A Dangerous Game? While there is dispute about whether video gaming can lead to addiction, there's evidence to suggest that, in rare cases, some players exhibit behaviors similar to those of a pathological gambler
A lot of people I know, online, in real life, they will actually take time off work.
They'll plan it.
(They say) 'I'm not going to go to work for these three days ... just so I can play straight through, literally.'
And I know people, they would play and play and play, probably over 20 hours, sleep three or four hours, then get up again and play and play and play.
Anya Starr knows they're out there. People who are lost in time, their minds streaming through a virtual world but their bodies perched elsewhere, sleepless, hungry and alone.
The 28-year-old Dubuquer started playing "World of Warcraft" three years ago, navigating the dozens of game levels with millions of other players.
Though some of her friends play hours at a time, she wouldn't classify anyone she knows as "significantly addicted."
Experts are divided over whether "video game addiction" should be qualified as a
mental
disorder. The American Psychiatric Association does not include such an
affliction in its Diagnostic and Statistical Manual of Mental Disorders. Researchers often use the term "video game overuse," but some called it an addiction after observing behaviors similar to those of a pathological gambler, according to a 2007 report to the American Medical Association's Council on Science and Public Health.
The general definition for an addiction is something that disrupts your life in a significant way and throws everything out of balance: health, social life and work. The question is whether compulsive gaming fits under the definition.
'Zero to Hero'
Anyone who plays video games is at risk of being a compulsive gamer, but researchers seem to agree that it is most common with those who play an "MMORPG," or massive multiplayer online role playing game. These games allow the user to join a complex virtual world, create an avatar (a computer-generated character that can be made to resemble the user) and compete with many other players in real time.
About 9 percent of gamers play MMORPGs, and younger players and females are increasingly attracted to such games, according to the AMA report.
Ben Johannsen, 25, of Dubuque, said he plays "World of Warcraft" for several hours a day to keep in touch with friends from college. He doesn't consider himself a serious player.
He says some friends have been "sucked into the game."
"It's taken over people's lives," he said.
Someone who feels "somewhat marginalized socially, perhaps experiencing high levels of emotional loneliness and/or difficulty with real life social interactions" might be vulnerable to compulsive gaming, the AMA report states. Some believe they can have more control over their social relationships online, rather than in real life.
Johannsen called it a "zero to hero" phenomenon.
"You go from a kid nobody likes in school to the top 'guild master' on your server," he said. "They associate it with, 'I'm no longer a nerd. I actually mean something.'"
Serious consequences
Talk to any serious gamer and they can tell you horror stories about people who have lost marriages, jobs and friends.
Roger Meyer, director of Counseling Services at the University of Wisconsin-Platteville, said some students have stopped going to classes and have risked dropping out of school due to gaming. It's an "under the radar" problem that often doesn't rear its head until a student already is in danger of failing school, he said.
"They'll stay up all night, doing video gaming, and they fall asleep and crash and miss all their classes," Meyer said.
School counselors and professors will work with a student to get them back on track, provided the student is willing to make changes that might include quitting altogether.
"There's not only an increase in the opportunity for online gaming but also the sophistication of the games and the high visual quality. They're very enticing, they're magnetic. Students can get very easily involved with the games," he said.
The symptoms of any addiction, which include depression and thoughts of suicide, can apply to a gaming addiction, said Coleen Moore, Coordinator of Resource Development at the Illinois Institute for Addiction Recovery in Peoria, Ill.
"Someone who is addictive, we see it as a disease. And how we would define that disease is that it's chronic, it's progressive, it's fatal, but treatable," Moore said. "We're seeing the same thing with gaming. There's definitely a progression that someone goes through within the behavior."
The more time one spends absorbed in a game, the less a person connects with those around them. The neglect can lead to social anxiety, hopelessness and the loss of control over one's life, Moore said. Some have turned to suicide.
"It has been fatal," Moore said. "We know of individuals, their families have reached out to us. They have taken their own lives as a result of where their progression led them in their gaming."
A concern,
but not a disorder
In 2007, the APA announced that it might consider including video game addiction as a formal diagnosis in the 2012 DSM, but current research does not support its inclusion.
"Psychiatrists are concerned about the well-being of children who spend so much time with video games that they fail to develop friendships, get appropriate outdoor exercise or suffer in their schoolwork," the APA announced. "Certainly a child who spends an excessive amount of time playing video games may be exposed to violence and may be at higher risks for behavioral and other health problems."
