In the past, I’ve applauded when the AMA called for more research on the issue before formally deciding to declare video game addiction diagnosable. I’ve been delighted with researchers’ efforts to distinguish between the “addictive” elements surrounding online gambling and traditional role playing games. Finally, my position piece on the issue, Video Game Addiction: Fact or Fiction, remains popular and is currently first to show up on Google searches for “video game addiction fiction,” and fourth on “video game addiction fact.”

So now, the time approaches for the DSM to be modified. One major development in the issue of video game addiction has been to roll it into a broader category of Internet addiction. Since most games these days are online, this sort of makes sense. Overuse of all types of screen time, though, might challenge the definition a bit. If a child spends too much time playing a game that is not connected to the Internet, could he be diagnosed as addicted to the Internet? You can see the difficulties.

Fortunately, the committee in charge of revisions sees the difficulties, too. News this week indicates that gambling will be included in DSM-V as a behavioral disorder, but Internet addiction will not. It will be relegated to an appendix in order to encourage more research, and possible future inclusion in DSM-VI. Of course with so many years between revisions, the relationships we’ve developed with Internet technology may substantially change by that time. Social networking hardly existed just a few years ago, after all.

So, this is a good thing. I’m glad this blog played a part, however small, in the discussion on video game addictions and the struggle over defining it. The public can comment on the proposed revisions to the DSM here, through April. DSM-V is scheduled to be published in 2012-2013, after field trials have been conducted on new and revised diagnoses.

References:
Gever, J. (2010, February 10). DSM-V draft promises big changes in some psychiatric diagnoses. [Online.] Available: http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/18399

More than 10 million of the country’s 100 million teenage web surfers are internet addicts, a survey by the China Youth Internet Association found last year. China has more than 338 million internet users, more than the entire population of the United States. Zhang Zhao , a Beijing-based mental health specialist with 15 years’ experience, told the South China Morning Post: “I can tie my patients to the chair in front of me, but I cannot unlock their hearts. Nobody can cure addicts without their co-operation.”

Recently the Health Ministry in China banned the use of electro-shock therapy in videogame and Internet “addiction” treatment. This article illustrates an extreme example of a misplaced emphasis on “addiction” to Internet and gaming. A far better term is “overuse.”

Certainly, beating to the point of death, or shocking someone, or otherwise torturing them to give up video games or Internet browsing is uncalled for in “treatment” of “addicts.” Read more on my thoughts on the matter here.

Parents are often concerned their children are playing addicting games. A new study offers clues to help determine if video games can be truly “addictive,” or are simply a preferred entertainment venue that crowds out other activities.

[For reprinting rights, contact John Rice.]

Another salvo has been fired in the war over video game addiction. In one camp are non-believers, who feel video games players may be impulsive but never truly addicted in the traditional sense. Their argument goes something like this: drug addicts are addicted because they have chemical dependencies. Video game players do not have a chemical dependency with the games, therefore they cannot be addicted in the sense most people define the word.

On the other side are true believers in video game addiction. They postulate an addiction can occur without drugs when the action involved harms the persons and/or those around them. Their strongest argument for video game addiction has revolved around linking video games with online gambling.

This is the strongest point the pro-video game addiction crowd has, that like gambling too much game play can be detrimental. But from there the argument loses steam. Someone addicted to gambling suffers clear detrimental consequences, mainly extreme loss of money. Gambling addicts have been known to lose their homes, jobs, spouses, and every dime that comes their way chasing the next opportunity to wager. Kids, or even adults, who like to while away their time on the latest video game rarely come close to that level of detrimental effect.

Nonetheless, many parents worry their kids are “addicted” to video games. Their children may get hold of a new title and disappear behind a monitor for hours on end. In some cases, grades and social opportunities may suffer due to intense game play, especially among adolescent boys.

But is this a true addiction? Does the overuse of video games lead to such negative life consequences that it should rank with gambling, nicotine, heroin and other drugs? Someone can overdose on heroin and die. Is it easy for someone to overdo a night of game play to the point it kills them? Should we be equating heavy video game playing with heroin addiction? Or is this simply a parental issue, something parents can simply pull the plug on if they feel their children play too much?

Ultimately, this is simply a war on terms. Using the proper term helps us to understand exactly what is being discussed. And to help nervous parents answer the above questions: no, a heavy video game player does not sink to the same level of addiction as a heroin addict.

The latest round in this ongoing discussion comes from a paper soon to be published in the journal Psychological Science by Douglas A. Gentile at Iowa State University. Dr. Gentile’s specialty is studying the effects of media. He has written or co-written several papers examining both the benefits and detrimental effects of videogames. Recently he co-authored a book, Violent Video Game Effects on Children and Adolescents: Theory, Research, and Public Policy, examining how violent video games may lead to proclivities in players for real life violence.

