addictive gaming is limited. Furthermore, the lack of consistent approaches to treating problematic video game playing and video game addiction makes it difficult to produce any definitive conclusions as to the efficacy of treatment, although at this stage CBT (as with the treatment efficacy of other addictions) appears to show good preliminary support. There remains a need for controlled, comparative studies of psychological and pharmacological treatments, administered individually and in combination with each other, to determine the optimal treatment approach.
In South East Asia there appears to be significant demand for treatment for online-related problems including gaming addiction. The South Korean government has reportedly established a network of over 140 counselling centres for treatment of online addiction. In Western countries, gaming addiction clinics have also started to emerge in places such as Holland and the UK. There are also treatment groups that are modelled on 12-step self-help treatment (e.g., Online Gamers Anonymous). However, little detail is known about the treatment protocols or their efficacy.
As you will see later in this book when Ciaran outlines some of my thoughts about addiction, I believe that all addictions share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflect a common etiology of addictive behaviour. Consequently, online game addiction is viewed as a specific type of video game addiction.
Some researchers do not differentiate between problematic video game use and problematic online game use. These scholars conceptualize problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. However, unlike me, their criteria for problematic video game use does not include other features usually associated with dependence or addiction (e.g., tolerance, physical symptoms of withdrawal), as they say there is no clear evidence that problematic gaming is associated with such phenomena. Other researchers such as Dr. Kimberley Young view online gaming addiction as a sub-type of internet addiction and that the internet itself provides situation-specific characteristics that facilitate gaming becoming problematic and/or addictive.
Irrespective of approach or model, the components and dimensions that comprise online gaming addiction are very similar to the IGD criteria in the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (1) preoccupation with internet games [salience]; (2) withdrawal symptoms when internet gaming is taken away [withdrawal]; (3) the need to spend increasing amounts of time engaged in internet gaming [tolerance]; (4) unsuccessful attempts to control participation in internet gaming [relapse/loss of control]; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]; (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict]; (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict]; (8) use of internet gaming to escape or relieve a negative mood [mood modification]; and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].
The fact that IGD was included in the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.
For epidemiological purposes, my Hungarian colleagues have asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Any instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of PAP gaming as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. They also noted that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity. In addition to further epidemiological and clinical research, further research is also needed on the neurobiology of IGD. A systematic review of neuroimaging studies examining internet addiction and IGD that I co-wrote with Dr. Daria Kuss noted that:
“These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains” (p.347).
The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. Books such as this one by Ciaran will help legitimize the concept of gaming addiction and how to treat it. For those who have problems concerning their gaming, it may not matter whether it’s called an addiction, compulsion, obsession or a dependency. In short, they simply want help in overcoming their problematic gaming. This book helps make that goal that little bit easier.
Further reading
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.
Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O. Kokonyei, G, Felvinczi, K, & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone. 0036417.
Griffiths, M. D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.
Griffiths, M. D. (2005a). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.
Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4.
Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.
King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology
