a fan of video games since the original NES and grew up alongside many of the classics.  I have been referred to as a Gamer, spent countless hours playing all sorts of games but never felt that games got in my way or that I was addicted to them.  I was excited when I leared about the Video Game Addiction book by David A. Olle and Jean Riescher Westcott and decided to read and review it.   Before you decide to buy a book, it is customary to check out the cover.  I loved the blue coloration but the layout and the picture reminded me of some of the video game box art from the 1980’s and 90’s.  I did not feel that this would reach modern day video game players but decided to proceed.  The cover promised an easy to follow Q&A format, companion files/resources/links/case studies and up-to-date treatments/meds and options.  The reverse face provided a wonderful, short, overview of the layout of the book.  It started with a case study about a New Mexico woman who neglected her daugther, mentioned briefly statistics about World of Warcraft players and then described how the book was designed to appeal to gamers and to their families/friends.  The book was broken up into three parts, with eleven total chapters.  Part one labelled as “Video Game Basics,” contained five chapers dedicated to the how’s/what’s of games: 1. What are Video Games?, 2. How are Video Games Categorized?, 3. What is the history of Video Games?, 4. How are video games played? and 5. What are the characteristics of video gamers?  Part two was designed to educate the reader about the nature of the addiction and why games are addictive.  This section had four chapters: 6. What is video game addiction?, 7. Why are video games addictive? 8. How can you protect against video game addiction?, and 9. What are the benefits of playing video games?.  Part three dealt with the treatment options for video game addiction and attempted to provide hope for those who have gone through it.  The final two chapters were dedicated to treatment and recovery: 10. Treating video game addiction and 11. life after video game addiction.

The 107 page book proved to be a relatively quick and easy read, especially part one.  I personally felt that part one was too basic for me and did not require a second look.  The chapter attempted to define video games, listed a few differences between the different platforms (PC, Console, Handheld, Arcade, Online, Mobile, VR) and discussed recent advancements in controlelrs.  Instead of judging the chapter negatively, I tried to read it as if I was a father struggling with a child that I did not understand.   For a beginner, the book did a great job at bringing people up to speed about the the different platforms.  Chapter 2 did a great job at detailing the genres of games.  This chapter was more useful and even provided me with some nuggets of information.  You may hear a television advertisement or read about a game release from Gamestop or your child may say I want the latest game.  If you have ever wanted to know the difference between action games, adventure games, action-adventure games, role-playing games, MMORPG (Massively Multiplayer Online Games), pages 9-17 will give you everything you need.  If you enjoy physical challenges and enjoy hand-eye coordination heavy games, action games may be right up your alley.  Perhaps you prefer more story driven content and wish to undertake an Adventure game.  Or perhaps you desire a combination of the two?  The chapter did a great job at describing what makes each type of game, how the sub-genres interact and provided some examples of games that fall into each group.  If acronyms like WOW, MMORPG or words like quests, guilds and raids sound like someone is speaking another language, pages 15-16 of the book will provide you a glimpse into a virtual, yet enticing world.  As a summary, the authors provided a very useful video game dimensional conceptual map from American Psychologist.   This broke games up into four main conepts non-social, complex, simple, social and placed every style of game into one of four quadrants.  Puzzle games tend to be non social and simple, whereas role-playing games add more complexity to the puzzle.  MMORPG add more social elements to the basic RPG elements.  This figure did a great job at summarizing the second chapter.