His latest study tackles a national survey of more than 1,100 youths by Harris Polls and looks at their self-reported video gaming habits. The survey used sets of questions, including one published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) designed to measure pathological gambling that had been modified for video games. This set included 11 questions such as, “Have you tried to play video games less often or for shorter periods of time, but are unsuccessful?” and, “Do you sometimes skip household chores in order to spend more time playing video games?” and, “Have you ever needed friends or family to give you extra money because you spent too much money on video-game equipment, software, or game/Internet fees?” Respondents replied with “yes,” “no,” or, “sometimes.”

Of course, answering yes or sometimes to one or a few of these questions did not automatically shunt a respondent into the pathological column. The bar was set at six positive replies, with “sometimes” counting as a half “yes.” Using that measurement, Genitle found almost 12% of boys surveyed qualified as “pathological” video game players, and almost 3% of girls, for a grand total of 8.5% of all respondents. There also seemed to be a correlation with students who performed poorly in school being more likely to rate as pathological game players.

Gentile reasoned video game players with pathological playing tendencies may be “behaviorally addicted.” Ultimately, he noted there is strong debate as to whether or not video games can be truly considered a behavioral addiction or not, and readily admitted his study would not resolve the question. The survey’s strongest element was its national scope, he wrote, but both the survey and his study were far from resolving the question of video game “addiction.”

Reaction in the media was swift. In light of the fact a national survey apparently indicated 8.5% of American children are “addicted” to video games, headlines quickly trumpeted the news. A backlash also developed. Renowned video game research blogger Wai Yen Tang noted the Harris Polls product was a self-reported Internet survey. The “yes,” “no,” or “sometimes” response on the modified scale seemed to be simplistic as a diagnostic tool and suggested professional follow up would be needed before any individual could be properly diagnosed. Jerald Block at Oregon Health Science University was quoted by USA Today, cautioning that the respondents placed in the pathological category were placed there without physician interviews. Nancy Shute at US News and World Report wrote that if avoiding chores and homework were signs of video game addiction, then she was definitely addicted to reading.

Despite proponents’ comparisons, there is no accepted diagnosis for video game addiction as there is for pathological gambling. Therefore, as far as the American Psychiatric Association (APA) is concerned, it does not officially exist. This has not stopped members from debating the issue, though, as efforts on the newest revisions to the DSM continue. In the APA’s 2007 annual meeting, a subcommittee studying the research on video games recommended using the term “overuse,” rather than “addiction,” and called for much more research before including excess video game playing as a diagnosable disorder.

Clearly there is a difference between behavioral addictions and chemical dependencies, and here is where terms matter. If a person can be chemically addicted to heroin, and behaviorally addicted to gambling, we should differentiate. Thus, the term “addiction” should be reserved for chemical dependencies. Gambling problems should fall under the term “pathological.” Playing video games to excess should be termed “overuse.” The overuse of videogames may result in lost sleep and delayed homework, but will usually not result in mortgaging the house for the next round of bets (e.g., pathological gambling) or in accidental overdoses resulting in death (e.g., heroin addiction).

Understanding the differences between the terms and resolving to use them in discussions about these issues should go a long way toward eliminating misunderstandings about players and their occasional overuse of video games.

Update:
Safad0 at GameSpot has a good discussion based on this article here.

Update:
Take a look at this class assignment over at UC Santa Cruz. Students had to take sides on the video game addiction debate. This article is cited. Lots of Wikipedia references, but there are a few other good articles on both sides of the debate the students uncovered.

Update:
Good news on DSM-V.

Richtel focuses on several college students and twenty-somethings who profess to barely have enough money to eat each month, but are more than willing to shell out $60 for GTA IV (or $90 for the collectors’ edition). Sales of five million copies are expected in coming days.

The so-called addictive nature of games is also brought up, with quotes from the only academic in the article:

“When gamers are in it, it’s like a druglike state. It feels so good,” said Jennifer Aaker, a professor at the Haas School of Business at the University of California at Berkeley. She said players face constant challenges and receive instant feedback, a superstimulating artificial environment.

Not only is the play experience emotional, but the purchase is emotional, too, Professor Aaker said. Players want to be the first to buy the game and master it, sweeping aside the matter of affordability.

“The last thing that comes to mind is: ‘Can I afford it?’ That question isn’t even on the radar,” Professor Aaker said. “The question is: How fast can I buy it?”

