Editor’s Note: The post originally appeared on The Fix, a Pacific Standard partner site.
Once a hobby just for nerds, video games have become as mainstream as alcohol. Whether they are—or will become—as addictive is hotly debated by experts. And as their popularity continues to soar, that debate carries a growing sense of urgency.
Modern games, which retail for around $60, are made with one goal in mind: keeping people entertained for hours—which can then be further monetized through subscriptions and expansions. But with Hollywood-sized budgets (sci-fi shooter Halo 4 was built on a budget of $100 million and made $220 million on the first day of its release) to throw behind writing, graphics, testing, and even psychological expertise to maximize fun, critics—including many parents—say that video games hold the attention all too well. Some gamers are losing productivity, relationships, and even their lives, and programs for pathological video-game play are springing up all over the world.
A World of Warcraft (WoW) player in Texas told The Fix about losing his marriage and career to the game. A professional trucker, he sustained a back injury on the job in 2001 that immobilized him; he sought ways to distract himself during his time at home between surgeries. Because of his military-related PTSD, he dislikes sitting with an idle mind, and WoW—with its massive fantastical world and giant community of fellow players—was his distraction of choice. “From that day forward I was either at the computer playing WoW, sleeping, or in the bathroom,” he recalls.
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Years later, he was still at it. “Fast forward to 2007—you know that meme of the Redditor guy with his sad-looking wife looking at him from the doorway?” he says. “That was the everyday scene at my house. Wife bored, frustrated, and horny, me at the computer doing my best to ignore her.” She finally gave him an ultimatum—get off the computer or get out. He packed his bags and left his wife and daughter that night.
Some gamers have even lost their lives. Today’s online digital landscapes drove one Chinese man to play for 27 days straight, subsisting only on instant noodles in an Internet cafe, until he died from cardiac arrest. A Taiwanese man, 23-year-old Chen Rong-yu, passed away after a 23-hour League of Legends bender, the rigid arms of his corpse still reaching for the mouse and keyboard.
But the DSM-5—the bible of the mental-health industry due out this month—declined to classify problem video gaming as an addiction, instead placing Internet pathologies in a “needs more research” sidebar. An official diagnosis of digitally fueled problems like video gaming could help spark the serious attention that many psychiatrists, who angrily lobbied their colleagues in charge of the DSM revision, say they deserve.
The U.S. gamer population stands at 211 million—more than two-thirds of the population. According to the Journal of Psychiatric Research, about three percent—or 6.3 million—play at a “pathological” level. And it’s not just teenage boys anymore. “The average age of the most frequent game purchaser is 35. Forty-seven percent of all game players are women,” claims the Entertainment Software Association, the industry’s lobbying group that has successfully resisted regulatory crackdowns in the face of much negative publicity. “In fact, boys age 17 or younger are now 18 percent of players.” The Nielsen Company, a consumer behavior information firm, corroborates these numbers, reasoning that women have flooded this market as smartphones—and the casual games on them—become increasingly prolific.
Health experts, however, are still mainly fretting over how video gaming affects young males. After all, the “hardcore gamer” stereotype is that of a socially awkward or outcast teenage boy. The violence of these games (rather than their potential addictiveness) often returns to the forefront of public awareness following a mass shooting committed by a young male who also happens to play video games—most recently the Newtown, Connecticut, killer Adam Lanza, who is said to have been immersed in the popular military shooter, Call of Duty.
But now, with the next generation of even more realistic and compelling gaming consoles just over the horizon, the fear is growing that video games will impair the mental health and social development of the next generation of males. Hilarie Cash, co-CEO of video-game rehab center reSTART, in Fall City, Washington, says that her clients are almost all males between ages 18 and 28; female gamers tend to play puzzle or social games, she says, and “manage” their gaming habits better.
So what’s all the excitement about? The games provide players with a rush in the head from winning with no tangible consequence for losing—and you get to keep playing as many times as you want. Outsmarting a legion of monstrous orc invaders feels more rewarding on your tenth try, as you finally develop the requisite skills to overcome everything the game throws at you. Brain scans show that victory feels very good indeed, activating the brain’s dopamine-producing pleasure pathways that are the center of addiction. And a Stanford MRI study found that video games light up men’s brains more intensely than those of women.
The DSM-5 followed this science, but only so far. “There is currently insufficient research to definitively conclude that video game overuse is an addiction,” it reads, “but symptoms of time usage and social dysfunction/disruption appear in patterns similar to that of other addictive disorders.”
These “dependence-like behaviors” are amplified when other players are involved, especially in the case of massively multiplayer online roleplaying games (MMORPGs), with sometimes millions of players competing or collaborating as denizens of a digital fantasy world. “When you can interact with others it becomes much more addictive. You get to be part of a community,” Cash says. “The social component really carries you into deep immersion.” World of Warcraft, with 9.6 million global players, is the most popular—and immersive—of them all. You can hold a wedding or a vigil for a player who passed away—or, if you’re in the opposing faction, raid these gatherings in a surprise attack.
