VIDEO GAME

ADDICTION

Video Game Addiction.indb 1 11/01/18 5:20 PM

 LICENSE, DISCLAIMER OF LIABILITY,
AND LIMITED WARRANTY

By purchasing or using this book and its companion files (the “Work”), you agree
that this license grants permission to use the contents contained herein, includ-
ing the companion files, but does not give you the right of ownership to any of the
textual content in the book / files or ownership to any of the information or products
contained in it. This license does not permit uploading of the Work onto the Internet
or on a network (of any kind) without the written consent of the Publisher. Duplica-
tion or dissemination of any text, code, simulations, images, etc. contained herein
is limited to and subject to licensing terms for the respective products, and permis-
sion must be obtained from the Publisher or the owner of the content, etc., in order
to reproduce or network any portion of the textual material (in any media) that is
contained in the Work.
The information provided in this book is designed to provide helpful information
on the subjects discussed. This book is not meant to be used, nor should it be used,
to diagnose or treat any medical condition. Although the material in the book draws
from numerous medical articles and sources written by medical professionals and
physicians, the publisher does not intend nor is it authorized to offer professional
medical or clinical advice. The reader should consult a physician for the diagnosis
or treatment of any medical problem. The publisher, authors, and anyone involved
with the preparation, production, or distribution of this book are not responsible for
any specific health or medical needs that might require medical attention and they
are not liable for damages or negative consequences of any kind from any treat-
ment, action, application or preparation, to any person reading or following the
information in this book or appearing on the companion disc. This includes, but is
not limited to, loss of revenue or profit, or other incidental, physical, or consequen-
tial damages arising out of the use of this Work. No warranties or guarantees are
expressed or implied by the publisher’s choice to include any of the content in this
volume. References are provided for informational purposes only and do not consti-
tute endorsement of any Web sites or other sources. The reader is solely responsible
for any medical action or decision based on the reading of this book. Readers should
be aware that the Web sites listed in this book are subject to change. The sole obli-
gation of Mercury Learning and Information to the purchaser is to replace the book
and/or companion files, based on defective materials or faulty workmanship, but not
based on the content, operation, or functionality of the product.
Mercury Learning and Information (“MLI” or “the Publisher”) and anyone
involved in the creation, writing, or production of the companion files, accompany-
ing algorithms, code, or computer programs (“the software”), and any accompany-
ing Web site or software of the Work, cannot and do not warrant the performance
or results that might be obtained by using the contents of the Work. The author,
developers, and the Publisher have used their best efforts to insure the accuracy
and functionality of the textual material and/or programs contained in this pack-
age; we, however, make no warranty of any kind, express or implied, regarding the
performance of these contents or programs. The Work is sold “as is” without war-
ranty (except for defective materials used in manufacturing the book or due to faulty
workmanship).
The sole remedy in the event of a claim of any kind is expressly limited to
replacement of the book and/or companion files, and only at the discretion of the
Publisher. The use of “implied warranty” and certain “exclusions” vary from state to
state, and might not apply to the purchaser of this product. The companion files are
available for downloading by writing to the publisher at info@merclearning.com.

Video Game Addiction.indb 2 11/01/18 5:20 PM

 VIDEO GAME
ADDICTION

David A. Olle
Jean Riescher Westcott

Mercury Learning and Information

Dulles, Virginia
Boston, Massachusetts
New Delhi

Video Game Addiction.indb 3 11/01/18 5:20 PM

 Copyright ©2018 by Mercury Learning and Information llc.
All rights reserved.
This publication, portions of it, or any accompanying software may not be
reproduced in any way, stored in a retrieval system of any type, or transmitted
by any means, media, electronic display or mechanical display, including, but
not limited to, photocopy, recording, Internet postings, or scanning, without
prior permission in writing from the publisher.
Publisher: David Pallai
Mercury Learning and Information
22841 Quicksilver Drive
Dulles, VA 20166
info@merclearning.com
www.merclearning.com
(800) 232-0223
David A. Olle and Jean R. Westcott. Video Game Addiction.
ISBN: 978-1-937585-82-2
The publisher recognizes and respects all marks used by companies,
manufacturers, and developers as a means to distinguish their products. All
brand names and product names mentioned in this book are trademarks or
service marks of their respective companies. Any omission or misuse (of any
kind) of service marks or trademarks, etc. is not an attempt to infringe on the
property of others.
Library of Congress Control Number: 2017960718
181920 3 2 1 Printed on acid free paper in the United States of America
Our titles are available for adoption, license, or bulk purchase by institutions,
corporations, etc. For additional information, please contact the Customer
Service Dept. at (800)232-0223(toll free).

All of our titles are available in digital format at authorcloudware.com

and other digital vendors. Companion files for this title are available by
contacting info@merclearning.com. The sole obligation of Mercury Learning
and Information to the purchaser is to replace the book, based on defective
materials or faulty workmanship, but not based on the operation or
functionality of the product.

Video Game Addiction.indb 4 11/01/18 5:20 PM

 Contents
Acknowledgments...................................................................... viii
Introduction.................................................................................. ix

PART ONE Video Game Basics

CHAPTER 1 What are video games?
  1. What are video games?.......................................................... 4
  2. What are platforms?.............................................................. 4
  3. What are recent advancements in controllers?.................. 8
CHAPTER 2 How are video games categorized?
  4. What are action games?........................................................ 9
  5. What are adventure games?............................................... 11
  6. What are action-adventure games?................................... 12
  7. What are role-playing games?............................................ 13
  8. What are massively multiplayer online games
(MMORPGs)?........................................................................ 15
  9. H
 ow has the concept of what constitutes a “video
game” changed?.................................................................... 17
CHAPTER 3 What is the history of video games?
10. When did video games become popular?........................... 18
11. How have technological developments affected the
evolution of video games?.................................................... 18
12. What is the current state of video games?........................ 18
CHAPTER 4 How are video games played?
13. How does a gamer begin a play session?........................... 19
14. How does gameplay develop?.............................................. 19
15. What is the unique nature of the avatar?......................... 20
CHAPTER 5 What are the characteristics of video gamers?
16. How are video gamers classified?....................................... 21
17. Who plays video games?...................................................... 22
18. What devices do gamers use?............................................. 23
19. What are the top three types of video games that
gamers most frequently play on their wireless or
mobile devices?..................................................................... 23
20. Who do gamers play with?.................................................. 23
21. How often do gamers play?................................................. 24
22. What benefits do gamers feel they gain with their
gaming?.................................................................................. 24
23. What are the “top” video games?........................................ 25
PART TWO Video Game Addiction
CHAPTER 6 What is video game addiction?
24. What is the nature of addiction?........................................ 30
25. Can playing video games lead to addiction?..................... 31

CONTENTS v

Video Game Addiction.indb 5 11/01/18 5:20 PM

 26. What are some withdrawal symptoms of video game
addiction?............................................................................. 35
27. D o playing violent video games result in violence
in real life?........................................................................... 40
28. W hat is the best way to study video game
addiction?............................................................................. 42
29. Is video game addiction similar to gambling
addiction?............................................................................. 53
CHAPTER 7 Why are video games addictive?
30. What is the physiological basis of video game
addiction?............................................................................. 56
31. W hy are video games addictive?....................................... 59
32. W hat basic human needs motivate people to seek
satisfaction through video games?................................... 61
33. How can the visual effect of playing video games
lead to addiction?................................................................ 64
34. W
 hat is the Tetris effect?................................................... 65
35. W
 hat is the Proteus effect?................................................ 66
CHAPTER 8 How can you protect against video game
addiction?
36. What personal strengths are important to protect
against video game addiction?.......................................... 66
37. How does the family environment affect video game
addiction among children?................................................ 67
38. What actions can parents take to reduce addictive
video gaming in their child?.............................................. 67
CHAPTER 9 What are the benefits of playing video games?
39. How can playing video games be beneficial?.................. 71
40. Can playing video games help people with
psychological problems?..................................................... 72
41. Can playing video games be useful in patient
education?............................................................................ 75
42. Can playing video games promote well-being?............... 77
43. How can video games be used to develop
mindfulness meditation?................................................... 79
44. How can video game playing provide benefits for
older adults?........................................................................ 82
45. How can virtual reality help in pain
management?...................................................................... 84
46. C
 an virtual reality be useful in stroke rehabilitation?.. 85
PART THREE Recovery from Video Game Addiction
CHAPTER 10 Treating video game addiction
47. What are the strategies for treating video game
addiction?............................................................................. 92
48. W
 hat is discussed during counseling sessions?.............. 92

vi CONTENTS

Video Game Addiction.indb 6 11/01/18 5:20 PM

 49. Can co-existing disorders contribute to video game
addiction?............................................................................. 93
50. S hould you consider a support group for treatment
and recovery from video game addiction?....................... 94
51. What are the barriers that prevent gamers from
overcoming their addiction?.............................................. 94
52. W hat actions can you as a gamer take to overcome
your addiction?.................................................................... 95
53. D oes video gaming lead to depression?........................... 95
54. W hat is cognitive-behavioral therapy?............................ 95
55. What is dialectical behavioral therapy?.......................... 97
56. What is acceptance and commitment therapy?............. 98
57. Do medications have a place in treating video
game addiction?.................................................................. 99
58. Is bupropion useful in treating video game
addiction?............................................................................. 99
59. I s escitalopram useful in treating video game
addiction?........................................................................... 100
60. Is naltrexone useful in treating video game
addiction?........................................................................... 100
61. Does combination therapy have a place in treating
video game addiction?...................................................... 100
CHAPTER 11 Life after video game addiction
62. How do you change your way of thinking about
gaming?.............................................................................. 101
63. Should parents allow video gaming to be
reintroduced to their child?............................................. 101
64. W
 hy is developing new interests and passions
important for the recovering gamer?............................. 102
65. W
 hat type of activities should you pursue to
replace video gaming?...................................................... 102
66. D
 oes video gaming have any place for the
recovering addict?............................................................. 103
Index. ....................................................................................... 106

CONTENTS vii

Video Game Addiction.indb 7 11/01/18 5:20 PM

 Acknowledgments
Several people gave valuable assistance in the development of
this book. Dr. Andrew Doan is a distinguished ophthalmolo-
gist and a recovered video game addict. Dr. Doan generously
allowed me to discuss his extraordinary story and provided me
with insights into the physiological basis of video game addic-
tion. Cam Adair is a speaker, writer, and prominent thought
leader on gaming addiction. Cam permitted me to relate his
remarkable story of gaming addiction and recovery, as well
as practical information on overcoming gaming addiction
obtained from his website. Dr. Douglas Gentile is a leading
expert on video game addiction. Dr. Gentile provided me with
his research papers on the subject. Dustin Weissman has a PhD.
in clinical psychology and is in private practice. Dr. Weissman
allowed me to quote from his dissertation on the effect of video
games on social connectedness among gamers.

viii AC K N O W L E D G M E N T S

Video Game Addiction.indb 8 11/01/18 5:20 PM

 Introduction
The term, video game addiction, can be somewhat controver-
sial. The American Psychiatric Association (APA) declined to
call the condition an addiction in their fifth edition of “Diag-
nostic and Statistical Manual of Mental Disorders” (DSM-5).
The APA instead used the term “Internet Gaming Disorder.” For
the multitude of gamers suffering from the condition, however,
the symptoms they are experiencing indeed have many of the
hallmarks of addiction.
This book is designed to appeal to gamers and concerned fam-
ily and friends alike. The first part discussing video game basics
is particularly useful to non-gamers as it describes the history
of video games, the types of video games, how the games are
played, and the nature of gamers.
Part two delves into the nature of addiction, discussing the
basis of why video games are addictive from physiological and
psychological points of view. Video game playing is not entirely
detrimental, and this section describes the many ways video
gaming can be beneficial. In fact, video gaming has unique
aspects to facilitate treating psychological problems.
Part three deals with the various treatments for video game
addiction, and how the recovering addict can begin a new life.
Many compelling stories from gamers are interspersed
throughout the book. The book is rich in illustrations including
pictures, tables, notes, and links to websites for more
information.

INTRODUCTION ix

Video Game Addiction.indb 9 11/01/18 5:20 PM

 VIDEO GAME BASICS
Arcade gaming at PAX South 2016.
SOURCE: https://commons.wikimedia.org/wiki/File:PAX_South_2016_-_Gaming_(24354713919).jpg

Part 1 is an introduction to video games and gamers. This

section discusses the hardware of video games, the types
of video games, and how video games developed. The non-
gamer will gain a little insight as to how video games are
played as well as how gamers perform.

PART ONE

Video Game Addiction.indb 2 11/01/18 5:20 PM

 CHAPTER 1
What are video games?

CHAPTER 2
How are video games categorized?

CHAPTER 3
What is the history of video games?

CHAPTER 4
How are video games played?

CHAPTER 5
What are the characteristics of video gamers?

Video Game Addiction.indb 3 11/01/18 5:20 PM

 CHAPTER

1 What are video games?

1. What are video games?
A video game is an electronic game that involves interaction
with a user interface to generate visual feedback on a video
device such as a TV screen or computer monitor. The video
device is also known as a display or output device that presents
information in visual form.

The electronic systems used to play video games are known as

platforms. Some examples of these are personal computers and
video game consoles. The input device used for games, the game
controller, varies across platforms. Typical controllers include
gamepads, joysticks, mouse devices, keyboards, the touchscreens
of mobile devices, and buttons, or even, with the Kinect sensor,
a person’s hands and body. Players typically view the game on a
video screen, television, or computer monitor. Video game tech-
nology continues to advance to include viewing on virtual real-
ity head-mounted display goggles. There are often game sound
effects, music and, in the 2010s, voice actor lines which come
from loudspeakers or headphones. Some games in the 2000s
include haptic, vibration-creating effects, force feedback periph-
erals, and virtual reality.

FIGURE 1.1
XBOX 360 Super Elite
Controllers
https://commons.
wikimedia.org/wiki/
Category:People_with_
game_controllers#/
media/File:XBOX_360_
controller.jpg

2. What are platforms?

The term “platform” refers to the specific combination of elec-
tronic components or computer hardware which, in conjunction
with software, allows a video game to operate. (Wikipedia 2017)

4 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 4 11/01/18 5:20 PM

 The term “system” is also commonly used. The types of platforms
used to play video games are the following:

PC
In common use, a “PC game” refers to a form of media that involves
a player interacting with a personal computer ­connected to a video
monitor. Personal computers are not dedicated game platforms, so
there may be differences running the same game on different hard-
ware components. PC manufacturers can accommodate gamers by
providing specialized high performance video cards. The PC platform
allows some attractive features like reduced software cost, increased
flexibility, increased innovation, the creation of modifications, open
hosting for online gaming (in which a person plays a video game
with people who are in a different household), and others.

Console
A “console game” is played on a specialized electronic device that
connects to a conventional television set or composite video ­monitor.
Unlike PCs, which can run all sorts of computer programs, a con-
sole is a dedicated video game platform manufactured by a specific
company. Usually, consoles only run games developed for it, or
games from other platform made by the same company, but never
games developed by its direct competitor, even if the same game
is available on different platforms. It often comes with a specific
game controller. There are currently three ­console manufacturers:
Sony (PlayStation), Nintendo, and Microsoft (Xbox).

Game developers earned money for console games in the sale of

the game with long lead times of development and then hopes of
a blockbuster release. At this time, the business was risky and
dependent on working from release to release to make money.

Handheld
A “handheld” gaming device is a small, self-contained ­electronic
device that is portable and can be held in a user’s hands. It ­features
the console, a small screen, speakers and buttons, joystick, or
other game controllers in a single unit. Like consoles, handhelds
are dedicated platforms and share almost the same character-
istics. Handheld hardware usually is less powerful than PC or
console hardware. Some handheld games from the late 1970s and
early 1980s could only play one game. In the 1990s and 2000s,
some handheld games used cartridges, which enabled them to be
used to play many different games.

W h a t a re v i d e o gam e s? | C H A P T E R 1 5

Video Game Addiction.indb 5 11/01/18 5:20 PM

 FIGURE 1.2
An illustration of a video arcade
https://commons.wikimedia.org/wiki/File%3A%22Game_On%22_at_Pacific_Science_
Center_(5559659293).jpg

Arcade
“Arcade game” generally refers to a game played on a more
specialized type of electronic device typically designed to play
only one game and is encased in a unique, large coin-operated
cabinet. The cabinet has one built-in console, controllers (joy-
stick, buttons, etc.), a CRT screen, audio amplifier, and speak-
ers. Arcade games often have brightly painted logos and images
relating to the theme of the game. While most arcade games are
housed in a vertical cabinet, which the user typically stands in
front of to play, some arcade games use a tabletop approach-
where the display screen is housed in a table-style cabinet with
a see-through table top. With table-top games, the users typi-
cally sit to play. In the 1990s and 2000s, some arcade games
offered players a choice of multiple games. In the 1980s, video
arcades were businesses where game players could use some
arcade video games. In the 2010s, there are far fewer video
arcades, but some movie theaters and family entertainment
centers still have them. In the 2000s and 2010s, arcades found
a niche market by providing games that use unique controllers

6 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 6 11/01/18 5:20 PM

 mostly inaccessible to home users, such as dance games that
have a floor that senses the user’s dancing. The arcade game is
now a more socially-oriented hangout, with games that focus on
an individual’s performance, rather than the game’s content, as
the primary form of novelty.

Web browser (online)

The web browser has also established itself as a distinct platform
in the 2000s while providing a cross-platform environment for
video games designed to be played on a broad spectrum of hard-
ware from personal computers and tablet computers to smart-
phones. This in turn has generated new terms to qualify classes
of web browser-based games. These games may be identified
based on the website that they appear, such as with “Facebook”
games. Others are named based on the programming platform
used to develop them, such as Java and Flash games.

With online play, games found new models of making money.

Consoles moved to online play and the selling of expansion packs,
new game maps, and items for in-game use. Other game develop-
ers went the subscription route. New types of games that relied
on the subscription model, emphasizing the community of play-
ers and supporting their interactions, came onto the scene.

Mobile
A mobile game is a video game played on a smartphone, smart-
watch, tablet computer, portable media player, or calculator.
With the advent of standard operating systems for mobile
devices, such as iOS and Android and devices with greater
hardware performance, mobile gaming has become a significant
platform. While many mobile games share similar concepts
with browser games, these games may utilize features of smart
devices that are not necessarily present on other platforms,
such as global positing information and camera devices to sup-
port augmented reality gameplay. Mobile games also led to the
development of microtransactions as a valid revenue model for
casual games.

Virtual reality
Virtual reality (VR) games require players to use a particu-
lar head-mounted unit that provides stereoscopic screens and
motion tracking to immerse a player into a virtual environ-
ment that responds to their head movements. Some VR systems

W h a t a re v i d e o gam e s? | C H A P T E R 1 7

Video Game Addiction.indb 7 11/01/18 5:20 PM

 include control units for the player’s hands as to provide a direct
way to interact with the virtual world. VR systems require a
separate computer, console, or another processing device that
couples with the head-mounted unit.

3. What are recent advancements in controllers?

A video game can use several types of input devices to translate
human actions to a game. The most common game controllers
are keyboard and mouse for PC games. Consoles usually come
with specific gamepads while handheld consoles have built-in
buttons. Other game controllers are commonly used for specific
games, like racing wheels, light guns, or dance pads. Digital
cameras can also be used as game controllers capturing move-
ments of the body of the player.

As technology continues to advance, more can be added to the

controller to give the player a more immersive experience when
playing different games. Some controllers have presets with but-
tons mapped a certain way to make playing certain games eas-
ier. Along with the presets, the player has the possibility to cus-
tom map the buttons to accommodate their play style better. On
keyboard and mouse, different actions in the game are already
preset to keys on the keyboard. Most games allow the player to
change that so that the actions are mapped to different keys that
are more to their liking. The companies that design the control-
lers are trying to make the controller visually appealing and also
feel comfortable in the hands of the consumer.

An example of a technology that was incorporated into the con-

troller is the touchscreen. It allows the player to interact with
the game differently than before. The person could move around
in menus easier and can also interact with different objects in
the game. They can pick up some objects, equip others, or even
just move the objects out of the player’s path. Another example
is a motion sensor where a person’s movement can be captured
and put into a game. Some motion sensor games are based on
where the controller is. A signal that is sent from the controller
to the console or computer results in actions being done that can
create specific movements in the game. Another type of motion
sensor game is the webcam, where the person can move around
in front of it and the actions done are repeated in a character of
the game you are playing as.
8 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 8 11/01/18 5:20 PM

 CHAPTER

How are video games 2

categorized?
Video games are classified according to gameplay interaction
rather than visual or narrative differences. A video game cate-
gory (or genre) is defined by a set of gameplay challenges and are
classified independently of their setting or game-world content.
FIGURE 2.1
Head sprites from Broforce video game.
A sprite is a two-dimensional bitmap that is
integrated into a larger scene. It can either
be a static image or an animated graphic.
Sprites can be objects in 2D video games.
https://commons.wikimedia.org/wiki/
Category:Video_game_sprites#/media/
File:Broforce_avatars.JPG

4. What are action games?

An action game is a video game genre that emphasizes physical
challenges, including hand-eye coordination and reaction-time.
The genre includes diverse subgenres such as fighting games,
shooter games, and platform games
which are widely considered the most First-person shooters are a
important action games, though mul- type of three-dimensional
tiplayer online battle arena and some shooter game, featuring a
DEFINITION DEFINITION NOTE
real-time strategy games are also con- first-person point of view
sidered to be action games. with which the player sees the action
through the eyes of the player char-
In an action game, the player typi- acter. They are unlike third-person
cally controls theTOOLS
protagonist or avatar.
ON THE WEB shooters,
PRACTICAL TIP in which the player can see

The avatar must navigate a level, col- (usually from behind) the character
they are controlling.
lecting objects, avoiding obstacles, and

NOTE How ALERT

a re v i d e o gam e sONcTHE e g or i z e d? | C H A P T E R 2
a tCD 9

Video Game Addiction.indb 9 11/01/18 5:20 PM

 battling enemies with various attacks. At the end of a level or
group of levels, the player must frequently defeat a boss enemy
that is more challenging and often larger than other enemies.
Enemy attacks and obstacles deplete the avatar’s health and
lives, and the player receives a “Game over” when they run out
of lives. Alternatively, the player wins the game by finishing a
sequence of levels. However, some action games, usually arcade
games, are unbeatable and have an indefinite number of levels.
The player’s only goal is to maximize their score by collecting
objects and defeating enemies.

