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I've been gaming ever since I could pick up a controller. My all time favorite games are Zelda: A Link to the Past and Ocarina of Time. I started my gaming career with an SNES, then went with N64, switched over to the PS2, and currently have an XBox360. I'm playing a lot of Madden right now with a bit of GH:WT on the side. In general, I'm big fan of sports games and RPGs.
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In 2007, video game addiction was denied entry into the Diagnostic and Statistical Manual for Mental Disorders. This manual, familiarly known as the DSM, is published by the American Psychiatric Association (APA) and is widely used by mental health professionals all over the world.

The APA concluded that there was insufficient evidence to prove that video game overuse can be classified as an addiction. The overriding factor in the rejection was that compulsive gaming acted as an outlet for a patient's pre-existing mental disorder. In other words, addiction to gaming is not a mental disorder on its own but the result of some other type of psychological distress.

Video games – and specifically online games – posses many characteristics of substance dependence, though, and should be recognized as an official addiction. This article will focus on online gaming, but the argument can be made that non-online gaming has similar affects.



To say that the popularity of online video games has risen over the last decade would be the understatement of the millennium. Millions of gamers spend hundreds of hours every week playing online games. Massively Multiplayer Online games are the most popular type of online games, specifically the Role Playing Games (better known as an MMORPG's). This genre includes titles such as Warcraft, Everquest, and GuildWars. These games generally function the same, so they have similar affects on gamers.

According to the DSM, for substance dependence to occur one or more of these symptoms must be present:

1.Substance abuse
2.Continuation of use despite related problems
3.Increase in tolerance
4.Withdrawal symptoms

All four of these factors are relevant when it comes to gaming. Many gamers can attest to the increase in tolerance and withdrawal symptoms, especially those who play MMORPG's. Substance abuse is also applicable to this issue.

According to the DSM, substance abuse occurs when one or more of these factors take place: (1) recurrent use interferes with school/work/home obligations; (2) recurrent use in physically hazardous situations; (3) legal problems resulting from use; or (4) continued use despite social or interpersonal problems which were originally caused by the addiction.

Two of these factors are definitely in play for gaming. There are many gamers who skirt off work, school, or relationships to play video games instead. Stories can be found all over the Web about how gaming has intruded on people's lives – and not just kids either. Many of these examples stem from the playing of World of Warcraft, currently the most popular MMORPG. These testimonies expose the potentially harmful nature of online gaming and how it can interfere with real world obligations and relationships.

The testimonies – found in the link above – not only exposes the harm compulsive gaming can do to personal relationships and responsibilities, but also the difficulty of quitting. Two of the gamers said that they had tried to quit playing, but eventually came back and got hooked on the game again. Withdrawal symptoms were also clearly present. One of the gamers claimed that playing the game was “all [he] thought about.”

The most dangerous aspect of these games, though, may be how easily and quickly a gamer's tolerance can rise. MMORPG's, for example, become more time consuming as the player progresses. They are also open-ended, meaning a player can never beat the game. The appeal of these games is to watch your character grow. As a gamer fights through the game, his/her character builds experience; and as it gains experience, the character grows to higher levels. As the gamer progresses to the higher experience levels, new items and abilities are unlocked. An increase in tolerance stems from the fact that the higher level a character is, the more experience – and time – it takes to achieve the next growth level. So, in MMORPG's, an increase in tolerance is actually necessary to progress through the game.




Clearly gaming has the potential to possess all of the attributes of substance dependence. Substance abuse, continuation of use despite related problems, increase in tolerance, and withdrawal symptoms are all present. But even with all of this evidence, gaming was denied its place in the DSM.


Gaming has been denied entrance for two reasons: (1) it is a fairly new concept and requires more research to completely understand the disease; (2) and more disturbing, is the fact that this addiction receives very little public attention.

The media normally focuses on in-game content when it discusses video games. There has been an outcry from parents in recent years over the severe violence, language, and sexual content of games. Gaming addiction has always remained in the shadow of this issue.

While monitoring the content of games is important, studies have shown that there is little correlation between the behavior in children and the video games that they play. Gaming addiction has more scientific data to support it, with more substantial studies on the way. Also, if we can find ways to treat an addicted gamer it would help in stopping kids from spending too much time playing these violent games.

There is no question that gamers experience symptoms of substance dependence. Also, like many recognized addictions, there is a major problem in diagnosing the condition. Like pathological gambling, for instance, gaming addiction does not take a noticeable physical toll. The affect of the disorder is completely behavioral which makes it much harder to diagnose the addict from a more intense gamer who has the ability to quit.

Dr. Allison Conner, a cognitive behavioral therapist, recognizes Internet addiction – including gaming – as a serious psychological issue. She believes this addiction could result in a patient's “retreat from real-life face-to-face relationships.” The more a gamer shies away from real human relationships, the more likely they are to become increasingly dependent on their virtual ones, thereby compounding the problem. Dr. Conner added: “video game addiction may eventually be recognized as a specific classification among other mental disorders.”

Although the physical dangers of gaming are minuscule, there are a myriad of examples of social and behavioral damage directly caused by video game overuse. Addiction clinics all over the world have begun to open their doors to gamers. I think that it is time that the rest of the psychiatric community do the same.

On a more personal note, I have played video games my entire life but would not classify myself as an addict. I am, however, scared to death to buy World of Warcraft because I have experienced how quickly you can get addicted to playing that (in fact, I have put off buying a desktop computer because I know as soon as I have one I'm going to buy WOW). Anyone else have a similar experience? Do you think that this is a serious problem? Be heard or be gone.


Resources
Brad Wright, “Sounding the Alarm on Video Game Ratings,” CNN.com, 18 Feb. 2004 (Oct. 20, 2008), <http://archives.cnn.com/2002/TECH/fun.games/12/19/games.ratings/>.

“Drug and Substance Abuse, Addiction Treatment,” 2008, (Oct. 20, 2008), <http://www.cognitive-therapy-associates.com/drug-substance-abuse.php>.

“Psychiatric Disorders: Substance Abuse,” May 15, 2004 (Oct. 20, 2008), <http://allpsych.com/disorders/substance/substanceabuse.html>.
Sherry Rauh, “Detox for Video Gamer Addiction,” CBSNews.com, 3 July 2006 (Oct. 2, 2008), <http://www.cbsnews.com/stories/2006/07/03/health/webmd/main1773956.shtml>.

Wikipedia.org, “Video Game Controversy,” October 20, 2008 (Oct. 20, 2008), <http://en.wikipedia.org/wiki/Video_game_controversy#Crime_and_violence>.
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