Not mentioned, but clearly related to the popularity of the series is its wide-open world approach, wherein players are not required to follow any set rules or instructions. Instead, players can simply do what they want in the environment. Such approaches are also popular in MMORPGs such as World of Warcraft.

Another interesting tidbit Richtel referenced in the article is the fact the gaming industry is booming despite hardships felt elsewhere such as rising food and fuel costs. Sales of consoles and titles are up across the board; GameStop excels while other retailers suffer.

References:
Richtel, M. (2008, April 29). For gamers, the craving won’t quit. New York Times. [Online.] Available: http://www.nytimes.com/2008/04/29/technology/29game.html?

A Randomized Controlled Study of the Effectiveness of Casual Video Games in Reducing Stress and Improving Mood
Carmen Russoniello, Eastern Carolina University

Should “Videogame Addiction” be in DSM-V?
Jack Kuo, Promises Treatment Centers

The World of Warcraft Blood Disease : Epidemiological Observations and Findings
Nina Fefferman, Tufts University

PDwii: Using Novel Interfaces to Promote Physical Rehabilitation & Achieve Quantifiable Results
Red Hill Studios

The one by Fefferman on the WoW disease will be intriguing because it will attempt to show how dynamic virtual environments can represent RL phenomena. I’ve covered Wii-hab, stress reduction, and the question of including videogame “addiction” in DSM-V here. (In a word, the answer to this question is, “No.”)

There are many more sessions, and all of them look inviting. The Games for Health conference is always chock full of good content, and this year will be no exception.

The electronic device was a product called TV Allowance from Mindmaster, Inc. The device resided between the television or computer and the wall plug, requiring a four digit code for access. The experimental group agreed to have the device installed and secured in place by university personnel.

Weekly limits for the experimental group were set from a baseline, and decreased regularly until the limits reached 50% of the baseline. Once the budgeted time was reached, the machine (TV or computer) could no longer be turned on for the remainder of the week. Additional monetary incentives were offered to the children at the rate of $0.25 per half hour under their weekly budget, up to $2.00. Research staff and parents also offered praise to the children for coming in under budget on their screen time. Staff sent a newsletter to parents offering sample praise and activity suggestions. Meanwhile, the control group children were allowed unfettered access to television and computer time, and were given $2.00 per week regardless of screen time.

The study lasted two years, and results showed BMI decreasing in the control group to a statistically significant extent.

Our findings show that television viewing and computer use can be modified in young children using behavioral engineering technology that provides parental control over a child’s screen time budget while giving the child the opportunity to choose how to spend this budget.

Also of interest, children from homes with lower socio-economic status seemed to benefit more from the control device. The researchers sum up thusly:

There may be unique advantages to environmental manipulations that modify the shared family environment, including television and computer use, in which children develop positive behaviors that provide the basis for lifetime good eating and physical activity habits and a healthy body weight.

Researchers on the team included: Leonard H. Epstein, PhD; James N. Roemmich, PhD; Jodie L. Robinson, MA, MBA; Rocco A. Paluch, MA; Dana D. Winiewicz; Janene H. Fuerch; and Thomas N. Robinson, MD, MPH.

Here is the UB press release, and here is a write-up by K.C. Jones in InformationWeek.

References:
Epstein, L. H, Roemmich; J. N., Robinson, J. L., Paluch, R. A., Winiewicz, D. D., Fuerch, J. H, & Robinson, T. N. (2008, March 3). A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Archives of Pediatric and Adolescent Medicine, 162(3). 239-245.

But, even more interesting, the researchers performed MRI scans of the subjects’ brains. The MRI scans showed the male players had much higher activity in parts of the brain associated with pleasure and rewards. This, the researchers speculate, may help answer questions as to why certain games seem to induce overuse in male players. To wit: men may be more susceptible to gaming overuse since their brains process the information in a more stimulating manner. Guys get more fun out of playing certain games.

This study is interesting in that it touches on the easy to measure aspects of MRI scans, as well as gender differences. It provides some data showing evidence for differences in the processing of videogame activity among the genders, and ultimately may open the door for some interesting new research.

Here is the abstract:

Little is known about the underlying neural processes of playing computer/video games, despite the high prevalence of its gaming behavior, especially in males. In a functional magnetic resonance imaging study contrasting a space-infringement game with a control task, males showed greater activation and functional connectivity compared to females in the mesocorticolimbic system. These findings may be attributable to higher motivational states in males, as well as gender differences in reward prediction, learning reward values and cognitive state during computer video games. These gender differences may help explain why males are more attracted to, and more likely to become ‘‘hooked” on video games than females.

