Video Game Addiction: Noticing Warning Signs, Getting Help

Jan. 23, 2023 – Tomer Shaked, an 18-year-old high school senior in Florida, started gaming around age 9. “I began spending more and more time playing video games in what I now know was a gaming addiction,” he says in an interview.

“At first, I didn’t play all that much, and still put school and homework first. And when I turned 10, I was still playing only during the weekends,” he reports. “But the screen time increased. My parents set some limits, but I eventually learned to get around my parents’ rules to get my ‘fix’ of gaming.”

By the age of 12, gaming consumed every free moment and was the only thing he thought about. He began lying to his parents about how much time he was gaming, which damaged his relationship with them. “All I wanted to do was game, game, game.”

Soon, “gaming wasn’t just one activity I enjoyed. It had become the only activity I enjoyed.”

Most youngsters who play video games do so “as a form of entertainment, which is what it’s supposed to be, but approximately 5% to 6% of video game users do so to the point where it interferes with their lives and use it as an addiction,” says David Greenfield, PhD, founder and clinical director of the Connecticut-based Center for Internet and Technology Addiction. 

Considering that there are about 2.7 billion gamers worldwide, with 75% of U.S. households having at least one gamer, even 5% to 6% is a staggering number of people.

Shaked has written a memoir, Game Over, which he hopes will “highlight important topics associated with gaming addiction that can speak to both teens and their parents who are experiencing this conflict in their own lives.”

He hopes other teens “can realize they can also live a full and productive life away from a video screen.”

A Problem of Staggering Dimensions

Video gaming has been around since the mid- to late 1970s, but not at the level it is now.

“When video gaming met the internet, it was like mixing peanut butter and chocolate together. As the internet’s popularity blossomed in the late 1980s and 1990s, that’s when it got out of hand,” Greenfield says. His clinic treats people who have addiction to internet content, and “by far the most common area we see is video gaming.”

What Makes Video Gaming So Addictive?

Greenfield says brain mechanisms involved in video game addiction are similar to the brain mechanisms involved in other addictions.

“The brain doesn’t know the difference between a drug and a video game because gaming activates the same receptors responsible for all other addictions, including substances and gambling.”

The key brain chemical involved is dopamine – a neurotransmitter involved in pleasure and reward, Greenfield says. From an evolutionary point of view, dopamine is what made mating and eating – the two most important survival activities – pleasurable and “increased the likelihood that we would continue to engage in them.”

In addiction, “you’re piggy-backing onto these ancient neural pathways and hijacking the reward mechanism that dopamine is responsible for,” he says. “On some weird level, your brain acts as if the activity is survival-enhancing when in fact it’s the opposite.”

Soon, people with this type of addiction feel there is no other source of pleasure in their lives because they’ve allowed other parts of their lives to fall by the wayside in their almost exclusive focus on gaming.

That’s what happened to Shaked.

“I think the appeal of gaming is the constant reward system in place,” he says. “These are virtual worlds that allow you to win battles that can’t be fought in the ‘real world’ in real time, allowing you to win soccer and basketball games and making you very popular in the ‘virtual’ world.”

You get to the point “where you know the games and how to play them, you get attention and admiration online, which have no value in the real world but are very addictive in the virtual world.”

And time goes by seamlessly. “Anyone who has ever played a video game – even someone without an addiction – can attest to the fact that time simply gets lost,” says Shaked.

Red Flags for Parents

What might start out as a break for parents – the kids are busy playing their video games and the parents have a few minutes to themselves – expands into something much bigger. But the progression doesn’t happen overnight, and parents might miss the clues.

Things like: 

  • Not wanting to leave the house unless required 
  • Not wanting to go on vacation without gaming equipment 
  • Refusing to go outside 
  • Rushing through normal activities, like meals, to get back to the games 

Greenfield says parents should look for changes in patterns of daily living – fewer social interactions, changes in patterns of hygiene, less physical activity, eating less, and worse academic performance. 

“The majority of people who come to treatment in our center are brought in by parents or other family members. Many have stopped showering and taking care of themselves, they’ve become more isolative, their friendships are related only to gaming or through apps they can use to communicate while gaming,” says Greenfield, who is the author of the book Overcoming Internet Addiction for Dummies.

Addictive video gaming can take a toll on the body, even leading (in extreme cases) to blood clots from sitting for so long, electrolyte imbalances from going without food for days, and other problems (like obesity) associated with sedentary living. Being in front of a computer can contribute to neck and back problems, headaches, and visual problems, among others.

