Exploring Gaming Addiction
Video Game Addiction is something that we're hearing more about these days. While the AMA still has yet to recognize it as a disorder, there are plenty of anecdotal instances of the problem. While the issue isn't limited to MMORPGs, the stories you hear often center around our genre. Whether it's someone playing WoW and failing out of school, or a couple that neglects their baby over Dungeons and Dragons Online, MMOs seem to be at the heart of this debate. Today, Staff Writer AJ Glasser takes her own look at the issue.
We've all heard the horror stories: a guy in Korea plays Lineage for 50 hours straight and dies of a heart attack; a couple in Reno, Nevada pleads guilty to child neglect, claiming that Dungeons & Dragons prevented them from feeding their children; a 17-year-old EverQuest fan hangs himself after being grounded from his computer. And nearly everybody has a friend of a friend who World of Warcrafted themselves right out of college.
"All I did was play WoW," says Jake , a former freshmen of English Lit major at UC Davis. "I didn't go to class. I didn't take my finals. I even forgot to eat."
Extreme or not, these are the examples people point to when they talk about video game addiction. Technically, video game addiction is not a real addiction, or even a disorder, until the American Medical Association (AMA) or the American Psychiatric Association (APA) says it is. Without official classification, game addiction cannot be diagnosed, treated, or its severity measured in a standardized way. This, however, has not stopped treatment centers from springing up across the globe to treat gaming addicts.
Diagnosis and treatments vary from clinic to clinic. According to a TGDaily article published in February, gaming addiction treatment clinics in China (which houses patients put there by their families or court order) employ everything from anti-depressants to electro shock therapy; the Smith & Jones Wild Horses Center in Amsterdam uses an eclectic mix of cognitive behavioral therapy and psychoanalysis and only accepts outpatients; and here in the U.S., the website On-Line Gamers Anonymous uses the 12-step program originally devised by Alcoholics Anonymous - and, as the name suggests, is entirely anonymous.
Justification for these practices usually comes with a comparison to substance abuse, to gambling addiction, and to alcoholism: "Working with this problem is no different than working with alcoholic patients," says Dr. Thomas Allen of the Osler Medical Center in a recent interview with Joystiq.com.
Other medical officials do not agree with Allen: "There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism of substance abuse," declares Dr. Stuart Gitlow of the American Society of Addiction Medicine. "And it doesn't get to have the word 'addiction' attached to it."
Those were the statements Gitlow made this spring, when the AMA declared that game addiction was not a physiological issue and deferred to the APA for the final word on whether or not video game addiction should be entered into the Diagnostic and Statistical Manual of Mental Disorders (DSM, or "psychologist's bible"). The APA is not expected to address the issue until its next DSM revision session in 2012. Even if they voted to include game addiction at that time, the revised edition of the DSM wouldn't be available until about 10 years from now.
But in the meantime, doctors like Allen will continue to treat patients that come to them suffering from game addiction.
We sat down with one of these doctors to pick their brains about gaming addiction and treatment. As the director of the Computer Addiction Studies at McLean Hospital, Dr. Maressa Orzack has been working with addicts since 1995 and we're convinced she knows her stuff.
Dr. Orzack sees computer (and gaming) addiction as related to an impulse-control problem, like gambling. "Similar brain connections exist," she tells us. "The reward system is the same." But unlike China, Dr. Orzack takes a cognitive behavioral approach to addiction:
"[When I diagnose] a patient, I always do a clinical interview first. I ask them 'what do you do when you're not here?'." Dr. Orzack has no specific criteria for diagnosis because none exists in the DSM. Instead, she defines the addiction in terms of losses (loss of your job, your girlfriend, etc.) In Dr. Orzack's experience, game addiction seems to go hand-in-hand with mood disorders (depression, obsessive-compulsion) and anxiety disorders, and sometimes manifests symptoms on the autism spectrum ("Where patients respond to objects rather than people.").
Dr. Orzack finds that the typical gaming addict is 1) a shy, young white male 2) with poor social skills who 3) is very smart. This subject then hits puberty, and undergoes dramatic change or, something occurs in the subject's family that instigates the change (death of a loved one, moving, etc.). It's around this time that the subject begins to develop a strong sense of belonging in his video game, and retreats there as a way to deal with stress, anxiety, and depression.
To treat the problem, Dr. Orzack first gets to the bottom of it: treating the patient for whatever underlying disorder has led them to compulsive gaming. Cognitive behavioral therapy involves coping skills, teaching patients how to identify and express their feelings and thoughts in a healthy way. For game addicts, this is important because gaming cuts them off from the outside world and impairs their ability to cope with real life (as in Jake's case).
The success rate of Dr. Orzack's treatments is just as hard to track as game addiction itself. Because gaming addicts aren't out puking in the gutters, or straddling a slot machine in public for nine days straight, it's hard to point to an example of destructive behavior that affects both the addict and those around him - until it's too late.
"My parents didn't even know I'd failed out of college until it was time for me to graduate," says Jake. "And by then, I had kind of gotten over it. I cut back on WoW and got a job testing video games. If I'm going to be addicted, I might as well be productive."
Ultimately, gaming addiction is about perception - of those who have it, those who might have it, and those who intend to treat it. Come 2012, the APA will have a much better idea of what game addiction is and what it isn't, which will help doctors and patients form these crucial perceptions about gaming habits. If the first step for an alcoholic is admitting that you have a problem, then for gaming addicts, it's finding out if there is a problem for you to have.