Adverse Interaction

My parents are about as interested in gaming as I am in fly fishing or step aerobics. Yet in the early days of the Nintendo Entertainment System, they both developed a borderline-unhealthy obsession with Dr. Mario. Eventually, their enthusiasm for the game waned, and with the exception of Spider Solitaire for my mother and internet chess for my father, no videogame since has appealed to them.

My dad, however, learned something from this experience. From Dr. Mario onward, he’s been decidedly against allowing any type of console in our house. His reasoning is simple: If he could be sucked in by a simplistic Nintendo-branded Tetris alternative, then videogames as a whole must be addictive. And believe it or not, plenty of people in the real-world medical community concur with that diagnosis.

That includes Brent Conrad, a Ph.D. candidate, practicing clinical psychologist and something of a specialist on videogame and online addiction. He’s also a self-described gamer. Conrad runs a website, www.techaddiction.ca, which includes information on videogame and online addiction, a support forum for addicts and a downloadable self-help book. ” I have certainly worked with people who have lost their jobs, their relationships or have dropped out of university due to spending 40, 50, 60 hours a week online,” he says.

He’s not alone. Dr. Maressa Orzack is a clinical psychologist and Harvard Medical School faculty member. She’s also the head of Computer Addiction Services at the McLean Hospital in Belmont, Massachusetts. According to her website, she first became interested in computer addiction when she noticed similarities between her Solitaire habits and the addictive behaviors she had studied for over 15 years.

Orzack’s research has been focused on the addictive properties of MMOGs. In an interview with Ars Technica, she talked about how MMOGs use variable ratio reinforcement to create an environment that often leads to detrimental play habits. In a separate interview with the Manitoban, she mentioned how addicts “get that sense of belonging, they blend with other people.” But what really separates the World of Warcraft junkie from a casual player is “presence” – as Orzack puts it, “where you essentially suspend disbelief, and you’re just there.” In other words, the game starts to feel more real then real life.

Conrad and Orzack aren’t the only ones focused on rehabilitating game addicts. The Smith and Jones Addiction Treatment Center, located in Amsterdam, opened the first clinic for videogame addiction. Founder Keith Bakker, a recovered drug addict, told MTV news, “We began to see a need for attention in this area in 2005, when a small number of clients being admitted for drug and alcohol addictions were also telling us about their compulsive gaming behavior. This was new to our staff – we had never heard of people spending up to 16 solid hours on a game trying to ‘level up.'” According to Bakker, “We got one kid in who was gaming 18 hours a day – I wanted to send him somewhere, and we looked around and there was nothing.” That helped motivate him to start the facility.

With so many medical professionals devoted to studying and treating videogame addiction, however, it might surprise you to learn that the condition doesn’t officially exist. Two years ago, the American Psychiatric Association took a vote on whether to include videogame addiction in the next version of the DSM (Diagnostic and Statistical Manual of Mental Disorders, the official handbook for psychiatrists and psychologists alike). The APA decided against the inclusion, suggesting, at least for now, that videogame addiction did not warrant such a classification. Nor did it warrant the label of “impulse control disorder,” which would have put it in the same class as pathological gambling. The European counterpart to the DSM, the ICD (International Classification of Diseases) has taken the same line of logic.

Dr. Conrad recognizes the APA’s motives for excluding videogame addiction. “Although there is a movement underway to include it,” he says, “I don’t think the research is quite where it needs to be for an official diagnostic category comparable to major depressive disorder or obsessive compulsive disorder.” What little information is available is often conflicting, and many doctors disagree on what separates an addict from an enthusiastic hobbyist. For example, some studies use the same criteria for videogame addiction as that of substance abuse. Dr. Conrad objects to this approach. “In my view, people become addicted to and stay addicted to alcohol for very different reasons than someone who develops excessive videogame habits,” he says, though he admits both alcoholics and videogame addicts are often trying to escape from real-world problems.

Furthermore, the methodology of many videogame addiction studies has come under scrutiny. Most of these studies have focused on teenagers, while Dr. Orzack says many of her patients are 40 or older. According to industry reports, the average age of a gamer is 35. But regardless of the design flaws of existing studies, the APA will not establish a diagnostic category without clear and abundant empirical evidence, and the testimony of clinical psychologists like Dr. Conrad and Dr. Orzack is not enough. Dr. Stuart Gitlow of the American Society of Addiction Medicine and Mount Sinai School of Medicine in New York may have stated the reasons for this stance best. Concerning the research into videogame addiction, he told Reuters, “There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn’t get to have the word ‘addiction’ attached to it.”

That the APA doesn’t recognize “videogame addiction” as an actual medical condition is little comfort to those who have suffered from compulsive gaming. One self-diagnosed addict I spoke with, who wished to be identified only as “Michael,” let his relationships and his college plans take a back seat to his MMORPG habit. Back in 2002, Michael bought a copy of EverQuest with a paycheck from a summer job. “Initially, I wasn’t all that into the game as it was very tough starting out,” he says. But a couple weeks later, “it became hard for me to focus on my work because all I could think about was the game.”

Having just finished his freshman year of high school, Michael says he was an excellent student, athletic and “the life of the party or group of people I hung out with.” He was, in short, “extremely happy with life.” Three years later, he graduated with straight Ds and a medical record that squashed any hope of him getting into the Air Force academy, a lifelong dream. He eventually went 30 hours straight playing the game, then 40. At one point he even spent time in a behavioral health institute. So unequivocally, Michael says he had a videogame addiction – DSM be damned.

Is Michael’s story so different from that of a compulsive gambler or alcoholic? His EverQuest habit was a compulsion – it interfered with all aspects of his life, and he found it impossible to stop. But without official recognition from the APA, Michael can’t get his insurance to cover his treatment. Even the behavioral institute his parents sent him to would not officially recognize his problem – his therapists dismissed his excessive playing as a symptom of an underlying cause like depression or anxiety disorder, both of which he denies having when his addiction first developed. For people like Michael, the APA’s recognition of “videogame addiction” isn’t simply a matter of semantics – it could be the difference between high quality, affordable treatment and no treatment at all.

At the time of this writing, the APA has no plans to include videogame addiction in the fifth edition of the DSM, due to be published in 2012. But while it may make getting effective treatment harder, there are benefits to this decision as well. Most proponents of videogame addiction’s inclusion in the DSM recognize that the condition requires more research and closer study. Hopefully, this will lead to a more complete understanding, not just of videogame addiction itself, but how to effectively prevent and treat it.

Elizabeth Marsh is a psychology student and aspiring crazy cat lady. She almost didn’t get this article done on time because she was too busy playing Half-Life.