Visions Journal

Benjamin Shing Pan Wong

Reprinted from the "Problem Gambling and Video Gaming" issue of Visions Journal, 2018, 14 (2), p. 8

From my perspective as a clinician who specializes in the treatment and prevention of problem video gaming, 2018 has been an eventful year.

This is not simply because an increasing number of people are struggling with this condition (which could be the subject of another article) or that the consequences people experience as a result of video gaming are increasingly serious (which could also be the subject of another article).¹

What makes 2018 remarkable is that the World Health Organization (WHO) included “gaming disorder” as a diagnosable psychiatric condition in the 11th revision of the International Classification of Diseases, published on June 18. Journalists—multitudes of them—leaped on the story. I have since given numerous media interviews, on and off camera, offering my opinions and insight.

My 18 years of counselling experience inform my rationale for treating video gaming (or, for that matter, any pathological digital dependency) as a potentially addictive behaviour. First, gaming is a behaviour that affects mood. Video gamers often see their games as a predictable, risk-free means of having fun and relaxing, unlike other, arguably riskier, pursuits that might affect mood but may not be predictably pleasurable (such as social relationships, school, work and physical fitness regimens).

Second, gaming is a behaviour that can affect one’s normal functioning. I have encountered video gamers so wrapped up in their own digital worlds that they fall into chaotic patterns of diet, personal hygiene, sleep, exercise, work life and interpersonal relationships.

Third, like other addictive behaviours, gaming is a behaviour that can be used as a means of coping with emotional distress brought on by challenging life circumstances. When we consider how video games are designed to provide fun and pleasure, it is hardly surprising that gamers play games to numb pain and relieve stress.^{2, 3}

Fourth, long-term video gaming can result in neurological and psychological changes. MRI studies reveal that the endorphin circuit (which controls pain relief), the dopamine circuit (which controls pleasure, elation, motivation and concentration), the impulse control circuit and the stress response circuit are all affected by long-term video gaming, in a way that is similar to how our brain circuitry is affected by long-term gambling and substance use.^4-6

The World Health Organization’s identification of gaming disorder as a psychiatric diagnosis comes as no surprise to mental health professionals. In 2013, the American Psychiatric Association (APA) included “internet gaming disorder” in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), intending to encourage further research into the condition’s etiology and potential treatment options (even before the disorder had received WHO’s official recognition).

An important implication of this evolution is the increasing availability and accessibility of psychiatric treatment for individuals and families affected by problem video gaming. When a condition or addictive behaviour is only casually or anecdotally recognized (as in the case of sex addiction and compulsive shopping, for example), the option of seeking professional help, when it exists, tends to be overlooked or under-exercised—or dismissed altogether.

For individuals struggling with digital dependencies, formal recognition of the condition by organizations like WHO and the APA is a victory. The individuals’ need for quality, professional help is legitimized, paving the way to more effective, evidence-based treatment options—and, ideally, positive outcomes.

Another implication is a better understanding of how the condition is formed (its etiology) and how it can be treated (its remedy). Now that the condition is diagnosable, we can begin to conduct more vigorous and systematic research and practice in the area of digital gaming.

In my counselling office, for example, we have had success with cognitive-behavioural therapy, acceptance and commitment therapy and motivational interviewing in our support of problem gamers’ quest for wellness, if not outright recovery. I expect that these and other counselling techniques commonly used to treat other addictive behaviours will soon be more formally evaluated as effective treatments for gaming disorder.

In my own practice, I have noticed two particular predictors of good therapeutic progress and positive outcomes. First, family participation is crucial, almost a prerequisite, in considering, planning and implementing change in the problem gamer’s life. This personal observation is consistent with what other clinicians have long known about addictions: family members becoming active participants in the solution is often the “game changer” in treatment.

In my practice, I help family members to identify and change behaviours that enable rather than help the gamer (like waking the gamer up so he won’t be late for work, or making the gamer lunch). In many cases, problem gaming behaviours subside (and the gamer’s wellness improves) even when family members engage in therapy without the gamer. This fact highlights how important an individual’s emotional environment is in the perpetuation of addiction and addictive behaviours, and in the gamer’s recovery.

A second predictor of positive outcome is a frank discussion (and the individual’s increased understanding) of the concept of technophilia. Technophilia is the mindless acceptance and inclusion of every novel piece of technology into one’s life without considering what value the technology adds or the purpose it serves. A technophile is someone who loses themselves in the dazzling and colourful promises of technology while utterly failing to recognize or acknowledge technology’s inherent dangers.

As individuals and as a society, we habitually exercise a blind faith in technological development. To my mind, this issue is not investigated deeply enough when we search for explanations for increasing rates of psychological disorder, suicide and mental illness in the 21st century.

While WHO’s formal identification of gaming disorder is a momentous step forward, it also generates a number of relevant and pressing questions. What intermediate steps were taken, between WHO’s suggestion that gaming be studied as a medical disorder and the condition’s anticipated recognition as one? How do we address fears that the identification of gaming disorder now characterizes as an individual’s medical problem what might be evidence of a societal problem?

Does the psychiatric community currently have sufficient clarity and agreement about how the condition is formed to warrant a diagnosis? And if so, what is the nature of that understanding? By enabling a diagnosis of gaming disorder, must we now brace for the impact of labelling problem video gamers as “patients” who might need psychotropic medications to “recover” from their “illness”? If so, what effect might that have on our society?

Mental health professionals around the world anticipate more developments. We hope these questions will have clearer answers as more information becomes available.