Subgenres
Action games have several major subgenres. However, there are
many action games without any clear subgenre, such as Frog-
ger, as well as other types of genres ,like Adventure or Strategy,
that have action elements.
• Beat ‘em ups are games that involve fighting through a
side-scrolling stage of multiple adversaries, using martial
arts or other close-range fighting techniques.
• Fighting games feature combat between pairs of fighters,
usually using martial arts moves. Actions are limited
to various attacks and defenses and matches end when
a fighter’s health is reduced to zero. They often make
use of special moves and combos. There are both 2D and
3D fighting games, but most 3D fighting games largely
take place on a 2D plane and occasionally include side-
stepping. They are distinct from sports games ,such as
boxing and wrestling games, which attempt to model
movements and techniques more realistically.
• Maze games such as Pac-Man involve navigating a maze
to avoid or chase adversaries.
• Platform games involve jumping between platforms of
different heights while battling enemies and avoiding
obstacles. Physics are often unrealistic, and game levels
are often vertically exaggerated. They exist in both 2D
and 3D forms.
• Rhythm action games challenge the player’s sense of
rhythm, and award points for accurately pressing specific
buttons in sync with a musical beat. Rhythm action games
is a relatively new subgenre of the action game. Rhythm
games are sometimes classified as a type of music game.

10 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 10 11/01/18 5:20 PM

 • Shooter games allow the player to take action at a
distance using a ranged weapon, challenging them to aim
with accuracy. Although shooting is usually a form of
violence, non-violent shooters exist as well. This subgenre
includes first-person shooters and third-person shooters,
as well as a plethora of other shoot ‘em up games taking
place from a top-down or side-view perspective.

FIGURE 2.2
S.T.A.L.K.E.R. Swamps Military.jpg
https://commons.wikimedia.org/wiki/Category:First-person_shooter_video_game_
screenshots#/media/File:S.T.A.L.K.E.R._Swamps_Military.jpg

5. What are adventure games?

An adventure game is a video game in which the player assumes
the role of protagonist in an interactive story driven by explo-
ration and puzzle-solving. The genre’s focus on story allows it
to draw heavily from other narrative-based media, literature,
and film, encompassing a wide variety of literary genres. Many
adventure games (text and graphic) are designed for a single
player since this emphasis on story and character makes multi-
player design difficult.

Initial adventure games developed in the 1970s and early 1980s

were text-based, using text parsers to translate the player’s
input into commands. As personal computers became more pow-
erful with the ability to show graphics, the graphic adventure

How a re v i d e o gam e s c a t e g or i z e d? | C H A P T E R 2 11

Video Game Addiction.indb 11 11/01/18 5:20 PM

 game format became popular, initially by augmenting player’s
text commands with graphics, but soon moving towards point
and click interfaces. Further computer advancements led to
adventure games with more immersive graphics using real-time
or pre-rendered three-dimensional scenes or full-motion video
taken from the first- or third-person perspective.

For markets in the Western hemisphere, the genre’s popularity

peaked during the late 1980s to mid-1990s when many consid-
ered it to be among the most technically advanced genres. By the
early 2000s, adventure games became a niche genre due to the
popularity of first-person shooters and it became difficult to find
publishers to support such ventures. Since then, a resurgence in
the genre has occurred spurred on by the success of independent
video game development, and the proliferation of new gaming
platforms including portable consoles and mobile devices.

Essential elements of the genre include storytelling, explora-

tion, and puzzle solving. Adventure games have been described
as puzzles embedded in a narrative framework, where games
involve “narrative content that a player unlocks piece by piece
over time.” While the puzzles that players encounter through
the story can be arbitrary, those that do not pull the player out
of the narrative are considered examples of good design. Combat
and action challenges are limited or absent in adventure games,
thus distinguishing them from action games.

6. What are action-adventure games?

An action-adventure game can be defined as a game with a mix

of elements from an action game and an adventure game, espe-
cially crucial elements like puzzles. Action-adventures require
many of the same physical skills as action games, but also offer a
storyline, numerous characters, an inventory system, dialogue,
and other features of adventure games. They are faster-paced
than pure adventure games, because they include both physi-
cal and conceptual challenges. Action-adventure games typically
include a combination of complex story elements, displayed for
players using audio and video. The story is heavily reliant upon
the player character’s movement, which triggers story events
and thus affects the flow of the game. Some examples of action-
adventure games include The Legend of Zelda, God of War, and

12 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 12 11/01/18 5:20 PM

 Tomb Raider series. Examples of games that can be classified as
either action or adventure games include Game of Thrones, Call
of Duty, Grand Theft Auto, Horizon, and Uncharted.

Action-adventure games are faster paced than pure adven-

ture games and include physical as well as conceptual chal-
lenges where the story is enacted rather than narrated. While
­motion-based, often reflexive, actions are required, the game-
play still follows some adventure game genre tropes (gathering
items, exploration of and interaction with one’s environment,
often including an overworld connecting areas of importance,
and puzzle-solving). While the controls are arcade-style (charac-
ter movement, few action commands) there is an ultimate goal
beyond a high score. In most action-adventure games, the player
controls a single avatar as the protagonist. This type of game is
often quite similar to role-playing video games.

7. What are role-playing games?

A role-playing video game is a video game genre where the
player controls the actions of a character (and several party
members) immersed in some well-defined world. Role-playing
games include developed story-telling and narrative elements,
player character development, complexity, as well as replayabil-
ity and immersion. In role-playing games, players control a cen-
tral game character, or multiple game characters, usually called
a party, and attain victory by completing a series of quests or
reaching the conclusion of a central storyline. Players explore a
game world, while solving puzzles and engaging in combat. An
essential feature of the genre is that characters grow in power
and abilities, and the player typically designs characters. Role-
playing games rarely challenge a player’s physical coordination
or reaction time, except action role-playing games.

Role-playing video games typically rely on a highly developed

story and setting, which is divided into some quests. Players
control one or several characters by issuing commands, which
are performed by the character at an effectiveness determined
by that character’s numeric attributes. Often these attributes
increase each time a character gains a level, and a character’s
level goes up each time the player accumulates a certain amount
of experience.

How a re v i d e o gam e s c a t e g or i z e d? | C H A P T E R 2 13

Video Game Addiction.indb 13 11/01/18 5:20 PM

 The premise of many role-playing games tasks the player with
saving the world or whichever level of society is threatened.
There are often twists and turns as the story progresses, such as
the surprise appearance of estranged relatives, or enemies who
become friends or vice versa. The game world tends to be set in
a fantasy or science fiction universe, which allows players to do
things they cannot do in real life and helps players suspend their
disbelief about the rapid character growth. To a lesser extent,
settings closer to the present day or near future are possible.

The story often provides much of the entertainment in the game.

Because these games have powerful storylines, they can often
make effective use of recorded dialog and voiceover narration.
Players of these games tend to appreciate extended cut scenes
more than players of faster action games. While most games
advance the plot when the player defeats an enemy or completes
a level, role-playing games often progress the plot based on other
important decisions. For example, a player may decide to join
a guild, thus triggering a progression in the storyline that is
usually irreversible. New elements in the story may also be trig-
gered by the mere arrival in an area, rather than completing a
specific challenge. The plot is usually divided so that each game
location is an opportunity to reveal a new chapter in the story.
FIGURE 2.3
Paladins Cover by Hi-Rez Studios.
https://upload.wikimedia.org/
wikipedia/commons/6/60/Paladins_
Twitch_Cover.jpg

14 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 14 11/01/18 5:20 PM

 8. What are massively multiplayer online
games (MMORPGs)?
A massively multiplayer online game is a multiplayer video
game which is capable of supporting large numbers of players
simultaneously. By necessity, the games are played on the Inter-
net. Many games have at least one persistent world. However,
others just have large numbers of players competing at once in
one form or another without any lasting effect to the world at all.
These games can be found for most network-capable platforms,
including the personal computer, video game console, or smart-
phones and other mobile devices.

MMORPG games can enable players to cooperate and compete

with each other on a large scale, and sometimes to interact
meaningfully with people around the world. They include a vari-
ety of gameplay types, representing many video game genres.

MMORPGs feature the usual role-playing game objectives of

completing quests and strengthening one’s player character but
involve up to hundreds of players interacting with each other in
the same persistent world in real-time. The game players tell
the stories through group interaction, the developers provide the
environment and players enter the online playground ready to
pursue shared quests with fellow gamers. The massively multi-
player concept was quickly combined with other genres.

FIGURE 2.4
Defenders of Ardania.
https://commons.wikimedia.org/wiki/Category:Defenders_of_Ardania#/media/
File:Defenders_of_Ardania_1.jpeg

How a re v i d e o gam e s c a t e g or i z e d? | C H A P T E R 2 15

Video Game Addiction.indb 15 11/01/18 5:20 PM

 The dominant MMORPG in the Western world is The World of
Warcraft from Activision Blizzard. As of the end of 2012, the
company reported some 9.6 million subscribers. The number of
subscribers is down somewhat from the peak at the end of 2010
of 12 million but is still an impressive subscriber base that keeps
it as the number one MMO game in North America.

In World of Warcraft (WoW) much of the game is spent performing

tasks singly and in groups to level up a character. Leveling up is
a process by which characters reach a new level by accumulating
“experience points” after completing a variety of tasks. The new
level permits access to new areas of the game, and to learn more
abilities. Unlike a loose and open world like Second Life, there
are lots of specified game scenarios that players complete that
earn them experience, in-game rewards, and advancing abilities.
Players can purchase in game items such as pets and accesso-
ries with additional expenditures beyond their monthly subscrip-
tion fees. The programming includes seasonal celebrations and
in many ways resembles a culture unto itself with clan loyalties,
specialized language, and rules of behavior. Self-organized and
semi-formalized groups of players called guilds are formed with
rules of their own and their own traditions.

FIGURE 2.5
Bloodfrontier v0.80
https://commons.wikimedia.org/wiki/Category:First-person_shooter_video_game_
screenshots#/media/File:Bloodfrontier_secure-the-flag_warground.png

16 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 16 11/01/18 5:20 PM

 The detailed gameplay, the sense of community, and the chance
for advancement in the game all reward players who spend more
time in the game. The more difficult quests can take ten to twelve
hours of constant gameplay with a group of players. Many play-
ers find that it can be hard to be both successful in the game and
in outside pursuits without significant planning.

9. How has the concept of what constitutes a

“video game” changed?
A video game has traditionally been considered as just enter-
tainment, but now video games are being used for a variety of
applications, including simulations, training education, and
social interaction.

FIGURE 2.6
Conceptual Map of the Main Genres of Video Games (With Examples) Organized
According to Two Important Dimensions: Level of Complexity and the Extent of Social
Interaction Required.

Source: American Psychologist (Reference 36, Chapter 8)

www.apa.org/about/contact/copyright/indes.aspx

How a re v i d e o gam e s c a t e g or i z e d? | C H A P T E R 2 17

Video Game Addiction.indb 17 11/01/18 5:20 PM

 CHAPTER

3 What is the history

of video games?
10. When did video games become popular?
Video gaming became popular in the 1970s and 1980s, when video
arcade games and gaming consoles using joysticks, buttons, and
other controllers, along with graphics on computer screens and
home computer games were introduced to the general public.
The golden age of arcade video games was from 1978 to 1982.
Video arcades with large, graphics-decorated coin-operated
machines were common at malls and popular, affordable home
consoles such as the Atari 2600 and Intellivision enabled people
to play games on their home TVs.

11. How have technological developments affected

the evolution of video games?
The widespread adoption of microchips, improved video graph-
ics, and software allowed the development of specialized gaming
computers, early online gaming, and handheld games.

The 1990s saw the resurgence and decline of arcades, the tran-
sition to 3D video games, improved handheld games, and PC
gaming. During the 2000s, online gaming and mobile games
became increasingly important. Consoles continued to develop
during this period; notably the launch of the top-selling Wii con-
sole, in which the user could control the game actions with real-
life movement of the controller. The period also saw the rise of
casual PC games marketed to non-gamers and the emergence of
cloud computing in video games.

12. What is the current state of video games?

In 2013, an advanced generation of consoles emerged, including
Nintendo’s Wii U and Nintendo 3DS, Microsoft’s Xbox One, and
Sony’s PlayStation 4 and PlayStation Vita. Since the develop-
ment and widespread consumer use of smartphones, mobile gam-
ing has been a driving factor for games, as they can reach people
formerly uninterested in gaming, and those unable to afford or
support dedicated hardware, such as video game consoles.

18 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 18 11/01/18 5:20 PM

 CHAPTER

How are video games 4

played?
13. How does a gamer begin a play session?
MMORPG games are used as an illustration due to their popular-
ity. MMORPG players control a character avatar within a game
world in third- or first- person view. Third-person view refers to
a graphical perspective rendered from a fixed distance behind
and slightly above the player character. This viewpoint allows
players to see a more strongly characterized avatar. Games with
a first-person perspective are usually avatar-based, wherein the
game displays what the player’s avatar would see with the ava-
tar’s own eyes. Thus, players typically cannot see the avatar’s
body, though they may be able to see the avatar’s weapons or
hands. The players explore the landscape, fight various mon-
sters, complete quests, and interact with non-player characters
(NPCs) or other players. MMORPG games require the player to
pay for a subscription. To enter the game, the player must select
a server, referred to in-game as a realm. Each realm acts as an
individual copy of the game world.

14. How does gameplay develop?

As characters become more developed
from their initial state, they gain vari- A squad is a group of play-
ous talents and skills. The player must ers who partner up to work
then further defi ne the abilities of that towards a common goal.
DEFINITION DEFINITION NOTE
character. Characters can choose two Squads are short-term
teams that can be easily formed and
primary professions and can learn sec-
disbanded.
ondary skills. Characters may form and
join guilds. MuchTOOLSof World of ON
Warcraft
THE WEB PRACTICAL TIP
play involves the completion of quests. A faction or guild is a longer
Quests usually reward the player with term grouping of people.
some combination of experience points, Some factions/guilds have
DEFINITION
items, and in-game NOTE
money.DEFINITION
Quests
ALERT
NOTE
ON THE CD
a purpose, goal, or mission
allow characters to gain access to new for its members, while others do not.
skills and abilities, as well as the abil- Factions/guilds may offer a sense of
ity to explore new areas. It is through community for many gamers in the
quests that much TOOLS
of the game’s story
ON THE WEB virtual world.
PRACTICAL TIP
REFERENCE ON THE WEB QUESTION

How a re v i d e o gam e s pl aye d? | C H A P T E R 4 19

NOTE ALERT ON THE CD

NOTE REFERENCE CONVERSATION

Video Game Addiction.indb 19 11/01/18 5:20 PM

 is told, both through the quest’s text and through scripted
NPC actions. Quests are linked by a common theme, with each
consecutive quest triggered by the completion of the previous,
forming a quest chain. Quests commonly involve killing some
creatures, gathering a certain number of resources, finding a
difficult to locate object, speaking to various NPCs, visiting spe-
cific locations, interacting with objects in the world, or deliver-
ing an item from one place to another to acquire experience and
treasures.

While a character can be played on its own, players can group

with others to tackle more challenging content. Most end-game
challenges are designed in a way that they can only be overcome
while in a group. In this way, character classes are used in spe-
cific roles within a group.

On both player versus player and player versus environment

server types, there are particular areas of the world where free-
for-all combat is permitted. Battlegrounds, for example, are
similar to dungeons: only a set number of characters can enter
a single battleground, but additional copies of the battleground
can be made to accommodate additional players. Each battle-
ground has a set objective, such as capturing a flag or defeating
an opposing general, which must be completed to win the battle-
ground. Competing in battlegrounds rewards the character with
tokens and honor points that can be used to buy armor, weap-
ons, and other general items that can aid a player in many areas
of the game. Winning a battleground awards more honor and
tokens than losing. Also, players also earn honor when they or
nearby teammates kill players in a battleground.

15. What is the unique nature of the avatar?

The choice of an avatar by the gamer can have profound effects
on how much he or she enjoys the game, how immersed they
become, and how much they identify with the avatar.

Studies have shown that, in general, gamers create slightly ide-

alized avatars based on their actual selves. These studies have
shown that players who were able to create an avatar that was
approximately their ideal body shape felt more connected to that
avatar and also felt more capable of changing their virtual self’s
behavior.

20 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 20 11/01/18 5:20 PM

 The avatar, therefore, provides a per-
ceived identity for the gamer and can An avatar is a video
game user’s representa-
alter the identity of the gamer that
tion of himself/herself or
uses them. This perceived identity with DEFINITION DEFINITION NOTE
alter ego.
the avatar has important implications
for the psychological well-being of the
gamer. If they do not build their self-esteem and work on their
identity in therapy or the real world, they will use online gam-
TOOLS ON THE WEB PRACTICAL TIP

ing to fill the void in their identity development. This void may
result in preference to their avatar over their real-life self. Fur-
thermore, their identity development may be influenced nega-
tively by how they interact with others (this means NOTE any personALERT ON THE CD

they encounter and build a bond with; positive or negative) in-

game. Even if they develop one personality and great self-esteem
in-game, it may be limited to virtual life scenarios while their
real-life self-esteem is fragile or non-existent.REFERENCE ON THE WEB QUESTION

CHAPTER

What are the 5

NOTE REFERENCE CONVERSATION

characteristics of video
gamers?
HEART HEALTH ON THE WEB PRACTICAL TIP

16. How are video gamers classified?

One classification scheme describes gamers according to the
degree of commitment to the games, time spent gaming, skill lev-
els attained, and degree of disruption with their other activities:
• Casual gamers lack attachment to the game and can
easily transition in and out of play. They typically
play less than 5 hours per week, and their social life is
undisturbed.
• Transitional players have some dedication to the game,
and play around 5-9 hours per week. Their social life may
or not be disturbed.
• Skilled players typically focus on one main character
and eventually achieves a high level of achievement. The
skilled player plays three or four sessions per week for

W h a t a re th e ch a r a c t e r i st i c s of v i d e o gam e rs? | C H A P T E R 5 21

Video Game Addiction.indb 21 11/01/18 5:20 PM

 a total of about 10–15 hours per week. They are mostly
able to maintain balance in their social life and to keep
up with their responsibilities.
• Second job players spend about 15–24 hours per week at
gaming, but can keep family, school, and job activities as
priorities. Gaming, however, is starting to take a toll on
his or her non-gaming life.
• Pro-gamers- spend more than 24 hours per week, and
in extreme cases more than 70 hours per week. They can
achieve great power in the virtual world and have often
taken on leadership positions. At this level, the game is a
priority, and all other responsibilities and obligations are
secondary. Their school/ work performance is greatly affected
which may result in failing grades and loss of jobs.

Another classification scheme is based on the motivations of the

gamer (Kabrick 2013):
• Casual – gaming is used primarily to unwind and relax,
rather than to seek challenges.
• Social – A social gamer is one who is motivated by
connecting with other people through the medium of
gaming. Their gaming habits are determined by their
social circle more than by what is popular in society.
• Specialist – a gamer who focuses on getting the most out
of their gaming experience. A specialist is passionate
about playing every part of specific games.
• Expert – in this classification, an expert is not necessarily
one who is highly skilled at games. Instead, they are
characterized by a wide range of tastes and a desire to
enjoy new gaming experiences.

17. Who plays video games?

The following statistics were gleaned from the 2017 report on
“Essential Facts about the Computer and Video Game Industry”
published by the Entertainment Software Association.
• Households
–– 63% of U.S. households have at least one person who
regularly plays (3 hours or more per week).
–– There is an average of 1.7 gamers in each game-
playing household.

22 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 22 11/01/18 5:20 PM

 –– 65% of households own a device used to play video
games, while 48% of U.S. households own a dedicated
game console.
• Age/Gender
–– Overall, 59% of game players are male, and 41% are
female.
–– Females tend to enter video gaming at a later age
¡¡The most frequent female game player is on average
44 years old and the average male game player is
35 years old
¡¡Women age 18 or older represent a significantly
greater portion of the game-playing population
(31%) than boys age 18 or younger (17%)
¡¡An equal number of female gamers are 35 years of
age or younger as are over 35 years of age
¡¡Gamers have been playing video games for an
average of 13 years

18. What devices do gamers use?

The devices gamers most frequently use are:
• PC (56%)
• Dedicated game console (53%)
• Smartphone (36%)
• Wireless device (31%)
• Dedicated handheld system (17%)
19. What are the top three types of video games that gamers
most frequently play on their wireless or mobile devices?
Puzzle/board game/card game/game shows (38%)
• Action (6%)
• Strategy (6%)
20. Who do gamers play with?
54% of the most frequent gamers play with others, including:
• 40% with friends
• 21% with family members
• 17% with parent(s)
• 15% with spouse/partner

W h a t a re th e ch a r a c t e r i st i c s of v i d e o gam e rs? | C H A P T E R 5 23

Video Game Addiction.indb 23 11/01/18 5:20 PM

 21. How often do gamers play?
The most frequent gamers who play multiplayer and online
games spend an average of:
• 6.5 hours per week playing with others online
• 4.6 hours per week playing with others in-person

22. What benefits do gamers feel they gain

with their gaming?
• 53% of the most frequent game players feel video games
help them connect with friends and 42% feel video games
help them spend time with family
• 75% of the most frequent gamers believe playing video
games provides mental stimulation or education.

