The Ultimate Guide to Video Game Addiction

At Cassiobury Court, although we are better known for our alcohol rehab and drug rehab treatment programmes, today we wish to discuss the topic of video game addiction.

Why? Because video game addiction affects many hundreds of thousands of people and so this topic is simply too prevalent to ignore.

Although video game addiction is not formally recognised by the current DSM-5, the condition is undoubtedly a problem that is capable of causing real and lasting damage to sufferers and their families.

Learning objectives

By the time you have completed reading this guide, you will have gained an understanding of video game addiction.

The key learning objectives of this guide include:

• The definition of a video game addiction
• The historical context of video game addiction
• The criteria for a gaming addiction
• Video game addiction as a coping skill
• Physical symptoms associated with video game addiction
• The glorification of gaming addiction
• Gaming addiction and age differences
• The neuroscience of gaming addiction
• The science of cravings, or the expectation of rewards
• The need for family therapy
• Quitting video games
• Further resources

What is gaming addiction?

Video game addiction is characterised by the excessive use of video games so that it begins to interfere with the sufferer’s daily life. People suffering from video game addiction isolate themselves from family and friends, often for 10-14 hours per day whilst they engage in video games.

Some gaming addicts even wear nappies so they do not have to go to the toilet whilst playing. This extreme behaviour often disrupts the sufferer’s education and other important ‘real world’ obligations. Video game addiction is also known to exist alongside a number of ‘co-occurring’ conditions such as social anxiety and substance misuse.

Gaming addiction can be described as the excessive use of video games resulting in social, occupational or academic impairment. Gaming addiction is a behavioural addiction.

However, video game addiction does not feature in the DSM-5. However, the DSM-5 signposts video game addiction as a ‘condition requiring further study.’

The DSM-5 was released in 2013, and there is a good chance video game addiction will be formally recognised as a behavioural addiction in the DSM’s next iteration.

The history of video gaming addiction

The introduction of the Nintendo in the 1980s and the PlayStation in the 1990s saw a dramatic increase in video gamers. The early 2000s saw a dramatic improvement in graphics, particularly for ‘first person’ role-playing games, where users can almost imagine themselves as ‘real world’ participants in these video games.

The criteria for video game addiction

Since a gaming addiction is not classified by the DMS-5, there exist no official criteria for the disorder. However, clinicians often utilise the criteria for gambling addiction when diagnosing the existence of gaming addiction.

The criteria include:

1. A preoccupation with video gaming: this is when the person frequently thinks about gaming even though he or she desires to prevent these thoughts from occurring.
2. Tolerance: gaming addiction requires longer or more frequent gaming ‘sessions’ in order to experience the desired pleasurable state.
3. Withdrawal: the person experiences psychological withdrawal symptoms such as restlessness or irritability when video gaming is stopped.
4. Video gaming is escapism: the person plays video games to improve his or her mood and to escape emotional problems.
5. Lying: the person attempts to conceal his or her video game usage and lies to family members to achieve this end.
6. Loss of control: the person is not able to stop gaming despite a strong desire to quit.
7. Illegal acts: the person breaks the law in order to play video games. This could include stealing a video game or downloading a video game illegally. Some gaming addicts have physically injured their loved ones in order to access video games e.g. Lonut Slavin, a 17-year-old from Romania who murdered his mother in 2010 because his mother attempted to stop him from playing video games.
8. Willingness to damage loving or professional relationships: the person plays video games despite losing a relationship as a result.
9. Bailout: The person turns to family for financial help as a result of video gaming.

Are video games designed to be addictive?

Video games are undoubtedly designed to be addictive. For instance, video games are designed to be difficult yet achievable.

Games also take advantage of ‘near misses’ in the same way as gambling slot machines do. Near misses motivate us to ‘try again’. Video games give the player multiple ‘lives’ to encourage the user to ‘try again.’

Video games also take advantage of Pavlovian conditioning. Again, this is very similar to the way gambling games are designed. For instance, when you win, the game makes lots of exciting noises, and when you lose, a noise associated with negativity is emitted.

Such features are known as ‘hooks.’ Other hooks include the ability to obtain a high score and the achievement of small rewards in the form of completed ‘levels.’

The social aspect of gaming

Modern video games are also linked to the Internet. This injects a social element into video games. Many video gamers suffer from social anxiety.

This condition prevents them from making meaningful ‘real world’ relationships. However, since they do not meet the people they play video games within real life when playing online, they are not prohibited by their social anxiety.