University of Dubuque professor Alan Garfield, who chairs the computer graphics and interactive media department, said many assumptions don't have enough evidence to back them up.
"When you talk about video games, in people's mind's eye, they think of pimply-faced high school 'goths' who are downstairs in the basement, who don't talk to mom, dad or sister, they don't even kick the cat, and they do these nasty things, and they're going to go deeper and deeper into this social malignancy," Garfield said.
Not true, he said.
Garfield asserts the biggest assumption is that video games lead to youthful aggression. However, federal crime statistics show violent crime among youth is decreasing, even as the video game market expands. Most studies on the link between gaming and aggression find a correlation rather than a casual relationship, which could indicate that aggressive people like aggressive entertainment, Garfield said.
The same argument could be extended to video game addiction, that perhaps those with a predilection for compulsive behavior cling to video games because gaming is one option among many, he said.
"I don't think it is an addiction," Garfield said. "There are preferences, I don't think people are addicted. I think kids just love to do it, and if mom and dad let them, it develops into perversion, perhaps, but I don't think it's addiction."
'Can this really
be a problem?'
Despite skepticism about gaming addiction, the number of people seeking help at the Illinois Institute for Addiction Recovery is growing. The clinic has treated 25 people for video game addiction since 2003, Moore said, but 20 of those patients entered the clinic after 2006.
"There is significant denial with this form of addiction," she said. "Usually it's the family members that call us ... They're kind of thinking that they're crazy. 'Can this really be a problem?' "
Treating video game addiction is similar to other addictions, Moore said. The center employs a 12-step program, inspired by Alcoholics Anonymous, and offers stays for up to 90 days.
The most important aspect of the program, she said, is that someone stops playing.
"Addiction is addiction, no matter what they're coming for," Moore said. "The thing that's unique is the whole concept of abstinence."
Gamers who check into the clinic no longer have access to a computer. But when they check out, or for those who seek help outside of an inpatient clinic, the incorporation of computers into everyday life poses a constant threat of relapse, Moore said.
"We have told individuals that if they use the Internet, and that was their source of gaming, then we've recommended for individuals to take their computer out of their home," she said.
Connie Sprimont, a gambling treatment counselor for Substance Abuse Services Center of Dubuque, said she faces the same struggles with clients who seek help for online gambling.
"I can't remove a computer from someone's home," she said. "We can ask someone to help monitor them, but wanting help is the biggest step."
Back to the real world
Researchers haven't pinned down whether compulsive gamers experience withdrawal symptoms when they're cut off. Some users say they don't get "cravings" to continue playing, while others find it nearly impossible to tear themselves away from the screen, according to the AMA report.
On the pathological gambling front, Sprimont said some of her clients have reported physical manifestations of withdrawal after they quit gambling.
The best way to help people through such an experience is to "retrain the brain," Sprimont said.
"We help them develop better social skills, reconnect with old friends, find activities they used to enjoy. The brain forgets what they used to do," Sprimont said.
A video game addiction clinic in Amsterdam now emphasizes such a strategy to treat clients. Smith & Jones Centre head Keith Bakker told the BBC News in November that while compulsive gamers might resemble other types of addicts, most of his clients will re-enter society successfully once they develop social skills.
"Many of the symptoms they have can be solved by going back to good old-fashioned communication," Bakker said. Bakker has recently rebuked the term "addict" because he said it takes away the element of choice a compulsive gamer has to walk away.
Josh Staudenraous, 28, who owns Comic World in Dubuque, said he and many of his friends play MMORPGs. Staudenraous might joke about being addicted, but he remains skeptical that people can become seriously addicted. Even so, he said he took steps to cut back after realizing how much he played.
"When I first started playing, I probably played too much at times. I'd even bring my laptop to work and play for hours," Staudenraous said. "People would yell at me."
Choice and luck
Anya Starr said she chooses to play "World of Warcraft" instead of drinking every weekend, or doing other activities that also could turn into addictions.
"Some people can drink socially, and it never becomes a problem," she said. "There are other people, they drink everyday, or they binge on the weekends, and it can become a serious problem."
Starr said the same thing can be said of video games. But she warned that just because someone plays every day doesn't mean they're addicted.
As for her friends who stave off sleep, Starr said their lives return to normal after they make it to the top level.
"That's almost more like a personal achievement to them, to be one of the first ones to hit the top level," she said, "I don't know if that's so much addiction than somewhat of a narcissistic thing."