Like a Sherpa guiding people up Mount Everest, Ollie and Westcott used chapter three to educate the reader about the gamer lifestyle.  WIth their onset in the 1970’s, to the hayday of arcades into the 1990’s, to the modern big three consoles (Sony, Xbox, Nintendo), to mobile gaming and to PC gaming, people truly can game anywhere. Section 10-14 on pages 18-21 did a great job at describing the loss of our social interaction as arcades died out.  Our modern day teenagers are losing malls, we have lost Toys-R-Us and just like the lost arcades, we have had to adapt to new changes.  High-speed internet has allowed games to go online and our physical hangouts have digitized and have moved off-world and sometimes into the cloud.  Without local outlets, without real-life friends, with a general lack of understanding by the public and or peers, it becomes very obvious that games can fulfill a basic need.  We all want to feel that we fit in, we want to belong and many game environments can provide this and an oppotunity for a gamer to do more than fit-in, they can feel that they dominate and excel.  There are multiple ways to describe a gamer.  You can base your label on time spent gaming (pages 21-22).  A  casual gamer (<5 hours per week), transitional palyer (5-9 hours per week), a skilled player (10-15 hours per week), a second job player (15-24 hours per week) or a pro-gamer (24+ hours per week).  You can also base this on age/gender, device, game type, or possibly who they play with (alone, friends, family, parents).  Pages 25-26 provided the first case study, a four paragraph description about Scott whose life was ruined by games.  I was displeased that there were no post scenario questions, no discussion information and no closure.  The scenario felt a little forced and left me wanting to know more information about Scott.  Why did he realize he was addicted, what led to this discovery, what did he do for work while he was younger.  He eventually become a computer programer, realized he had an addiction to alcohol and to gaming.  He sought help, created a group like AA and stopped playing.  I wanted more information about him.  I was also disappointed in the references/end notes for this section.  Of the eight references, five of them were Wikipedia, which should not be the basis for a scientific/self-help style book.

Section two, chapters 6-9 (pages 28-89), was the largest section of the book and did require more thought/interaction than part one. This section talked about the signs and symptoms of addiction, tried to discuss differences between common substance and psychological addictions and then tried to finish with some of the positive aspects to gaming.  These sections were based on science/medicine and did a great job at providing some understanding about many of the physical and psychological problems.  The authors utilized the following definition of addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry ” and the pathological need to pursue reward. It becomes easy to understand why someone would want to play when they have people that like them, understand them and the individual feels needed as part of a community.  It also becomes obvious that people can use artificial environments to avoid real-life issues.  If the world sucks, video games and the internet provide an avenue to let you find a better one.  Even though there is no chemical substance to become addicted to with gaming, the chapters detail many of the symptoms that overlap with chemical addictions.  They provide pros and cons, detail why this has been so controversial and essentially leave it up to you to decide.  Similar to ICD-10, there is a separate list of psychological diagnoses released by the American Psychiatric Association (APA) called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The group did not feel that video game addiction was a mental disorder and required more research but did add “Internet Gaming Disorder.”  Pages 31-35 provided more information about this topic, and reasoning as to why it should not be rushed into mainstream diagnostic manuals.  The book does not play sides, instead offers up the competing thoughts about the problem.  Do we allow this diagnosis to enter the mainstream medical world and perhaps overdiagnose or misdiagnose people, or do we leave this out and prevent some people from getting help?

Pages 36-39 detailed many of the symptoms of addiction, similar to what an introductory college psychology class may provide.  Each of the ten listed symptoms was compared within the realm of the DSM-V and whether or not the criteria were used to define the addiction types.  After reading this section a few times, you will likely gain a better understanding of how providers utilize the DSM-V to diagnose some of these problems.  I truly enjoyed Cam’s story, pages 43-53, as it highlighted many of the stereotypes of the “GAMER.”  If you have watched the news in the past few months, the term “Millenial” has been thrown around in a derogatory way, similar to how GAMER can be utilized at times.  This story detailed a bullied, struggling youth, trying to find time for life in his escape to the Starcraft world.  He could not just dabble, he could not just play a round and move on, it owned his life and he could not stop.  He detailed the escape, the connection online, positive feedback loop of climbing the ranks and earning achievements (REWARD), overcoming challenge and feeling a purpose.  He turned his problem into a solution for others and launched Game Quitters.  The book reported data from 2009 suggesting that 8.5% of US youth showed “diagnosable signs of pathological gaming.”  These numbers were staggering when I turned to census data.  When you relate 8.5% to the total number of youth in America in 2015 to be roughly 41,731,233 (13% of the population aged 10-19) you get 3,547,155 kids affected with this.  Compare this to the CDC data on obesity from 2013-2014 that state 17.4% of kids were obese, or the ADHD stats from the National Center for Health Statistics that stated 10.4% of children were diagnosed with ADHD between 2013-2017.  Again, the book painted a clear idea why this needs further study.  Despite similarities with other forms of addiction, video game addiction seems to fit its own criteria.  The story of Lucas pages 54-56 provided another example similar to Cam’s story.

