Video Game Use and Addiction Michael S. Lewis, MA, LPCC-S
Ohio Dominican University • MMORPGs
– Massively Multiplayer Online Role-Playing Game
– Roots are formed in 1970’s tabletop game Dungeons and Dragons – Common games include World of Warcraft, Everquest I & II, Star Wars
The Old Republic, Ultima Online, Runescape, Lord of the Rings Online, though hundreds exist.
– http://www.mmorpg.com
– 11% of the gaming market but 80% of gamers – Different than other games like:
• First-Person Shooters (Call of Duty, Halo) • Open World (Skyrim, Grand Theft Auto IV) • Social Network (Farmville, Words with Friends) • Characteristics of MMORPGs
– Subscription-Based vs. Free-to-Play
– Designed to allow hundreds of thousands of users to play the same game at the same (over the Internet)
– Typically themed to a genre
– Players create avatars to represent them in-game and to interact with the game environment
– Open world • Role-Playing
– Avatars take on some type of role that helps inform and prompt how the player plays
– Typically a fighter, wizard, healer, or hybrid
– For example, Everquest has ‘classes’ of warrior, mage, wizard, monk, ranger, druid, bard, shaman, and rogue among others
– Additionally, players choose their avatar’s race, gender, and cosmetic characteristics
– As players progress they can change other factors such as skill sets, spells, weapons, and armor
– These factors may or may not have an impact on gameplay but can change how they are viewed by other players
• 6 Criteria of a MMORPG
– Hussain & Griffiths (2009)
• Persistence – always online • Physicality – a virtually real place
• Player Representation – avatars
• Vertical Gameplay – characters develop and change • Perpetuity – no end point
• Who Plays MMORPGs
– Accurate measures can be difficult due to anonymity
– Popular misconception of the gamer geek is no longer applicable – Approximate measures suggest:
• 60-80% of users are male depending on the study • Average age is 31 years old (range 12-65)
• 19% are 18-22
• 36% are married or engaged
• 74% are college educated – mean household income of 84,000 • >50% work full-time / 12% work part-time
• Average play = 25.86 hours per week –females more than males
• Mental and physical health differ • MMORPG Population
– As a country, World of Warcraft would rank as the 75th largest country in the world between Zimbabwe and Greece
– In 1999 paid MMO players would compare to the population of Barbados – in 2012 they are comparable to Australia
– All players (paid and free-to-play) is equal to the size of Germany • Addictions
– Chemical Additions
• Alcohol, heroin, crack, etc. – Process Addictions
• Gambling, sex, shopping, Internet, etc. – Chemical vs. Process Addictions
– Addiction is a common catchall for compensatory behaviors with consequences – easy to define or ‘know it when we see it’
– Chemical vs. process/behavioral/psychological addictions • Tolerance & withdrawal
• Process Addictions
– In 2011, the American Society of Addiction Medicine formally added process addiction in their definition
– A chronic disease involving brain reward and motivation – Characteristics of addiction include:
• Negative consequences related to use • A pattern of use, remission, and relapse • Inability to control use or abstain • Cravings for use
• Online Addictions
– Defined as compulsive overuse of the Internet (in its many forms) despite consequences – characterized by building and release of tension
– Related heavy Internet use to Problematic Gambling
– First large scale studies estimated prevalence of heavy Internet use at about 6% of users
• Additional studies suggest as high as 15%
• College students appear to be in highest risk group at 13%-18%
• Online Gaming Addiction
– Fastest growing process addiction
– Prevalence estimated to be 7-12% of gamers – What defines online gaming addiction
• The Playing Time Myth – Relationship to consequences
– Preliminary tests show on several measures that compulsive online gamers follow similar patterns as those who have other more familiar addictions.
– Jellinek chart – gamers see similar patterns
– Brain activity and reactions suggest there is withdrawal syndrome present
– Physiological and psychological reactions – irritability, anger, post-play depression
– Research is sparse and often contradictory – Mostly qualitative until the past three years
– Quantitative research has surfaced - shed light on some of the issues such as demographics, relationship to addiction, diagnosis, treatment, and comorbidity
– Real world negative consequences linked to excessive online gaming – Divorce, failure in school, neglect, hygiene, loss of job, etc.
