Are video games really addictive? The World Health Organization added "gaming disorder" to its dictionary of maladies, the International Classification of Diseases (ICD), which published its 11th edition last month. But while a similar diagnosis is being considered in the United States, the condition has yet to be officially included in America’s psychiatric disorder catalog, now DSM-5. And if the experience of Asian countries that have embraced the diagnosis is anything to go by, the so-called cure could be much worse than the disease.
Certainly, no one doubts the compelling power of games and electronic devices, and some people who use them do so to the point of self-destruction. From Farmville to the current Fortnite craze, the capacity of gaming—and the Internet more broadly—to suck up time and sometimes money is unquestionably real. I certainly find myself going online when I know I shouldn’t, and I don’t know anyone who hasn’t gotten pulled into their phone when they should be paying attention to the real live human being in front of them.
But the general definition of addiction has long been contested, which has also meant that treatment is poorly defined. That, combined with frequent moral panics over drugs, gambling and technology, means we need to carefully consider whether adding a new diagnosis is a good idea. Behavioral addictions—gaming among them—can cause real distress, but we need to make sure we know what we're treating before we upend peoples' lives, however troubled they may seem.
As Dr. Allen Frances, one of the authors of DSM IV and former chair of the psychiatry department at Duke put it, “The experts who keep inventing an ever expanding array of new psychiatric diagnoses always hype benefits, never calculate risks. And if any new disorder can possibly be misused, it definitely will be misused—especially when someone can reap profit from it." While he thought there may be a small number of people who do have a genuine problem, millions more are likely to be harmed rather than helped in the case of gaming treatment, he suggested.
China, for example, has treated internet addiction more broadly as a disease for a decade now. The results haven’t been pretty. At least 23 million people had, as of last year, been described as addicted to what the government calls "electronic heroin." Treatment, such as it is, mainly seems to consists of boot camp-style programs, with regimes so dangerous that at least seven teens had died as of 2014. Hundreds of these programs, both private and government-run, have long been said to operate with little oversight.
In these camps, Chinese children have allegedly been beaten, forced into solitary confinement, and experienced dangerous kidney problems. The New York Times reported last year that at least 6,000 addicts had been subjected to punitive electroshock therapy, which causes painful convulsions, even though China supposedly banned it in 2009, after an outcry. Korea, too, has fallen prey to the boot camp cure.
If you think it couldn’t happen here, think again. As I described in my book Help At Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, the US already has a network of boot camp, wilderness and other poorly regulated residential programs, which typically enroll children whose parents suspect them of drug use or other forms of rebellion. During the 90s and 2000s, dozens of children died in these programs, which often used similar tactics to those described in the Asian ones. The 2008 crash appeared to shrink the industry considerably, but these programs often already accept any child a parent worries about, including gamers (so long as the parents are willing to pay). An official new diagnosis like “gaming disorder” could easily be used to drum up new business.
Indeed, although there’s no evidence that it uses abusive tactics, a nine-to-12 month residential program for internet-addicted teens already exists in the US—despite the lack of any such diagnosis in the DSM or any evidence that such long term care is even helpful. As Frances put it, “Expect a new industry of expensive gaming programs that will rob precious treatment resources needed to treat people with severe psychiatric disorders.” Not to mention potentially ripping off parents and harming children.
The irony here is that harsh tactics are known not to work for addiction or delinquency of any type—and the data has been in for years. The most accepted definition of addiction—used by the National Institute on Drug Abuse and the DSM—is basically compulsive drug use or other behavior that continues despite negative consequence. To be clear, there's considerable evidence this does happen with electronic devices and gaming. But since persisting in spite of punishing experiences is literally written into the definition of the problem, punitive or humiliating approaches are not exactly likely to work—and they don't.
Besides, not only do we have fuzzy definitions for addiction, defining what behaviors here are problematic is much more difficult than with a particular chemical or even, say, gambling.
“Internet games are broadly defined,” said Andrew Przybylski, director of research at the Oxford Internet Institute at Oxford University in the UK. “Any two fixed-odds betting machines are much more similar than any two ‘internet games.’ Equating the two despite clear differences like this introduces a slippery slope where any aspect of life with possible negative consequences could qualify as an addiction.”
Indeed, these days, many people actually make a living playing video-games—and it’s not hard to imagine that this is easier to achieve than making a living as a musician in the post-Napster world. But would we call someone who avoids socializing and spends nearly every second thinking about or playing guitar or violin a “music addict”?
All addictions involve developing a consuming passion for the substance or activity—and such intensity is not at all pathological when devoted to love, child-rearing, art, work, or other interests that society has deemed acceptable. I would argue, in fact, that while these passions share the persistence despite consequences that characterizes addiction—no one could manage to raise a child if they couldn’t push through some seriously rough experiences—the term addiction dissolves into meaninglessness if they are labeled as such. To be addiction, a compulsive activity must be harmful and continue nonetheless; it can’t just be an activity that society sees as trivial or frivolous or not worthy of devotion.
Meanwhile, the research on internet addiction, such as it is, suggests extremely high levels of what psychiatrists call “co-morbidity”—in other words, many people who develop this problem are already troubled and have conditions like depression, anxiety or ADHD that they are trying to manage. Of course, comorbidity and self-medication are common in all addictions, but if you are going to give one a new label, you really need to be able to specifically describe what actions are the essence of the problem. We haven't done that yet.
None of this is to say people can't get so wrapped up in gaming or other online activity that it can wreck their lives. It’s just that what’s wrecking their lives is not the game or the internet, but whatever is driving their need for escape. This is something we still need to understand about drug addictions, too, or else risk forever chasing the current panic and never really helping those who are hurting.
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