FIGURE 5.1
Young person playing with a GameCube.
https://commons.wikimedia.org/wiki/Category:People_with_game_controllers#/media/
File:Attention_span.jpg

24 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 24 11/01/18 5:20 PM

 TOOLS ON THE WEB PRACTICAL TIP

23. What are the “top” video games?

NOTE ALERT ON THE CD

A vast number of video games are on

the market, and new ones are continu- For comprehensive lists
of top video games ranked
ously launched, so it is difficult to come by journalists, critics, and
up with a definitive list of the top games.
REFERENCE ON THE WEB
publications visit:
QUESTION
In fact, there are many ways to evalu-
https://en.wikipedia.org/wiki/List_of_
ate games. The most common method is video_games_considered_the_best
by popularity based on number of sales.
Many organizations evaluate games NOTE
by variousREFERENCE
criteria of quality.
CONVERSATION
The top video games can also be categorized by type of platform.
For the interested reader, the best way to obtain the latest infor-
mation on top video games is to conduct a Google search using the
search term “top video games.” In the top line of the search results,
HEART HEALTH ON THE WEB PRACTICAL TIP
Google presents icons of the top video games of all time with links
to more details about the games. The results pages provide links
to organizations giving their lists of the top or best video games.
Although these lists are often designed for sales of games, they
can also provide the non-gamer with familiarity about the games.

CASE STUDY

Scott J began as a casual gamer during his teenage years. At

that time, he played single player games such as Nintendo.
These games did not hook him. A more serious problem for
Scott was alcohol addiction. He eventually found out that
the signs of alcohol addiction parallel that of video game
addiction, namely obsession, compulsion, growing over time,
neglecting other things, hiding the activity, and especially
denial. Scott had to realize that he had a problem before he
could take steps to overcome the addiction.

It was many years before Scott returned to video gaming. At

this time, video games had become more sophisticated involv-
ing multiple players. When he encountered emotional pain in
his life, he played games for relief and diversions. However, he
found out that gaming itself could cause emotional pain and
distress, mainly as a result of sleep deprivation. Several years
had passed before he accepted that he was addicted. There were
stretches of time that he only went to single player games, but
even these became addictive. He found that the social compo-
nent is important in both alcoholism and video game addiction.

W h a t a re th e ch a r a c t e r i st i c s of v i d e o gam e rs? | C H A P T E R 5 25

Video Game Addiction.indb 25 11/01/18 5:20 PM

 Scott found other gamers who had become addicted and
they formed a community that was structured like Alcohol-
ics Anonymous. Scott would go to meetings where the mem-
bers could share their experiences. Scott would find out how
others were able to overcome their addictions. The members
discussed how their problems with addiction evolved over
the years.

Scott is now 44 years old and has not been addicted to video
games for five years. He is a computer programmer so is
continuously exposed to the Internet. His interest in video
games is still there, but he plays other types of games with
his friends, such as board and card games.

26 PA R T O N E | V i d e o G am e B a si c s

Video Game Addiction.indb 26 11/01/18 5:20 PM

 TOOLS ON THE WEB PRACTICAL TIP
EFINITION DEFINITION NOTE

NOTE ALERT ON THE DVD

TOOLS ON THE WEB PRACTICAL TIP

References and Endnotes

EFERENCE ON THE WEB QUESTION
NOTE ALERT ON THE DVD
EFINITION DEFINITION NOTE

CHAPTER 1

1. Wikipedia (2017) “Video Game”

NOTE REFERENCE CONVERSATION
EFERENCE ON THE WEB https://en.wikipedia.org/wiki/Video_game
QUESTION
TOOLS ON THE WEB PRACTICAL TIP
EFINITION DEFINITION NOTE

CHAPTER 2

ART HEALTH ON THE WEB 2. Wikipedia

PRACTICAL(2017)
TIP “List of Video Game Genres”
NOTE REFERENCE CONVERSATION
NOTE ALERT https://en.wikipedia.org/wiki/List_of_video_game_genres
ON THE DVD
TOOLS ON THE WEB PRACTICAL TIP
EFINITION DEFINITION NOTE
3. Wikipedia (2017) “Massively multiplayer online role-playing
games.”
https://en.wikipedia.org/wiki/Massively_multiplayer_online_role-
ART HEALTH
EFERENCE
ON THE WEB
ON THE WEB playing_game
PRACTICAL TIP
QUESTION
NOTE ALERT ON THE DVD
TOOLS ON THE WEB PRACTICAL TIP

CHAPTER 3

4. Wikipedia (2017) “History of video games.”

NOTE REFERENCE CONVERSATION
EFERENCE ON THE WEB https://en.wikipedia.org/wiki/History_of_video_games
QUESTION
NOTE ALERT ON THE DVD

CHAPTER 4

ART HEALTH ON THE WEB 5. Wikipedia

PRACTICAL(2017)
TIP “World of Warcraft”
NOTE REFERENCE CONVERSATION
EFERENCE ON THE WEB https://en.wikipedia.org/wiki/World_of_Warcraft
QUESTION

CHAPTER 5

ART HEALTH ON THE WEB 6. Entertainment

PRACTICAL TIP Software Association. 2017 Essential Facts about
NOTE REFERENCE CONVERSATION
the Computer and Video Game Industry.
http://www.theesa.com/article/2017-essential-facts-computer-
video-game-industry/

7. Kabrick, Arthur. (2013) “The Four Types of Gamer-Article”

ART HEALTH ON THE WEB VGChartz
PRACTICAL(Video
TIP Game Charts) http://www.vgchartz.com/
article/256049/the-four-types-of-gamer/

8. Waite, Terry. (2007) “Plugged In: A Clinicians’ and Families’

Guide to Online Video Game Addiction.” Publish America.
www.publishamerica.com

V i d e o G am e B a si c s | PA R T O N E 27

Video Game Addiction.indb 27 11/01/18 5:20 PM

 VIDEO GAME ADDICTION

Part 2 delves directly into the question of video game

addiction, including whether it can be considered a true
addiction or more correctly a disorder. Comparisons are
made with other types of addiction, both substance and
psychological addictions. The factors that can make video
games addictive are discussed in depth, as well as actions
parents can take to reduce the possibility of addiction.
Chapter 9 discusses the many benefits of playing video
games when understood and applied.

PART TWO

Video Game Addiction.indb 28 11/01/18 5:20 PM

 CHAPTER 6
What is video game addiction?

CHAPTER 7
Why are video games addictive?

CHAPTER 8
How can you protect against video
game addiction?

CHAPTER 9
What are the benefits of playing video games?

Video Game Addiction.indb 29 11/01/18 5:20 PM

 CHAPTER

6 What is video game

addiction?
24. What is the nature of addiction?
Addiction can be due to a substance problem (nicotine, alcohol,
illegal drugs, or prescription drugs), or due to psychological dis-
orders related to gambling, food, or sex. Substance addiction can
also have a psychological component.

The physiological basis of addiction is related to the reward

system in the brain. When people have good experiences, such
as eating favorite foods, listening to music, or watching a good
movie, the brain releases a neurochemical known as dopamine.
A psychological addiction to video games rests on how much
dopamine is released in those who are believed to be video game
addicts, in comparison to the levels released during other posi-
tive lifestyle activities.

Addiction is a psychological disorder that affects the way the

brain functions by impacting chemical processes related to moti-
vation, decision making, learning, inhibitory control, and pleasure
seeking. Behavioral addictions like gambling and sex are forms of
psychological dependence; addictions to substances like drugs and
alcohol are forms of both psychological and physical dependence.

Addiction is primarily considered to be a brain disorder involv-

ing the transmission of nerve impulses and interactions among
neurons (nerve cells) within areas of the brain known as “reward
structures.” An external stimulus leads to the release of the neu-
rotransmitter dopamine from the reward structures. Dopamine
release increases brain stimulation reward. As a result, healthy
behaviors are replaced by addictive behaviors. The circuitry of
brain neurons can change such that the memory of previous
exposures to rewards (such as food, sex, alcohol, and other drugs)
leads to a biological and behavioral response to external cues, in
turn triggering craving and engagement in addictive behaviors.

Addiction is a primary, chronic disease of brain reward, moti-

vation, memory, and related circuitry. Dysfunction in these
circuits leads to characteristic biological, psychological, social,

30 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 30 11/01/18 5:20 PM

 and ­spiritual manifestations. This dysfunction is reflected in
an individual pathologically pursuing reward and relief by sub-
stance use and other behaviors. A person with addiction exhibits
problems in inhibiting impulsivity and in delaying gratification.
These problems are associated with changes in the frontal cortex.

Addiction is characterized by an inability to consistently abstain

from an activity, impairment in behavioral control, craving,
diminished recognition of significant problems with one’s behav-
iors and interpersonal relationships, and a dysfunctional emo-
tional response.

The characteristics of an addictive person can include:

• Preoccupation with substance use
• Placing more value on the benefits associated with
drugs or rewarding behaviors rather than their
detrimental effects.
• The inaccurate belief that problems experienced in
one’s life are attributable to causes other than as a
consequence of addiction
• Increased anxiety, dysphoria, and emotional pain
• Increased sensitivity to stressors associated with the
recruitment of brain stress systems, such that “things
seem more stressful” as a result
• Difficulty in identifying feelings, distinguishing between
feelings and the bodily sensations of emotional arousal,
and describing feelings to other people

25. Can playing video games lead to addiction?

Video game addiction is hypothesized to be an excessive or com-
pulsive use of computer games or video games, which interferes
with a person’s everyday life. Video game addiction may ­present
itself as compulsive gaming, social isolation, mood swings,
diminished imagination, and hyper-focus on in-game achieve-
ments, to the exclusion of other events in life.

The American Psychiatric Association (APA) periodically

revises its “Diagnostic and Statistical Manual of Mental Disor-
ders” which is recognized as the standard for defining mental
disorders. The manual is widely used by researchers, doctors,
health insurance companies, pharmaceutical companies, and

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 31

Video Game Addiction.indb 31 11/01/18 5:20 PM

 policy makers. In its 2012 revision (DSM-5), the APA declined
to include video game addiction as a mental disorder, stating
that more research was necessary to study the condition. When
the APA determines a mental disorder is an addiction, it can
have important implications such as insurance claims. The APA
instead introduced the category “Internet Gaming Disorder.”

Video gaming does not involve a chemical substance, a common

feature of addiction. Research does show that those who exces-
sively play video games report some addiction-like symptoms,
including impairment in normal social and occupational or edu-
cational functioning, tolerance, withdrawal, relapse, and the like.

The APA has been discussing among their colleagues how much this
disorder is caused by the gaming activity itself, or whether it is to
some extent an effect of other disorders. Contradictions in research
examining video game addictiveness may reflect more general
inconsistencies in video game research. For example, while some
research has linked violent video games with increased aggressive
behavior, other research has failed to find evidence for such links.

According to the APA, Internet Gaming Disorder can include the

following symptoms:
1. Pre-occupation. Do you spend a lot of time thinking
about games even when you are not playing or
planning when you can play next?
2. Withdrawal. Do you feel restless, irritable, moody,
angry, anxious, or sad when attempting to cut down
or stop gaming, or when you are unable to play?
3. Tolerance. Do you feel the need to play for increasing
amounts of time, play more exciting games, or use
more powerful equipment to get the same amount of
excitement you used to get?
4. Reduce/stop. Do you feel that you should play less,
but are unable to cut back on the amount of time you
spend playing games?
5. Give up other activities. Do you lose interest in or
reduce participation in other recreational activities
(hobbies, meetings with friends) due to gaming?
6. Continue despite problems. Do you continue to
play games even though you are aware of negative

32 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 32 11/01/18 5:20 PM

 consequences, such as not getting enough sleep, being
late to school/work, spending too much money, having
arguments with others, or neglecting important duties?
7. Deceive/cover-up. Do you lie to family, friends or
others about how much you game, or try to keep your
family or friends from knowing how much you game?
8. Escape adverse moods. Do you game to escape from or
forget about personal problems,
or to relieve uncomfortable
feelings such as guilt, anxiety, Surveys conducted with
helplessness or depression? communities of gamers
found that gamers expe-
9. Risk/lose relationships/
DEFINITION DEFINITION NOTE
rienced an average of six
opportunities. Do you risk or out of the nine criteria for addiction
lose significant relationships, established by the APA during the last
or job, educational or career twelve months.
opportunitiesTOOLS because ofONgaming?
THE WEB PRACTICAL TIP

In a study on pathological video games use, Dr. Douglas Gen-

tile asked gamers the following eleven questions to assess if the
gamers were addicted:
NOTE ALERT ON THE CD

1. Have you been spending an increasing amount of

time playing video games, learning about video game
playing, or planning the next opportunity to play?
REFERENCE ON THE WEB QUESTION
2. Do you need to spend more time and money on video
games to feel the same amount of excitement as you
do with other activities in your life?
3. Have you tried
NOTE to play video games forCONVERSATION
REFERENCE shorter
durations of time without success?
4. Do you become restless or irritable when you attempt
to cut down or stop playing video games?
HEART HEALTH ON THE WEB PRACTICAL TIP
5. Have you played video games as a way to escape
problems or negative feelings?
6. Have you lied to family or friends about how much
you play video games?
7. Have you ever stolen a video game from a store or a
friend, or stolen money to buy a video game?
8. Do you sometimes skip homework or work to play
more video games?

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 33

Video Game Addiction.indb 33 11/01/18 5:20 PM

 9. Do you sometimes skip household chores to play
more video games?
10. Have you ever done poorly on a school assignment,
test, or work assignment because you have spent so
much time playing video games?
11. Have you ever needed friends or family to give
you extra money because you’ve spent too much of
your own money on video games, software, or game
Internet fees?

Does “Internet Gaming Disorder” have clinical relevance?

The APA considers Internet Gaming Disorder to be a “condition
for further study.” As a follow-up, a study was conducted in 2016
to begin evaluating the clinical relevance of the condition. Sur-
vey participants were asked about problems related to Internet
gaming based on the proposed list of symptoms in the DSM for
Internet gaming disorder. The study compared Internet gaming
to gambling, the only non-substance related addiction included in
the DSM.

The results indicated that less than one out of three gamers
experienced symptoms of the disorder, and that gaming was
less addictive than gambling. The authors concluded that the
evidence linking Internet gaming disorder to game engagement
was strong, but that links to physical, social, and mental health
outcomes were decidedly mixed.

Read more at: https://ajp.psychiatryonline.org/doi/10.1176/appi.

ajp.2016.16020224

Why is the adoption of “Gaming Disorder” as a new

diagnostic category by the World Health Organization
controversial?
As of the publication of this book, the World Health Organiza-
tion is considering the adoption of “Gaming Disorder” as a new
diagnostic category in its ICD-11 (International Classification of
Diseases, 11th revision).

This category parallels the category of “Internet Gaming Disor-

der” in DSM-5, and presents the same issues that the APA had

34 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 34 11/01/18 5:20 PM

 to deal with in its deliberations on the category. The DSM-5
category is a condition warranting more clinical research and
experience before it might be considered for inclusion DSM-5 as
a formal disorder. The WHO ICD-11 does not have a category
for tentative disorders and would have to include gaming disor-
der as a definitive disorder with a fixed set of criteria. A group
of scholars took issue with WHO’s proposed action, stating that
gaming disorder is not yet a condition ready for clinical use.

Dr. Van Den Brink responded to this debate by agreeing that

there is not anything inherently wrong with gaming. He points
out, however, that by identifying gaming disorder as a potential
problem will not stigmatize gamers, and that many gamers with
the problem can recover without professional help.

Read more at: https://www.ncbi.nlm.nih.gov/pmc/articles/

PMC5700715/pdf/jba-06-03-040.pdf

26. What are some withdrawal symptoms of video

game addiction?
The following withdrawal symptoms of video game addiction are
provided on the On-Line Gamers Anonymous website and show
similarities to other types of addiction. It should be noted that
this is a compilation of symptoms and not all will be present in
a given individual.
• A feeling of emptiness
• Depression
• A disruption in sleep pattern
• Excessive amounts of time spent sleeping
• “Brain fog:” Difficulty with focus, concentration, and
completing complex tasks
• Fantasies and dreams about the game
• Restless, unfulfilling, taunting dreams
• The urge to go back to gaming and try to control the time
played
• Thinking about the game for extended periods of time
• Irritability or restlessness
• Relief
• Uncontrollable feelings or rampant mood swings

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 35

Video Game Addiction.indb 35 11/01/18 5:20 PM

 • Anger and verbal abuse, sometimes extreme
• Excessive crying
• Anxiety
• Fear
• Sadness
• Loneliness
• Boredom/inability to find an activity of interest
• Lack of motivation/direction
• Difficulty facing obligations, procrastination
• Feeling as though a return to gaming will make you feel
better
• Physical illness, i.e., colds, allergies
• Nausea

A paper titled “Diagnostic Criteria for Problematic Internet

Use among U.S. University Stu-
Symptoms are subjective (what the dents: A Mixed-Methods Evalu-
patient experiences about a condi- ation” form the online journal,
tion), while signs are objective PLOS One, described the signs
DEFINITION DEFINITION NOTE
(what can be seen and measured and symptoms of Internet gam-
by a physician or nurse). ing disorder experienced by uni-
versity students:
TOOLS ON THE WEB PRACTICAL TIP

1. Use Longer than Intended

Taking a substance in larger amounts or over longer periods
than was intended is a sign of substance use disorder. This sign
NOTE is not ALERT
assessed by ON
DSM-5
THE CD criteria for gambling disorder and
Internet gaming disorder. Focus group participants reported
similar signs about their Internet use. Many group members
had experienced being on the Internet longer than they had ini-
REFERENCE tiallyONintended.
THE WEB Participants
QUESTION noted that they often lost track of
time while on the Internet for recreational purposes, resulting in
loss of sleep, less social interaction, and reduced academic work
productivity. Young’s Diagnostic Questionnaire (YDQ) results
NOTE showed that 96.3% of
REFERENCE participants reported having stayed on the
CONVERSATION

Internet longer than they intended. Similarly, 80.8% of partici-

pants reported that they often/very often continued to use the
Internet despite their intention to stop.
HEART HEALTH ON THE WEB PRACTICAL TIP

36 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 36 11/01/18 5:20 PM

 2. Preoccupation
Preoccupation is characterized by individuals devoting a great
deal of time to obtaining, using, and recovering from the effects
of substances. This criterion is also used to assess gambling and
Internet gaming disorder in DSM-5, and refers to persistent
thoughts of previous gambling/gaming activity, anticipating,
and planning the next gambling/gaming venture, and ­thinking
of ways to get money for gambling. Preoccupation refers to when
substance use, gambling, or Internet gaming has become the
dominant activity in an individual’s daily life. Focus group partic-
ipants reported similar signs concerning their problematic Inter-
net use. Participants noted spending substantial amounts of time
thinking about activities on the Internet, not only while using the
Internet but also when not using or anticipating the next session
of use. YDQ results showed that 81.5% of participants felt preoc-
cupied with the Internet. According to the Compulsive Internet
Use Scale (CIUS), 29.6% of participants frequently thought of the
Internet (even when not online), and 33.3% of participants often/
very often reported looking forward to their next Internet session.

3. Withdrawal Signs/Symptoms
Withdrawal refers to a characteristic syndrome of signs and
symptoms that follow abstinence from a substance in a person
dependent on that substance. Withdrawal signs and symptoms
assessed in the DSM-5 diagnostic criteria for gambling and
Internet gaming disorder only include psychological depen-
dence. Such psychological dependence is characterized by feel-
ing restless, irritable, or sad when attempting to cut down or
stop gambling or gaming, or when one cannot access games.
Similarly, focus group participants reported experiencing psy-
chological withdrawal symptoms when unable to use the Inter-
net. Participants noted negative mood states such as “frustra-
tion,” “irritation,” and “anxiety” when they were unable to access
the Internet or had attempted to reduce or stop their Internet
use. YDQ indicated that 44.5% of participants had experienced
feeling restless, moody, depressed, or irritable when attempting
to cut down or stop their Internet use. CIUS results showed that
44.4% of participants frequently experienced feeling restless,
frustrated, or irritated when they could not use the Internet.

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 37

Video Game Addiction.indb 37 11/01/18 5:20 PM

 4. Tolerance
Tolerance is characterized by individuals needing increasing
amounts of a substance over time to achieve intoxication or
desired effects. Tolerance is also a criterion included in the DSM-5
criteria for gambling and Internet gaming disorder. It parallels
the criterion for substance use disorder and refers to needs to
gamble with increasing amounts of money or to spend increas-
ing amounts of time engaged in Internet gaming to achieve the
desired excitement. Focus group participants reported using the
Internet in greater amounts due to its accessibility. Some par-
ticipants noted using the Internet for the entire time they are
awake. Participants also indicated that they could use the Inter-
net more when they have smartphones with unlimited data.
YDQ results showed that 55.6% of participants reported feeling
the need to use the Internet for increasing amounts of time to
achieve satisfaction. Tolerance was not examined on the CIUS.

5. Unsuccessful Attempts to Stop or Reduce Internet Use

This sign is characterized by individuals having made unsuccessful
efforts to stop or cut back on use of a substance. This criterion is also
assessed in DSM-5 criteria for gambling and Internet gaming disor-
der. It refers to a desire to stop or cut back on pathological gambling
or gaming behaviors but being unable to do it. Focus group partici-
pants reported similar signs about their Internet use. Participants
noted a desire to reduce their Internet use, followed by unsuccessful
attempts to stop or reduce their Internet use. YDQ results showed
that the majority of participants had repeatedly made unsuccess-
ful efforts to control, cut back, or stop Internet use (74.1%). CIUS
results suggested that more than 80% of participants (84.6%) fre-
quently found it difficult to stop using the Internet once they were
onlin, and almost half of the participants (48.3%) reported they had
frequently unsuccessfully tried to spend less time on the Internet.

6. Craving
Craving refers to strong desires or urges to use a substance.
However, craving for gambling or playing Internet games is not
assessed in DSM-5 criteria for gambling and Internet gaming
disorder. Focus group participants reported craving regarding
their Internet use. Participants noted urges or a strong desire to
engage in activities on the Internet, specifically, when ­Internet

38 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 38 11/01/18 5:20 PM

 access is available to them. Neither the YDQ nor the CIUS
included items related to craving.