Here is the link to an online PDF of the article over at Stanford.

References:
Hoeft, F., Watson, C. L., Kesler, S. R., Bettinger, K. E., & Reiss, A. L. (In Press). Gender differences in the mesocorticolimbic system during computer game-play. Journal of Psychiatric Research.

This is a good example to watch typical media treatment with easy to digest sound bites and oversimplification of complex issues, all crammed together in a tight time slot between advertisements. Here’s my summary of the segment, FWIW:

The segment opens with a tragic discussion of how Ms. Woolley’s son committed suicide after overuse of EverQuest, leading her to start OGA. Winterburn concedes gaming can become addictive in the sense that games can fill a hole in the lives of certain socially repressed people. Ouellette tries to get into an explanation of the research surrounding videogames, bringing up Loftus & Loftus (1983) regarding inherent reward schedules in games.

But, the journalists wanted to focus on the suicide related to EverQuest and ask Woolley if games like EQ should simply be banned. Ouellette gets back in to the conversation, and points out that comic books were blamed for youthful degeneracy in the 1950s, back-masking in rock lyrics were considered bad in the 1970s, and that basically each generation embraces a medium parents don’t understand. However, now parents have grown up with games and are more accepting. Woolley tries to ask that because Ouellette is a gamer and understands the medium, would he be more careful with his children playing, but this line of discussion is cut off due to lack of time. The journalist wraps up by belittling Ouellette’s last point, saying we’ve come a long way from the days of Pong and comic books with these videogames.

References:
Loftus, G. R. & Loftus, E. F. (1983). Mind at play: The psychology of video games. New York: Basic Books.

Eyder Peralta, writing in the Houston Chronicle on Thursday, offered a sober and balanced look at the question of blame for WoW on the death of children (a couple other cases have occurred in Korea). Peralta spoke with Dr. Celia Pearce, director of Georgia Tech’s Experimental Games Lab, who said, “We have to be cautious and not think everyone online is crazy.” Dr. Pearce also pointed out that with membership approaching 10 million players, two or three negative occurrences show little in the way of supporting a relationship between playing WoW and the death of children. Dan O’Halloran, over at WoWinsider.com, and Frank Pearce (no relation to Dr. Pearce), senior VP of product development at WoW parent Blizzard, also receive prominent mention.

Dr. Pearce is allowed to wrap up the article, maintaining that relationships beginning online are substantially the same as relationships beginning in a bar or some other RL place. After all, people are people, wherever they first meet.

It is unfortunate that every murder case where somebody played a videogame, be it the victim or the suspect, will be trumpeted in the press. This continues to make acceptance of instructional videogames that much more difficult in school settings. Peralta does a good job this time, however, in bringing in the experts and getting a much clearer perspective.

References:
Peralta, E. (2007, November 29). Did meeting online have tie to baby’s death? Houston Chronicle, p.E7. [Online]. Retrieved December 2, 2007 from http://www.chron.com/disp/story.mpl/life/main/5336859.html

First up is Stanford grad student extraordinaire Nick Yee:

According to one of Yee’s 2005 studies, 84 percent of “World of Warcraft” players are male, and 16 percent are female. The average player’s age is 28, and female players tend to be a few years older than male players. Regardless of their gender, players spend an average of 21 to 22 hours a week playing the game … Of course, these statistics may have shifted since Yee collected his data.

Yee continues to document his work at The Daedalus Project.

Next up is information on a report from the legendary Palo Alto Research Center:

According to research conducted at the Palo Alto Research Center in 2005, players tend to put in an extra burst of playing time when a character is about to reach a milestone level. The most dramatic spike occurs when approaching level 40, the level at which characters gain access to a mount, such as a horse or a tiger, and lots of new abilities and skills. The spike in play time leading up to level 40 is even greater than the spike leading to level 60, which was the highest possible level when the study was conducted. However, once people reach the highest levels, they generally spend more time playing than they did at lower levels

Finally, academic gaming luminary Richard Bartle is mentioned. Besides helping to invent text MUDs (multi-user dungeons/domains), Bartle was key in framing research questions surrounding online interactive environments. His four categories of players: achievers, socializers, explorers and killers, provide a taxonomy that remains relevant in today’s graphical MMORPGs. Bartle remains active in ongoing discussions, and is a regular over at Terra Nova, the Wonderland Blog, and elsewhere.

As the hunger for solid research on educational gaming, MMORPGs, and related popular phenomena shows no signs of abating, resources such as Wilson’s article in How Things Work will provide road signs on the Web to the research out there. Let’s hope folks find what they’re looking for.