Video game addiction is very much a condition of the 21st century. Although it is not yet recognized by the American Medical Association as a diagnosable disorder, video game addiction is a very tangible problem for many.
Recent studies suggest that 6 – 15% of all gamers exhibit signs of addiction. This is a significant wedge of the population as it is estimated that more than 1.2 billion play video games worldwide. 
About video game addiction
The world is constantly in search of escapist ideation, none so much so than the arena of gaming. People become enthralled with an imaginary world creating an outlet for stress in a completely controlled, escapable universe. Goals are clearly defined and well stated and personal progression is simplistic and consequence free thanks to the reset button. It is ultimately narcissistic and simulates feelings of happiness. It gives gamers an outlet for self-expression and ultimate control over events, where they might not exercise that control in real life.
With an increasing proportion of the population becoming involved in gaming, it is no longer strictly the stomping ground of teenagers and 20-somethings, but more and more diverse target groups are becoming entrenched in the gaming world. According to Griffiths, technological addictions such as video game addictions are categorized as non-chemical or behavioral addictions. 
Studies show that excessive gamers tend to show many of the core components of addiction such as mood modification, tolerance, withdrawal symptoms, cravings and relapse. Although some will agree that video game addiction is a disease and should be treated as such, there are just as many who would contest this statement for various reasons. According to Professor Griffiths of Nottingham Trent University, any behavior that fulfills the six criteria of addiction should be defined as such. These six criteria are:
- Salience – This occurs when gaming becomes the primary activity in a person’s life and dictates thinking, feelings and behavior.
- Mood modifications – This refers to the feeling of escapism or euphoria felt subsequent to engaging in a video game.
- Tolerance – This is the phenomenon whereby increasing gaming is required to achieve the former feelings
- Withdrawal symptoms – This refers to the unpleasant feelings or physical effects occurring when gaming is discontinued including involuntary shaking and irritability.
- Conflict – This refers to the interpersonal conflict as a result of gaming with those around them that are concerned with the amount of time spent gaming.
- Relapse – This refers to the propensity for recurrent returns to prior patterns of video game addiction. 
If we are to use Griffith’s definition of addiction, then video game addiction unquestionably fulfills these criteria. There are many parallels that can be drawn between gaming addiction and gambling addiction. Some go so far as to say that “gaming is a non-financial form of gambling”. This stands to reason as many of the physiological mechanisms of the two discrete addictions have similarities. So much so that gaming addiction researchers actually use screening equipment and tools adapted from gambling addiction research, as well as many of the treatment regimens for treating video game addiction are derived from gambling addiction treatment protocols. 
There are several risk factors that may facilitate gaming addiction and these include affordability, anonymity, convenience, disinhibition, escapism and social acceptability. Statistical evidence suggests that particular personality traits are associated with video game addiction such as:
- Sensation seeking
- State anxiety
- Low emotional intelligence
- Social inhibition
In video game addiction, it is found that males are more likely to develop gaming addiction than females. Among male gamers, more severe online video games addiction is correlated with older age, lower self-esteem, and lower dissatisfaction with daily life. This relationship did not hold true for female gamers in conducted studies. 
Some studies also show that negative parenting styles, such as authoritarian, are closely associated with video game addiction among high school students. This lends itself to the fact these adolescents would rather escape into a virtual reality than deal with the oppressive nature of their environment. 
The consequences of video game addiction can be substantial and in order to understand the problem, it is first necessary to understand the mechanism of action governing the addiction and the neuroscientific background before one can determine if there is indeed a problem, and how to treat it adequately and appropriately.
There are two types of video games, one being the standard single player video game designed with a distinct goal to achieve. In terms of addiction, these sorts of games involve obsessive behavior regarding completion or task achievement. The other type of video game addiction is associated with online multiplayer games. These games are played in an online platform with other people and involve intricate fantasy worlds and characters. This is a specifically dangerous addiction as these games pose an escape from reality and an acceptance into an online community which is continuously accessible.
Analysis of the individual’s gaming motivations revealed that these sorts of games allowed players to achieve game goals, which boost egotistical aspirations of power and reputation, socialize and immerse in the game which involves character discovery and escapism. The pure variety of gaming motivations that can be gratified by online multiplayer role playing games is an indication of the versatility of these games as they can literally be customized to each individual catering to their particular emotional needs and preferences. 
The structural characteristics of the game itself can have an effect and subsequently increase the risk for video game addiction. This pertains to online games rather than offline ones, games that impose positive reinforcement, game features such as adult content, the viewing of cut scenes from the game and particularly, viewing the virtual character as better than the reality. These characteristics indicate why certain games are more addictive than others which is what video game developers exploit for maximum exposure. 