This means they may feel accepted when playing video games in ways that are not achievable in the real world. This feeling of acceptance fulfils a need in the video game addict’s primal desires as a social animal. This social aspect of modern video gaming also makes it a highly addictive activity.

Other addictive cues and triggers

Other factors that make video games addictive include:

• Guilds and raids
• Creation of an avatar
• No beginning and no end to games
• No face to face element

Video game addiction as a coping skill

All addictions are essentially coping skill and video game addiction is no exception to the rule. Addictions are maladaptations, but addictions are still essentially a coping skill.

Whilst the person’s addiction continues to serve a purpose, the individual will not take the required action to get rid of the addiction. It’s thus important to determine in therapy how video games help the person ‘cope’, and what is this ‘something’ that the game is helping him or her cope with.

Often, video games help sufferers numb and alleviate anxieties that were caused by traumatic events in their past. An addiction to video gaming is thus a bona fide coping skill. When you remove the coping skill, this assumes the person will not be able to ‘cope.’

It’s thus important to arm the sufferer with alternative coping skills during therapy sessions. During formal psychotherapy sessions, the therapist will help the sufferer better process these traumatic events in different ways. The therapist also needs to help his or her client fulfil these needs in healthier ways.

The dangers of DIY therapy

If the coping skill of playing video games is removed before the underlying mental issue is dealt with, it’s highly likely another maladaptive coping skill will arise. This could include substance misuse or another behavioural addiction such as problem gambling.

The question to ask is: if gaming addiction is a coping skill, what do you replace it with? Many of these people suffering from a video game addiction play these games for around 6-12 hours each day. When they suddenly stop playing these games, they will suddenly have lots of ‘free time’ on their hands.

It’s important they develop alternative strategies, or they could relapse or even begin to abuse substances or engage in other behavioural addictions.

Again, this is because the coping skill has been removed without any provision for alternatives.

Transformation of character

All addictions are characterised by a ‘need that must be fulfilled.’ Gaming addiction allows the sufferer to feel powerful and important. This allows the sufferer to ‘take them away from themselves.’ The addict gets to be ‘somebody else’ when playing video games.

This transformation of character is typical of all addictions, including drug and gambling addiction. For instance, a person may feel shy in social situations.

When they drink alcohol or take cocaine they boost their confidence so they may become who they want to be. There is another example of a need that must be fulfilled.

The dangers of unfulfilled needs

When this need is not fulfilled, the person feels worthless and undesirable. Gaming addiction fulfils this need to feel desirable and worthy by allowing the person to experience life as a warrior or some sort of hero. With the use of gaming, the sufferer gets to be who he or she wants to be, and this desirable identity is typically perceived to be stronger than the sufferer’s true identity.

This desirable emotional state associated with gaming addiction is easily accessed at the click of a few buttons. The gaming addict will repeat this process over and over again until the addiction is firmly established.

However, the gaming addict will deny the existence of this addiction precisely because it helps him or her feel ‘good’. He or she may reason that “when I get to play this game, I feel strong, powerful and in control. It makes me feel like a god.” It’s key for the therapist to help the sufferer gain these positive emotions associated with power and control but in healthy ways.

The glorification of gaming addiction

Today there exists a sort of glorification when it comes to gaming addiction. There are a number of professional gamers who make a living from playing video games and countless more men and women who aim to give up their day job to become a ‘professional gamer.’ However, it’s clearly very difficult to achieve this status of ‘video game star.’

Most people are simply not going to reach a stage where they can make a living from their gaming. However, they may still convince themselves that they can because playing video games is fun.

They have the illusion that ‘one day I won’t have to go to work or spend many years studying when I can just play a video game and make money. Many of these people will even drop out of college, school or university based on this dangerous belief that they might one day become a ‘video game star.’

Gaming addiction thus becomes viewed as a profession. These people may know that they are addicts, but if they can make money at it, then everything is somehow OK.

Physical symptoms associated with video game addiction

We now list a number of physical symptoms associated with video game addiction. These physical symptoms include:

• Carpal tunnel syndrome
• Blisters/Callus on fingers and thumbs
• Dry eyes
• Migraine headaches
• Backaches
• Eating irregularities
• Failure to attend to personal hygiene & incontinence
• Sleep disturbances/change in sleep pattern

Gaming addiction and age differences

Gaming addiction may affect people of any age. There exists a common misconception that gaming addiction only arises for young people. However, this belief is far from the truth. Whilst some games are not targeted to any particular age group, some games are designed for a particular age group.

