Sense and Nonsense About Video Game Addiction

"IT’S DIGITAL HEROIN: HOW SCREENS TURN KIDS INTO PSYCHOTIC JUNKIES."

That’s the dramatic headline screaming above a New York Post article, by a Dr. Nicholas Kardaras, which many readers sent to me shortly after it was first published. In the article, Kardaris claims, “We now know that those iPads, smartphones and Xboxes are a form of digital drug. Recent brain imaging research is showing that they affect the brain’s frontal cortex — which controls executive functioning, including impulse control — in exactly the same way that cocaine does.”

Although Kardaras attributes these horrendous effects to all sorts of screen use, he particularly singles out video gaming, when he says: “That’s right—your kid’s brain on Minecraft looks like a brain on drugs.” That is utter nonsense, and if Kardaras read the actual research literature on brain effects of video gaming he would know it is.

You can find many similar scare headlines and articles elsewhere in the popular media, including even some here at Psychology Today. What seem to be most frightening to parents, and appealing to journalists and others trying to grab readers' attention, are references to research suggesting that screen use, and especially video gaming, affects the brain. The assumption to which many people leap is that any effect on the brain must be harmful.

What are the actual effects of video gaming on the brain?

The research that Kardaris referred to demonstrates that certain pathways in the forebrain, where dopamine is the neurotransmitter, become active when people are playing video games, and drugs like heroin activate some of these same pathways. What Kardaris’s and similar articles leave out, however, is the fact that everything that is pleasurable activates these pathways. These are the brain’s pleasure pathways. If video gaming didn’t increase activity in these dopaminergic pathways, we would have to conclude that video gaming is no fun. The only way to avoid producing this kind of effect on the brain would be to avoid everything that is pleasurable.

As gaming researchers Patrick Markey and Christopher Ferguson (2017) point out in a recent book, video gaming raises dopamine levels in the brain to about the same degree that eating a slice of pepperoni pizza or dish of ice cream does (without the calories). That is, it raises dopamine to roughly double its normal resting level, whereas drugs like heroin, cocaine, or amphetamine raise dopamine by roughly 10 times that much.

But actually, video gaming activates much more than pleasure pathways, and these other effects are not at all like the effects of drugs. Gaming involves lots of cognitive activities, so it necessarily activates parts of the brain that underlie those activities. Recently, neuroscientist Marc Palaus and his colleagues (2017) published a systematic review of all the research they could find—derived from a total of 116 published articles—concerning effects of video gaming on the brain.[3] The results are what anyone familiar with brain research would expect. Games that involve visual acuity and attention activate parts of the brain that underlie visual acuity and attention. Games that involve spatial memory activate parts of the brain involved in spatial memory. And so on.

In fact, some of the research reviewed by Palaus and his colleagues indicates that gaming not only results in transient activity in many brain areas, but, over time, can cause long-term growth of at least some of those areas. Extensive gaming may increase the volume of the right hippocampus and the entorhinal cortex, which are involved in spatial memory and navigation. It may also increase the volume of prefrontal regions the brain that are involved in executive functioning, including the ability to solve problems and make reasoned decisions. Such findings are consistent with behavioral research showing that video gaming can produce improvement in some cognitive abilities (which I previously reviewed here). Your brain is, in this sense, like your muscular system. If you exercise certain parts of it, those parts grow bigger and become more powerful. Yes, video gaming can alter the brain, but the documented effects are positive, not negative.

How is video game addiction identified and how prevalent is it?

The fear spread by articles such as Kardaris’s is that young people who play video games are likely to become "addicted” to them. We all know what it means to become addicted to nicotine, alcohol, heroin, or other drugs. It means that we have serious, physical withdrawal symptoms when we stop using the drug, so we are driven to continue using it even when we know it is hurting us and we very much want to stop. But what does it mean to be addicted to a hobby, such as video gaming (or surf boarding, or any other hobby you might have)?

The question of whether or not the term “addiction” is useful at all, in relation to anyone’s video gaming, is very much debated by the experts. Currently, the American Psychiatric Association is considering the addition of “Internet Gaming Disorder” (their term for video gaming addiction) into their diagnostic manual. Research shows that the great majority of video gamers, including those who are heavily immersed in games and spend large amounts of time at them, are at least as healthy psychologically, socially, and physically as are non-gamers. In fact, in my next post I’ll describe evidence indicating that, on average, they are healthier than non-gamers in all of these respects. But the same research shows that some small percentage of gamers are suffering psychologically in ways that at least are not helped by gaming and maybe are worsened. That’s the finding that leads the American Psychiatric Association to propose the addition of Internet Gaming Disorder (IGD) to its official manual of disorders.