Kicking the Gaming Habit

Shaked’s journey was unusual: at the age of 17, he had an epiphany while driving home from school. “I looked at myself and asked how I had been spending my childhood. I had been in front of the computer screen more than in front of my parents. You never want to say you’ve been in front of a computer screen more than in front of people, because that’s pretty sad.”

He realized that he had “lost” himself. “I had been so lost in a fake video game world that I had lost my identity and had become a video game character, not a real person.” He decided to completely stop playing video games.

But most people don’t have these types of epiphanies and need family intervention or even professional help to give up gaming, Shaked notes. He doesn’t advise others to “go cold turkey,” although that’s what he did. Doing so creates a tremendous void because the person does not yet have an activity to fill that time.

Greenfield, who’s also author of the book Virtual Addiction, agrees. His center helps parents gradually reduce screen time by helping them install software that limits how much time the teen can spend on the screen. “Kids have to get used to real-time living because the brain gets used to the level of dopamine that comes from gaming. They need to relearn how to experience normal pleasure in other areas of life.”

Some parents and kids might simply need education about gaming addiction, although others also need therapy. Some might even need residential treatment. “The needs of gaming addicts run the entire gamut.” 

It’s important to find a therapist familiar with video gaming addiction, Greenfield warns. Because videos are so pervasive, less knowledgeable therapists might dismiss a gaming addiction as harmless fun. But gaming addiction should be taken as seriously as any other addiction.

Today, Shaked leads a full and meaningful life. He’s involved in rowing and has received a varsity award. He completed a law fellowship for high school juniors, joined a beach cleanup crew, and received first prize in a state Spanish competition. He also has volunteered at the Jack and Jill Foundation of America and plans to donate the proceeds of sales of his book to the foundation, which helps children from underprivileged communities get access to educational programs.

“The organization really touched my heart, and that’s why I dedicated this book to them,” he says.

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Struggling to Focus? Try Video Games

Nov. 23, 2022 You may not think that children with attention deficit hyperactivity disorder, or ADHD, have a lot in common with older adults.

The kids struggle to sit still and focus on a task. The older adults are great at sitting still, but they often have a hard time following the conversation at a holiday dinner.  

In both cases, the problem is one of attention.

Yes, that’s obvious for someone who’s been diagnosed with ADHD. It’s right there in the name. With ADHD, the brain is constantly searching for new and interesting ways to distract itself.

But older adults aren’t searching for distractions. They just can’t ignore the distractions that find them. 

“Focusing attention has two sides: focusing and ignoring,” says Adam Gazzaley, MD, PhD, a professor of neuroscience at the University of California, San Francisco. “It’s the act of filtering out irrelevant information that declines with aging.” 

That’s why Gazzaley invented EndeavorRx, a therapeutic video game you may have heard of, especially if your child has ADHD. In 2020, the FDA approved EndeavorRx to treat kids with ADHD between the ages of 8 and 12, making it the first digital therapy to get the green light for any condition.

What you may not know is that the game was originally used to help seniors. Or that therapeutic games are now being developed and tested for a wide range of conditions and populations. 

Gazzaley calls it “experiential medicine” and says it has one major advantage over traditional medicine: It adapts to you. While the patient is learning to play the game, the game is learning to work with the patient. 

How Video Games Work Like Exercise for Your Brain

This adaptive quality is the key to EndeavorRx and what makes it different from commercial video games. Gazzaley calls it an “adaptive closed-loop algorithm.”

Put simply, the game adjusts to the player. Better players encounter tougher challenges, while those with less skill can still work through the game’s levels and unlock its rewards. 

Your brain, in turn, adapts to the challenges with structural changes, not unlike the adaptations your body makes when you exercise. 

Just as your muscles respond to strength training by getting bigger and stronger, your brain adapts to challenges by forming new connections between and within neural networks. It works the same for all ages, whether you’re an older adult who’s never played a video game or a young person who’s possibly played too many. (It’s worth noting that too much gaming can hurt your mental health.)  

The brain’s ability to adapt to new information, circumstances, or demands is called neuroplasticity, and it’s the key advantage that experiential medicine has over drug treatments. Changes in the brain not only translate to real-life improvements in attention, but they also remain intact after the patient has finished their prescribed time with the game. 