Because of this, even people as old as 50 and 60 may develop an addiction to gaming. For instance, the game ‘Minecraft’ is not targeted to any particular age group, yet hundreds of thousands of people over the age of 40 are thought to be addicted to this game.

The neuroscience of gaming addiction

Everything we do as humans are defined by needs. Our basic needs are to eat, sleep and shelter. However, gaming has become a need for many people. This is when gaming satisfies a major component in people’s lives.

When somebody has developed this need to game, they may become addicted where they do not eat or sleep. They simply play their video games because these games have become more important to them. This is because their addiction to video games overtakes their basic survival needs.

Why? Because video games trigger dopamine production in the nucleus accumbens region of the brain. The nucleus accumbens is responsible for dopamine production and it thus plays a critical role in our decision-making ability.

This region is often referred to as the brain’s pleasure centre or the emotional centre. The nucleus accumbens is linked to other important parts of the brain such as the frontal cortex, hippocampus, amygdala and ventral tegmental.

Dopamine compels us to perform behaviours that allow us to survive such as eating, drinking, sex and engaging in social interactions. For instance, dopamine compels you to meet a partner in order to have sex, because once you have had sex you will feel good about yourself.

The structure of the brain

The brain is made up of nerve cells. These nerve cells pass information to one another via chemical messengers. These messengers are known as neurotransmitters. Dopamine is one type of neurotransmitter. When a nerve cell is stimulated, an electrical impulse travels down the ‘axle’ of the nerve cell down to the nerve terminal.

This electronic impulse is known as an ‘action potential.’ The nerve terminal is at the bottom of a nerve cell. The electrical impulse triggers the release of the neurotransmitter known as dopamine. Dopamine is released into the synaptic cleft.

The synaptic cleft is the space that separates neurons. Dopamine then binds to a receptor on an adjacent neuron. This allows information to pass between neurons.

The reward pathways see the release of dopamine from the ventral tegmental region of the midbrain. This allows messages to travel to the limbic system (including the nucleus accumbens or reward centre) and the frontal cortex regions of the brain (known as the mesolimbic dopamine pathway). When a pleasurable activity is anticipated, the ventral tegmental fires off action potentials i.e. electric impulses that transport messages from the ventral tegmental to the limbic system and frontal regions of the brain.

Dopamine is then released from the nerve terminal of each nerve cell along that particular pathway in the brain. This is known as a pleasure pathway. Dopamine then binds to each of the dopamine receptors located at the top of each receiving nerve cell. Researchers believe we experience pleasure when dopamine binds to the receptors of neighbouring nerve cells.

Over time, these nerve cells bind together causing the formation of fixed neural pathways. These pathways serve as a sort of memory. This means you will feel pleasure when you merely think about playing video games due to the formation of these tangible reward pathways.

Once you’ve had thought enough times, it becomes very difficult not to have this thought. This is how all addictions arise. This is a numbed sense of pleasure that manifests itself in the form of cravings. You will feel anxious until you play video games.

When you abstain from playing video games for many months or years, these pleasure pathways become weaker and weaker until cravings to play video games are weakened.

A build-up of dopamine causing cravings and euphoria

Like other addictions, video game addiction causes dopamine to build up in the synaptic cleft to far greater volumes than is considered normal. This causes overstimulation of receptors located on receiving nerve cells. This is responsible for the feeling of euphoria when you play video games.

Overexposure to video games desensitises your reward system. Your reaction to normal pleasurable stimuli is numbed. The only thing that’s really pleasurable is exposure to video games. After long-term exposure to video games, even video games lose the ability to stimulate your reward system.

You will need an ever increased dose of video games in order to function and achieve the desired rewarding effects.

The science of cravings, or the expectation of rewards

A study conducted by Wolfram Schultz illustrates the reaction of the nucleus accumbens to Pavlovian conditioning. In the experiment, a conditioned stimulus was associated with a reward. At the beginning of this experiment, this neutral stimulus had no value.

However, during the conditioning process, the animal subject began to predict a reward when it was exposed to this stimulus. At the beginning of the experiment, the animal’s dopamine neurons reacted to the reward of food.

When the animal was exposed to the reward, there was a burst of dopamine activity in the animal’s nucleus accumbens. During the experiment, the animal’s nucleus accumbens stopped reacting to the reward and instead began to react to the conditioned stimulus. This proved that the nucleus accumbens doesn’t record actual reward values, but it records expected or anticipated rewards.

