Ian was in his 20s when he started gaming in the mid-1990s. A long-time interest in building PCs had developed into an initially healthy interest in first-person shooters like Counter-Strike and Team Fortress, which he’d play at weekends and when he came home from work. It was the online element of these games, he says, that changed his relationship to gaming, and what started as a hobby quickly took over his life. “I was working, I had a family, so it was a slow progression,” he says. “But then – and it sounds really weird when I say it now – I started thinking about it at work, and the first thing I’d do when I got home started drinking and start up the internet and game.” Video games are enjoyed by millions of people around the world without any harmful effects whatsoever. Most players will never have to worry about it becoming a problem. But for a small number of people, what starts out as a fun hobby becomes a debilitating habit. Though behavioural addictions like gaming, gambling or sex can be less physically debilitating than similar addictions to drugs or alcohol, their impact can be no less severe. Ian recalls setting up a computer in his dining room, where he’d play until midnight every night – the time his dial-up connection finished – often using drugs and alcohol to allow him to keep gaming. “Every night up until that time I would play,” he says. “When I got home on a Friday night, I would sit at the computer, and I wouldn’t leave until Sunday night. I would use amphetamines to stay awake and just game continuously, and I would only leave the computer to go to the toilet. It just consumed my life.” Ian’s addiction to gaming got so bad that, eventually, he ended up losing his family and job. “I just wasn’t there – I was there in a body in the house, but I wasn’t looking after my children,” he says. “I wasn’t there for them.”
Though often sensationalised by a tabloid press keen to put the boot into the latest gaming fad, gaming addiction is a real and growing problem. The World Health Organization has listed and defined gaming disorder as a condition warranting further research in the 11th edition of International Classification of Diseases (ICD-11), citing an increase in the development of treatment programmes across the world – something that has already started happening in the UK. One centre providing such treatment is Primrose Lodge, an addiction centre set in quiet, leafy countryside just outside Guildford. The staff there say they have seen a recent increase in patients seeking help for gaming addiction. “It’s happened over the last 12 months or so,” senior therapist Matthew Preece tells me. Preece runs one-to-one and group sessions with patients at the centre, with a focus on techniques taken from dialectical behavioural therapy (DBT). “The key element of DBT is that it’s based on mindfulness practice,” Preece explains. “We’re talking about relapse prevention here – the person being able to maintain their emotional regulation, being able to recognise emotions, and challenging existing thoughts and behaviours.” Other techniques include exercises to help change physical sensations and manage compulsive behaviours – something that could be as simple as a focused, structured breathing exercise, or plunging your hands into cold water – and processes to help people with confrontation, dialogue and communication.
Spotting the difference between obsession and addiction can be hard, Preece says, especially when it comes to gaming. Someone with a gambling addiction, he suggests, may be more easily able to tell that they had a problem because they might be losing tens of thousands of pounds. When someone has a gaming addiction, however, “the consequences are more subtle”. Millions of people enthusiastically play games – and despite media scrutiny of popular games like Fortnite or Call of Duty, the vast majority of them are not addicted in any real sense. It’s when gaming “starts to be of detriment to other areas of someone’s life – their work, relationship, their self-care,” that it becomes a problem, Preece says. “If someone tries to cut down, and they find they can’t control that, or if they start to be secretive or dishonest about their behaviour – they’re kind of the main things to look out for.”
We still don’t know exactly what the basis for gaming addiction is, explains Pete Etchells, lecturer in biological psychology at Bath Spa University. “There’s a lot of debate and argument in the research literature about this,” he says. “There’s a lot of uncertainty around whether it’s best to frame it as something akin to a substance abuse disorder, or whether it’s best looked at regarding something like an impulse control behaviour. There’s also the wider question of whether gaming disorder is an actual disorder in and of itself, or whether it masks other underlying disorders. So, say you have a person with signs of clinical depression who uses gaming as a coping mechanism – it might look as though they have a gaming addiction. But actually, it’s the underlying depression that probably needs to be treated.” The problem is not purely psychological, either, adding another element to the debate. “All games need a hook,” Adam Procter, programme leader of the Games Design and Art BA course at the University of Southampton, says. Designers – somewhat obviously – focus on mechanisms that draw players in, he explains, something that “often involves a level of replayability.” This could be something as simple as a leaderboard – where you can compare your gameplay with friends – or as varied as purchasable in-game content that allows you to enhance your character or make changes to the game experiences. This could come in the form of a loot box – where you don’t know what kind of content you might end up with – or in the form of specific purchases.
Research confirms this: one pilot study in 2013 found that specific features of games were associated with “problematic behaviours associated with addiction-like experiences.” Games providing increasing rewards – earning points or finding rare items, for example – or games with a “high social component,” where players were likely to play and share tips and strategies with others, had a significant association with addictive behaviour. These kinds of mechanisms are built into games – something Procter compares to Sean Parker’s statement that his team at Facebook constantly asked themselves: “How do we consume as much of your time and conscious attention as possible?” This kind of functionality was pivotal in Ian’s addiction – he specifies purchasable skins and character upgrades and leaderboards as part of his obsession – and has frequently been cited as problematic elsewhere. Loot boxes in particular, which work much like gambling, have been described as “predatory,” with the Belgian Gaming Commission even going so far as banning them.
So, with a growing awareness of gaming disorder, do designers have a responsibility to prevent or curtail addiction? Preece thinks so. “There needs to be a responsibility,” he says. “They’re deliberately tapping into an addictive process … so yes, I would like to see more responsibility around that.” Procter says that game makers “should be aware that the product they’re making will have an impact on players,” and that “there will always be a responsibility for makers to consider their impact on the world. As designers, we should recognise this rise in games addiction, and have an open discussion about industry-wide safeguards along with parent education,” he says. Ian, now in recovery from his addiction and rebuilding his life, hopes that the ICD listing of the disorder will raise awareness of the issue – and educate people on something that they currently don’t understand. “People look down on it. They don’t think of it as serious,” he says. “But it’s the same as gambling, alcohol, drugs, or any other addiction. It can be very dangerous, very harmful, and very destructive.”
Credit: Emily Reynolds for The Guardian, 18 June 2018.