Online and Gaming Addiction Treatment

According to the World Health Organisation (WHO), Internet Gaming Disorder (IGD) is defined as a pattern of gaming behaviour characterised by impaired control over gaming, and increasing priority given to gaming over other activities. Such behaviour ends up taking precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.

Gamers exist on a spectrum, from recreational – to at risk – to problematic – to gaming addiction. It is estimated that amongst the billions of gamers, only 3-4 % have an addiction issue. Most gamers who seek treatment fall within the at risk or problematic band.

The key difference between a recreational gamer and a problematic gamer lies in the extent of compulsivity of gaming, obsession when not gaming, disengagement from other aspects of life and changes in behaviour.

The prevalence of hyper-stimulating environments (loud noises, vivid colours, etc) in video games provide rapid dopamine overload. Dopamine is a neurotransmitter that signals the anticipation of pleasure, conditioning the brain to actively seek out and repeat the activity. Over time, this creates an increasingly entrenched autonomic pattern of behaviour.

The online world has been artificially constructed to meet human needs that are sometimes not satisfied in the physical world. These can include:

• Safe Space – Escape from stress, difficulties, and failures in the physical world
• Physiological Needs – Skins, coins, health, energy, immortality
• Social Connection – Community and friendship from around the world
• Sense of Achievement – Scoreboards, status ranking, measurable progress, and instant rewards
• Sense of Purpose – Clear goals and a variable but predictable set of rules, tasks, and outcome

In one research study, the amount of dopamine released while playing video games is similar to what is seen after an intravenous injection of stimulant drugs. The stark contrast between the seemingly “boring” real life environment and in-game is extreme, and this helps explain why someone can be increasingly drawn into the gaming world.

• Spending a lot of time thinking about games even when you are not playing, or planning when to play next
• Feeling restless, irritable, moody, angry, anxious, bored, or sad when attempting to cut down, stop playing, or when you’re unable to play
• Feeling the need to play for increasing amounts of time, playing more exciting games, or purchasing more powerful equipment to achieve the same level of excitement
• Feeling the need to cut back on the amount of time spent playing games, but have not been able to
• Losing interest in or reducing participation in other recreational activities (sports, hobbies, meeting with friends) due to gaming
• Continued gaming despite being aware of negative consequences (e.g not getting enough sleep, reduced performance at school/work, or neglecting important duties)
• Trying to keep family, friends or others from knowing about how much you game, sometimes turning to deception
• Gaming as a means of escapism or to relieve uncomfortable feelings such as guilt, anxiety, or depression
• Risked or lost significant relationships, job, educational or career opportunities due to gaming

If you have responded ‘yes’ to 5 or more of the above indicators, you are at risk of an online gaming addiction and have gone past recreational gaming.

• Self-harming
• Depression/isolation
• General Anxiety
• Explosive Rage
• Stealing to finance behaviour

Did you know that an average person spends almost 7 hours daily online (According to Digital 2021 – Global Overview Report)? Time spent comprises gaming, social media, broadcasts and streaming, music streaming, podcasts, online reading hours, e-shopping, and school/work related activities. Hence, treatment of online gaming addiction should also tackle the trappings of our modern lifestyle, societal and familial norms.

Treatment for online video game addiction typically starts with an intake assessment, followed by 6 individual and 2 family sessions in the first stage of recovery.

The Intake Assessment (Usually a 1 hour session)

The clinician will take a thorough history of the presenting issues and relevant family history. Depending on circumstances, the individual and family may be interviewed separately or together. At the end of the assessment, the clinician will discuss with the individual/family on the next steps, providing referrals if needed.

First Stage of Recovery (First 2 months)

At this stage, the therapist will work with the individual and his/her family to identify the underlying factors that have led to, are sustaining, and aggravating the condition. If additional risk factors are present, the therapist will work with the individual to address these risk factors through psychotherapy or medications as appropriate.

Goals for this stage of recovery include stabilising the individual, developing a customised addiction treatment plan, and learning coping skills to enable the individual and family to re-design their lifestyle.

Second Stage of Recovery (3^rd month)

It is recommended that individuals who are in healthy recovery continue to maintain the lifestyle change through group therapy or online support groups.

For individuals with increased risk factors, the therapist will work with the individual to resolve more deep-seated underlying problems. Where appropriate, family therapy is recommended to support the healing process.

After the initial 90 days, individuals and family members are encouraged to continue their efforts of recovery independently and check-in with the therapist only as needed.

Takeaway

Changing ingrained behaviours takes effort and patience from both the individual and the family. New thought processes and behaviours take time to become routine and they must be applied consistently to be effective for long-term change.

Over time, the old neural pathways that were once active due to dopamine overload will be less powerful. With the reduction in compulsive activity, and the application of healthier coping behaviours, new neural pathways will be formed, enabling the individual to enjoy the freedom from his/her addictive behaviours.