While most of the public views game addiction in terms of video games, game addiction can take many forms. People can be addicted to board games, card games, game shows and other forms of games. Video games are the most visible because they are more relevant in pop culture and are having a greater impact on the younger generations, so much of our data and research will be dealing with that. However, these concepts can be applicable to games of any and all ways, shapes and forms.

History

As long as there have been games , there have been addicts, much like with other addictive substances. One form of these addictions is caused by video/computer games. The term idea of video game addiction was first introduced to mainstream media in the early 80s. U.S. Surgeon General Everett Koop (the Life-Alert guy) released a statement on November 10, 1982 saying that video games might be hazardous to the health of young people, who, he said, are becoming addicted to the machines body and soul ^[1]. At the time he had very little evidence to support his claim but he predicted that in a few years medical professionals would ascertain this evidence through research. Almost thirty years of research coupled with more advanced technology for gaming now shows that Dr. Koop was accurate with his claims. In July 2006, the world’s first video game addiction clinic opened in Amsterdam ^[2]. Since then other countries like the United States, Canada, China, and Korea have opened treatment centers. These treatment centers and the methods they implement to help video game addicts will be discussed in the Prevention and Correctional Programs section.

Addiction Defined

Addiction is an emotionally charged word with negative connotations. It turns out to be much harder to define what it is than it might at first appear. While there is not a steadfast, undebatable definition in the Diagnostic and Statistics Manual Volume IV (the "bible" of Medicine), there is a definition of the term "dependence". Dependence is defined as "Substance use history which includes the following: (1) substance abuse; (2) continuation of use despite related problems; (3) increase in tolerance; and (4) withdrawal symptoms." ^[3] Peter Laurie ^[4] presents a table with various drugs such as amphetamines and caffeine, and qualities of those drugs. To illustrate the point he includes 'trousers' in this table, which tick the boxes for 'Psychic dependence', 'Physical dependence' and 'Psychotoxic on withdrawal'.

Addiction to computer games is often seen as a social problem. Addiction to sports or to games of skill such as chess are more rarely seen as being a problem. Why is this? When does a passion for an activity become an addiction? Looked at more objectively, addictions are activities that society in general does not approve of. A passion for football or for chess is something society as a whole can approve of, even when pursued to the detriment of other activities. They are less prone to being categorised as an addiction. In approved of and unapproved of activities we can analyse the elements that make the activity 'addictive', the cycles of reward, the emotional circuits that are being tapped into.

Symptoms

While video game and internet addiction are not actually classified in the (DSM)-IV, the American Medical Association is reviewing research to determine whether or not these terms should be included in the next update of the manual in 2010. As many as 10% of gamers exhibit addictive behaviors ^[5].

Game addiction can include any number of symptoms mentioned below:

• Preoccupation: person seems unusually concerned with the game, may seem irritable or distracted, will talk about gaming frequently to his peers
• Lack of control: the person feels as if they need to play the game in order to function. The person cannot go for an extended period of time without playing the game. An example of this would be the YouTube sensation "The Greatest Freak Out Ever" from username wafflepwn (http://www.youtube.com/watch?v=YersIyzsOpc). The teenager's reaction to the loss of his World of Warcraft account is a symptom of game addiction.
• Lying: fabrications of how much time is spent playing video games. The person may lie to his friends and family about playing video games in order to prevent intervention.

Many of the symptoms and causes of game addiction are similar to that of gambling addiction, or problem gambling. In fact, gambling addiction and game addiction experience a lot of overlap, especially in terms of card games and slot machines. Where they differ is in sports betting, which is not seen by the public as a game.

Side Effects

Problem Games

Some games that have been heavily targeted by organizations as being more addictive than others include the following:

• World of Warcraft: World of Warcraft has gotten the most scrutiny of all video games by far. It's role playing aspects, large following and seemingly endless updates make it a prime target for game addiction. There is a lot more to read about World of Warcraft in our colleague's MMORPG page.
• The Halo Franchise: This is the World of Warcraft of console games. Halo is one of the most popular game franchises of all time. On its first day, Halo:Reach sold over $200 million worth of games. ^[6] It's online multiplayer is massive and very popular for its simplicity: kill or be killed. The fan base for the Halo series is also very loyal. On April 15, 2010, Microsoft shut down their servers that supported the original Xbox games' online play. The way they kicked players off of the server was that whenever they logged off, they would not be allowed to log back on. Some Halo 2 players heard this news and made a pact to keep playing as long as possible. So for days upon days, these players kept playing Halo 2. After 26 days, the last player, Apache N4SIR, was booted from the system.^[7]
• Tetris: Tetris is heralded by many gaming authorities as one of the greatest games of all time. However, it is also very addictive. One of the primary reasons for this is the concept of the high score. Since there are no levels in Tetris, one could theoretically play the game forever, so success in Tetris is measured by the highest score. The portability and ease of the game has allowed Tetris to experience a rebirth in the age of cell phones and iPods. As of January 2010, more than 100 million copies of Tetris have been sold on cell phones alone.^[8]

Potential Benefits

Surprisingly, a new trend called ‘Exergaming’, proves that physically demanding games can help combat child and teenage obesity in America. An international online survey found that Konami's Dance Dance Revolution improves physical health, endurance, muscle strength, and sense of rhythm in addition to facilitating social interactions.^[9] Other reports have found that the wide range of movements required in playing Nintendo’s Wii Fit has made the game an increasingly popular alternative for exercise as well as pediatric and physical rehabilitation.^[10] This is sometimes referred to as 'Wiihabilitation'.^[11]