On a trial basis, the APA is proposing that a person receive the diagnosis of Internet Gaming Disorder if at least five of the following nine characteristics apply to that person:

• Preoccupation: Spends lots of time thinking about games, even when not playing them.*

• Withdrawal: Feels restless when unable to play games.

• Tolerance: Needs to play more, or play more powerful games, to get the same excitement as before.*

• Reduce: Feels he or she should play less, but is unable to.

• Give up other activities: Reduces participation in other recreational activities.*

• Continue despite problems: Continues to play games despite knowing that they have a negative impact on his or her life.

• Deceive: Lies about how much he or she games.*

• Escape mood: Plays games to reduce anxiety or stress.*

• Risk: Risks loss of significant relationships or employment because of games.

Just from reading this list you can perhaps see why this definition is controversial. The proposal is that if any five of these nine characteristics apply to a person, then that person has IGD. But think about it. In the list above I placed asterisks after five characteristics that might well apply to anyone who is intensely interested in any hobby (an idea suggested by Markey & Ferguson, 2017). Consider them:

Preoccupation may just mean that the person is really into gaming. Anyone who has a passionate interest in any hobby is likely to “spend a lot of time thinking about” it. When I was 11 I thought about fishing almost all the time, and I regularly dreamed about it at night.

Tolerance likewise applies to almost any hobby. As you develop increased ability at anything, you need to increase the level of challenge to get the same thrill that you got before. If you are a skier, for example, the bunny hill is exciting at first, but then you need steeper hills.

Give up other activities. Well, of course, whenever you spend more time on any hobby there is less time for other things. Time is finite, so there’s always a tradeoff.

Deceive. In a world where others disapprove of video gaming and are continuously nagging the gamer to play less, it is hardly surprising that some would lie about how much they play.

Escape mood. Don’t we all sometimes, if not often, engage in our favorite hobby as a way of reducing anxiety or stress? If the hobby were reading, or chess, or skiing, people might regard this as a plus, not a minus.

What I’m suggesting here is that a person who has a quite healthy passion for video gaming, who is not at all suffering, could very well check off these five “symptoms” and thereby get a diagnosis of IGD. The other four items on the list, however, seem to be more indicative of something wrong. If someone is restless when not able to play, is losing significant relationships or meaningful employment because of gaming, feels that gaming is causing more harm than benefit, and yet is unable to stop—then that person has a problem.

Given the vagaries of this diagnostic procedure, it is not surprising that various studies of the prevalence of gaming addiction have revealed a wide range of findings. One large-scale, well-designed study conducted in Norway concluded that 1.4% of video gamers are addicted (Wittek et al, 2016). Other studies, conducted in various parts of the world and with various age groups of gamers and various assessment criteria, have revealed prevalences of addiction among gamers to be anywhere from as low a 0.6% to as high as 6% (reviewed by Wittek et al, 2016; Ferguson et al., 2011; and Markey & Ferguson, 2017). In other words, no matter whose numbers you look at, the vast majority of video gamers are not addicted. The research also makes it clear that simply spending lots of time playing video games is not evidence of addiction (Stockdale & Coyne, 2018). Intense, prolonged immersion in video games and addiction to video games are not the same thing.

Why do some video gamers become addicted?

In a recent study, Laura Stockdale and Sarah Coyne (2018) identified a sample of teens and young adults who were addicted to video games, as assessed with the 9-item IGD scale shown above, and compared them on various clinical questionnaires to other teens and adults who played video games extensively but were not addicted. They found that the addicted players, regardless of gender, were more anxious and depressed, and showed poorer impulse control and cognitive functioning than gamers who were not addicted. This was a correlational study, not an experiment, so it’s hard to know to what degree gaming addiction was a cause of these psychological detriments or a result of them. Other research (e.g. Bickel et al., 2014), however, has shown that poor impulse control and poor cognitive functioning are risk factors for various kinds of addiction, so at least these characteristics are likely to have contributed to the onset of gaming addiction. Other research, some of which I discussed here, has likewise suggested that pre-existing depression and anxiety can lead to addictive video gaming (for more on this, see Ferguson et al., 2011).

In another research study, Daniel Loton and his colleagues (2016) found that gaming addiction was most likely to occur in people who were depressed or in other ways stressed and who had an avoidant rather than approach method of coping. In other words, they were people who dealt with life problems by trying to avoid them rather than by trying to confront and solve them. They were apparently playing video games not so much because they enjoyed playing, but more because gaming diverted their attention from serious problems they didn’t want to think about. If video gaming wasn't an option, they would quite likely use some other means of distracting themselves from their problems.

So, if you know someone who seems to be addicted to video gaming, your attempt to help should probably not focus on taking the video screen away. It should focus, instead, on trying to understand, and help that person understand, what is missing or wrong in other parts of his or her life and how that problem might be solved.

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