7. Loss of Interest in Other Hobbies or Activities

A loss of interest in other hobbies or activities is a sign of sub-
stance use disorder and Internet gaming disorder. This crite-
rion is not included in the DSM-5 criteria for gambling disorder.
Participants noted having lost interest in (or having partici-
pated less often in) activities they had previously found enjoy-
able including “socializing with friends or family,” “going-out,”
and “exercising” due to Internet use. CIUS responses indicated
that 22.2% of participants often/very often preferred to use the
Internet instead of spending time with others. The YDQ did not
include questions regarding the loss of interest in other hobbies
or activities.

8. Excessive Use Despite Problems

This sign is characterized by continued use of a substance
despite a persistent physical or psychological problem associ-
ated with substance use, or playing video games on the Internet.
This criterion is not included in the DSM-5 criteria for gambling
disorder. Focus group participants reported similar behavior
vis-a-vis their problem Internet use. Participants noted contin-
ued excessive Internet use despite problems such as academic
under-achievement, conflict with others about Internet overuse,
negative physical outcomes (e.g., inadequate amount of sleep),
and Internet use while driving. Another related criterion in the
DSM-5 criteria for substance use, gambling and Internet gaming
disorder assesses the actual negative consequences (e.g., jeop-
ardizing or losing important relationships or work/educational
opportunities) of substance use, pathological gambling or Inter-
net gaming. Focus group participants reported adverse health
and psychosocial consequences due to their problematic Internet
use behaviors. The negative consequences related to problem-
atic Internet use have been reported in the previous study by the
authors. YDQ results showed that 33.3% of participants had jeop-
ardized or risked the loss of a significant relationship, job, educa-
tional, or career opportunity because of their Internet use. CIUS
responses indicated that 62.9% of participants ­frequently expe-
rienced being short of sleep because of their excessive Internet

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 39

Video Game Addiction.indb 39 11/01/18 5:20 PM

 use, 38.5% frequently rushed through their homework to get on
the Internet, and 44.4% frequently neglected their daily obliga-
tions because they preferred to access the Internet.

9. U
 se of the Internet to Escape or Relieve a
Negative Mood
This sign is characterized by individuals using a substance to
cope with negative moods such as depression, guilt, or anxiety;
or gambling or playing Internet games when feeling distressed
(e.g., helpless, guilty, anxious, or depressed). However, this cri-
terion is not included in the DSM-5 criteria for substance use
disorder. Focus group participants noted engaging in excessive
Internet use to escape from, or cope with, negative moods or
feelings such as “sadness,” “annoyance,” or “boredom.” YDQ
results showed that 63.0% of participants had used the Internet
as a way to escape from problems or relieve a dysphoric mood.
CIUS findings indicated that half (50.0%) of participants often/
very often used the Internet when they were feeling “down”
and almost half (42.3%) frequently used the Internet to escape
from their sorrows or get relief from negative feelings.

10. Lying about Use

Individuals having lied to family members, a therapist, or oth-
ers to conceal the extent of their involvement with gambling or
gaming on the Internet characterize this theme. However, this
criterion is not included in the DSM-5 criteria for substance use
disorder. Focus group participants also reported deceit in associa-
tion with their Internet use. Some participants noted having lied
to cover up the extent of their Internet use, such as the amount
of time spent on the Internet or the specific activities performed
online. YDQ results showed that 25.9% of participants had lied
to family members, a therapist, or others to conceal the extent of
their involvement with the Internet. The CIUS did not ask ques-
tions regarding this theme.

27. Do playing violent video games result in violence

in real life?
It seems logical that when players become totally engaged in
violent video games that they can mix up gaming with reality
and begin to feel violence is all right in real life. However, many
exhaustive studies have failed to find such a connection.

40 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 40 11/01/18 5:20 PM

 • U.S. Supreme Court case “Brown Versus Entertainment
Merchants Association.”
• Australian Government-2010.
• Meta-analysis of studies by social scientists

In the following article, “The contested field of violent video

games: Research roundup,” (Weigel 2015)Margaret Weigel sum-
marizes research on the issue:

A range of legal, policy, and moral issues relating to video games

and their possible connection with real-world violence continue
to be debated. Few questions in social science are ever defini-
tively “settled,” but the cumulative evidence found in academic
studies can make one side of the argument significantly more
persuasive. Much can depend on the design of experiments and
the precise framing of research questions, however. A prominent
example of contested academic terrain is the field of violent video
game research, which journalists sometimes find themselves
examining and grappling with when reporting on the roots of
violent acts and behaviors.

The connection with real-world violence may seem obvious and,

at the anecdotal level, the news periodically seems to furnish
fresh evidence. For example, the man who killed 77 people in
Norway in 2011 testified that he prepared for the assault by
playing the first-person shooter video game Call of Duty: Mod-
ern Warfare 2. Extensive research has linked violent video games
and aggressive behavior, with outcomes only moderated slightly
when cultural biases and gender are taken into consideration. At
the same time, numerous well-designed studies have found no
effect or even a decrease in violent crime in response to violent
video games.

Research on how scientific knowledge has been reflected in the

media suggests that there have been patterns at work in the
press over the past 30 years. A 2013 study in the Journal of Com-
munication suggests that, in the past, media consistently con-
nected real-world violence to violent entertainment and media,
but beginning in 2000 the stance became more neutral in tone:

Rather than sensationalizing a moral panic about media vio-

lence, the news media are suggesting significant ambiguity exists
within the research. The overall trend in article tone appears to

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 41

Video Game Addiction.indb 41 11/01/18 5:20 PM

 be toward even less conclusiveness, with articles from the last
five years presenting a less convincing stance than any five-year
period since the early 1980s. We argue that a ­possible explanation
for the shift in tone is the coverage of video games. We found fewer
stories about video games that suggest a link exists and more sto-
ries that take a neutral tone relative to stories about television.

The authors of that study, from Indiana University and the Univer-
sity of Utah, state that this is not necessarily an accurate reflection
of trends in research studies. “Collectively, this body of work shows a
consistent pattern: Exposure to media violence increases the risk of
subsequent aggression,” they write. “Meta-analyses (a compilation of
research papers) of the research generally have supported this con-
clusion.” Also worth noting is that, in general, female reporters are
more likely to highlight a strong connection between media and real-
world violence than their male counterparts, the researchers find.

Examples of recent studies that support this connection to vio-

lence — the prevailing theory and the one most cited in pub-
lic discourse — are detailed in Reference 15, Ch. 6, along with
a wide variety of counterexamples. Journalists would be well-
served to pay attention to the nuances of the arguments and the
framing of the research questions. Studies on both “sides” often
look at slightly different aspects of the overall question.

Adam Thierer of the Cato Institute entered the controversy

with an article entitled “Regulating Video Games: Must Govern-
ment Mind Our Children?” He made a strong appeal that video
gaming should not be regulated by the government. He instead
proposes that industry self-regulation and parental supervision
provide the best solution to the problem.
SOURCE: https://www.cato.org/publications/techknowledge/regulating-video-games-
must-government-mind-our-children

28. What is the best way to study video game addiction?

Similar to other medical studies, the best way to study video
game addiction is through randomized, controlled studies.

This book presents an abundance of case studies on video game

addiction to dramatize the situation and to provide stories that
the reader can relate to. However, you should realize that true
addiction occurs in a small portion of gamers.

42 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 42 11/01/18 5:20 PM

 CAM’S STORY

“I dropped out of high school, twice.”

My name is Cam and by the age of 21 I

had been addicted to playing video games
for over ten years.

This addiction affected many areas of my

life, including being a major influence
in my decision to drop out of high school
not once, but twice. I never graduated,
never went to college, and struggled with Credit for photograph:
depression for many years. Derek Heisler
www.derekheisler.com

I want to be very clear, I don’t blame video games for why

this happened, nor do I think video games were the problem.

I’m not here to vilify gaming, tell you that it’s bad or debate
with you about whether you or not you should play; because
I don’t believe gaming is bad and if someone wants to play
then I would encourage them to go ahead and play.

What I do want to share with you is about my experience

playing video games and how the decision to move on from
them has taught me more about living a meaningful life than
anything I’ve done before, and how over the last five years
my journey has led me to founding Game Quitters, the larg-
est support community for people who struggle to overcome
a video game addiction. Today Game Quitters has members
in over 60 countries around the world.

Growing up
I was a fairly normal Canadian kid. I went to school, I played
hockey and then I would go home and play video games. I
was happy, I felt smart, and I had friends.

My nickname was even “Smiley.”

That all changed in the 8th grade when I began to experience

intense bullying. For example, the fun game to play for kids
in the 9th grade was “Can we put Cam in a garbage can?”

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 43

Video Game Addiction.indb 43 11/01/18 5:20 PM

 Every day during lunch hour kids
would chase me around the school,
trying to put me in a garbage can. I
would kick and scream and squirm
and do everything in my power to
avoid this happening, because other-
wise I would be humiliated.

Life on my hockey teams wasn’t much

better, and after a game in Red Deer,
Alberta we all got on the team bus
to head back home, and for an entire
hour I laid at the back of the team bus
in fetal position being spit on.

To be honest, sharing about these situations now feels very

odd and bizarre to me. They seem like a different life. But
they are true and they are experiences I went through,
amongst many others.

What these experiences did was cause me to isolate myself

away. I didn’t really enjoy going to school much anymore and
hockey wasn’t any better. The less I went to school and the
less I went to hockey, the more I played video games.
They were a place for me to escape to, a place I had more con-
trol over my experience.

I didn’t have to worry about kids bullying me online because

if they did I could just block them, move to a different server
or play a different game. Eventually I dropped out of high
school, and retired from hockey, the game I loved more than
anything else.

For the next year and a half I was depressed, living in my

parents basement, playing video games up to 16 hours a
day. My parents would get on my case that if I wasn’t going to
school then I had to get a job, so I worked the odd job here and
there, but I would rarely last over a month before I quit.

I Pretended to Have Jobs

Every morning my dad would drop me off at a restaurant
where I was a prep cook. As soon as he drove off I would

44 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 44 11/01/18 5:20 PM

 walk across the street, and catch the bus back home. I would
sneak in through my window and go to sleep — I had been
up all night playing video games.

A few weeks later my parents would wonder where my pay-

check was, so I would make up an excuse that I quit, or I
got fired, or whatever else I could confuse them with. Then
I would “get” “another” “job,” rinse and repeat. After doing
this a few times my parents just gave up and left me to fig-
ure things out.

Looking back I’m embarrassed by this behavior, but I was

doing anything I could to play video games. They were a way
for me to check out and escape from my situation.

When I was gaming I didn’t have to think about how bad my

life had gotten, and how depressed I was.

Unfortunately, although I could escape from dealing with it,

games didn’t fix the problem, and things only continued to
get worse, until one night when I wrote a suicide note.
Thankfully I didn’t go through with it because I’m writing
this to you right now, but what that night did make me real-
ize was that I needed to get professional support. I no longer
felt safe with myself. So I asked my dad if he could help me
and I started to see a counselor.

My Counsellor Made Me a Deal

He said I either had to get (and keep) a job, or I had to go
on anti-depressants. I’m not sure why, but if there was any-
thing I was certain of at that time in my life, it was that I did
not want to go on anti-depressants.

I’m not specifically against them or anything, but I just knew

they were not something I wanted for myself. So I got a job.

What the job gave me was stability and with stability I felt
inspired that I had a second chance. My life had gotten com-
pletely out of control, but this was an opportunity for a fresh
start. And I could make this new life anything I wanted it to
be. I wanted to see what I could do with it.

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 45

Video Game Addiction.indb 45 11/01/18 5:20 PM

 I didn’t have very many goals at the time, but one of the
goals I did have was to learn more about social skills and
how to make friends.

With all the bullying I went through growing up I never

really understood why it seemed like 50% of people liked me,
and 50% didn’t. As I’ve gotten older I’ve realized that’s just
something called life, but at the time I wanted to feel more
in control of my social experience.

So I figured if I was going to improve my social skills, I had to

start going out to meet people. I didn’t really know anything
else I could do, so I committed to going out every single night
to nightclubs. I would be there to learn so I wouldn’t drink alco-
hol, and I would carry a journal to write down the lessons I was
learning. Eventually I started to post these lessons on a blog.

But I knew if I was really going to do this, then I couldn’t

play video games, because I would avoid going out, and just
stay in to game.

So I quit cold turkey and for two years I didn’t touch a

game. To succeed, I was just never home. I would work from
7am to 4pm, come home, nap, shower, get dressed, eat and
go out.

But Then I Relapsed

I had just moved to Victoria, B.C. because I was feeling
depressed again, and felt like I needed a change of scenery.
Looking back I was just running away from my problems, and
instead of using video games to escape I moved to a new city.

I had just moved in with new roommates, and one of them

was a professional poker player named Ben. My first night
at the house Ben and I started talking about our past gam-
ing histories, and we realized we used to play the same
game — Starcraft. Ben said he was going to go to the store
and buy it for us to play.

I told him I had quit, and really didn’t want to play video
games anymore. He just laughed it off. Later that night I was

46 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 46 11/01/18 5:20 PM

 sitting at my desk working on my blog when he came home
with a big grin on his face and put the game in front of me.
“Just one game,” he said.

I sighed, and agreed to play. Over the next 30 minutes he

absolutely destroyed me.

Humiliated in defeat, I committed to doing everything pos-

sible to improve so he could never beat me like that again,
and for the next 5 months I played 16 hours a day, and did
nothing else but game.

I stopped working, never went out to meet new people, and

barely even left the house. I would eat, sleep and game.
Every single day.
About one month later my two roommates left on a three
week trip. I remember being so excited to have the house
to myself, where I could just game all day without anybody
knowing, or having to feel a single ounce of guilt anytime
my roommate, James, would invite me to go on adventures.

Around this time I realized my gaming was out of control, and

I needed to quit again, but I decided to do it at the end of my
5 month stay in Victoria to give myself the closure I was look-
ing for. This isn’t something I recommend to others because
it’s a slippery slope, but I do recognize that for me, this helped.

I Quit Once Again

I took time to reflect on why I was so drawn back to games,
even after I had quit successfully for two years. How did I go
from not gaming for two years to playing 16 hours a day,
again, overnight?

What I discovered was that there were four main reasons

why I played. It wasn’t just because games were fun, but
because of these specific reasons:

1. Temporary Escape
With games I could escape. When I was feeling stressed out
or needed a break from the day, I could just game and forget

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 47

Video Game Addiction.indb 47 11/01/18 5:20 PM

 about the situation. And I certainly didn’t have to deal with
my depression or anxiety.

2. Social Connection
Gaming is a community, and it’s how you interact with a lot,
if not all, of your friends. It’s where you feel welcome and
safe. It’s where you feel accepted.

In our society we stigmatize gamers as being nerds, loners

and losers. We say they are lazy and they are wasting their
potential, so they don’t feel accepted outside of games, and
because they feel this way, their online gaming communi-
ties are a place where they all have a special bond. It’s them
against the world.

Also because I was playing with friends, I didn’t feel like I

missed out on being social by staying in on a Friday night,
because I was being social — I was gaming with my friends.

A lot of parents believe the relationships you have with your

gamer friends are not real relationships — and this couldn’t
be further from the truth.

Last year I traveled to Singapore and for the past seven

years I’ve been interacting with a fellow blogger online
named Alden Tan. We spent the week together hanging out
and having a great time. We still stay in-touch today. The
relationships gamers have online are real and meaningful
relationships.

3. Constant Measurable Growth

Games give you a feedback loop. You get to see growth and
progress, and it happens immediately through instant grati-
fication.

Today I DJ, and I surf, and both of these fulfill the same
need for constant measurable growth, but it’s much harder
to see my progress. I don’t have a scoreboard, a badge or a
new level to achieve; I just fall on my face less.

48 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 48 11/01/18 5:20 PM

 4. Challenge (Sense of Purpose)
Games give you a sense of purpose, a mission and a goal to
work towards. And they are specifically designed this way.
It’s part of the invisible game design. You always know what
the next thing is that you need to do. You have to beat this
boss, get this weapon, achieve this level. If you don’t have
a sense of purpose outside of games, they will provide it
for you.

These four needs are all human needs we have and there’s
nothing wrong with them.

We all need a break from stress. We all need to feel social

connection. We all want to grow, to be challenged and to
have a sense of purpose. The power comes in understanding
what these needs are, and then being intentional to choose
how we fulfill them.

For example, if you were going to stop playing video games,

you would need to fulfill these needs in alternative
­activities — otherwise you will continue to be drawn back
to games, just like I was.
Gaming is just an activity. You don’t game just because you
“love video games,” or because games are fun; your drive to
game comes from your desire to fulfill these needs.

After I learned these reasons I figured if I struggled to quit

playing video games than surely there were many others out
there in the world who struggled as well, so I looked online
to see what the current advice was about how to quit playing
video games, and let’s just say I became pissed off.

Imagine identifying that you have a problem, a real prob-

lem, and you feel inspired enough to search for an answer.

You don’t really know where to turn. You know your family
won’t empathize, and will instead take the opportunity to
shame you for playing in the first place: “told you so!” and
you certainly can’t bring it up with your friends, they all play
and will wonder why you’re making such a big deal about it.

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 49

Video Game Addiction.indb 49 11/01/18 5:20 PM

 You Don’t Have Anybody Else.
So you go where you know you can find an answer: Google,
and with a subtle rush of hope you type “How to quit playing
video games” and hit enter. If anybody knows how to quit,
your friend Google will!

Instead of getting practical advice that can help, you get

advice like, to study more — when the whole reason you’re
playing video games is to avoid studying — or, to hang out
with your friends — when all of your friends play.

Is there anything more frustrating than being courageous

enough to admit you have a problem (and need help), and
then assertive enough to actually search for an answer…
only to get one you know is shit?

What I do know is that this process is discouraging, and the

consequence of it is that people who were originally open to
seeking help are now just like “fuck it, I’ll just continue to
play video games.”

These gamers didn’t need a “typical adult” to pretend to have

the advice they were looking for, they needed a fellow gamer
who had been through the same experience, who understood
it and could speak their language.

So I felt called to share what I had learned through my jour-

ney as a hardcore gamer who struggled with the same ques-
tion, and what helped me recover from my addiction, and
into a new chapter in my life.

In May of 2011, I published my story and what I had learned

in a blog post online titled How to Quit Playing Video Games
FOREVER and the article (more of a rant) went viral and
instantly became the go-to resource online for those in the
gaming community looking to quit.
Every day I woke up to new comments.

And these weren’t comments just saying “thank you”, they

were thousand word essays of fellow gamers sharing their
life story. It was an outlet for them to finally speak up about
their experience, and today there are almost 1,600 of them.

50 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 50 11/01/18 5:20 PM

 And they were young. I received comments from gamers as
young as 10, 11, 12 years old, young teenagers opening up
and being vulnerable. I also got comments from other demo-
graphics as well, including wives of husbands who were
neglecting their families for these games, concerned par-
ents, and everything in between; but it was this group of
young teenagers that really stood out to me.

Imagine being 12 years old and you’re self-aware enough to

recognize that you might have a problem.

So you search for the answer in Google, and read an arti-

cle that is six pages long. Then you go through the com-
ments — many of which are over 1,000 words — and you’re
courageous enough to leave your own.

At school your teacher struggles to get you to write three

paragraphs for an essay about something you don’t care
about, but here you are writing multiple pages about how
you struggle to quit playing video games.

And then you’re assertive enough to click “Contact” in the

menu bar, and email the author to ask for additional help.
And you’re 12 years old.

So between the quantity of comments, the quality of them

and the ages, I knew there was a real problem here, and it
wasn’t a problem only I dealt with.

Two years later, in September 2013, the article turned into a

TEDx talk, which today has over 125,000 views, and over
1,000 comments.
With an incredible response to the TEDx talk I realized I
needed to do more. Sure, I could answer all the comments
and emails I received on a daily basis, which I did, but in
almost 3+ years since my article came out there were still
very few resources outside of mine available.

You Deserved Better

You deserved the best tools and resources to support you to
overcome this problem, and instead of waiting for someone
else to solve it I would take matters into my own hands.

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 51

Video Game Addiction.indb 51 11/01/18 5:20 PM

 In January of 2015, I launched Game Quitters and it’s been
an incredible ride ever since.

Today we have members in over 60 countries, includ-

ing the U.S., Canada, Singapore, South Africa, Russia,
China, Japan, India, Morocco, Poland, Indonesia, Finland,
Germany, the U.K., New Zealand, Mexico, Brazil, Turkey,
Tunisia, South Korea, Israel, and the Netherlands, amongst
others. Our members represent all six habitable continents.

We have a YouTube channel with over 90 videos and over

150,000 views. We have over 5,000 members, a community
forum with over 14,000 journal entries in the past year
alone — where members share their journey and interact
with others — and over 80 new posts on average each day.

We have an online program to help you quit playing video

games called Respawn.
We have 20,000+ unique visitors to the StopGaming
­community on reddit every month — with growth doubling over
the last six months. Our community is growing rapidly, but…

We’re Only Scratching the Surface

Research from 2009 suggests that in the U.S. alone, 8.5% of
youth show diagnosable signs of pathological gaming1. That
can be as many as a few million youth.
If you add in countries like China, Japan, South Korea, Can-
ada, Australia, and European countries such as Finland,
France, Germany2, and Poland, I estimate there are at least
between 10 and 50 million video game addicts in the world
right now, many of whom struggle in silence.
This issue is much bigger than me and I’m only one of millions
who struggle with compulsive gaming or video game addiction.
You can read the stories of others in our Case Studies section.
There is also a need for research and that is why we have
partnered with Dr. Daniel King from the University of Ade-
laide in Australia to run a scientific study on our 90 day
abstinence protocol – the “90 Day Detox” – a first of its kind
in the academic literature.
Imagine a world where if you’re a gamer who struggles
with a video game addiction, you are able to find a support

52 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 52 11/01/18 5:20 PM

 c­ ommunity who you resonate with, where you feel welcome
and safe, where you feel understood.

Where you get to learn and be educated on why the problem

happens, and exactly how to recover from it. And for this
recovery to not just be about surviving without games, but
thriving and living a meaningful life.

