The fact that members of the England football team have been glued to their video-game screens to distract themselves from the pressures of the World Cup is evidence of how gaming has become part of the fabric of everyday life. Harry Kane and Dele Alli are part of a community of 32.4 million people in the UK who play games. But an activity once considered harmless fun has a darker side: the addictive nature of the latest generation of video games.
Last month, the World Health Organisation (WHO) issued a new medical classification so that anyone whose computer gaming “takes precedence over other life interests” can be diagnosed as suffering from an internet addiction disorder. Meanwhile, doctors in the UK are set to launch the first NHS internet addiction clinic to treat the condition.
The move follows stories of children as young as 10 becoming addicted to games such as Fortnite (the game favoured by the England team), and the case of a young man who attributed his spiralling use of cocaine to a need to keep playing the game through the night.
‘Things won’t change overnight’
Such cases are clearly concerning, but the psychologist whose research into internet gaming addiction helped to pave the way for the WHO diagnosis warns that we may be getting the problem out of perspective.
“In some gamers, the brain lights up in the same way as for other addictions”
Dr Mark Griffiths
Dr Mark Griffiths is the director of the International Gaming Research Unit and a professor of behavioural addiction at Nottingham Trent University. He is also a member of the WHO working group which found that there was sufficient evidence to support a classification for internet gaming disorder. Dr Griffiths tells i: “Here in the UK it is not going to change things overnight. The number of people who will ever be diagnosed with a gaming disorder are very few and far between.”
He says that UK cases of internet addiction disorder may not reach more than a few dozen. In Spain, where Dr Griffiths has been closely working with the national gaming addiction clinic, doctors recognised just 50 cases. Nevertheless, for the small number whose lives are being destroyed by their addiction, the WHO decision opens the way for GPs in Britain to offer help on the basis of a solid medical diagnosis.
Gamers, gamblers and alcoholics
During the 1990s, Dr Griffiths was one of the very few academics investigating video-game addiction. His pioneering work on the topic helped to shape future research. He says: “In study after study I was arguing that, for a small minority of people, gaming was something that completely took over their lives and, to all intents and purposes, they were addicted. But I was told that it must be shown in other countries with more samples and there must be neurobiological research.”
What the WHO says
For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
Since Dr Griffiths got the ball rolling, there have been hundreds of international studies that offer the same conclusion the British psychologist came to nearly 30 years ago: a small, but significant, minority of video gamers are suffering the same kind of addiction identified in gamblers and alcoholics. Dr Griffiths says: “The brain lights up in the same way as for other addictions.”
In the worst cases, it is an addiction with just as serious consequences as gambling or alcoholism, including fatalities, mostly from spending too long in sedentary positions. These tend to relate to deep-vein thrombosis (DVT) conditions, more commonly found in frequent long-haul flying. But in one British case a boy became so addicted to playing his video game that he routinely suppressed his toilet breaks, leading to acute kidney failure.
Referral rates rising
Dr Louise Theodosiou is a member of the Child and Adolescent Faculty at the Royal College of Psychiatrists. Over the past 10 years, she has seen a steady rise in the numbers of children with internet gaming disorder, although she suspects that referral rates are rising because doctors, social workers and parents are all more aware of the phenomenon.
Dr Theodosiou is aware of young people who “have been gaming in their room to the exclusion of everything else and have struggled hugely as a result of that”. She adds: “There have been situations where kids have not been going to school, not engaging with activities with their peers. In my own clinical experience, empowering families to set boundaries in place with kids can be very useful.”
It is a view echoed by Dr Griffiths, who says that the vast majority of children playing games like Fortnite are doing so safely, and that it is often bad parenting which allows gaming to disrupt lives. Nor does he think Fortnite is the most addictive game on the market. Instead, he points the finger at World of Warcraft, which has features such as online multiplayer options that he says help to feed gaming addiction.
Children at risk
For some time, psychiatrists have noted that a gaming addiction is, more often than not, symptomatic of an underlying mental illness such as depression, bipolar disorder or attention deficit hyperactivity disorder (ADHD). These findings have been used by the gaming industry to claim that their games are not causing the addiction.
“But that’s not it at all,” argues Dr Griffiths, “because the way you market and advertise those products has an impact. The structural characteristics in a video game mean that, if you are vulnerable or susceptible, you can get hooked into playing.”
And it is children who are most at risk. Dr Theodosiou says: “Quite a lot of evidence now shows that the prefrontal cortex – the part of the brain that controls your personality, how you interface with society, how you manage your impulses – that part does seem to be anatomically different in kids who are gaming in an addictive fashion.”
Wariness over medication
There are also fears that the WHO classification means we will follow the example of America, where doctors have started trials for prescribing medication to neutralise the dopamine stimulation believed to be associated with a gaming addiction. But British doctors and psychiatrists remain very wary of using drugs to treat addictions like video gaming.
Dr Theodosiou warns: “We would really need to understand a lot better the impact on the brain before we start using medication. We don’t yet fully understand all of the affected brain areas and we don’t have a clear enough picture. I would want to know the results and the long-term outcomes of the [US] cases.”
In some ways we have been here before. Older readers will remember arcade and pub games in the late 1970s and 1980s, such as Space Invaders or Galaxian, and the fears that a generation of children were turning into zombie gamers. Dr Griffiths, a former Space Invaders enthusiast, began his research studying slot-machine addicts in the 1990s. He noticed that children who were addicted to arcade slot machines were also playing a lot of arcade games.
“The only difference was that the video-game players were playing for points and the slot-machine gamblers were playing for money,” he says. “The basic philosophy of the slot-machine player was to stay playing as long as possible using the least amount of money. And that was identical to what the arcade video-game players were doing.”
Since then, video games have moved from the arcade to the bedroom. For the millions of kids today who simply prefer to allocate more of their free time playing video games the problem is one of time management and peer pressure.
Dr Theodosiou recalls: “I remember hearing of one case where a child was asked how he would you feel if Fortnite was banned and the kid said, ‘I would be sad that I couldn’t play it, but relieved that nobody else could play it anymore either’.”
A nation of addicts
One in three people in the UK is addicted to something.
Addiction is defined as not having control over doing, taking or using something – to the point where it could be harmful to you.
The top four addictions in the UK are gambling, drugs, alcohol and nicotine. The NHS warning signs for less common addictions, including gaming, are as follows:
Some people are obsessed with their work to the extent that they become physically exhausted. If your relationship, family and social life are affected and you never take holidays, you may be addicted to work.
As computer and mobile phone use has increased, so too have computer and internet addictions. People may spend hours each day and night surfing the internet or gaming while neglecting other aspects of their lives.
Shopping becomes an addiction when you buy things you don’t need or want to achieve a “buzz”. This is quickly followed by feelings of guilt, shame or despair.
Volatile substance abuse is when you inhale substances such as glue, aerosols, petrol or lighter fuel to give you a feeling of intoxication.
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