There have been many tragic cases resulting from video game addiction. In one case, a thirteen year old committed suicide after gaming for 36 hours straight and another of a three year old Korean girl who perished because her parents neglected her whilst gaming. There are other cases of video game-related violence that have erupted due to perceived threats and crimes committed within the games, most notably a person being stabbed to death because he stole a virtual sword!
These are the extremes of addictive behavior and not the norm but it is important to understand the psychological motives driving these people to commit such atrocious acts. To do this, it is important to ask “What are people addicted to?” Is it the games themselves or the feeling of euphoria and well-being that lure people to increasingly seek this type of gratification and defend their gaming so intensely and aggressively? 
Signs and symptoms of video game addiction
As with any addiction, people in the clutches of video game addiction exhibit particular signs and symptoms. It is important to recognize these emotional and physical signs in order to effectively diagnose and propose treatment for a person who is suffering from this addiction. Video game addiction is especially prevalent in people who have depressive tendencies or do not have other sources of pleasurable experiences in their lives.
Emotional signs of addiction may include a sense of euphoria when gaming, inability to stop the activity, restlessness and irritability when unable to play, preoccupation, deceit of friends and family regarding time spent playing and gradual isolation from others in order to play video games. Furthermore, there are physical symptoms and these include fatigue, eye dryness and strain, migraines due to increased screen time, Carpal Tunnel Syndrome from mouse usage, poor personal hygiene, sleep disturbances and malnourishment.
There have been documented cases of individuals holed up in their apartment for days gaming without washing or eating. Research reveals a case where children playing video games become so engrossed that they repress the need to go to the bathroom resulting in physiological disturbances. 
As previously stated video game addiction, as with any other compulsive disorder, can have dire consequences. There are the short term negative effects such as eye strain and migraines but there are more severe long term effects that manifest if not addressed. Video game addiction can result in gamers not sleeping or eating adequately, and isolation from friends and family which can result in severe health issues and permanent sequestration from their emotional support structure.
There are also financial, academic and occupational consequences. For example, video games, video game accessories and running costs are expensive, as well as time consuming potentially taking time away from careers and education, as well as leaving them substantially out of pocket. 
Most of these symptoms are mild and transient, spontaneously resolving themselves once exposure to video gaming is reduced. What can’t be undone so easily is the damage to interpersonal relationships, loss of employment and financial troubles arising as a result of gaming.
The warning signs of video game addiction include:
- Gaming to escape difficult life situations
- Playing for longer periods as time goes on
- Skipping showers and meals to play
- Poor performance at work or school
- Lying to others to hide gaming activities
- Exhibiting signs of irritation when forced to stop gaming
It is vital to react sooner rather than later on recognizing these signs and symptoms in an individual.
The science behind video game addiction
It is almost impossible to determine what causes addiction in any one individual. It is caused by a myriad of factors. The reason video games in particular are so addictive, is because they are fundamentally designed to be that way. The programmers exploit the neuroscience of our brains to design games that cater directly to our reward responses and the inherent need to fulfill those responses. In other words keeping gamers gaming!
The design optimizes the balance between a difficulty level that keeps the gamer interested and stimulated but not so difficult that it causes frustration. The goal being to create “manageable stress” wherein there is appropriate challenge and an emotionally engaged response. This state of emotional engagement is the ideal state for assimilation of information to occur which opens up the potential for video games to provide a teaching platform, although the negative stigma leaves this application of video games as an educational tool largely untapped. 
Addiction is defined as the “repeated compulsive use of a substance despite negative health consequences”. Behavioral addictions such as video game addiction have prompted a new definition of addiction which is now defined as “repeatedly pursuing a rewarding experience despite serious repercussions”.
Fundamentally, addiction is associated with the dopaminergic pathway or reward system. The playing of video games increases the amount of dopamine available to act on the D3 receptors in the brain. Long term addiction, results in the development of tolerance to dopamine and hence increases the amount of exposure required in order to achieve the desired effect. 
A neurotransmitter is a chemical substance released at the end of a nerve fiber by the arrival of a nerve impulse and by diffusing across the synapse, enables the transfer of the impulse to another nerve fiber, muscle fiber or area of the brain. Dopamine is one such neurotransmitter, that when released in higher than normal quantities, extends beyond the synapse and affects other regions in the brain, especially the limbic region which controls pleasure response. It is essentially a survival trait, as this pleasurable reward response in reaction to beneficial behavior occurs so that it will be repeated and result in life sustaining choices and behaviors. 
The psycho-physiological mechanisms underlying video game addiction are mainly stress-coping mechanisms, emotional reactions, sensitization and reward and long term gaming may lead to endogenous changes in the reward system of the brain. This increased release of dopamine is the brain’s reward response to achievement of a challenge working as a positive reinforcement for good behavior, choices or actions, thus the brain wants to repeat those actions and receive more dopamine induced pleasure. This feedback loop is what causes gamers to continuously play video games wherein virtual challenges accomplished result in the self-same release of dopamine which stimulates the brain’s pleasure response, which in turn results in an increase in gaming to maintain that feeling and resultant compulsive, addictive gaming. 