That’s the world I imagine; that is my dream, and our mis-

sion is to positively impact at least 10 million video game
addicts in the next three years.

Today I am not only a recovering video game addict,

but the leading expert and pioneer of the video game
addiction field.
I speak regularly at international addiction conferences, and
on college campuses. Recently I have been signed by CAM-
PUSPEAK, a higher education speaking agency.
My work has been featured in two TEDx talks, and in major
media outlets such as VICE, FOX, CW, The Huffington Post,
TV Asia, and the Gavin McInnes Show.

In my spare time I enjoy traveling (22 countries to date), DJing,

and surfing. I currently live in beautiful San Diego, California.

Reproduced with permission from Cam Adair, founder and

owner of:
www.gamequitters.com

29. Is video game addiction similar to gambling addiction?

Some people have considered that video game addiction is simi-
lar to gambling addiction since neither involves chemical sub-
stances. However, the two types of addiction are different.

Gaming is principally defined by its interactivity, skill-based

play, and the means by which the gamer progresses and suc-
ceeds in the game. In contrast, gambling is defined by the meth-
ods of betting and wagering, outcomes that are predominantly
chance-determined, and features that involve risk and payout of
money to the player.
W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 53

Video Game Addiction.indb 53 11/01/18 5:20 PM

 Most gambling games, especially the ones that people become
addicted to, are games of chance. They are designed in such a
way to allow you to win a few times to keep you gambling, but
you will always lose in the long term. Gambling games work on
the psychology of the person so that he or she feels that winning
will undoubtedly take place after the next game. The gambling
industry has been promoting some electronic gambling activi-
ties as “gaming,” emphasizing the “entertainment” component
of gambling.

Video games, in contrast, are games of skill. Success depends

on perseverance, intelligence, practice, and learning, not chance.
The rewards are not random, they are earned.

CASE STUDY

Lucas is a 20-year-old college student. He was 14 when he

started playing a fantasy MMORPG (massively multiplayer
online role-playing game). He had always enjoyed playing
video games on consoles and hand-held systems. Around
school, he had the reputation of being an excellent gamer
and his circle of friends enjoyed the same interests. He was
a smart kid with average grades, played some sports in com-
munity leagues, loved movies, science fiction, and was part
of a happy family.

As he steadily increased his prowess at the questing in the

online game, his friends were not keeping pace with his skills.
Their parents either didn’t want to pay the online ­subscription
price or restricted their time online and some of them had other
interests that kept them away from the computer screen.

He sought out new friends online and joined a guild (a team).

These new friends appreciated his humor and his approach
to playing the game. He enjoyed that this guild had adults
and teens as members as well as players from around the
world. Game play became more challenging than before and
his skills increased from his previous abilities.

His schoolwork was often a struggle. Learning the concepts

came easy to him, but he needed to be organized and com-
plete work after school. His diagnosed ADHD was poorly

54 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 54 11/01/18 5:20 PM

 controlled, and he just wasn’t willing to put in the work after
school when he would rather be online gaming.

His efforts in the online gaming world brought digital

achievements that he could display among fellow gamers.
To excel he needed to put in a great effort and lots of time,
and his game statistics should that he was making progress
towards mastery. Unfortunately, his grades showed the
results of lack of effort and time given.

Lucas’s parents knew he was developing a problem. They

restricted his access to the account to just the period right
after school and sometime in the evening if he completed
homework and chores. Poor grades resulted in denial of access
to his computer. Over the years there were many attempts to
balance his gaming time with school and family activities.

There seemed to be positives to his gaming. He was learning

to be a leader, part of a team, making friendships with those
with different backgrounds. He used strategy, cunning, and
was able to weigh multiple variables to achieve success in
the game. The achievements he had in the game gave him
social status among his circle of friends. He made friends
online as well and shared his interests in matters other than
gaming with this online circle.

He decorated his room with images from the game and wore
clothing that identified his allegiance to the game. He read
novelizations of the game that provided background stories
to the online characters. Any money he earned doing chores
was spent on buying more game time or other products affili-
ated with the game.

School struggles became more severe as he approached the

end of high school. Over and over again, he was punished for
falling asleep in class and not being engaged with the les-
sons. As far as his parents knew he was getting a full night
of sleep. He denied that he was depressed and insisted that
he wasn’t sleeping, just incredibly bored.

What his parents didn’t realize was that Lucas was going
online at night and ”raiding” with his guild members. He

W h a t i s v i d e o gam e a d di c t i on? | C H A P T E R 6 55

Video Game Addiction.indb 55 11/01/18 5:20 PM

 would wait until the family was asleep and sneak down-
stairs and go on all night sessions. Some nights he got less
than an hour’s sleep, then went to school, napped for a few
hours, and then appeared at dinnertime. He grew cranky
and had a short temper. Other days he would be dropped off
at school and then leave for home missing school entirely.

Discussions of his temper, behavior, and failing grades often

ended in frustration for Lucas and his parents. Eventually,
a counselor suggested an alternative path — a GED pro-
gram designed for older high schoolers. He participated, suc-
ceeded, and realized that this was a turning point.

Lucas went cold-turkey. He realized that he needed to stop

playing the game that had taken over his life. After cutting
off his access to the game, he confessed to his parents the
extent of his compulsion to play the game.

He still plays games, including online strategy games. He still

self-identifies as a gamer and spends hours each day online.
He balances it, however, with schoolwork at a local college,
a part-time job, and time with his family. He knows that his
addiction to the MMORPG cost him the ability to start his
college career at a four-year school and caused many years of
frustration and friction with his family and teachers.

He has told his friends and family about the problem he

developed with gaming and asked them to support his deci-
sion to give up the game that caused him so many problems.

CHAPTER

7 Why are video games

addictive?
30. What is the physiological basis of video game addiction?
As briefly mentioned in Question 31, addiction is primarily
considered to be a brain disorder involving the transmission of
nerve impulses and interactions among neurons. Dopaminergic

56 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 56 11/01/18 5:20 PM

 pathways are sets of neurons in the brain that synthesize and
release the neurotransmitter dopamine. In the brain, dopamine
functions as a neurotransmitter -a chemical released by neu-
rons (nerve cells) to send signals to other nerve cells. The brain
includes several distinct dopamine pathways, one of which plays
a prominent role in reward-motivated behavior. Most types of
rewards increase the level of dopamine in the brain and many
addictive drugs increase nerve activity due to dopamine.

Dopamine contributes to the action selection process in at least two

notable ways. It sets the “threshold” for initiating actions. The higher
the level of dopamine activity, the lower the stimulus required to
evoke a given behavior. As a consequence, high levels of dopamine
lead to high levels of motor activity and impulsive behavior.

Many structures in the brain serve as the “reward pathway.” The

striatum is part of this pathway and is involved in the release of
dopamine. The striatum is involved in nerve cell (neuron) activity
related to movements and rewards. The activities of the striatum
are determined by its connections to other structures. Striatal neu-
rons show activity related to the preparation, initiation, and exe-
cution of movements. Nerve activity in the striatum is regulated

FIGURE 7.1
Dopamine Pathways. In the brain, dopamine plays an essential role in the regulation
of reward and movement. As part of the reward pathway, dopamine is manufactured
in nerve cell bodies located within the ventral tegmental area (VTA) and is released in
the nucleus accumbens and the prefrontal cortex. Its motor functions are linked to a
separate pathway, with cell bodies in the substantia nigra that manufacture and release
dopamine into the striatum.
Author: Quasihuman, May 2,2013
https://www.oist.jp/news-center/photos/dopamine-pathways

W hy a re v i d e o gam e s a d di c t iv e? | C H A P T E R 7 57

Video Game Addiction.indb 57 11/01/18 5:20 PM

 FIGURE 7.2
Location of the anterior cingulate cortex (ACC) in the brain. The cognitive division is
outlined in red dashes, while the affective (emotional) division is outlined in blue dashes.
Author: Pancrat
https://fr.wikipedia.org/wiki/Cortex_cingulaire_ant%C3%A9rieur#/media/File:Cortex_
cingulaire_anterieur.jpg

by reward expectation independent of the movement necessary to

obtain it. Rewards are events or objects that promote learning,
affect a person’s behavior, and produce positive emotions.

The cingulate cortex is a part of the brain involved with emotion

formation and processing, learning, and memory. The combina-
tion of these three functions makes the cingulate cortex highly
influential in linking behavioral outcomes to motivation.

The anterior cingulate cortex (ACC) has been the focus of atten-
tion in studying addiction. The ACC can be divided anatomically
based on cognitive (dorsal), and emotional (ventral) components.
The dorsal part of the ACC is connected with the prefrontal cor-
tex and parietal cortex. It lies in a unique position in the brain,
with connections to both the “emotional” limbic system and the
“cognitive” prefrontal cortex.

The limbic system is a set of brain structures located on both

sides of the thalamus, immediately beneath the cerebrum. The
limbic system supports a variety of functions including emo-
tion, behavior, motivation, long-term memory, and olfaction.
­Emotional life is mainly housed in the limbic system and it has
a great deal to do with the formation of memories.
58 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 58 11/01/18 5:20 PM

 The anterior cingulate cortex (ACC) is a part of the brain that is
involved with emotion formation and processing, learning, and
memory. The combination of these functions makes the ACC
highly effective in producing a positive emotional response as a
result of a particular action.

The unique functions of the ACC are due to its connections to

two sets of brain structures. The “limbic” system supports a vari-
ety of functions including emotion, behavior, motivation, long-
term memory, and olfaction. The “cognitive” system resides in
the cerebral cortex and is involved in thinking, understanding,
learning, and remembering.

31. Why are video games addictive?

Some theorists focus on presumed built-in reward systems of the
games to explain their potentially addictive nature. Many video
games, especially massively multiplayer online role-playing games,
social network, and mobile games, rely on a “compulsion loop” or
“core loop,” a cycle of activities that involve rewarding the player
and driving them to continue through another cycle, retaining them
in the game. The anticipation of such rewards can create a neuro-
logical reaction that releases dopamine into the body so that once
the reward is obtained, the person will remember it as a pleasurable
feeling. This feeling has been found similar to the same neurological
reaction believed to be associated with gambling addiction. Griffiths
has also proposed that another reason why online video games
are potentially addictive is that they “can be played all day every
day.” The fact that there is no end to the game can feel rewarding
for some thereby further engaging players in the game.

According to a motivational psycholo-

In psychology, “flow,” also
gist, many video games satisfy basic
known as the zone, is the
psychological needs. Players often con-
mental state of operation
tinue to play because
DEFINITION of rewards, free-
DEFINITION NOTE
in which a person perform-
dom, and a connection to other players. ing an activity is fully immersed in a
• Gaming triggers the brain’s feeling of energized focus, full involve-
reward system. Video game ment, and enjoyment in the process of
TOOLS ON THE WEB
manufacturers exploit this the activity.
PRACTICAL TIP In essence, flow is charac-
terized by complete absorption in what
system by providing satisfaction
one does, losing a a sense of space and
by earning points, completing
time. Video game players are often
levels, and winning games. described as being “in the flow.”
NOTE ALERT ON THE CD

W hy a re v i d e o gam e s a d di c t iv e? | C H A P T E R 7 59

REFERENCE ON THE WEB QUESTION

Video Game Addiction.indb 59 11/01/18 5:20 PM

 • Games never end, people are counting on you. You are
part of a group.
• Social obligation-guilt about leaving.
• Escapism-gaming may empower people who live
humdrum lives, may be unpopular, or depressed.

CASE STUDY — THE PULL OF CALL OF DUTY

Steve was an accomplished Call of Duty soldier. After he

logged into the PlayStation Network, he was determined and
focused on winning. He quickly checked for his friends. He
even spent $50 of his own hard-earned money mowing lawns
at $10 per yard to purchase a Bluetooth headset, allowing
him to chat online and talk smack with other players. He
carefully picked out his gear, examined his weaponry, deter-
mined the grenades he needed, and planned out his strategy
during the week.

His parents limited his access to the game, only allowing him
to play on the weekends for a few hours, but he spent many
hours during the week focusing on his weekend battles. He
watched YouTube videos on the latest strategies, read up on
new ways to conquer the game, and, every day, all day long,
he plotted what he was going to do on Friday evening when
he would be allowed to play. At school, between classes and
during lunch, he talked to other kids about the game. Steve
found a way to feed his obsession with Call of Duty, even
with limitations on playing time.

When Steve logged onto his PlayStation Network, he found

hundreds of thousands of other players ready for death
matches. The game paired them up in groups, and they
prepared to go into battle -good against evil, squad against
squad, nation against nation. Eyes fixated on the screen,
Steve ran into the battlefield. He shook his handheld knife;
he crawled on the ground finding sniper positions. He fired
his weapon through the glass, aiming to kill the enemy. He
was concentrating on achieving kill streaks, allowing him
the ability to launch special weapons. The adrenaline and
endorphins surging through his body were potent. He wiped
his sweaty hands on the side of his pants and continued to

60 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 60 11/01/18 5:20 PM

 play with a sense of concentration that was rarely exhib-
ited in his day-to-day activities of school and competitive
soccer. If left alone, Steve would play all day and late into
the evening.

Before becoming obsessed with Call of Duty, Steve was

bright and athletic. He maintained a solid 3.5-grade point
average. As Steve became more obsessed with Call of Duty,
however, his school performance dropped. He also underper-
formed on the soccer field. At the height of his game playing,
Steve was barely making a 3.0-grade point average and was
not maintaining his physical fitness. Running and working
out was stressful and tiring. School was boring, unlike the
video game, which gave him a thrill of excitement that he
could indulge on a regular basis. The digital accolades and
pixelated medals he received as a five-star general in the
game superseded any real-life awards or r­ ecognition.

32. What basic human needs motivate people to seek

satisfaction through video games?
Dr. Andrew Doan describes nine ways in which playing video
games satisfy basic human needs in his book on “Hooked on
Games”:
1. Satisfies curiosity: A video game is a new universe to
travel, a new puzzle to solve, a new task to achieve.
As the player achieves new levels, the undertaking
becomes more difficult.
2. Provides a sense of purpose in life: When people lack
a purpose in life, the game provides this purpose
in a digital world. The goal may be a quest to find
a magical item, seeking and destroying criminals,
living with an ideal partner, pursuing a dream career,
or receiving a reward after a successful quest. The
gamers feel like they are accomplishing something.
3. Instills a sense of invincibility: Gamers develop the
power to overpower and kill their opponents. If the
gamer dies, it is not permanent; they can resurrect by
just pressing the reset button.

W hy a re v i d e o gam e s a d di c t iv e? | C H A P T E R 7 61

Video Game Addiction.indb 61 11/01/18 5:20 PM

 4. Feeding the ego: Video gamers can be generals, kings,
and practically gods. Gamers are made to feel like
they are the ideal avatar they created. If a gamer
becomes lost, forlorn, depressed, and overwhelmed
from issues in real life, he or she can find escape by
returning to the game.
5. Overcomes isolation in real life by offering
companionship: Gamers waste time on digital
relationships instead of investing time in real-world
relationships. Digital world companionship is very
common and easy to foster.
6. Satisfying the need for challenges: The new games
allow one human mind to compete with another.
Games offer unlimited challenges.
7. Gratifying the need to be a leader: Video gaming
provides an outlet for natural leaders who otherwise
would not have an outlet. Other gamers may not have
the skills to become successful leaders in real life, but
are given opportunities to succeed in gaming.
8. Fulfilling sexual fantasies: The avatars invented
online are idealized characters in physical
characteristics that do not age. The gamer thereby
has the confidence to enter into a relationship with
another idealized avatar. A digital partner may
always be ready, willing, and able to have virtual sex.
9. Meeting the need for love and acceptance: When
people have problems with their real marriage,
gaming provides an idealized alternative.

CASE STUDY — CHALLENGES FACED IN WARCRAFT III:

REIGN OF CHAOS

Andrew logged onto Battle.net, Blizzard’s online gaming net-

work. He felt the adrenaline rushing through his body. His
heart raced and he was eager to play a Warcraft III: Reign of
Chaos ladder match. Andrew was within reach of advancing
within the top 100 players on Battle.net. The game matched
him with another player and they were transported to a

62 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 62 11/01/18 5:20 PM

 r­ andom map where the one-on-one battle would take place.
The winner would advance up the ladder ranking and the
loser would drop in ranking.

Andrew quickly examined the map and assessed the pos-

sible starting locations for the other player. He studied
his location and prepared the battle plan. While planning
his attack strategy, Andrew directed his online workers to
collect gold and lumber resources required to build build-
ings and assemble troops. The faster the workers collected
resources, the quicker he could build an army to defeat my
opponent.

After wiping his sweaty palms on the side of his pajama

bottoms, Andrew clicked on the peasant who was chopping
wood, and he said, “Yes, me lord?” Amused by the audio
response of his peasant worker, Andrew felt powerful and in
command. Andrew was the army commander for the Human
Alliance. After thousands of hours devoted to the game, he
felt some emotional attachment to the digital characters he
controlled. Andrew was delighted by their animations and
audio responses. He was directing and micromanaging his
workers and growing army. Andrew had a good start and
felt confident that victory favored him in this game.

As Andrew was commanding his workers to gather resources

to build farms and barracks for troops, hee did not know what
his opponent was doing as he could not see beyond the edge
of the base due to the “’fog’” of war.” He continued ­creating
farms and barracks, carefully maintaining an optimum ratio
to them to the peasants. He created the first three ground
units called footmen. As Andrew planned his strategies on
how to advance and to attack his opponent, he contemplated
rushing with footmen versus upgrading to knights, or pos-
sibly creating air-units.

Suddenly Andrew was ambushed by three grunts, the Orc

equivalent of his footmen. It was a three-on-three battle. His
opponent had the upper hand, the element of surprise. The
grunts concentrated their attack on one footman and quickly
killed him. It was now a three-on-two battle. Andrew rallied

W hy a re v i d e o gam e s a d di c t iv e? | C H A P T E R 7 63

Video Game Addiction.indb 63 11/01/18 5:20 PM

 his peasants to arm themselves as militia, but his opponent
was stronger than his peasants, and soon these grunts killed
his footmen. Two more grunts arrived as reinforcements, and
the Orc army began to wreak havoc on his militia, annihilat-
ing his peasants and destroying his newly created barracks
and farms. The game was over. Andrew’s heart was racing,
his palms were sweaty, and his lips were quivering. Andrew
was frustrated and full of rage. He was defeated and his
ranking dropped on Battle.net. Yelling profanity at the com-
puter screen, Andrew manically prepared for another battle.

33. How can the visual effect of playing video games

lead to addiction?
In a telephone conversation, Dr. Andrew Doan discussed the
visual effect of playing video games. When a person is playing
video games, their eyes are receiving vast amounts of images.
These images impact millions of nerves in the retina, which fire
and stimulate the reward system, initiating a release of dopa-
mine. This effect is what happens during addiction but instead
of getting high off taking a drug, the player gets high off their
own neurotransmitters.

FIGURE 7.3
Trying out a virtual reality headset
SOURCE: Lucas Giolito tries out virtual reality
AUTHOR: Arturo Pardavila III
https://commons.wikimedia.org/wiki/index/php?curid=50175887

64 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 64 11/01/18 5:20 PM

 As what happens in other addictions, the gamer’s body adjusts
its hormonal output to the stimulus, reducing its effect. Game
developers are well aware of this effect, and are continuously
coming out with new, more challenging games to keep the mind
stimulated.

The visual effect of playing video games is further explored in Ques-

tion 45: “How can virtual reality help in pain management?”

34. What is the Tetris effect?

The Tetris effect (also known as Tetris Syndrome) occurs when
people devote so much time and attention to an activity that it
begins to pattern their thoughts, mental images, and dreams.
This effect takes its name from the video game Tetris. The Tetris
effect can be a result of MMORPG addiction.

Examples of the Tetris effect are images falling from the ceiling
or interpreting images differently.

FIGURE 7.4
Enigma Screenshot.
https://commons.wikimedia.org/wiki/File:EnigmaScreenshot.png

W hy a re v i d e o gam e s a d di c t iv e? | C H A P T E R 7 65

Video Game Addiction.indb 65 11/01/18 5:20 PM

 35. What is the Proteus effect?
The Proteus effect describes a phenomenon in which people
derive their expected behaviors from observing their avatar’s
appearance. The person’s usual behavior is thereby changed to
fit these expectations. Studies have shown that our virtual bod-
ies can change how we act with others in actual avatar-based
online communities as well as in subsequent face-to-face inter-
actions. The concept’s name is an allusion to the shape-changing
abilities of the Greek god Proteus.

Psychology recognizes that self-perception affects behavior.

How we think about ourselves affects the confidence with which
we approach the world. Self-perception applies in the virtual
world too. Studies have shown that the appearance of the ava-
tar’s height and attractiveness were significant predictors of the
player’s performance. The avatar’s appearance affects not only
the player’s behavior but how other players interact with the
avatar. Research suggests that the qualities you acquire online,
whether it is confidence or insecurity , can spill over and change
your conduct in the real world, often without your awareness.

CHAPTER

8 How can you protect

against video game
addiction?
36. What personal strengths are important to protect
against video game addiction?
Personal strengths are the traits of children that are associ-
ated with healthy development and life success. These personal
strengths have been identified from decades of research on risk
and protective factors that are important to the well-adjusted
development of children.

Personal strengths consist of five components: emotional aware-

ness, emotional regulation, goal setting, empathy, and social
competence. Personal strengths can be expressed internally, such
as depression, or externally, such as pathological video-gaming.

66 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 66 11/01/18 5:20 PM

 These personal strengths are self-regulatory, which is the abil-
ity to act in the child’s long-term best interest, consistent with
his or her deepest values. Such personal strengths are essential
in allowing video-gaming to be a harmless and enjoyable pas-
time rather than a destructive preoccupation.

37. How does the family environment affect video game

addiction among children?
The family environment can be either nurturing or dysfunc-
tional. A healthy family environment is nurturing, providing a
variety of education and leisure activities for children. A healthy
social environment is facilitated, minimizing children from being
addicted to video gaming.

