Video game addiction

The public bandies about the term "addiction" freely, talking about being "addicted to e-Bay" or "addicted to food." Players of the online game series EverQuest half-jokingly refer to it as "Never Rest" and "EverCrack" because of its supposedly addictive qualities. The vignette below presents the case of an adolescent who plays video games up to 12 hours a day. Although many parents and some physicians would refer to this type of behavior as an addiction, is that really the case?

Case Vignette: Video Game Play as a Marker of a Psychiatric Disorder

Ben is a 15-year-old boy who has been hospitalized for depression and for cutting himself. He is failing in school, not because he is not smart, but because he cannot reduce the time he spends playing Worlds of Warcraft. He spends 10 to 12 hours a day playing the game—until somebody makes him get off the computer. His parents have put controls on the computer to limit its use, but he has figured out ways to bypass them. He pretends to go to sleep and gets up in the middle of the night to play.

In psychotherapy, Ben revealed that his use of games was "to distract himself" and "to feel happier and not be so upset about things." It became apparent that his game use was, in part, related to untreated depression. With a combination of medication management and individual psychotherapy, the depression improved, and so did his game use. However, the long-standing involvement with games had to be replaced by other hobbies and social activities, and this has become a focus of therapy and work in his daily life.

The AMA has recently considered whether Internet and video game addiction should be considered formal diagnoses and added to the next edition of DSM. In its recent report, "Emotional and Behavioral Effects, Including Addictive Potential, of Video Games," the AMA refers to such behaviors as video game overuse. It concluded that more research is needed before making specific recommendations.

Alcohol and heroin addiction clearly meet the criteria for addiction. Do video games? Unfortunately, the best answer we can give is that we do not know. Some "video-game addicts" may be struggling with a compulsion similar to an obsessive-compulsive disorder. Although their game playing may be interfering with their lives, the underlying mechanism may be different from that of someone addicted to a drug. Others may simply be more sensitive to the variable-ratio reinforcement schedule that is inherent in many games. Thus, video-game overuse may have more in common with compulsive gambling than with drug addiction.

Some supposedly addicted game players may be behaving normally—but not in the ways that the adults around them believe to be normal. For example, many young children and adolescents have difficulty with transitioning between activities, especially when the initial activity is pleasurable. Is this a sign of addiction? No. It is a reflection of normal brain development. But parents sometimes misinterpret this type of behavior as anything from spite to laziness.