Some critics accuse game designers of utilizing sophisticated behavioral psychology research to keep gamers hooked. A famous study of rats and rewards offers a model: When rats are given food every time they pull a lever, they use the lever only when they are hungry. But if the food is given in an unpredictable pattern, the rat remains in such a heightened state of desire and frustration that it keeps pulling the lever until it dies of exhaustion. When applied to games, this random-reward system keeps players clicking—and hoping their next click will be a winner. The video below explains and argues against using this kind of game design:
All the hubbub about games designed according to the lessons of behavioral psychology stemmed from an article by John Hopson, a behavioral psychologist and gamer who is now head of user research at Bungie, the studio behind Halo. Hopson says that his article is widely misunderstood. How often rewards come, and how valuable they are, are always in play no matter what we do. “Many people seem to assume that there are no such contingencies in a game unless they’re explicitly added. This is simply wrong,” Hopson writes. “Contingencies are fundamental to all games.”
Cash doesn’t blame game design for addiction so much as she blames the disease of addiction itself. Like all addicts, her clients have a predilection—genetic, family history—and most suffer from a mental disorder, such as ADHD, social anxiety, or depression, that makes them even more susceptible. Video gaming becomes their “substance” of choice. “But most significant is that the earlier they start video games, the more vulnerable they are to addiction,” she says, adding that that’s a problem exacerbated by parents who toss their kids their iPhones whenever they need quiet time.
An official DSM diagnosis would emphasize the gravity of the condition. “Everyone will have to take it more seriously and not just pooh-pooh the idea,” she says. “Even the addicts.”
Aaron Delwiche, a professor of video game culture at Trinity University in San Antonio, does pooh-pooh the idea. “Contemporary culture offers many avenues for compulsive and problematic behaviors,” he says. “Sure, you can make a convoluted argument about endorphins and dopamine in an attempt to suggest that there are parallels to physical addiction, but it’s just not the same thing.” The CDC reports a 13 percent problem usage rate among people who drink alcohol, with 80,000 annual deaths, compared to video games’ relatively meager three percent. But gaming’s deaths, although rare, serve as horror headlines, he says.
Delwiche advises that before gaming is medicalized—with diagnoses and treatments in the DSM—there should be an investment in a public-health effort to help people become more aware of how they are affected by the digital revolution. “I think it’s clear that something is happening with human beings and our connections to our machines,” he says. He suggests an approach based on harm reduction. “Once someone realizes that we’re not trying to abolish the source of their gaming pleasures altogether, they are more likely to find times to interact with us in the physical world.”
But some former gamers prefer abstinence. After moving out in 2007, our Texan WoW player continued his eat, sleep, play lifestyle until one night in 2010. “My daughter called me from her home over 1,000 miles away. I don’t get to see her very often and rarely get calls from her,” he recalls. “My answering machine picked up, I listened to my daughter’s voice as she left me a ‘Sorry, I missed you’ message. Tears came to my eyes. I logged off Ventrilo, turned off the computer, and haven’t played WoW or anything like it since.”
Jason, another ex-WoW player, snapped out of his compulsive play by himself. At the age of 15, he was playing for 10 hours a day, seven days a week. At 20, he came to realize that he hadn’t created any new, strong memories in years and had slowly become more and more unhappy with himself. “I canceled my account,” he recalls. “Quitting the game caused me to lose 50 pounds, enroll in a serious amount of classes, and touch a girl’s naughty bits for the first time.” Despite relapses, by sustaining work on his real self rather than his avatar, he finally managed to wean himself off MMORPGs for good.
Mental health experts are treating problem gaming with the standard addiction blend of psychopharmacology, psychotherapy, and 12-step programs. Cash’s reSTART offers clients a way to detox, reversing the effects of chronic sleeplessness, unhealthy diet, and lack of exercise, by means of cross-training, healthy eating, and 12-step talks—and no digital devices without permission!
There is also On-Line Gamers Anonymous, where you can log in 24/7 to chat with fellow self-identified online gaming addicts. There’s a list of games reported to be addictive (MMORPGs, like WoW, top the list) and a dedication page that pays tribute to those who have lost their lives to video gaming.
Video games are only going to get more advanced, pushing the boundaries of what consumers want with new high-tech bells and whistles to players chasing that victorious dopamine rush. Game companies envision video games that are so immersive that you don’t interface with a controller at all—a microchip in the brain will let you control games with your mind. “The real model we’re building is the one in your head, not on the computer,” one game maker says in the PBS documentary The Video Game Revolution.
That’s something that the game industry and mental health and addiction experts can agree on: It’s all in your head. And with research underway to discover more about the disease’s effects on the brain, video gaming, like the growing list of other Internet compulsions, is likely to become an addiction as routinely diagnosed as alcohol. Whether treatment for the condition will be more successful remains to be seen.