In a dysfunctional family environment, family relationships are

highly stressful, and children are less likely to conform to their
parents’ requests regarding video gaming.

FIGURE 8.1
Dialog between parent and child is essential to regulate video game use
https://pixabay.com/en/face-dialogue-child-talk-psyche-2670533/

38. What actions can parents take to reduce addictive

video gaming in their child?
There are many actions parents can take if they are concerned
if their child’s video gaming is getting out of control. If the home
environment is dysfunctional, however, bear in mind that the
child may resist the parent’s actions or find ways to circumvent

How c a n you pr ot e c t a ga in st v i d e o gam e a d di c t i on? | C H A P T E R 8 67

Video Game Addiction.indb 67 11/01/18 5:20 PM

 the actions. Parents should not facilitate addictive behavior. The
best way to control video game addiction is by prevention.
1. Establish ground rules for video gaming:
–– Limit gaming to a certain number of hours per day or
per week
–– Gaming should not be allowed until homework, or
household chores are done.
–– Children must eat regular meals with the family
–– Children must pay for their own game subscriptions
through their allowance.
2. Show an interest and understanding in the games.
Offer to participate in the games.
3. Discuss with the child why they have lost interest in
other activities. Offer a goal- oriented activity they
can participate in.
4. Remove the computer or tablet from the child’s room and
place in a common area. The computer should be locked
down with a password that only the parents know.
5. Cancel Internet access. Unfortunately, this action is a
drastic move that can impact the rest of the family.

CASE STUDY — ANDREW DOAN

Dr. Andrew Doan has an extraordinary background. He came

to the U.S. at an early age with his parents as Vietnamese
immigrants. The family had a difficult time adjusting to life
here. The family was poor, and Andrew faced prejudice from
classmates at school. Andrew became interested in video
gaming. His parents, with the best of intentions, brought
home an Atari 2600 gaming console and Space Invaders when
he was ten years old. The event was crucial as Andrew was
immediately hooked and played for twelve hours straight
the first day. Andrew found that all the stresses of his life —
the fights in the house, the struggles to fit in, and the pres-
sures to make a name for himself — melted away when he
played the game. He had discovered a way to escape and to
find peace. He was able to conquer and felt in control of his
life. In gaming, Andrew found an alternate reality where he

68 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 68 11/01/18 5:20 PM

 could fit in, in contrast to the real world. Andrew enjoyed
being entertained and immersed in a virtual world.

Eventually, playing video games was more important and enjoy-

able than eating. When his mother gave him $10 to purchase
lunch at a deli while she was shopping, he spotted a Missile
Command arcade machine. He cashed in the $10 for quarters
and spent all the money gaming with nothing left for lunch.

In high school and undergraduate college, Andrew developed

other interests, putting video gaming on the back burner.

He received a full scholarship and attended John Hopkins

School of Medicine. After medical school, we went on to pur-
sue a Ph.D. program in neuroscience. He spent long hours in
the lab which proved to be incredibly isolating. At this time
Andrew married, and the couple had infant children. Andrew’s
isolation increased as his wife worked long hours as a nurse,
leaving Andrew at home caring for their infant children.

After long, frustrating days in the lab, Andrew went home to

dive into video games to escape. While his infant son slept in
a baby carrier next to his computer, Andrew was transported
to a new world that kept him entertained, engaged, and chal-
lenged throughout the night. The video game facilitated his
social interaction without requiring him to leave the apart-
ment. During the height of Andrew’s video game addiction,
Andrew played Diablo for forty hours per week. He spent
much of his time playing with other strangers to such an
extent that he placed more value on his Diablo characters
than on his real-life relationships.

Andrew was able to overcome his addiction and was doing

well in his career as an eye surgeon and physician. However,
one fateful day a colleague placed a CD-ROM of World of
Warcraft on his desk. Andrew had not been playing for three
years, so thought he could control his playing. He was wrong.

His playing went from one hour a night to eventually all

night long. His commute to work was hell, with nodding off at
the wheel to even hallucinating. He found it necessary to pull
over into a parking lot to nap before continuing his commute.

How c a n you pr ot e c t a ga in st v i d e o gam e a d di c t i on? | C H A P T E R 8 69

Video Game Addiction.indb 69 11/01/18 5:20 PM

 Every day he looked forward to coming home from work
and playing a “quick” game before dinner. One evening, he
started a game of Starcraft, hoping to beat his opponent in
a fifteen-minute match. After thirty minutes, his wife called
him to dinner. He yelled back that he would be there in just
a few minutes. His opponent was challenging to defeat, and
he lost track of time. Two hours later, he ate a cold dinner
alone, not an unusual occurrence.

Andrew enjoyed defeating other players online in real-time

strategy games like Warcraft III and Starcraft. He felt a
great sense of accomplishment as he climbed the ladder of
rankings, seeing his name at the top of the charts. He felt
proud that he won more games than he lost. By feeding the
ego, even though the accomplishments were not real, he felt
important, successful and skilled. Unfortunately, this sense
of success was not long lasting. When he left the game, he
had real-life problems and real-life challenges to face, so he
had to play more to help forget the real-life issues.

Andrew’s addiction during this period continued for over

nine years, playing 40–50 hours per week. He began to
change mentally, physically, and spiritually. He was abu-
sive towards his wife and kids, perpetually irritated, and
constantly angry. His mind was always preoccupied with
video games. He withdrew from his friends and family. He
preferred to be alone so he could sneak in additional hours of
play. He was glad when his wife went to bed early so that he
could have more hours playing before morning. With exces-
sive play, Andrew began to show physical symptoms. He had
frequent headaches, chronic red and dry eyes, and rapidly
gained thirty pounds. He had urinary incontinence problems
and hemorrhoids from sitting for long periods of time.

Eventually, Andrew crushed his wife’s spirit with a constant

barrage of severe verbal abuse. She secretly moved 3000 miles
away with the help of her mother. She filed a restraining order
against Andrew and petitioned for divorce, ­seeking custody of
the kids. Eventually, after defense attorneys and custody bat-
tles, his wife agreed to give Andrew a second chance with the
understanding that he would start going to church with her.

70 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 70 11/01/18 5:20 PM

 After a few relapses, Andrew is now a changed man. He attri-
butes his recovery through the reading of Purpose Driven
Life and realizing that he was created with a specific pur-
pose. He could use these gifts for this purpose or could con-
tinue to waste them. Andrew attributes his religious faith to
be essential to his recovery.

CHAPTER

What are the benefits of 9

playing video games?
39. How can playing video games be beneficial?
According to a paper in American Psychologist, playing video
games may have beneficial effects in four areas:
1. Cognitive
a. Spatial skill improvements can be transferred to other
areas such as science and technology: Gamers have
shown an improved ability to track moving objects in a
field of distractors (items that can divert your attention).
b. Neural processing and efficiency. Gamers can focus their
attention more efficiently: Extended video game playing
can result in improved visual contrast sensitivity (the
ability to distinguish subtle differences in shades of
gray).
c. Problem-solving skills: All genres of video games are based
on problem-solving which are often open-ended, requiring
the gamer to solve problems through experimentation, past
experiences, and intuition. Gamers develop the ability to
allocate his or her mental resources (such as perception,
attention, memory) in ways that allow for rapid, efficient
problem solving or decision-making. Studies have shown
that experience with action video games improves people’s
abilities to switch rapidly and without error between tasks
that have conflicting demands.

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 71

Video Game Addiction.indb 71 11/01/18 5:20 PM

 d. Job performance: Many studies indicate that video
games improve job performance, especially for jobs that
require good eye-hand coordination, attention, excellent
working memory, and quick decision-making.
e. Enhanced creativity-
2.DEFINITION
Motivational: Video
DEFINITION games provide
NOTE feedback on the
persistence and continuous effort by the gamer.
3. Emotional: Several studies have shown a causal relation
between playing preferred video games and improved mood
TOOLS ON THE WEB PRACTICAL TIP
or increases in positive emotion. In psychology, flow
experiences have repeatedly been linked to a host of
positive outcomes for adolescents, including commitment
and achievement in high school.
NOTE ALERT ON THE CD

4. Social: The average gamer

Mike Langlois, a Clinical Social is not socially isolated. Over
Worker and Therapist, presented
a seminar, “Rethinking Video 70% of gamers play their
Game Addiction.” AtREFERENCE
the Pax East ON THE WEB games
QUESTION with a friend, either
2013 convention. He discussed cooperatively or competitively.
ways that playing video games may be a posi-
tive influence in the lives of many people. In the virtual social
communities involved in games,
https://www.youtube.com/ decisions need to be made at
watch?v=EJXjtaODsok NOTE REFERENCE CONVERSATION
the moment about whom to
trust, whom to reject, and how
to most effectively lead a group.
HEART HEALTH ON THE WEB PRACTICAL TIP
40. Can playing video games help people with
psychological problems?
This book has largely focused on the psychological and emotional
problems that can arise as a result of playing video games. How-
ever, studies are emerging to demonstrate the video gaming can
actually be beneficial for people with these problems, under con-
trolled conditions. These conditions include the development of
games specifically designed to treat people with these condi-
tions, and to use them under controlled conditions.

A study was conducted by the

The term “serious games” denotes
digital games serving serious
University of Barcelona to deter-
purposes like education, training, mine if playing a video game
DEFINITION
advertising, DEFINITION
research, and health. NOTE called Play Mancer could be useful
for treating patients with specific
72 PA R T T W O | V i d e o G am e A d di c t i on

TOOLS ON THE WEB PRACTICAL TIP

Video Game Addiction.indb 72 11/01/18 5:20 PM

 ­ ental ­disorders, namely, eating disorders and impulse control
m
disorders. Due to the lack of effective strategies and adequate
psychotherapy tools to cure these cognitive and emotional pro-
cesses, the researchers decided to consider approaches based on
serious games. The primary underlying reasons for using such
an approach were, on one hand, the potential positive internal
characteristics of the video games (namely intensiveness, isola-
tion from outside world, immersive capacity, low resistance to
be used) and on the other hand, their demonstrated effects in
brain activity.

The game involves a scenario which is called “Islands,” based on

the idea that the patient is on an island that forms part of sev-
eral islands in an archipelago. On each island, different activi-
ties are available. The activities are linked to varying difficulty
levels of game tasks. In this adventure game, the player is con-
fronted with several challenges, situations to improve the skills,
and attitudes that we are trying to change (i.e., problem-solving,
impulse control, facing situations associated with frustration
and adverse emotion management). As the player completes the
various tasks of the game, he or she can advance to higher lev-
els of difficulty. The final objective is not to win, in a classical
game manner, but to achieve a greater capacity of self-control.
At all times, the patient receives feedback regarding his or her
achievements.

Although new technological approaches have increasingly

been used as therapy for mental disorders, there is a lack in
the literature regarding the use of video games and controlled
studies analyzing its effectiveness. The few studies attempt-
ing to analyze video games, as combined therapy in mental
disorders, are merely descriptions of series of cases or natural-
istic studies with significant methodological limitations. How-
ever, the internal features of this type of technologies may
encourage clinicians and technicians to continue investigating
this field.

Taking into account our clinical experience using and develop-

ing video games, the most important lessons that the research-
ers learned were the following:

(a) the acceptance of mental disorder patients is very

high for participating and using video games;
W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 73

Video Game Addiction.indb 73 11/01/18 5:20 PM

 (b) this approach is a good platform to work out
underlying attitudinal and emotional problems,
that otherwise are difficult to treat in mental
disorders (such as impulsiveness, emotional
regulation, frustration), in an intensive and
motivating way;
(c) internal characteristics of video games make it
feasible to apply techniques that tend to be difficult
to apply in those patients, such as controlled
intensive exposure, immediate positive and negative
reinforcing, complex biofeedback approach, and
real-time monitoring of physiological-emotional
reactions.

Currently the PlayMancer evaluation trials are still ongoing,

but initial results, based on more than 40 mental disorder out-
patients, seem to indicate that:
(a) emotional disorder and impulse control disorder
patients feel comfortable using such a video game
(usability over 85%);
(b) a source of stress (such as specific parts of Islands)
is able to trigger high physiological and emotional
reactions in mental disorder patients, and is
moreover over expressed when compared with
healthy controls;
(c) negative and positive emotions (namely anger and
joy, respectively) are positively linked with higher
physiological reactivity in mental disorders;
(d) as shown in other studies, relaxation and intensive
biofeedback may significantly reduce the tension
triggered by the game. The respiration rate
increases during the game play and decreases during
the relaxation time (before and after).

Looking at the short-term effects, after using this video game strat-
egy, the patients started to show new coping styles with ­negative
emotions in normal stress life situations, additional generalization
patterns, and more self-control strategies when confronted with
them. As shown in previous studies, working with underlying atti-
tudinal and emotional factors, in emotional disorders and impulse

74 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 74 11/01/18 5:20 PM

 FIGURE 2.4
Example of Scenario in Islands

This discussion on Play Mancer uses portions of the introduction and Discussion
sections from the following article:
“Video games as a complementary therapy tool in mental disorders: PlayMancer, a
European multicentre study.” Journal of Mental Health. (2012 Aug). 21, no. 4: 364 –374.
Authors: Fernando Fernández-aranda, Susana Jiménez-murcia, Juan Santamaría,
Katarina Gunnard, Antonio Soto, Elias Kalapanidas, Richard Bults, Costas Davarakis,
Todor Ganchev, Roser Granero, Dimitri Konstantas, Theodoros Kostoulas, Tony Lam,
Mikkel Lucas, Cristina Masuet-aumatell, Maher Moussa, Jeppe Nielsen and Eva Penelo.
©2012 The Authors. Published by Taylor & Francis.
http://www.tandfonline.com/action/showCopyRight?scroll=top&doi=10.3109%
2F09638237.2012.664302

control disorders, we may reduce their potential maintaining

capacity and therefore enhance the long-term effectiveness of tra-
ditional therapies. In that case, new technological approaches,
namely video games, can certainly be one positive option.

41. Can playing video games be useful in

patient education?
Patient education involves methods used to inform patients of
their medical condition so that they can better understand their
illness and to participate in their treatment. The following are
examples of studies:
• A video game, “Re-Mission,” was developed to
actively involve young people with cancer in their

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 75

Video Game Addiction.indb 75 11/01/18 5:20 PM

 own treatment. Re-Mission provides opportunities
to learn about cancer and its treatment. A study was
conducted with participants receiving either a regular
commercial game (control) or both the regular game
plus Re-Mission. Participants were given a mini-PC
with the games installed and requested to play for an
hour each week for three months. A test on cancer-
related knowledge was given before gameplay (baseline)
and again after one and three months. Analyses of the
knowledge test scores showed that whereas scores of
both groups improved significantly over the follow-up
periods, the scores of the Re-Mission group improved
significantly more.
• The purpose of a review paper was: (1) to identify
diabetes education video games and pilot studies in
the literature; (2) to review themes in diabetes video
game design and evaluation; and, (3) to evaluate the
potential role of educational video games in diabetes
self-management education. Nine studies featuring
eleven video games for diabetes care were identified.
The video games targeted children with type 1
diabetes mellitus and used situation problem-solving
methods to teach diet, exercise, self-monitored blood
glucose, and medication adherence. Evaluations
have shown positive outcomes in knowledge, disease
management adherence, and clinical outcomes.
The results indicated that video games for diabetes
education show potential as effective educational
interventions.
• Chronic conditions in children are very prevalent,
affecting about 25%. Patient education is frequently
provided to these children to improve their
understanding of the condition, but also to enhance the
self-management skills, which in turn can improve the
overall health status, reduce healthcare utilization,
and minimize the overall burden of the condition.
Although individually tailored educational programs
are most effective, these are very resource consuming.
By contrast, more traditional and passive methods of
patient education, such as oral lecturing or offering
printed reading material, fail to improve clinical
outcomes substantially.

76 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 76 11/01/18 5:20 PM

 A more recent alternative approach relies on video games as a
medium for improving medical skills and knowledge, as well
as a tool in medical treatments, therapy, and disease manage-
ment. Gaming is a particularly useful tool for children as they
are typically more visually oriented than older age groups,
can easily manage several flows of information simultane-
ously, and have a preference for inductive reasoning and fast
interactions.

A systematic review of studies found that educational video

games can be useful in improving knowledge and self-manage-
ment in young people with chronic conditions.

42. Can playing video games promote well-being?

Psychological well-being is closely
related to flourishing mental health. Psychological well-being
The essence of well-being is not the can consist of many factors:
1. Self-acceptance
absence of mental illness but DEFINITION
DEFINITION the pres- NOTE
2. Personal growth
ence of positive mental health. Well-
3. Purpose in life
being has emotional, psychological, and 4. Environmental mastery
social components. 5. Autonomy
TOOLS ON THE WEB 6.PRACTICAL
Positive
TIP relations with others
Psychological well-being is closely
related to flourishing mental health.
The essence of well-being is not the absence of mental illness
but the presence of positive mental health. Well-being has emo-
NOTE ALERT ON THE CD
tional, psychological, and social components.

A comprehensive review of the relationships between playing

video games and well-being resulted in the following findings:
REFERENCE ON THE WEB QUESTION

Existing research suggests that videogames contribute to young

people’s emotional, social and psychological well-being. Spe-
cifically, videogames have been shown to positively influence
young people’s emotional
NOTE state, self-esteem,
REFERENCE optimism, vital-
CONVERSATION

ity, resilience, engagement, relationships, sense of competence,

self-acceptance, social connections, and functioning. Emerging
research suggests that how young people play as well as whom
they play withHEART
may
HEALTH be more ON
important
THE WEB in PRACTICAL
terms TIP of well-being
than what they play. People who play many hours may socially
isolated and have lower well-being to begin with, and are using

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 77

Video Game Addiction.indb 77 11/01/18 5:20 PM

 gaming to escape from their problems. In Question 40, we dis-
cussed the use of video games to help people overcome psycho-
logical problems. In this question, we illustrate that video game
playing can also be beneficial for children without psychological
problems. You may notice that many of these benefits may seem
contrary to the detrimental effects seen in players with addic-
tion. These results indicate the importance of proper video gam-
ing management.

Regarding positive emotional impact, playing video games can:

• Contribute to positive emotions
• Contribute to emotional stability
• Facilitate relaxation and stress reduction
• Reduce a depressed mood
• Reduce emotional disturbances
• Provide changes in mood in response to problems with
friends or parents.

Regarding promoting healthy relationships and improved social-

ization, playing video games can:
• Promote higher levels of family closeness, less risky
friendship networks, and better attachment to school
than non-players
• Provide a healthy source of socialization, relaxation, and
coping
• Create social networks through online gameplay with
other MMORPG players to extend real-life relationships,
meet new people, and form relationships
• Result in social interactions that occur within and
outside of MMORPG play that are highly social,
providing opportunities to create strong friendships and
emotional relationships

Regarding self-esteem, playing video games can:

• Result in higher ratings of self-esteem and self-concept
among players compared to non-players
• Allow players to express themselves in ways they may
not feel comfortable doing in real life because of their
appearance, gender, sexuality, and age
• Increase their feelings of self-confidence and self-worth,
potentially impacting positively on psychological health

78 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 78 11/01/18 5:20 PM

 43. How can video games be used to develop
mindfulness meditation?

The purpose of mindfulness meditation is to achieve a mental

state in which a person has a calm mind. Through meditation
techniques, the person concentrates on the present moment,
while letting go of past or future thoughts. The practice of mind-
fulness has been shown to be closely related to greater well-being
and perceived health. Mindfulness practice is being employed
in psychiatry to reduce depression symptoms, to reduce stress,
and anxiety. Mindfulness meditation consists of repeating men-
tal exercises that lead to an experience of stillness and clarity
achieved by these exercises.

Although video gaming might be perceived to be entirely con-

trary to mindfulness meditation, many games have been devel-
oped to improve the person’s mindfulness practice. Video games
have been notable for entirely directing the gamer’s attention,
so games designed for meditation can provide a calm focus. Peo-
ple playing video games as or practicing meditation have been
described as entering a “flow” state. Flow, also known as the
zone, is the mental state of operation in which a person perform-
ing an activity is fully immersed in a feeling of energized focus,
full involvement, and enjoyment in the process of the activity.
In essence, flow is characterized by complete absorption in what
one does, losing a sense of space and time. Examples of video
games specifically designed for meditation practice include flOw,
1 Giant Mind, Pause, and Tenacity.

CASE STUDY

Melissa is a 36-year-old copywriter in a media company. She

lives in a condo in a suburban neighborhood and commutes
into the city.

She has been working in the field since college, progressing

rapidly at first, but in the tight employment market facing
the news industry she has stopped getting annual raises and
feels lucky to still have a job. Every time there is a com-
pany-wide meeting or a closed door in her office, her stomach
drops and she worries if that day is the day she loses her job.

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 79

Video Game Addiction.indb 79 11/01/18 5:20 PM

 Since getting a smartphone a few years back, she plays games
on her long commute back and forth to downtown. It helps to
pass the time and keeps strangers from approaching her. At
first, she would play stand-alone games like Solitaire or Tetris,
but she quickly switched to social games. The social aspects
of the games allowed her to play with her large circle of Face-
book friends. Social media reconnected her with friends from
her sorority days, from her year teaching English in Poland,
from her church young singles group and friends from the
city she left behind to pursue a career writing in New York.

Her core group of girlfriends used social media to schedule

their busy lives when they were in their late 20s and new
to the city. Now many of them had moved away to pursue
new career opportunities, to start families, or just stopped
‘having the time.’ Pictures and news were still shared, but
in-person socializing had become rare. Getting in a game of
Words with Friends or helping out each other’s Farmville
crops was the extent of many of her interactions.

At work, colleagues of her tenure were busy with their out-

side lives and the only new faces coming aboard were end-
less streams of interns. At first, she felt like she had a lot
in common with these young, eager people and was happy
to trade career insights and mentor them as they so hope-
fully started out on their own path. A few went on to other
magazines or online media start-ups, using their experience
at her company along with their connections made in school.
She tried not to be jealous when they did land a position that
she would have loved to have been considered for, but she
had a mortgage and couldn’t take a chance on a lower salary
to get in at the ground level of the “next new thing.”