A brain imaging study has proved that healthy subjects showed a 10.5% dopamine receptor occupancy after playing a video game compared to baseline levels of binding, which is due to the increased release and binding to its receptors. Recovered ecstasy users showed no change in levels after playing the same game. The conclusion is that psycho-stimulant users have decreased sensitivity to natural reward. In the same study, game addicts showed a reduced dopamine response to stimuli due to sensitization. The impact of this is that addicts require more and more of their “fix” resulting in more and more time spent gaming and a consequent increase in the health, social and economic negative implications of gaming. 
This is why people are motivated to keep playing video games as they are designed to give frequent feedback regarding the accuracy of their choices, for example hitting targets, accumulating points and progressing to higher game levels. Video games show incremental goal progress as point accumulation, visual tokens or congratulatory sound effects which all stimulate the dopaminergic response. Unless the challenge is incremental, there will no longer be a response and the person will lose interest. But video game designers know this and capitalize on this response by making the games increasingly difficult to captivate the player effectively and irresistibly. 
A new study suggests changes in brain regions associated with addiction in gamers, in both frequent and occasional gamers. By using magnetic resonance imaging, they performed brain scans which revealed that frequent gamers had a significantly greater volume of grey matter on the left side of the ventral striatum of the brain, which is known to play a role in reward and addiction.
Furthermore, while inside the MRI scanner, participants were asked to perform a task that involved pushing buttons to achieve varying levels of points for correct responses and were kept informed of their scores. This was designed to gauge brain activity of perceived losses. Frequent gamers showed higher levels of ventral striatum activity when receiving feedback regarding losses which mirrors the results obtained from addicted gamblers.
The science seems to suggest that addiction to video games strongly resembles the addiction to narcotics, alcohol and gambling. This revelation opens up many treatment methodologies that can be adapted and transformed to suit the intricacies of gaming addiction.
Treatment for video game addiction
With video game addiction on the rise, there has been a subsequent increase in research into multifaceted programs to treat video game addiction based on cognitive-behavioral therapy, behavior modification and 12-step programs.
Half the issue with treating this particular addiction is actually diagnosing the problem. Recreational gaming is not only harmless, but can actually have cognitive enhancing properties especially with regard to puzzles and decision making skills. Where does one draw the line? When does harmless, recreational gaming become a life altering obsessive behavior? The issue lies with overuse as many gamers are tempted to escape reality and immerse themselves in their games neglecting real life commitments and responsibilities. Diagnosis hinges on recognizing the signs and symptoms of the disorder and then taking steps to help the person regain their self-control. 
Communication is key, either communication with the affected individual or communication of the affected individual with a professional. This can help an individual open up and recognize their compulsive behavior. As often this gaming compulsion is a manifestation of underlying issues such as depression, stress or anxiety. 
In particular, the treatment of adolescents and teens centers on adult intervention. Teens are just as susceptible to emotional and mental stress as adults, but without the emotional maturity and wherewithal to resolve such issues, which can result in a compulsive escape into video games. Adults in this case, need to implement a reasonable gaming schedule or simply replace gaming with an alternative activity. There are various applications and timing devices available to control time spent on the computer which can be used to great effect. 
Dealing with the withdrawal symptoms is a large part of recovery for an addictive gamer. Negative emotional responses can occur including anger, depression and feelings of desolation and need to be alleviated. Having a strong support structure can help this and there are many support groups for such eventualities. The person needs to find ways to counteract these negative reactions and respond appropriately to emotional stimuli which can be achieved with effective therapy. 
Cognitive behavioural therapy involves the addict undergoing a series of steps to change their behaviour and perceptions of the relevance of gaming to real life. Learning to identify and resolve their underlying psychological problems and determine coping skills to prevent relapse. It involves the identifying and changing of thought patterns, replacing those that lead to compulsive behaviour with healthier thought patterns, allowing the person to modify their thoughts and ultimately their behaviour positively. This includes setting goals and learning to overcome the thinking that acts as a catalyst for compulsive gaming, such as examining emotional motives that prompt the excessive gaming and finding substitute methods to satisfy those needs. 
Another treatment methodology called Motivational Interviewing is being used by clinical psychologists to treat gaming addiction. It is client centered counselling, incorporating strategies of cognitive therapy and the psychology of persuasion. This theory maintains that because gamers are often coerced into therapy by a third party, the first strategy of the therapist is to motivate clients to engage in self-changing behavior. The general principles of this therapeutic approach include:
- Expressing empathy
- Developing discrepancy
- Avoiding argumentation
- Rolling with resistance
- Supporting self-efficacy
Such a cognitive client centered approach does seem to have the potential to rehabilitate those addicted to video games, but there is little clinical research available regarding the efficacy of this method. 
