Today’s video game addict has many places to go. Websites like Online Gamers Anonymous, Quit Wow Now, and Video Game Addiction all exist to offer him relief. There are even clinics specifically aimed at helping video game addicts.

On top of that, research has found that video game playing can release as much dopamine in your brain as a shot of intravenous amphetamines. This dopamine is, among other things, the “damn-I’m-so-good” neurotransmitter involved in learning and achievements.

So are video games the drug of our generation, or might something else be going on?

Definition of Addiction

To know if video game addiction exists at all, we have to know what an “addiction” truly is. In common day speech an addiction is a “persistent compulsive use of a substance known by the user to be harmful”. For every day use, this definition is great.

You can say you are addicted to cashew nuts, because 3 bags a day is really too many. You can say that you are addicted to taking the car to work, because walking/biking would be so much healthier but you cannot bring yourself to do it. In the same way, you can say you are addicted to playing video games, because you play more than you think is good for you.

However, this Merriam Webster definition is not enough to define clinical addiction. That is the type of addiction that you get treatment for, because it is considered a mental illness. The definition of a clinical addiction is a lot more elaborate. You can find it in the Diagnostic and Statistical Manual (DSM), the bible of mental illnesses.

This bookwork contains all the criteria for all recognized mental disorders. It is put together by the American Psychological Association (APA), the largest group of psychologists in the world that ever sat down together to write a book. If a disorder is not in the DSM, then it is traditionally not considered a mental problem (in the Western World).

They are not infallible, of course. Homosexuality was recognized as a disorder in the DSM from 1952 through to 1973. They publish a new version of the book every few years, updating the criteria and recognized conditions based on recent research. Currently they are considering video game addiction as a candidate.

Not under that name though. “Addiction” is not a term that they use in the DSM. Right now they recognize substance-related disorders and impulse-control disorders. Video games cannot fall in the first category as they do not come in pills, syringes, or any other form that would make it pleasant to insert them into your body.

The category of impulse-control disorders is more hopeful. One of its members is “pathological gambling”. You can find the criteria here. Some criteria might apply to video games too, while others really cannot. Most notably, the life-destroying-criteria do not apply: Gamers do not need to play more and more to get the same effect (2). Gamers do not involve themselves in criminal activity to support their addiction (8).

Gamers do not generally need to financially rely on others because they lost money gaming (10). If they did lose money gaming then it was probably a gambling game. Also, a gamer cannot “chase his loses” because there are none (6). So four out of ten criteria for a gaming addiction similar to that of gambling already fall away.

Now, the criteria for pathological gambling have one big footnote. This diagnosis only applies if the symptoms cannot be better explained by another disorder (in this case Manic Episode). Now, the question is, could “pathological gaming” be added to the DSM in a similar form to its gambling cousin?

The American Medical Association (AMA) sure thinks so. They urged the APA to do so in a report they brought out in 2007. This report reviews the effect of video games on our health. They conclude the research so far is inconclusive but that they still encourage “internet/video game addiction” to be included in the DSM.

Based on the report, we can only conclude that they reason that it is better to include this diagnosis “in case video game addiction exists”. This lack of research evidence will hardly convince the APA to add such an addiction in the next version of the DSM.

Research

There are two major issues plaguing all research into video gaming addiction. The first is the most important: a causal link. They need to find healthy, balanced people whose lives gaming ruined. This is a lot harder than it sounds. Part of what makes gaming so alluring is that it so good at making us forget about our daily concerns.

Escapism is a powerful way of dealing with negative emotions. There is nothing wrong with this. If you dread a visit to the dentist, then it is better to distract yourself with a game than to indulge in agonizing mouth surgery fantasies. In the same way, gaming is often a symptom of other problems in people’s lives.

Anything from depression, to grieving for a loved one, to anxiety, can make a powerful fantasy world very appealing. So if gaming can be a symptom of other problems, then it becomes much harder to find cases in which the games are the sole cause of the problems. I have not been able to find any research showing a significant causal link between gaming and the symptoms of an addiction/compulsion.

The second major problem is definition. There is a lot of research into the prevalence of video gaming addiction. Many researchers assume that there is a problem, pick a set of criteria and see who fits into that slot. There is even research that uses the Merriam Webster definition. That was the definition we declared irrelevant a few paragraphs up. Fortunately, the more common criteria are adjustments of the substance-related disorder and the pathological gambling diagnosis.

As mentioned before, the first definition is meaningless until the day that gaming molecules can pass through the blood-brain barrier. A definition based on pathological gambling might be a more hopeful road. However, we should all agree what that should be. Some papers simply mention they adapted criteria from pathological gaming, without saying what adjustments they made. Others try to find reliable criteria, but admit there is still a way to go.

One interesting area of research into video game addiction is brain research. Avid gamers do activate the same brain pathways that substance abusers do. Dopamine was mentioned before, but the general brain activity of video game enjoyment is also very similar to getting high on drugs.

In itself, there is nothing wrong with these pathways being activated. It is probably a big part of why games are so much fun in the first place. It will be interesting to see where such research will lead.

Who’s the Addict?

Though video game addiction is not a clinical diagnosis, there are still people who adopt or receive the label. According to the information we have now, those people fall into one of four categories (based on work by Richard T.A. Wood):

1. People who are labeled video game addicts by others even though they do not experience any problems with their gaming behavior themselves.

2. People who have labeled themselves as addicts as a result of “being convinced” by the media or others of their problems.

3. People who are not good at managing their game time and communicating about it with their friends and family.

4. People who use video games as an escape from deeper problems.

If you feel you might have a problem with your gaming behavior, then try to find out in which category you fall. Categories 1 and 2 are harmless. If you are a healthy and balanced person, then do not worry about your gaming habits.

If there is more going on, try to see if it is simply a matter of time management and communication. If none of this applies to you and you still feel there is a problem, then you might want to look more closely at your life. Gaming is offering you a relief, but a relief from what?

If you are interested in reading in more detail about this topic, I highly recommend reading this literature review. It is an overview of the solid facts without any media distortion.

“But what about gaming clinics and people who play themselves to death?”. Clinics like the one in Amsterdam obviously have an audience. If people feel these programs help them, then I am the last one to try to convince them otherwise.

However, might these clinics not simply be teaching people those time management skills we talked about? Or maybe they treat the underlying issues that cause gamers to go overboard on the play hours?

As for the extreme cases of gamers playing to exhaustion or death, there is most likely more going on with these individuals than meets the eye. The extreme cases will always get a lot of media attention, and “uninteresting” details might be left out in favor of hyping a good story. Check out the literature review for some case studies and explanations.

For now, we have seen that the concept of a video game addiction is more likely to be a media hype or symptom of an underlying problem than a true addiction. Of course, in daily speech most of us are probably video game addicts. Just like most of the Western population is a TV addict or a car addict.

However, clinically speaking, there is no such thing. All the research so far that says otherwise is based on shoddy premises. One day new facts might come to light that change the whole situation. For now, just focus on leading a healthy and balanced life. And game on!

If you want to, of course :)

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