• Similarities
– Compulsive (ingestion vs. behavior) – Domain specific
– Cravings
– Tolerance & withdrawal – Ego-syntonic to ego dystonic – Consequences
• Differences
– Motivation to persist
• Chemical euphoria produces a reinforcement • Connection to identity and self-worth
• Etiology
– Cognitive- Behavioral Model
• Features core components of addiction • Salience • Mood modification • Tolerance • Withdrawal • Conflict • Relapse
– Davis (2001) went a step further suggesting maladaptive thinking/coping patterns were part of the core issue (overgeneralizing, catastrophizing, minimizing, etc) – Neuropsychological Model
• Not fully substantiated but appears that dopamine levels rise in behavioral addicts much the same as physiological use • Brain neuropathways of reward and motivation
• Primitive drive to pleasure/away from pain • Internet use
• Euphoric experience • Numb experience • Repeated use/tolerance • Maladaptive coping styles – Compensation Theory
• Internet used as a way to cope with deficits in self-esteem, identity, relationships, other perceived or real weaknesses • Loneliness scales, Social intimacy
• Anonymity protects/frees the user • Escapism
– Situational Factors
• Increased reliance on Internet use during times of life change or development – usually associated with increased stress
• Divorce, change in job, going to college, etc. • Viewed as a stress response – adaptation – No one model exactly fits
– Continued effort to create a catchall but appears that differing theories may be better attributed to more specific uses (gaming, gambling, sex, etc.)
– Further research needed to better understand motivational factors, family history and dynamics, personality, and comorbidity play roles • Motivation to Play
– What draws people to play these games?
– What perpetuates continued play despite consequences? – Motivations to Play
– 3 Primary Motivations for Play – Yee’s Typology • Achievement
• Advancement, Mechanics, Competition
• Working to progress avatar to be optimized • Top level
• Best armor and weapons • Accomplish hard to reach feats
• Virtual Skinner Box – always a reward around the corner
• Social
• Socializing, Teamwork, Relationships
• Team up with other players to quest together • Join guilds for many reasons
• Meet new people
• Become intimate with others
• Create and maintain a vast social network • Correlated with extended play time but not
necessarily dependency • Immersion
• Discovery, Role-Playing, Escapism, Customization • Exploration of the huge game world
• Role-play the player’s avatar to others • Closely identifying with the personification
created online
• More closely correlated with dependency – particularly escapism sub-component • Dualistic Model of Passion
– Posited by Vallerand, et al (2003) – derived from Self-Determination Theory (Deci & Ryan, 2000)
– Attempt to understand why some become addicted to behaviors while others do not
– People self-select activities that feel comfortable and fulfill psychological needs (autonomy, relatedness, & relatedness) – Behaviors become part of one’s identity (a runner vs. running) – Two types of passion
• Harmonious Passion
– Freely chosen and willingly engaged in behavior – Can be desired but also let go
– Behavior does not persist in unreasonable circumstances or despite consequences
• Obsessive Passion
– Behavior is controlled
– Driven by values, needs, self-esteem, desire, and connection to identity
– Behavior persists despite consequences or circumstances that are unfavorable or even dangerous
• Current Study • Diagnosis
– Disagreement amongst professionals as to if this may qualify as an addiction
– Currently not on the list to be added to the DSM-5 but was under consideration
– Gaming Addiction is being viewed as a subset of general Internet Addiction or Problematic Internet Use – no clear definition yet – Current best diagnosis – Impulse Control Disorder NOS
– Conceptually, it will fall into the compulsive-impulsive spectrum of the DSM-5
– 3 subtypes: excessive gaming, sexual preoccupation, email/text messaging
– All share 4 components • Excessive use • Withdrawal • Tolerance
• Negative consequences • Comorbidity
– Online Gaming Addiction is highly correlated with: • ADHD
• Substance abuse issues • Bipolar disorder
• Obsessive-compulsive disorder
– Additionally have lower than average self-esteem and social skills – Denotes the need for holistic and comprehensive treatment plans • Assessment
– Young (2009) – developed the Internet Addiction Diagnostic Questionnaire for online/Internet addiction that relates specific to DSM-IV chemical addiction criteria
– Kim & Kim (2010) - developed the Problematic Online Game Use Scale - a specific assessment for online gaming addiction
– Vallerand (2010) developed a scale for dualistic model of passion which has been linked to addiction
• Treatment Models
– Cognitive Behavioral Therapy
• Teach clients to monitor thoughts and identify triggers • Teach alternative coping skills
• Computer and non-computer behavior observation • Specific or generalized use
• Treatment Models – 12 step program
• Online Gamers Anonymous
• Dedicated inpatient and outpatient facilities are beginning to be built devoted specifically to Internet and technology based addictions
• If no therapist that specializes in this discipline is available and no treatment groups are near some general 12 step treatment facilities are willing to take online/technological addiction clients
• Several concerns and considerations – Other types of therapy or techniques recommended
• Social Cognitive Theory – learned self-regulation • Cognitive Behavioral Therapy
• Systems Therapy
• Diagnosis and treatment of comorbid disorders • Support groups • Psychopharmaceutical • Skills training • Holistic wellness • Emotional regulation • Stress management