Wilderness therapy is a relatively new and controversial treatment option for video game addiction. This involves removing the addict from the source of addiction completely by placing them in a natural environment; free of technology affords them the chance to learn to be comfortable with their emotions. The worry with this type of treatment is that relapse will occur once the person is back in their old environment, exposed to the same life stresses and temptation to play to escape might recur. The question begs: Is escape into the wilderness not just another means of escaping the realities of life?
There are however, Residential Inpatient Gaming Addiction Treatment Centers designed for those addicts who need to be removed from their immediate environment in order recover. These centers offer an array of group therapy and individual counselling sessions. Addicted gamers have often allowed their lives to plummet to such an extent that they are unable to recover on their own and this is where these sorts of facilities have merit. They help the addicts learn coping skills for their various socio-psychological issues and help them successfully reintegrate into society.
Outpatient rehabilitation shares many of the traits with inpatient programs but allow significantly more freedom for the addict, allowing them to maintain commitments to work, school or family. This also allows a modicum of discretion, as patients can attend treatment sessions without the knowledge of their boss for example; as they might feel their addiction status may impact negatively on their career prospects.
There is an organization called Online Gamers Anonymous which is a forum for those addicted to video games which can offer support as they share experiences and help each other recover from the addiction. Much like the other “Anonymous” groups, they follow a 12 Step Program:
- Step 1 – We admitted we were powerless over gaming— that our lives had become unmanageable.
- Step 2 – Came to believe that a Power greater than ourselves could restore us to a normal way of thinking and living.
- Step 3 – Made a decision to turn our will and our lives over to the care of this Power of our own understanding.
- Step 4 – Made a searching and fearless moral and financial inventory of ourselves.
- Step 5 – Admitted to ourselves and another human being the exact nature of our wrongs.
- Step 6 – Were entirely ready to have these defects of character removed.
- Step 7 – Humbly asked God (of our understanding) to remove our shortcomings.
- Step 8 – Made a list of all the persons we had harmed and became willing to make amends to them all.
- Step 9 – Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Step 10 – Continued to take personal inventory, and when we were wrong promptly admitted it.
- Step 11 – Sought through prayer and meditation to improve our conscious contact with God as we understand him, praying only for knowledge of His will for us and the power to carry that out.
- Step 12 – Having made an effort to practice these principles in all our affairs, we tried to carry this message to other compulsive gamers. 
These steps and counselling methods have shown renowned success in other forms of addiction, so it stands to reason that it can be helpful to those suffering from gaming addiction as well.
In China, there is an interesting anti-online gaming system to prevent the excessive playing of video games. It allows only 3 hours of gaming per day without penalties, thereafter the values of items or games won decreases and after 5 hours, no gaming benefits can be accumulated. This system could potentially work, but there seem to be work-arounds to beat the system by creating multiple accounts. This system would require intensive monitoring and evaluation and perhaps might not function in countries where there is greater freedom. China also bans teenagers from cyber cafes and provides boot camps and psychological counselling for those addicted. 
There have been successful pharmaceutical interventions for video game addiction. One such medication is Buproprion which works to alter the brain’s chemistry to decrease cravings for video game play. It functions as a dopamine re-uptake inhibitor, effectively increasing the amount of dopamine available to the neurons to transmit impulses. Although devoid of the common anti-depressant side effects of sexual dysfunction and weight gain, there are however some side effects including drowsiness, dry mouth, excessive sweating, itching and fever which are not ideal.
The difficulty with video game addiction is that computers are an omnipresent feature of contemporary life, thus many treatment options expound control rather than complete abstinence, as with drugs and alcohol. There is no cure for video game addiction; the key to treatment is to stay away from triggers whilst participating in therapy of some kind.
There is no “fix all” solution to this problem. But a case study involving a 16 year old Korean adolescent depicts him receiving five counselling sessions which were deemed ineffective in correcting his gaming addiction. He was then subjected to follow-up treatment with a combination of three therapies, namely cognitive-behavioral therapy, behavior modification and a 12-step program, after which there was a significant improvement in his behavior and addiction, and consequently his grades. Thus, it is imperative to approach video game addiction with a holistic approach to treat not only the addiction, but the underlying factors contributing to the addiction. 
There are many educational, social and therapeutic benefits to gaming as a recreational activity but the evidence suggests, however, that this pastime can become highly addictive when done in excess, specifically with regard to online games which essentially never end and have the potential to be played constantly. 
Thus it is essential to be aware of the potential for addiction and exercise a modicum of restraint when engaging in gaming activities. It is also important to be aware of the signs exhibited by others that may be in the grip of this life destroying addiction and get them the help they need to escape the virtual clutches of video games.
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