Dopamine doesn’t necessarily equate with the feeling we experience when a reward is achieved. Dopamine is triggered before the reward is received.

In this same way, the brain’s goal-direction mechanism is hijacked by the anticipation of receiving a reward by playing video games. When you expect to play video games, there is a huge inflow of dopamine into the nucleus accumbens. This will create a desire to experience the anticipated reward. If the reward is not received, you will feel agitated and on-edge.

Many of you are thus using video games to fill your survival needs with false fixes. This is because video games hijack the brain’s reward centre.

The need for family therapy

Like other addictions, an addiction to gaming typically causes damage to the family system. In fact, addiction is known as a family system disorder. For instance, if one family member develops an addiction, it’s not unknown for another family member to develop an addiction, perhaps to attain their caregivers’ attention or out of spite.

This is particularly the case when a parent develops an addiction. The children of the addicted parent are then at an increased risk of developing their own addiction as a result.

Since the family system undergoes damage due to gaming addiction, it’s important the family as a whole is involved in the therapeutic process. We recommend the family undergoes ‘family therapy’ or at least sit down together to work these issues out.

However, in practice, this very rarely occurs and these emotional scars may drive a wedge between family relationships for many years, often unnecessarily. To avoid this, it’s important the family is involved in the gaming addicts treatment as much as possible.

Quitting video games

We now list 12 tips to overcoming your video game addiction for good:

#1. Admit that you have a problem

Any solution is not viable if you are not ready to admit you have a problem. Since gaming addiction is a coping skill, it’s difficult for many gaming addicts to admit they have a problem, at least initially.

Adolescent gaming addicts are known to be particularly hostile towards admitting the existence of a problem. So how do you defeat this resistance? The first recommendation is to keep a diary of how your gaming addiction negatively impacts you or your loved one’s life. For instance, you or your loved one may neglect work or education or cause altercations within the family.

#2. Parents must admit up to their own addiction

Parents of a gaming addict may have an addiction of their own. Their child may have developed a gaming addiction in response to their parent’s addiction. If this is found to be the case, it’s essential the parent takes steps to treat his or her own addiction.

The agent of change in defeating their child’s video game addiction is thus in them seeking out help themselves. This parental addiction is typically an addiction to the Internet, alcohol or even drugs. The parent must admit they themselves have a problem, and reveal this problem to their child. This generally helps the child work through their issues with video game addiction.

Therapy should encourage the family to work together since the problem is typically a ‘family addiction.’ If the family does not work together, the change will not take place.

If the parent is not willing to tackle his or her addiction, the child will conclude his parent is a hypocrite, so why change his or her addiction if the parent is unwilling to change? This conclusion will de-motivate the child to undergo treatment for video game addiction.

#3. Determine the underlying emotional issues that cause gaming addiction

If you recall, gaming addiction is a maladaptive coping strategy that masks underlying emotional issues and thus caters to a need. Thus, if the gaming addiction is removed, these emotional problems will persist whilst this need goes unfulfilled. It’s thus essential to determine the nature of these underlying emotional issues so that they may be tackled in healthier ways.

The question is, what is this need that causes these emotional problems? In therapy sessions, we ask the client what it feels like to play video games. We determine what the need is that playing video games satisfies.

Typical needs that playing video games supplies includes:

• Power
• Esteem
• Control
• Approval
• Acceptance

This is not intended as a definitive list of needs that are satisfied by playing video games. It’s usual that multiple needs are satisfied by playing video games, and it’s rare playing video games will only satisfy one or two needs.

In real life, video game addict will struggle to fulfil these needs due to being too shy and anxious. When the video game addict plays video games, these needs will be satisfied making him or her feel good.

We recommend you or your loved one keep a ‘needs diary’ and note down the positive reasons for playing video games. This diary will reveal the need that’s being met by playing video games. These needs are often deep psychological needs that may require the video game addict some time to recognise.

The video game addict may feel embarrassed to admit that he or she is drawing psychological esteem from playing video games, so it’s essential you put these feelings to rest when you explain the purpose of keeping a ‘needs diary.’

The needs identified by this diary will help the therapist personalise his or her treatment and help the client develop specific strategies that address these emotional needs in healthier ways.

#4. Improve your social skills

If you play video games to fulfil a need, it follows that the video game addict may not be able to fulfil these needs using interpersonal skills. For instance, a video game addict may not be able to attain acceptance due to social anxiety. Thus, the therapist should help the video game addict work on his or her social skills. This means the need to be accepted will be achieved through natural means that do not involve playing video games.