Mobile GamesFor the scientist at heart or the budding neurologist, pages 56-60 dove into the neurobiological reward pathways of dopamine and the cingulate cortex involved in memory. emotion. and learning. They included two very useful brain diagrams detailing brain anatomy.  This section ended with Steve’s Case Study of the need to achieve Call-of-Duty glory.  Andrews study on the draw of Warcraft III detailed the fulfillment of basic human needs (pages 62-64) through gaming.  Dr. Andrew Doan’s story, pages 68-71, showed that this can affect everyone independent of economic, racial, or gender factors.  The last sections of the second part of the book detailed some of the benefits to gaming.  We can gain increased cognitive function, better focus, better problem solving skills,  job performance, motivation, emotional well being, hand eye coordination, and increased social interaction.  Studies are underway to see if games can help with some psychological issues (NCBI study, Playmancer Evaluation Trials).  Interestingly, the authors used Melissas story later in this chapter which provided a similar saga to Andrew and Dr. Doan.  However, her story moved more into treatment, meditation, and social media/gaming diet/rationing. Instead of mindlessly moving to her smart device, she would preoccupy herself with a list of To-do’s.  The chapter ended with a discussion of a futuristic topic of the use of virtual reality for pain management.  We are still early in our understanding of the brain and with pathways of pain.  Whether or not this has future benefit is unknown.  The endnotes/references of section two utilized 29 references and only one was wikipedia.  Overall this section was more daunting and required a higher level of understanding.  It added to the first section very well and provided a good argument for the inclusion of this problem in ICD-11 and the future DSM-6.

It is not enough to diagnose a problem, we also need to have a plan to further evaluate and treat it.  Chapter ten (pages 92-100) attempted to talk about some of the treatment modalities for video game addiction.  The book noted that the treatment options were very similar to those for other addictions, despite the lack of a currently available diagnosis.  When evaluating someone for this problem, they also have to be evaluated for co-existing psychological problems like ADHD, OCD, anxiety, and depression.  I liked that the book mentioned medications but used them as an adjunct to individual and family counseling.  The book also stated that complete avoidance may not be necessary but with some caveats.  Perhaps MMORPG or online friend generation should be avoided.  Perhaps meeting friends at an arcade or physically playing cooperatively may be okay.  Perhaps setting strict time limits may be okay.  With the listed case studies, we need an indivdualized approach to help the struggling indivuals.  The endnotes for this section used 12 references and only a single Wikipedia link.

The book did a good job at detailing why gaming has become so popular, the history of gaming, types of games, types of consoles and locations of play.  I was able to understand that we use the DSM V manual to diagnose psychiatric diseases and that the diagnosis of video game addiction is controversial.  Internet and gambling are listed and compared yet unlike video game addiction.  Loneliness, awkwardness, a need to fit in, and bullying may lead to gaming and more specifically community based online gaming.  The movie Ready Player One shows a similar idea.  Who would not want the option to go online and to become whatever you want to be.  Create your own perfect self-image-based-Avatar and become popular, fit in and join a community that accepts you.  I loved the Q&A approach to the book, I loved that the stories were relatable and I saw pieces of the stories in myself.  The book briefly mentioned video games and violence and the use of gaming for medical/counseling techniques.  If you are looking for a stepping stone to understand video game addiction, look no further than the Video Game Addiction book written by David A. Ollie/Jean Riescher Westcott, copyright 2018 by Mercury Learning and Information