She found herself becoming more cynical and snarky when

she was around their optimism, sometimes making cutting
remarks. She turned to playing games on her smartphone
instead of joining others at lunch to avoid drawing attention
to her own unhappiness with the state of her career.

The friends she played with online or even those who she
was randomly matched were impressed by her ability to get

80 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 80 11/01/18 5:20 PM

 the high score that showcased her impressive vocabulary.
She was also eager to help someone else with their virtual
farms. She was popular in her circles and she received lots
of warm praise.

Her work life frustrated her so she would often check in with
her gaming and social media friends more frequently through-
out the work day. This first was a matter of checking in during
lunch breaks as she began to avoid the chatty lunches with
her co-workers. It spilled over into more of her workday. As a
mini-reward for completing tasks, she’d give herself ten min-
utes of game time. Then it became a reliable alternative to
working on her assignments. Some of her colleagues that were
”friends” on social media made comments about her game play.
She found ways to adjust her settings so that only her gaming
friends saw her statuses that reported game achievements.

Unfortunately, these same friends could see her list of game

achievements if they visited her page. When the next round
of belt-tightening occurred at work, she was given notice that
her position was being eliminated. She was asked to train
one of the less-experienced staffers to take on her responsi-
bilities and given a termination date.

With losing her job, she found that gaming was a ­distraction
from dealing with her new financial reality. She avoided
her friends, not wanting them to know that she had lost
her job. She retreated more and more from outside life.
When nothing in her ”real” world looked hopeful, she
loved that online she was popular and that the games she
played had simple rules where her time was rewarded with
achievements.

Her sleep was affected by gaming in bed, the glow of her

cellphone screen and the constant notifications keeping her
brain waiting for the next update instead of calming down
at the end of the day. Without work to get her out of bed, she
got less and less exercise and always felt tired.

After receiving notice after notice from financial institutions

that her accounts were delinquent, she finally reached out

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 81

Video Game Addiction.indb 81 11/01/18 5:20 PM

 to her family for help. They insisted that a condition of their
help was that she would seek out help from a mental health
professional. Her primary care physician screened her for
depression and referred her to a psychiatrist.

After evaluation, Melissa started a program of anti-depres-

sants and talk therapy. The gaming was seen as both an
avoidance technique from her general dissatisfaction with
the direction of her career and life in general and as a way to
have many small pleasurable interactions that counteracted
the physical symptoms of depression that had become more
common in her everyday life.

Within six months of treatment, she found the energy to look

for work again and to work on getting writing assignments.
Melissa also got involved with a charity that tutored chil-
dren after school. On her therapist’s advice, she put herself
on a gaming and social media diet, and developed techniques
to divert her attention when the urge to turn to a game
comes on. One especially useful technique was to take a walk
around the block, do a load of laundry, or call a friend when
she found herself mindlessly reaching for the cell phone.

Based on an actual case study of video game addiction.

44. How can video game playing provide benefits for

older adults?
A Nature article titled: “Video Game Training Improves Cogni-
tive Control in Older Adults.” was summarized by Carol Torgan
in NIH Research Matters: (https://www.nih.gov/news-events/
nih-research-matters/video-game-training-improves-cognitive-
control-older-adults).

Researchers found that seniors who play a 3D video game

improve their ability to sustain focus and multitask successfully.
The results highlight the potential of the aging brain to improve
specific skills.

As we age, changes in our brain can affect our cognitive abilities

and memory. One function that may be altered is multitasking,

82 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 82 11/01/18 5:20 PM

 the ability to accomplish multiple goals simultaneously. Multi-
tasking behavior is becoming more common because of new tech-
nologies and demands. For example, you may type an email or
text message while talking on the phone. When driving a car,
you simultaneously perform numerous tasks, such as scanning
the road, steering, and using the brakes.

A team led by Drs. Joaquin A. Anguera and Adam Gazzaley from

the University of California, San Francisco, examined the abil-
ity of seniors to multitask and improve their cognitive control —
the ability to interact with a complex environment to accomplish
a goal. The study, funded in part by NIH’s National Institute on
Aging (NIA), appeared on September 5, 2013, in Nature.

The researchers first assessed multitasking ability in 174 par-

ticipants ranging in age from 20 to 79 years. Using a custom-
designed 3-D driving game, they found that multitasking perfor-
mance dropped linearly with increasing age.

To test whether older adults could improve multitasking ability,

the researchers randomly assigned 46 healthy adults, ages 60 to
85, to 1 of 3 groups: multitask training using the 3-D videogame,
single-task training using a similar videogame or no videogame
training. During multitask training, participants used a joystick
to maintain a moving car in the center of a winding road while
also responding to road signs that popped up. As participants
improved, the games got harder.

Seniors who played the multitasking game on a laptop at home

for one hour a day, three times a week for four weeks (12 hours
of total training) significantly improved their multitasking per-
formance index at the end of the training period. The levels
they achieved were superior to the levels achieved by a group
of untrained 20-year-olds. When the seniors who completed the
multitask training were tested six months later, the gains were
still present.

The researchers found that the multitask training resulted in gen-

eral improvements to cognitive abilities that are known to decline
with age, particularly working memory and sustained attention.
Using electroencephalography (EEG) to assess the neural basis of
the cognitive changes, they found changes in the prefrontal cortex
area of the brain, a region involved in cognitive control.

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 83

Video Game Addiction.indb 83 11/01/18 5:20 PM

 “The fiDEFINITION
nding is a powerful
DEFINITION
example ofNOTE
how plastic the older brain
is,” Gazzaley says, referring to the brain’s ability to adapt and
change. Follow-up studies will be needed to better understand
the neural basis for these performance changes.
TOOLS ON THE WEB PRACTICAL TIP
Compared to traditional interventions, serious games may help
older adults to improve their health by enhancing physical fit-
ness and coordinative abilities by combining increased motiva-
tion, game experiences like fun and game flow and training.
NOTE ALERT ON THE CD
Serious games, especially adven-
A paper in the journal European
ture and shooter games, already
Review of Aging and Physical play an important role in health
Activity described a broad range education, prevention and reha-
REFERENCE
of prevention and rehabilitation
ON THE WEB
bilitation, e.g., to enhance health-
QUESTION

benefits of playing video games by elderly related physical activity, improve

people. sensory-motor coordination, pre-
https://link.springer.com/article/10.1007/
vent asthma, change nutrition
s11556-011-0093-x
NOTE REFERENCE
behavior and alleviate diabetes
CONVERSATION

and prevent smoking or HIV.

45. How can virtual reality help in pain management?

HEART HEALTH ON THE WEB PRACTICAL TIP
The experience of pain is frequently related to physical causes, such
as inflammation or injury. However, pain is entirely subjective,
making management of pain difficult. Having patients play video
games during normally painful medical procedures has been looked
into as a non-pharmacological alternative to pain management.

Hunter Hoffman and David Patterson of the University of Wash-

ington School of Medicine teamed up to study the use of vir-
tual reality headsets in reducing pain with burn patients. They
understood that the sensation of pain has both physiological and
psychological components. If attention can be re-directed from
pain signals, pain can be significantly diminished. Diminished
pain occurs when patients are immersed in a three-dimensional
virtual world, thereby distracted from ordinarily painful proce-
dures during rehabilitation and wound care.

Following up on Dr. Hoffman’s work, a randomized clinical trial

was conducted with children who suffered severe burns. Chil-
dren who played virtual reality games during painful dressing
changes experienced less pain than children who received pain-
killing drugs alone.

84 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 84 11/01/18 5:20 PM

 46. Can virtual reality be useful in stroke rehabilitation?
A large percentage of stroke survivors continue to experience
motor deficits (problems with movement). Standard rehabili-
tation after stroke (physiotherapy and occupational therapy)
usually provide only modest benefits. Scientific advances have
shown the brain’s remarkable ability to heal itself through the
process of neuroplasticity. Recent studies have shown that for
rehabilitation to be effective it must be challenging, repetitive,
task-specific, motivating, prominent, and intensive. Conven-
tional rehabilitation has many limitations in meeting these cri-
teria, and there is often a shortage of rehabilitation providers
and services in many regions.

Virtual reality has been studied as a unique method of stroke

rehabilitation. The virtual reality method satisfies many of the
criteria for effective rehabilitation. The patients become engaged
in the games, costs can be reduced, and at times the games can
even take place at home.

A meta-analysis (a compilation of the

results of many studies) has shown Neuroplasticity: The
that virtual reality methods resulted in brain’s ability to reor-
ganize itself by forming
improvements in arm movement speed, DEFINITION DEFINITION NOTE
new neural connections
the range of joint motion, and force of
throughout life. Neuroplasticity
movement. These results are promis- allows the neurons (nerve cells) in
ing but only preliminary as the studies the brain to compensate for injury
did not compare the benefit of combin- and disease as well
TOOLS asWEB
ON THE to adjust PRACTICAL TIP
ing conventional therapy with virtual their activities in response to new
reality techniques. Also, most studies situations or to changes in their
included patients with mild to moder- environment.
ate stroke and did not assess the more NOTE ALERT ON THE CD
challenging severely affected patients.

REFERENCE ON THE WEB QUESTION

NOTE REFERENCE CONVERSATION

HEART HEALTH ON THE WEB PRACTICAL TIP

W h a t a re th e b e n ef it s of pl ay in g v i d e o gam e s? | C H A P T E R 9 85

Video Game Addiction.indb 85 11/01/18 5:20 PM

 TOOLS ON THE WEB PRACTICAL TIP

NOTE ALERT ON THE DVD

References and Endnotes

REFERENCE ON THE WEB QUESTION

CHAPTER 6

1. American Society of Addiction Medicine. “Public Policy State-

NOTE REFERENCE CONVERSATION
ment: Definition of Addiction.” (2011)
https://www.asam.org/resources/definition-of-addiction

2. Arias-Carrión,Oscar, Maria Stamelou, Eric Murillo-Rodríguez,

Manuel Menéndez-González, and Ernst Pöppel. “Dopaminer-
HEART HEALTH ON THE WEB gic reward
PRACTICAL system:
TIP a short integrative review. ”International
Archives of Medicine. 3, no.24 (Oct. 2010):1-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958859/

3. Baez-Mendoza, Raymundo and Wolfram Schultz. “The role of the

striatum in social behavior.” Frontiers in Neuroscience. 7, Article
233 (Dec. 2013):1-14.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857563/pdf/
fnins-07-00233.pdf

4. Gentile, Douglas, et al. “Pathological video game use among

youths: A two-year longitudinal study.” Pediatrics. 127(2011):
319-329.
http://pediatrics.aappublications.org/content/pediatrics/
early/2011/01/17/peds.2010-1353.full.pdf

5. Griffiths, Mark. “The Six Components of Addiction as Defined by

Mark Griffiths, PhD.” Word Press Blog.
https://tristanno.wordpress.com/2011/04/22/the-six-components-
of-addiction-as-defined-by-mark-griffiths-ph-d/

6. King, D. et al. “Distinguishing between gambling and gambling

activities in addiction research.” Journal of Behavioral Addic-
tions. 4, no. 4 (2015):215-220.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712754/

7. Li, Wen, Jennifer E. O’Brien, Susan M. Snyder, and Matthew O.

Howard “Diagnostic Criteria for Problematic Internet Use among
U.S. University Students: A Mixed-Methods Evaluation.” PLOS
One. Jan. 11, 2016.
http://journals.plos.org/plosone/article?id=10.1371/journal.
pone.0145981

8. Liau, A. et al. “Pathological video-gaming among youth: A pro-

spective study examining dynamic protective factors.” Addiction
Research & Theory.” 23, no. 4 (2015):301-308.
http://pediatrics.aappublications.org/content/pediatrics/
early/2011/01/17/peds.2010-1353.full.pdf

86 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 86 11/01/18 5:20 PM

 9. Wikipedia. “Anterior cingulate cortex.”
https://en.wikipedia.org/wiki/Anterior_cingulate_cortex

10. Parker, Laura. “Game Addiction: The Real Story.” Game Spot
(CBS Interactive) (2009)
https://www.gamespot.com/articles/game-addiction-the-real-
story/1100-6207309/

11. Sarkis, Stephanie. “Internet Gaming Disorder in DSM-5.” Psy-

chology Today. (2014)
https://www.psychologytoday.com/blog/here-there-and-every-
where/201407/internet-gaming-disorder-in-dsm-5

12. Scott, Jonathan & Alison Porter-Armstrong. “Impact of

Multiplayer Online Role-Playing Games upon the Psychosocial
Well-Being of Adolescents and Young Adults: Reviewing the
Evidence.” J Psychiatry. 2013 (2013) https://www.ncbi.nlm.nih.
gov/pubmed/24236279

13. Stevens, Francis, Robin Hurley, and Katherine Taber. “Anterior

Cingulate Cortex: Unique Role in Cognition and Emotion.” J
Neuropsychiatry Clin Neurosci 23, no.2 (Spring 2011):120-125.
http://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.23.2.jnp121

14. Thomas, Kathleen, Douglas Gentile, and Craig Anderson. “Violent

Video Game Effects on Brain Activation of High and Low Aggres-
sive Game Players” Center for the Study of violence conference.
Ames IA, Sept. 5, 2008. drdouglas.org/drdpdfs/CSV_Brain.pdf

15. Weigel, Margaret. “The contested field of violent video games:

Research roundup.” Journalist’s Resource. (2015).
https://journalistsresource.org/studies/government/criminal-jus-
tice/value-violent-video-games-research-roundup

16. Weissman, D. “Impacts of Playing Massively Multiplayer Online

Role-Playing Games (MMORPGs) on Individuals’ Subjective
Sense of Feeling Connected with Others.” Dissertation (2017)
Antioch University Repository and Archive. Santa Barbara.

Case Study

1. “8.5 percent of U.S. youth addicted to video games, study finds,”

Iowa State University, 2009. Retrieved from: https://www.
engadget.com/2009/04/20/8-5-percent-of-u-s-youth-addicted-to-
video-games-study-finds/

2. “Half of Germany’s adult population plays videogames,” Newzoo,

2011. Retrieved from: https://www.destructoid.com/half-of-ger-
many-s-adult-population-plays-videogames-208505.phtml

V i d e o G am e A d di c t i on | PA R T T W O 87

Video Game Addiction.indb 87 11/01/18 5:20 PM

 NOTE ALERT ON THE DVD

REFERENCE ON THE WEB QUESTION

CHAPTER 7

17. Das, D. et al. “The efficacy of playing a virtual reality game in

NOTE REFERENCE CONVERSATION
modulating pain for children with acute burn injuries: A random-
ized controlled trial.” BMC Pediatrics. 5, no. 1 (2005): 1-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC554986/

18. Doan, Andrew. “Hooked on Games: The Lure and Cost of Video
HEART HEALTH ON THE WEB Game and Internet
PRACTICAL TIP Addiction.” 2012. Book. Free Educational
DEFINITION DEFINITION NOTE
Publications International.
http://www.fepint.org/

19. Hoffman, Hunter. “Virtual Reality Therapy.” Scientific American

8 (2004) 58-65.
TOOLS ON THE WEB PRACTICAL TIP
www.scientifi camerican.com

20. Hoffman, Hunter. “Virtual Reality-Riding the Wave of Innovation

at UW Medicine.” UW Medicine. (2006):10-14.
http://www.hitl.washington.edu/research/vrpain/index_files/
NOTE ALERT UWMedicine.pdf
ON THE DVD

21. Liau, A. et al. “Pathological video-gaming among youth: A pro-

spective study examining dynamic protective factors.” Addiction
Research & Theory. 23, no. 4 (2015):301-308.
REFERENCE ON THE WEB http://ira.lib.polyu.edu.hk/handle/10397/43300
QUESTION

CHAPTER 9

22. Anguera, J. et al. “Video game training enhances cognitive control

NOTE REFERENCE CONVERSATION
in older adults.” Nature. 501, no. 7465 (2013):97-101.
https://www.nature.com/nature/journal/v501/n7465/full/
nature12486.html

23. Charlier, Nathalie, Nele Zupancic, Steffen Fieuws, Kris Den-

HEART HEALTH ON THE WEB haerynck,
PRACTICALBieke
TIP Zaman, Philip Moons. “Serious games for
improving knowledge and self-management in young people with
chronic conditions: a systematic review and meta-analysis.” J Am
Med Inform Assoc. (2016). 23:230-239.
https://www.ncbi.nlm.nih.gov/pubmed/26186934

24. DeShazo, Jonathan, Lynne Harris and Wanda Pratt. “Effective

Intervention or Child’s Play? A Review of Video Games for Dia-
betes Education.” Diabetes Technology & Therapeutics. (2010) 12,
no. 10:815-822.
http://online.liebertpub.com/doi/abs/10.1089/dia.2010.0030

25. Fernandez-Aranda, Fernando, et.al. “Video games as a comple-

mentary therapy tool in mental disorders: PlayMancer, a Euro-
pean multicentre study.” Journal of Mental Health. (2012 Aug).
21, no. 4: 364-374.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433177/

88 PA R T T W O | V i d e o G am e A d di c t i on

Video Game Addiction.indb 88 11/01/18 5:20 PM

 26. Granic, I., Lobel, A., and Engels, C. “The Benefits of Playing Video
Games.” American Psychologist. 69, no. 1 (2014):66-78.
http://www2.apa.org/pubs/journals/releases/amp-a0034857.pdf

27. Johnson, Daniel, Christian Jones, Laura Scholes, and Michelle

Carras. “Videogames and Wellbeing: A Comprehensive Review.”
Young and Well Cooperative Research Centre.
https://www.researchgate.net/publication/251478450_Video-
games_and_Wellbeing_A_Comprehensive_Review

28. Wiemeyer, Josef and Annika Kliem. “Serious games in prevention

and rehabilitation — a new panacea for elderly people?” Eur Rev
Aging Phys Act 9 (2012):41-50.
https://link.springer.com/article/10.1007/s11556-011-0093-x

29. Wikipedia. “Well-being.” (2017).

https://en.wikipedia.org/wiki/Well-being

V i d e o G am e A d di c t i on | PA R T T W O 89

Video Game Addiction.indb 89 11/01/18 5:20 PM

 RECOVERY FROM VIDEO
GAME ADDICTION
Splitshare (Pixabay)
SOURCE: https://pixabay.com/en/guitarist-acoustic-guitar-man-boy-407212/

Part 3 discusses the various treatment strategies for video

game addiction. After successful treatment, a crucial stage
of the gamer has arrived – how to recover his or her life
without falling back on addiction. Critical in this respect is
the necessity to change your way of thinking. You need to
find new activities (or revive old interests) that can fill in the
gap provided by gaming.

PART THREE

Video Game Addiction.indb 90 11/01/18 5:20 PM

 CHAPTER 10
Treating video game addiction

CHAPTER 11
Life after video game addiction

Video Game Addiction.indb 91 11/01/18 5:20 PM

 CHAPTER

10 Treating video game

addiction
47. What are the strategies for treating video game addiction?
Treatment of video game addiction is similar to other types of
addiction (even though it is not yet recognized as an addiction
by the American Psychiatric Association). The overall approach
is as follows:
• Individual and family counseling
• Behavior modification
– Cognitive behavioral therapy
– Dialectical behavioral therapy
– Acceptance and commitment therapy

48. What is discussed during counseling sessions?

Counseling sessions are an essential first step in understanding
the unique history of each addict, and to work out a treatment
plan. Psychotherapists attempt to help the addict understand
how gaming is related to their school or job, emotions and moods,
and sense of life goals and rewards.

A family-based approach aims to improve family functioning

while decreasing the behavioral problems of the addiction. A
family-based prevention should include skills training for par-
ents (or whoever is involved in the person’s treatment). It should
aim to improve communication skills related to the person’s
addiction. These communication skills include:
• Helping the addict develop social skills
• Helping family members reduce maladaptive family
function
• Fostering skills for healthy family interactions
• Sustaining effective family monitoring
• Promoting discipline within the addict

The skills training would be introduced and practiced in family

therapy sessions. Each member would work on strengthening
their own skill set to improve the whole family unit’s functioning.

92 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 92 11/01/18 5:20 PM

 49. Can co-existing disorders contribute to video
game addiction?
Several mental disorders can contribute to video game addic-
tion. Identifying any underlying causes of the addiction is essen-
tial. The following are principal co-existing disorders:
• Obsessive Compulsive Disorder: People with OCD feel
the need to check things repeatedly, or have certain
thoughts or perform routines and rituals over and
over. The thoughts and rituals associated with OCD
cause distress and get in the way of daily life. The
frequent upsetting thoughts are called obsessions. To
try to control them, a person will feel an overwhelming
urge to repeat certain rituals or behaviors called
compulsions.
• Generalized Anxiety Disorder: The person exhibits
excessive anxiety and worries about some events or
activities extending over a period of many months. The
disorder leads to significant distress or impairment in
social, occupational, or other daily activities.
• Attention-deficit/hyperactivity disorder (ADHD):
ADHD often begins in childhood and can persist into
adulthood. The symptoms of ADHD include attention
difficulty, hyperactivity, and impulsiveness.
ADHD is thought to involve deficits in dopamine
release in the prefrontal cortex, similar to video game
addicts. A study (Chan 2006) found that adolescents
who play more than one hour of console or Internet
video games may have more or more intense symptoms
of ADHD or inattention than those who do not.
However, these findings are just an association and do
not show that playing video games leads to an increase
in ADHD symptoms, or if adolescents with more
ADHD symptoms tend to spend longer times playing
video games. Methylphenidate is a stimulant used to
treat ADHD. A study (Han 2009) was conducted to
see if the drug could be used to treat gaming addicts
who also have ADHD. The authors cautiously suggest
that methylphenidate be evaluated to treat internet
addictions.