“It just sticks, which is incredibly different from how drugs work now,” Gazzaley says.

Treating kids with ADHD is just one of many potential applications. 

“The game has no specificity toward a particular pathology or age group,” Gazzaley says. “It challenges the brain in such a way that it leads to this benefit in sustained attention in any population we’ve ever tested.”

Case in point: He and his colleagues at UCSF have now tested closed-loop games with people who have depression, multiple sclerosis, and lupus, all of which may affect the ability to focus. 

But it all started with one very specific population.

How Video Games Became Therapy

In the early 2000s, Gazzaley worked with older patients who were having problems with their thinking skills for the first time.

“They would often tell me they were distracted,” he says. “They just couldn’t hold their attention.”

That led to a series of studies on the source of the problem. In a study published in 2005, for example, his research team found that older adults could focus on a task as well as 20-year-olds. 

“What they were failing to do was ignore,” he explains. “There’s so much irrelevant information that needs to be filtered out. That’s what was causing the impairment.”

A subsequent study that was published in 2008 found that the impairment was worsened by a slowdown in the brain’s processing speed. It took older adults longer to decide if an interruption actually required their attention, which meant each distraction was more disruptive than it would’ve been to their younger selves.

For seniors, those challenges are especially apparent when they try to multitask, when you rapidly redirect your attention from one thing to another. The ability to multitask typically peaks around your 20th birthday and declines throughout life. 

That was the focus for Gazzaley and his game development team at UCSF when they published their initial findings in a landmark study in 2013.

After playing a game called NeuroRacer (the forerunner to EndeavorRx), seniors got much better at multitasking improvements they retained in a follow-up 6 months later. 

And that wasn’t all. The people in the study also improved their thinking skills in areas that weren’t targeted: sustained attention and working memory. It was the first evidence of the potential for therapeutic video games to target and enhance those abilities. But it wouldn’t be the last. 

Which brings us back to kids with ADHD.

Is There a Therapeutic Video Game in Your Future?

Working memory the ability to retain information long enough to use it is a key to success in school, work, and everyday life. Like the ability to focus attention, it’s a higher-level executive function, which means the two processes share some of the same neural networks in the same parts of the brain. Not coincidentally, working memory deficits are one of the hallmarks of ADHD.  

Medications can certainly help.

But so does playing video games, according to a recently published study. Nine- and 10-year-olds who played commercial video games for several hours a day had better working memory and response inhibition stopping themselves before allowing a distraction to pull them off task than kids who never played. 

Fortunately, kids don’t need to play multiple hours a day to achieve benefits.

“We saw linear effects in pretty much everything we looked at,” says Bader Chaarani, PhD, an assistant professor of psychiatry at the University of Vermont and the study’s lead author. 

“Light gamers who played on average 1 hour per day showed the same improvements in cognition, response inhibition, and working memory, compared to those who never played video games,” he says. “These effects were intermediate between non-video gamers and the heavy video gamers.”

This helps explain why video games are getting so much attention in neurological, medical, and psychological research. 

In addition to EndeavorRx, Gazzaley and his team have developed several others for different populations and preferences. 

MediTrain, for example, uses digital technology to help young adults master meditation, the timeless practice of stillness and presence. 

Rhythmicity, a musical game designed to help seniors improve short-term memory, also helps them remember faces. (Grateful Dead drummer Mickey Hart helped develop the game.) 

Body-Brain Trainer, another game created for seniors, combines cognitive training with exercise, using the closed-loop algorithm to adjust both interventions to the user’s ability. Those who used the game for 8 weeks improved in two fitness measures (blood pressure and balance) as well as in their ability to sustain attention. 

Gazzaley plans to explain in a future study how games with such different mechanics and tempos — from an obstacle-dodging run to drumming to slow-paced meditation — lead to similar improvements in attention.  

Again, that’s similar to exercise, where almost any kind of training will lead to improvements in heart health, which in turn reduce the risk of premature death from any cause. 

Because there are so many ways to get to the same destination, you can find effective exercise programs to fit just about any combination of abilities and preferences. You can also advance through a fitness program at your own pace. 

That may be how we use therapeutic video games as the category develops.  

“Now that we have so many types of games and so many populations, we’re getting a richer understanding of how you can push and pull these systems to get these outcomes,” Gazzaley says. “That’s what makes me so excited about the future.”

Games as medicine? Seems worth paying attention to. 

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