don’t have serious arguments with my kids very often. My 12-year-old twin boys are well-mannered and cooperative. But last week they had me spitting mad. I had to ask again and again, and finally to cajole, bribe, and threaten to get them to turn off their Playstation and get in the car. Their screen time wasn’t up yet, they shot back. I don’t care, I hissed: we have to go shoe shopping. But we’re in the middle of a game!
Of course video games can seem addictive. Almost every parent, or adult gamer, appreciates that. So the fact that the World Health Organization (WHO) just added a “gaming disorder” diagnosis to the International Classification of Diseases (ICD), fitting snugly next to substance use disorders, pathological gambling and the rest, isn’t a big shock. But is addiction to video games a “real” addiction? Is an obsession with Fortnite as bad as an alcohol problem?
Experts have pointed to parallels between behavioural addictions, such as gambling, and substance addictions, like drugs and booze, for years, with brain research bolstering their findings. Both addictions are defined similarly: as a compelling activity you find difficult to stop despite the fact that it’s wrecking your life. Both correspond with differences in brain structure and function that look remarkably similar. The people (whether children or adults) who are most prone to either kind of addiction are more likely than others to score high on impulsivity and low on measures of inhibition, decision-making and cognitive control. And they are more likely to have suffered psychological problems such as depression and anxiety, often resulting from childhood experiences such as parental neglect or abuse.
But video game-playing is rarely addictive. That makes it a very different animal from, say, gambling or binge eating. Experts estimate that problematic play is exhibited by 0.5% of the general population and less than 1.0% of adult gamers. For these few, the “addiction” label may apply. But a similar fraction can get addicted to almost anything that’s attractive or fun, including shopping and sports. Is it meaningful to invent a “disorder” to fit that fringe? Might it even cause more harm than good?
Not only does “internet gaming disorder” have no adverse effects on health, socialising or physical activity, but there has been an outcry from researchers and scholars, warning of the dangers of pathologising a normal behavioural outlet. In China, teens are being hauled off to “boot camp” for spending more time online than is deemed appropriate. The danger for us may be creating a mental “illness” that didn’t previously exist.
That isn’t to say that we shouldn’t be concerned. Heroin was a technological advance over opium. And my favourite, scotch, is a big improvement over the brews of yesteryear. But video games reflect technological evolution at an unprecedented scale. Their appeal may increase exponentially, and what we see today may be the beginning of a new age of compulsive play. In fact, the attractiveness of video games says more about the brilliance of designers and their stunning technology than anything else. There is no regulating body in place to control the addictiveness of commercial products, unless they happen to be booze or drugs. So game players young and old are at the mercy of corporate giants motivated primarily by profit. And they are moving fast.
Yet gaming has unique benefits, as well as potential pitfalls. Firstly, video games are a lot of fun. Second, they can be good for you. Dozens of studies have shown correlations between video game use and improved spatial processing, multitasking, attentional control, and perseverance. And (sorry to have to add this, parents) the games many of us hate the most – first-person shooters – get top grades for cognitive enhancement. Games also improve emotional self-control and social skills. Today’s kids play games with teams of other kids, who may be friends from school or strangers from across the planet, people whose real names they’ll never know but whom they learn to care about and trust. And lastly, recent research reveals a Goldilocks effect. One to two hours of daily screen time (including WhatsApp, movies and video games) are optimal for teens’ “mental wellbeing,” that is to say, better than either no screen time or more than three or four hours daily.
A new direction in gaming research is to use the inherent appeal of the games – the thing that makes them so attractive – to help to improve child mental health. The Playnice Institute develops and tests games that are potent at counteracting childhood anxiety, the most serious psychological problem facing US families. Rather than try to drag anxious or depressed kids to the therapist’s office once a week – a strategy that has only limited chances of success– psychological researchers are teaming up with designers to structure game environments to help anxious kids to control their emotions and build self-confidence, both on the screen and in what we like to call real life.
So the attractiveness of gaming cuts both ways. I hope our kids will be OK because we control their screen time. Other children won’t have that kind of monitoring, or won’t get “addicted” until they’ve left home. I recently met a young man who desperately wanted my help, having squandered his entire undergraduate career in his efforts to lead Roman legionaries to victory over the barbarians. And there’s a gaming culture growing quickly among teens and preteens that’s completely beyond most parents’ understanding or control. Not only are kids getting transfixed by the games themselves, they are being ushered into YouTube communities that mess with their very identities, measuring merit in terms of wins, kills, levels, and skins (what their Fortnite avatars wear in battle). Those things make life so much more exciting than schlepping from home to school to sports and music lessons. We don’t yet know whether that is good or bad for our kids. What we do know is that it’s a competition we won’t easily win.
Defining a certain amount of gaming as an addiction isn’t easy, and the new diagnostic label is unlikely to help. The WHO wants to enable doctors and insurers to decide who’s addicted and who’s not, based on the same stodgy metrics they have used for years: a minimum of 12 months of “persistent or recurrent” behaviour of “sufficient severity”. These arbitrary delineations have never been reliable for deciding who’s depressed or anxious enough to be treated one way or another. I doubt they’ll do better with gaming.
Psychiatric labels for identifying psychological problems, boxes and baskets, can be useful in getting us to pay attention. Video games are powerful, and they can alter people’s behaviour. But to identify addiction, we have to go deeper – to ask what it is that people are missing that makes them pursue something so compulsively. And that’s a lot more complicated.
• Marc Lewis is a neuroscientist and author of The Biology of Desire: Why Addiction is Not a Disease
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