T re a t in g v i d e o gam e a d di c t i on | C H A P T E R 10 93

Video Game Addiction.indb 93 11/01/18 5:20 PM

 50. Should you consider a support group for treatment and
recovery from video game addiction?
A support
DEFINITIONgroup is a DEFINITION
community of people
NOTE who are suffering from
or recovering from video game addiction. The websites of some
major support groups are as follows:
• Computer
TOOLS
Gaming Addicts Anonymous (CGAA) — cgaa.info
ON THE WEB PRACTICAL TIP

CGAA groups share their collective experience and the princi-

ples that helped them, but CGAA has no dogma, no teachings, no
gurus, and no rules. Their members usually do not advise each
NOTE ALERT
other. They share personal expe-
ON THE CD

rience, strength, and hope, and

To watch YouTube stories of
gamers who have recovered are free to try out or disregard
through the CGAA programs, the suggestions of the program
visit: REFERENCE ON THE WEB and other
QUESTION members. CGAA has a

https://www.youtube.com/channel/ Twelve Traditions patterned after

UCLjD3R2yJ5wriHFY7XdjDBg Alcoholics Anonymous that serve
as guidelines for their activities.
• OLG-Anon (Online Gamers Anonymous) — www.onganon.org
NOTE REFERENCE CONVERSATION

On-Line Gamers Anonymous®, founded in 2002, is a self-

help fellowship. OLG-anon members share their experiences,
strengths and hopesONin
HEART HEALTH order to help
THE WEB each
PRACTICAL TIP other recover and heal

from problems caused by excessive game playing, whether the

playing takes place by computer, video, console, or online. The
community includes Recovering gamers (OLGA members), Fam-
ily members, loved ones, friends, concerned others (OLG-Anon
members), and those who Educate and reach out to others (Out-
reach members).

After registering to the site, various programs such as forums,

chat rooms, and meetings are available.
• Anxiety Gaming — http://anxietygaming.com
Anxiety Gaming focuses on providing affordable consultation
services through its professional staff.

51. What are the barriers that prevent gamers from

overcoming their addiction?
Gamers continue gaming due to emotional attachments that
override decisions based on rationality or good judgement. Two

94 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 94 11/01/18 5:20 PM

 types of attachments are important causes for gamers to con-
tinue gaming:
1. Sunk Cost Fallacy: Sunk cost focuses on past cost
rather than future utility. (Leahy 2014) This fallacy
causes gamers being reluctant to give up gaming due to
the commitments they have made in time, money, and
effort in gaming. Even though the gamer may realize
their future would be better without gaming, the gamer
does not want to feel they have wasted all that effort.
2. Loss aversion: People are more sensitive to loss than
the prospect of gain. This tendency causes gamers to
continue gaming rather than to lose the characters
they have developed or the money they spent on games.

52. What actions can you as a gamer take to

overcome your addiction?
An essential action you can take as a gamer is to acknowledge
that you have an addiction and must take steps to overcome the
problem. To minimize the temptation to game, the following
steps should be taken:
• Uninstall your games
• Delete your accounts and unsubscribe from gaming
channels
• If you have gaming consoles, they should be sold or given
away

53. Does video gaming lead to depression?

The New York Times reported on two studies that seem to indi-
cate that excessive video gaming may lead to depression. How-
ever, noted video gaming expert Dr. Douglas Gentile stated that
his research does not show this effect. Instead, he says that in
young people video game addiction and a range of mental health
problems may develop in tandem.

54. What is cognitive-behavioral therapy?

Cognitive behavioral therapy (CBT) focuses on the develop-
ment of personal coping strategies that target solving current
problems and changing unhelpful patterns in cognitions (e.g.

T re a t in g v i d e o gam e a d di c t i on | C H A P T E R 10 95

Video Game Addiction.indb 95 11/01/18 5:20 PM

 thoughts, beliefs, and attitudes), behaviors, and emotional regu-
lation. It was initially designed to treat depression and is now
used for some mental health conditions. A review article found
that CBT is quite widely used to treat video game addiction.(Igor
Lemos 2014) CBT is a psychosocial approach that looks at the
combined influence of psychological factors and the surrounding
social environment have on the individual’s physical and mental
wellness as well as their ability to function.

CBT model combines basic principles from behavioral and cogni-

tive psychology. It is different from historical approaches to psy-
chotherapy, such as the psychoanalytic approach where the ther-
apist looks for the unconscious meaning behind behaviors and
then formulates a diagnosis. Instead, CBT is “problem-focused”
and “action-oriented,” meaning it is used to treat specific prob-
lems related to a diagnosed mental disorder. The therapist’s role
is to assist the patient in ­finding and practicing effective strate-
gies to address the identified goals and decrease symptoms of
the disorder. CBT is based on the belief that thought distortions
and maladaptive behaviors play a role in the development and
maintenance of psychological disorders, and that symptoms and
associated distress can be reduced by teaching new information-
processing skills and coping mechanisms.

Modern forms of CBT include a variety of diverse but related

techniques such as exposure therapy, stress inoculation, cogni-
tive processing therapy, cognitive therapy, relaxation training,

FIGURE 10.1
This diagram depicts how
emotions, thoughts, and
behaviors all influence
each other. The triangle
in the middle represents
CBT’s tenet that all
humans’ core beliefs can
be summed up in three
categories: self, others,
future.
CREDIT: Urstadt
https://en.wikipedia.org/
wiki/Cognitive_behavioral_
therapy#/media/
File:Depicting_basic_
tenets_of_CBT.jpg

96 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 96 11/01/18 5:20 PM

 dialectical behavior therapy, and acceptance and commitment
therapy. Some practitioners promote a form of mindful cognitive
therapy which includes a greater emphasis on self-awareness as
part of the therapeutic process.

55. What is dialectical behavioral therapy?

Dialectical behavior therapy (DBT) treatment is a cognitive-
behavioral approach that emphasizes the psychosocial aspects
of treatment. The theory behind the approach is that some peo-
ple are prone to react in a more intense and out-of-the-ordinary
manner toward certain emotional situations, primarily those
found in romantic, family and friend relationships. DBT theory
suggests that some people’s arousal levels in such situations
can increase far more quickly than the average person’s, attain
a higher level of emotional stimulation, and take a significant
amount of time to return to baseline arousal levels.

DBT has the following characteristics:

• Support-oriented: It helps a person identify their
strengths and builds on them so that the person can feel
better about him/herself and their life.
• Cognitive-based: DBT helps identify thoughts, beliefs,
and assumptions that make life harder: “I have to be
perfect at everything.” “If I get angry, I’m a terrible
person.” DBT helps people to learn different ways of
thinking that will make life more bearable: “I don’t
need to be perfect at things for people to care about me.”
“Everyone gets angry; it’s a normal emotion.”
• Collaborative: It requires constant attention to
relationships between clients and staff. In DBT
people are encouraged to work out problems in their
relationships with their therapist and the therapists to
do the same with them. DBT asks people to complete
homework assignments, to role-play new ways of
interacting with others, and to practice skills such as
soothing yourself when upset. These skills, a crucial part
of DBT, are taught in weekly lectures, reviewed in weekly
homework groups, and referred to in nearly every group.
The individual therapist helps the person to learn, apply
and master the DBT skills.

T re a t in g v i d e o gam e a d di c t i on | C H A P T E R 10 97

Video Game Addiction.indb 97 11/01/18 5:20 PM

 56. What is acceptance and commitment therapy?
The objective of ACT is not elimination of difficult feelings;
instead, it is to be present with what life brings us and to “move
toward valued behavior.” Acceptance and commitment therapy
invites people to open up to unpleasant feelings, learn not to over-
react to them, and not avoid situations where they are invoked.
Its therapeutic effect is a positive spiral where feeling better
leads to a better understanding of the truth. In ACT, “truth” is
measured through the concept of “workability,” or what works
to take another step toward what matters (e.g., values, mean-
ing). For example, actively creating valued interactions with the
kids would lead the parent to feel more satisfaction, which in
turn, would help create more valued interactions.

ACT differs from traditional cognitive behavioral therapy (CBT)

in that rather than trying to teach people to better control their
thoughts, feelings, sensations, memories, and other private
events, ACT teaches them to “just notice,” accept, and embrace
their private events, especially previously unwanted ones. ACT
helps the individual get in contact with a transcendent sense of
self-known as “self-as-context” – the you that is always there
observing and experiencing and yet distinct from one’s thoughts,
feelings, sensations, and memories. ACT aims to help the indi-
vidual clarify their values and to take action on them, bringing
more vitality and meaning to their life in the process, increasing
their psychological flexibility.

While Western psychology has typically operated under the

“healthy normality” assumption which states that by their
nature, humans are psychologically healthy, ACT assumes,
rather, that psychological processes of a normal human mind
are often destructive. The core conception of ACT is that psy-
chological suffering is usually caused by experiential avoidance,
cognitive entanglement, and resulting psychological rigidity
that leads to a failure to take needed behavioral steps in accord
with core values. As a simple way to summarize the model, ACT
views the core of many problems to be due to the concepts repre-
sented in the acronym, FEAR:
• Fusion with your thoughts
• Evaluation of experience
• Avoidance of your experience
• Reason-giving for your behavior
98 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 98 11/01/18 5:20 PM

 The healthy alternative is to ACT:
• Accept your reactions and be present
• Choose a valued direction
• Take action
ACT commonly employs six core principles to help clients develop
psychological flexibility:
• Learning methods to reduce Reify is to make (something
the tendency to reify thoughts, abstract) more concrete or
images, emotions,
DEFINITION and DEFINITION NOTE real.
memories.
• Acceptance: Allowing thoughts to come and go without
struggling with them.
• Contact withTOOLS the present moment:
ON THE WEB Awareness
PRACTICAL TIP of the
here and now, experienced with openness, interest, and
receptiveness.
• Observing the self: Accessing a transcendent sense of
self, a continuity
NOTE of consciousness
ALERT which isCDunchanging.
ON THE

• Values: Discovering what is most important to oneself.

• Committed action: Setting goals according to values and
carrying them out responsibly.
REFERENCE ON THE WEB QUESTION

57. Do medications have a place in treating video

game addiction?
Medications haveNOTEa place in controlling
REFERENCE extreme behavior associ-
CONVERSATION

ated with video game addiction. It should be remembered, how-

ever, that medications treat outward symptoms, but do not over-
come the underlying causes of the addiction.
HEART HEALTH ON THE WEB PRACTICAL TIP
The medications described in Questions 58–61 have been used to
treat other types of addiction or psychological problems. Since med-
ications to treat video game addiction have not been specifically
studied, researchers and physicians have used medications that act
on metabolic processes involved in other psychological conditions.

58. Is bupropion useful in treating video game addiction?

Bupropion is a medication primarily used as an antidepressant
and smoking cessation aid. Bupropion has also been used as a
treatment for attention deficit hyperactivity disorder (ADHD)
with reports of positive results in both minors and adults.

T re a t in g v i d e o gam e a d di c t i on | C H A P T E R 10 99

Video Game Addiction.indb 99 11/01/18 5:20 PM

 Bupropion is thought to act as a dopamine reuptake inhibitor.
Bupropion, therefore, increases the concentration of dopamine
in the brain, stimulating the reward center.

Major depression is considered to be one of the more prevalent

comorbid (occurring together) disorders in adolescents with prob-
lematic online gaming. Studies have shown that administration
of bupropion during game playing reduced the time of game play
as well as symptoms of depression. Additionally, problematic
game play continued to be reduced for at least four weeks after
bupropion was discontinued.

59. Is escitalopram useful in treating video

game addiction?
Escitalopram is a selective serotonin reuptake inhibitor that
is used to treat depression and generalized anxiety disorder
(GAD). A study was conducted to see if administration of esci-
talopram during internet gaming would reduce time of gaming.
The results indicated that escitalopram reduced time of gaming
during treatment, but the difference was not maintained after
treatment was discontinued.

60. Is naltrexone useful in treating video game addiction?

Naltrexone is usually used to treat opioid or alcohol addiction.
It has found some application to treat video game addiction as it
blocks the reward center of the brain.

61. Does combination therapy have a place in treating

video game addiction?
In a study conducted in Brazil, patients with Internet addiction
were treated with a combination of medications and psychotherapy.
Patients received medications prescribed by physicians to treat
panic disorder, generalized anxiety disorder, and Internet
addiction. The patients also received cognitive-behavioral ther-
apy. All the patients in this small study felt very positive about
their treatments. The limitation of this study was that it could
not determine additive effects since all patients received both
medications and psychotherapy, not one type of treatment or
the other.

100 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 100 11/01/18 5:20 PM

 CHAPTER

Life after video game 11

addiction
Overcoming addiction is only the first step in the gamer’s life. He
or she must develop a plan to reduce the real possibility of relapse.
The plan must recognize the reasons for the gamer’s addiction
and provide replacement activities to satisfy these needs.

62. How do you change your way of thinking

about gaming?
To start thinking as if you are not addicted, focus on the following:
• Separate yourself emotionally from gaming-no
attachments to gaming.
• Reserve absolute terms like “must do” for real-life events
only
• Be present in the moment. Do not think about gaming
while doing daily activities.
• Dismiss all online social obligations related to gaming.
After all, you are going to develop a new social life in the
real world.

63. Should parents allow video gaming to be reintroduced

to their child?
Access to the Internet is ubiquitous, so it is unrealistic to think
that the child will not be exposed to video games. Every child is
unique in their causes for video game addiction, and how they
can control their impulses after treatment. It is best to proceed
slowly, and see how the child adapts to his or her life after
recovery. In the early stages after recovery, emphasis should be
placed on adapting to a new lifestyle (or restoring the lifestyle
that existed before addiction).

After one month, the recovering gamer may be allowed to play

at an arcade or may use a hand-held or Console system. Online
gaming involving MMORPG games and role-playing should be
prohibited. Playing with friends should be encouraged, but no
online friends should be permitted.

L ife af t e r v i d e o gam e a d di c t i on | C H A P T E R 11 101

Video Game Addiction.indb 101 11/01/18 5:20 PM

 As time goes on, the recovering gamer can begin to control the
amount of their gaming. Parents can monitor the situation to be
sure the child’s gaming does not begin to interfere with school,
family relations, or social activities. Some recovering gamers
may be able to control limited online gaming.

64. Why is developing new interests and passions important

for the recovering gamer?
When gamers have overcome their addictions, a void in their life
occurs. Gamers are drawn to video games to fill certain needs
in their lives. An important need is the feeling that they are in
DEFINITION
control of their lives.DEFINITION NOTE
These needs must be filed by new activities
to avoid being drawn to gaming again.

The following are the needs that gaming fulfills:

• Temporary
TOOLS
Escape:
ON THE WEB
They help you escape from the stress
PRACTICAL TIP

in your life.
• Social: They give you a sense of community and most (if
not all) your friends play.
NOTE ALERT
• Constant
ON THE CD Measurable
Growth: You see progress and
For ideas on developing new
interests to replace video gam- receive feedback and instant
ing, visit gamequitters.com, and gratification.
download the pdf file “60+New
REFERENCE
Hobby Ideas.” A list of activities
ON THE WEB • Challenge:
QUESTION You have a
categorized as active, resting, social, and structured way to find your
achievement based are presented. sense of purpose, a goal and
mission to work towards.
NOTE REFERENCE CONVERSATION

65. What type of activities should you pursue to replace

video gaming?
• The activity should be mentally engaging — Gamers
have been characterized
HEART HEALTH ON THE WEB
as being “in the zone” (Question
PRACTICAL TIP

43 and Note on page 59). Being mentally engaged has

important advantages in academic achievement and
other successes in life, but can be detrimental in gaming.
• The activity should be restful (but not mindless) when
you are tired from the day.
• The activity should replace the social activities of gaming
(particularly MMORPG games). You should seek to make
new friends that are not involved in gaming.

102 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 102 11/01/18 5:20 PM

 Once gaming addiction is put aside, you have the opportunity to
begin your life anew. Always question your sense of direction to
see if it can be improved. Consider the following:
• What makes me happy and good about myself?
• Do I have friends that are supportive and rewarding?
• Does my work give me a sense of satisfaction?
66. Does video gaming have any place for
the recovering addict?
With the ubiquitousness of the Internet and Internet gaming,
it is unrealistic that the recovering gamer can entirely avoid
exposure to video gaming. Initially, it will be necessary to self-
impose (with the help of family and friends) strict limits on video
gaming. After gamers begin to become confident in their recov-
ery, they can begin to play games casually. The games should
not require a strong emotional commitment (such as MMORPG
games).

L ife af t e r v i d e o gam e a d di c t i on | C H A P T E R 11 103

Video Game Addiction.indb 103 11/01/18 5:20 PM

 TOOLS ON THE WEB PRACTICAL TIP

NOTE ALERT ON THE DVD

References and Endnotes

REFERENCE ON THE WEB QUESTION

CHAPTER 10

1. Chan, Philip and Terry Rabinowitz. “A cross-sectional analysis of

NOTE REFERENCE CONVERSATION
video games and attention deficit hyperactivity disorder symp-
toms in adolescents.” Annals of General Psychiatry.”5 (2006):1–10.
https://annals-general-psychiatry.biomedcentral.com/
articles/10.1186/1744-859X-5-16

HEART HEALTH ON THE WEB 2. Dell’Osso,

PRACTICALB.
TIP et al. “Escitalopram in the treatment of impulsive-

compulsive internet usage disorder: an open-label trial followed

by a double-blind discontinuation phase.” J Clin Psychiatry. 69,
no. 3 (2008):452–6.
https://www.ncbi.nlm.nih.gov/pubmed/?term=18312057

3. Han, Doug, et al. “The effect of methylphenidate on Internet video

game play in children with attention-deficit/hyperactivity disorder.”
http://www.comppsychjournal.com/article/S0010-440X(08)00123-5/
abstract

4. Han, Doug and Renshaw, P. “Bupropion in the treatment of

problematic online game play in patients with major depressive
disorder.” J Psychopharmacol. 26, no. 5 (2012):689-696.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638175/pdf/
nihms734110.pdf

5. Leahy, Robert. “Letting Go of Sunk Costs.” Psychology

Today. (2014) https://www.psychologytoday.com/blog/anxiety-
files/201409/letting-go-sunk-costs

6. Lemos, Igor, Cristiano de Abreu, and Everton Sougey. “Internet

and video game addictions: a cognitive behavioral approach.”
Archives of Clinical Psychiatry (Sao Paulo). 41, no. 3 (2014):82-88.
http://www.scielo.br/pdf/rpc/v41n3/0101-6083-rpc-41-3-0082.pdf

7. Przybylski, A., Netta Weinstein, & Kou Murayama. “Internet

Gaming Disorder: Investigating the Clinical Relevance of a
New Phenomenon.” American Journal of Psychiatry. 174, no. 3
(2017):230-236.
http://ajp.psychiatryonline.org/doi/full/10.1176/appi.
ajp.2016.16020224

8. Rabin, Roni “Video Games and the Depressed Teenager.” NY

Times-Well. (Jan. 11, 2011)
https://well.blogs.nytimes.com/2011/01/18/video-games-and-the-
depressed-teenager/?mcubz=3&_r=0

104 PA R T T H R E E | R e c ov e r y f r om V i d e o G am e A d di c t i on

Video Game Addiction.indb 104 11/01/18 5:20 PM

EFINITION DEFINITION NOTE

TOOLS ON THE WEB PRACTICAL TIP

9. Santos, Veruska, et al. “Treatment of Internet Addiction with

Anxiety Disorders: Treatment Protocol and Preliminary Before-
NOTE ALERT After ON
Results
THE DVD Involving Pharmacotherapy and Modified Cognitive

Behavioral Therapy.” JIMR Res Protoc. 5, no. 1 (2016):e46

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822035/

10. Wikipedia. “Acceptance and Commitment Therapy.” (2017).

EFERENCE ON THE WEB https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy
QUESTION

CHAPTER 11

11. Game Quitters. “Respawn-v4” and “60-Hobby-Ideas-v3.” (2017)

NOTE REFERENCE CONVERSATION
https://gamequitters.com

12. Waite, Terry. “Plugged In: A Clinicians’ and Families’ Guide to

Online Video Game Addiction.” Book (2007). Publish America.
Baltimore.
ART HEALTH ON THE WEB PRACTICAL TIP

R e c ov e r y f r om V i d e o G am e A d di c t i on | PA R T T H R E E 105

Video Game Addiction.indb 105 11/01/18 5:20 PM

 Index
A massively multiplayer online
game
acceptance and commitment
World of Warcraft, 16
therapy, 98
massively multiplayer online
addiction
game, 15–17
characteristics, 31
mobile game, 7
gambling addiction, 30
play session, 19
physiological basis, 30
role-playing game, 13–14
types of addiction, 35
virtual reality game, 7–8
avatar, 20
video game addiction
anterior cingulate cortex, 58
C co-existing disorders
cognitive-behavioral therapy, 95 attention-deficit/
console game, 5 hyperactivity disorder, 93
generalized anxiety
D disorder, 93
dialectical-behavioral therapy, 97 obsessive-compulsive
disorder, 93
F dopamine, 30
family counseling, 92
family environment, 67 medications
control video gaming, 67 bupropion, 99–100
combination therapy, 100
H escitalopram, 100
handheld gaming device, 5 overcoming addiction, 101
personal strengths protect
I against, 66–67
Internet Gaming Disorder physiological basis, 56–57
symptoms, 32 Proteus effect, 66
psychological basis, 72–73
P questions to assess addiction,
33–34
platform, 4 recovery
developing new interests, 102
V replacement activities, 101
video game related to real-life violence?,
action game, 9–10 40–41
action-adventure game, 12–13 signs and symptoms, 35–40
adventure game, 11–12 support groups, 94
arcade game, 6–7 Tetris effect, 65
definition, 4 visual effect, 64–65
history, 18 withdrawal symptoms, 35–36

106 INDEX

Video Game Addiction.indb 106 11/01/18 5:20 PM

 Video game addiction develop mindfulness
APA position, 31–32 meditation, 79
video gamer patient education, 75–77
human needs satisfied, 61–62 promote well-being, 77–78
video gamers psychological problems,
classification, 22 72–75
statistics, 22–23 virtual reality
video gaming pain management, 84
benefits, 82–84 stroke rehabilitation, 85
cognitive control, 83

INDEX 107

Video Game Addiction.indb 107 11/01/18 5:20 PM