It’s very rare a video game addict will solely suffer from an addiction to video gaming. In reality, these sufferers also suffer from a range of mental issues such as anxiety, depression and traumatic stress disorder. It’s vital these issues are treated to ensure the video game addict is able to function without video games.

#5. Find alternative activities

It’s important to find alternative non-electronic activities. We recommend you socialise, go to parks, play board games, go to the cinema or to museums. It’s vital these activities do not involve the use of electronics in any shape or form. Force yourself to leave the house if you have to.

#6. Encourage ‘real-world’ reward systems

It’s important you encourage your loved one to forge a strong ‘real world’ identity by socialising with real people. Over time, your child will prefer ‘real world’ rewards to rewards achieved by playing video games. We also recommend you stop rewards that complement video gaming e.g. stopping video game magazine subscriptions and not giving your child money to invest in computer hardware updates.

You could perhaps use gaming as a reward when you child achieves a ‘real world’ accomplishment such as winning a sports game or achieving a high academic grade. Over time, these competing reward systems will displace the reward system associated with video gaming.

#7. Limit your gaming time

Firstly, you must determine how many hours you or your loved one spend on video games each day. Once you determine this duration, you must work to reduce the amount of time you or your loved one spend playing video games. Use the time on your mobile phone to work out with accuracy how long you or your loved one spend on video games each day. With this figure in mind, work to reduce this time gradually over a two week period.

Since video game addiction is a highly impulsive behaviour, it’s unlikely you will know just how long you or your loved one spend on video games unless you use a device to track this time. You are likely to be very surprised to learn just how much time you or your loved one are wasting on video games each day. 10 hours a week equates to a massive 3500 hours per year. This is the equivalent of 145 days per year or 39.7% of an entire year!

#8. Cut the Internet off after a certain time

We recommend you cut the Internet connection off after a certain time. This includes cutting off the wireless signal so you or your children are not able to play video games ‘in secret.’

#9. Reach out to old friends or find new ones

It’s also important to reach out to friends, no matter how long ago it was when you last saw them. If your child is addicted to video games, it’s important you help your child find new friends or connect with current friends.

Many children become addicted to video games because they do not have friends. Take your children to social events so that they may find new friends or strengthen bonds with people they already know.

It’s also important to realise that people you play games with in real life or online are not ‘real friends.’ These are simply people who use you or children to play games with. Unless these people also show a desire to stop or limit their gaming, find other friends instead.

Due to a lack of meaningful social interactions, many gaming addicts suffer from social anxiety. Overcome this disorder by forcing yourself to go out and talk to real people. Within time, your social anxiety will all but disappear. Therapist say their clients suffering from video game addiction recover from the addiction fairly quickly, However, video game addiction has caused powerful social anxiety that’s typically much more difficult to treat.

If your social anxiety is preventing you from making new friends, we recommend you retain the services of a professional therapist who specialises in psychotherapy for behavioural addictions and anxiety disorders.

#10. Don’t play video games alone

This tip is a harm reduction technique as opposed to abstinence-based. Gaming alone is a clear sign you may be developing an addiction. This is similar to the gambling addict who goes to casinos alone.

#11. Avoid highly addictive games

We recommend you avoid first-person shooters (FPS) and massively multiplayer online games (MMOGs). The problem with MMOGs is that they consist of a persistent environment with no beginning and no end. This means people can literally play these games for decades without any closure.

MMOGs include popular titles such as World of Warcraft, RuneScape, Guild Wars, and League of Legends. FPS include games such as Half-Life and Doom. Although we cannot list a definite list of games you should avoid, these games.

#12. Avoid playing games on your mobile phone

This includes games such as Clash of Clans and Candy Crush. These games also charge your credit card for certain transactions. Thus, these games are addictive and expensive. These micro-transactions are extremely addictive, and video game production companies likely understand and profit from the addictive nature of their games.

Further resources

• A Therapist’s Guide to Assess and Treat Internet Addiction by Dr. Kimberly S. Young
• The truth about addiction and recovery: The life process program for outgrowing destructive habits by Peele, S., & Brodsky, A
• Doing Psychotherapy by Michael Franz Basch
• Video Gamers Anonymous by Kenneth M. Woog
• Computer Gaming Addiction in Adolescents and Young Adults, Solutions for Moderating and Motivating for Success
• StopGaming on Reddit
• Understanding online gaming addiction and treatment issues for adolescents by Kimberly Young
• Udemy course of video game addiction