Action games that demand multitasking and rapid information processing can enhance a range of visual skills. One study by Dye et al reports that avid video game players experience faster reaction times in a variety of tasks including spatial cueing, inhibition of return, and flanker interference than non-video gamers.^[12] The research also showed that non gamers who underwent action game training experienced a greater increase in reaction times than those who had been trained in control gaming. In another experiment by Green and Bavelier, people who typically played action video games for more than five hours a week were able to maintain target identification with distracters in closer proximity than non game players. After given 30 hours of action game training, these non-video game players saw improvements in their visual acuity and were able to decrease their visual crowding threshold.^[13] These studies suggest the causal relationship between action games and heightened visual skills. Furthermore, in a Multiple Object Tracking task study by Sun et al, gamers that had ceased to excessive playing as much as two years prior, exhibited superior visuospatial abilities than a control group.^[14] Thus, not only can video games improve perceptual reaction times, visual targeting abilities, and selective attention, but their benefits can be potentially long term. In the future, action video games might play an rehabilitative role for people with poor eyesight.

Causes - Who is Vulnerable?

According to a survey conducted by USA Today, the average age of the typical gamer is 29, and men make up 59% of the gamer population ^[15]. Adults that are not happy with their occupations or want more excitement in their lives may use video/computer games to gain satisfaction. A majority of younger game addicts include individuals who don't fit in or are not athletic in school. Others use computer and video games as a way to cope with social deficiencies.

Causes - How are games made addictive?

The most common causes of video/computer game addiction are:

• A sense of achievement
• The ability to escape real life
• The ability to be anyone you want (especially for online games)
• Connections with other players

Achievement systems

Many video game companies release new versions of their games annually, while most computer games are subscription based. This means it is beneficial for the companies to keep their customers entertained and playing their games. These companies implement certain strategies to ensure this happens.

Video and computer games give the players give the players a sense of achievement to get them hooked. This is analogous to the scenario of a lab hamster on a wheel. As long as the hamster continues to turn the wheel, he will be given food pellets. If the hamster stops running the pellets will be withheld . Most games implement this strategy by having short levels so it is quick and easy to reach some sense of achievement. The players usually get an adrenaline rush while playing, which is sometimes associated with the music in certain games during play. However, as the players' achievements begin to build up their brains release small amounts of dopamine ^[16]. To use a human example it is like convincing someone to eat a bag of chips. It is easy to convince the person to eat just one, however once they have the taste in their mouths it usually is not long before the entire bag is gone. Another aspect is that in most games the levels or space between checkpoints slowly get longer and more difficult the more that someone plays, making it harder to reach the same sense of achievement . This directly mimics the effect of most drugs, where as the chronic users must take more of a drug to reach the same high as their bodies get used to the effects.

Another way achievement systems are used to get people to keep playing video or computer games is by implementing a play it or lose it strategy ^[17]. This brings us back to the hamster on the wheel analogy. Now if the hamster stops turning the wheel it will be punished by the lab working, who will administer electric shocks to the rodent until he begins running again. This is similar to many games in which the player will lose achievements the longer they refrain from playing. Most players do not want to lose what they have work so hard to gain.

Player Control

Many players gain a sense of control from playing video and computer games. They are able to escape from their own limitations in real life and become someone completely different in the game world. This leads to a greater sense of achievement and satisfaction when playing the game as opposed to real life.

Social Connections

Players are also attracted to the video games because of the social connections they can make with other players playing the game. This is true for both online and offline games. Players can find common ground with other players in real life by discussing the game with friends, while online players can meet people from all over the world and immediately have a connection.

Prevention and Correctional Programs

Over the past ten years, a few treatment centers specializing in game addiction have emerged in Amsterdam, China, and the USA.^[18][19] These facilities, typically residential, tend to utitlize family therapy and social skills training. While some clinics focus on abstinence, others believe that gaming behavior can be relearned. Cognitive Behaviour Therapy has been used to help gamers recognize the emotional reasons behind their excessive game playing, and motivational interviewing techniques have been incorporated to aid in establishing positive goals and time management skills.^[20] In 2009, Cosette Rae and Hilary Cash founded one of America's first residential rehab centers in Fall City, Washington. For $15,500 guests can spend 45 days cut off from computers and integrated into a real family's home with chores and daily therapy sessions. The program, called ReStart, also requires mandatory downtime sessions to help game addiction victims learn to deal with boredom in order to prevent relapse in the future.^[21]

There are also many online forums for those affected by gaming addiction. One example, Elizabeth Wooley’s self-help site, Online Gamers Anonymous, provides message boards, online meeting places, and a 12 step recovery plan.^[22] These online websites attest to the serious withdrawal symptoms that game addicts in detox can experience including anxiety, irritability, restlessness, depression, disrupted sleep pattern, and violent mood swings.^[23]

New technologies have been developed offering parents more control over limiting excessive video game playing in children. In 2004, a universal video game controller that's operating time could be limited by parents was patented.^[24] The following year, parents could purchase the token-operated PlayLimit to indirectly control the operation time of televisions and video game consoles in their own homes. According to the website, this technology is beneficial because it forces kids to play a more active role in managing their playing time.^[25] By requiring children to put tokens in for 15 minutes of play time, this reward based system might actually perpetuate the problem it attempts to solve.

Law and Video Games

As problematic excessive video gaming becomes more apparent, developers might be required to include warning labels on their products in the future. In October of 2009, a man named Craig Smallwood filed a lawsuit against NcSoft Corporation for emotional distress and misrepresentation. He claimed that the company failed to warn him about the potentially destructive addictive nature of their game Lineage II.^[26] While the charges of misrepresentation and intentional infliction of emotional were dismissed by Judge Kay in April 2010, the company is still facing counts of defamation and negligent infliction of emotional distress.^[27]

References