About five years ago, James Good realised he had a problem. The now 24-year-old clocked that his gaming hobby had become a full-blown addiction, practically trapping him at home. "I didn’t sleep, I didn't eat, I didn't leave, I didn't clean myself. I didn't do anything but sit there for 32 hours," hellbent on completing role-playing game Dark Souls. Over the phone, I can almost hear him wince. "I could have stopped and started playing again the next day, but instead I decided to starve myself and neglect my health, my relationships – everything."
One game had seemingly taken over his life. He pauses for a moment. "I don't think I even enjoyed it. It was more about being lost inside the game – I was addicted to it, 100 percent."
The World Health Organisation added "gaming disorder" to its International Classification Of Diseases two years ago. You might have seen the term floating around since then, discussed in tabloid op-eds and dissected in motivational blog posts on Reddit. There have even been lawsuits, like a recent one filed by a French gamer who alleges he fell behind on rent payments due to his FIFA addiction. But what's the reality of gaming addiction like, behind the headlines? And like other addictions: where can you head for support on the road to recovery?
It's best to start with a definition. Much like problematic drinking or drug use, problem gaming is about a loss of control. It's characterised by choosing to game over other activities and responsibilities in spite of negative consequences, rather than for casual fun. You can be addicted to any game, too – it isn't specific to genre or title. Epic multiplayer shoot-em-ups like Fornite land in the news because they're popular with young children (among other stories, a nine-year-old girl's rehab stint hit headlines in 2018). But you could easily be slamming away to your detriment on any other game.
"Gaming disorder is about gaming that can be very very compulsive, with a loss of control in relation to your life, your duties, your goals," Dr Henrietta Bowden-Jones OBE confirms to me. We're speaking in the Centre for Internet and Gaming Disorders., a new west London-based NHS clinic of which she's Director. It opened in late 2019, after WHO included gaming disorder in its international index, and is now the first NHS clinic of its kind.
Right now, many patients are teens or young adults – "mainly men, and mainly 15 to 25", Bowden-Jones says – though she insists they take a "very open-armed approach". In translation: anyone is welcome. WHO estimates that gaming disorder affects no more than 3 percent of gamers worldwide. Since – according to Washington Post report – an estimated 2 billion people globally play video games regularly, that could mean tens of millions of affected people. In the US, a 2018 Pew Research Center report found that 83 percent of girls and 97 percent of boys regularly play games. If other countries follow similar patterns, we could expect to come across compulsive playing across the board, regardless of gender.
Ease of access has spurred gaming disorder's rise and relevance. Twenty years ago, gamers would own home consoles, like a Playstation or Xbox. Online gaming on a console remained in its infancy then, so gamers were mostly relegated to playing alone, offline, while home from work or school. But today they can game on the go: whether that's blasting through PlayerUnknown's Battlegrounds on a mobile phone, or picking up the latest colourful release on Nintendo's Switch. "For people who are vulnerable to excess and compulsivity, it's very difficult. It's like having a little bottle of vodka in your pocket at all times," Bowden-Jones tells me.
Even if you're not racking up game hours yourself, a video game is still never far away. James tells me the accessibility of services like Twitch – where you can watch other gamers livestream – led to him recently breaking five years of game-free life. He started by looking at gaming-adjacent material on Reddit, YouTube and Twitch. Then he downloaded Path Of Exile and Faster Than Light to his laptop. "It's not great for gaming – but in six days I played 50 hours of games and watched 60 hours of Twitch," he says. "I'd completely derailed my entire life. I almost lost my job. And it's all because I couldn't resist playing the games."
So why do people become involved with video games to the point of excess? Bowden-Jones reckons one issue, among others, is self-esteem – it's easy to be validated if you're constantly winning. James says the escapist element drew him in: "I wasn't in a great place at university from a mental health perspective – I didn't enjoy it, and I ended up dropping out. But when I was gaming, I was in control. Nothing could go wrong and nothing could fail. It was powerful." With online multiplayer games in particular, there can also be the allure of working together in a team.
Matúš Mikuš, 24, found himself locked in a loop of compulsive gaming when he moved to university, at 18. Away from his high school friends for the first time, he socialised with them on battle game League of Legends instead. "But I was in a loop where I wouldn't go out to see new people because I stayed in and played games," he says, speaking over the phone from the Netherlands.
Though he never engaged in intense extended gaming sessions like James, Matúš' gaming still negatively impacted his life. He couldn't make new friends, and his other relationships suffered. He lived with his girlfriend, but "eventually we broke up. One of the reasons was because I wasn't spending much time with her – and that was because I was playing games a lot."
So what do you do when you want to quit gaming? When they decided gaming had been having an adverse effect on their lives, Matúš and James both came across Games Quitters. It's a for-profit organisation (where, full disclosure, James is now a Marketing Director) that offers support to gamers and parents affected by video game addiction, with masterclasses, access to therapists and programmes like their 90 Day Detox. But not everyone can afford that sort of support. The free NHS clinic centres itself on a different angle of treatment. It's called stimulus control and is common with treatment for gambling, involving blocking negative behaviours and reinforcing positive ones.
I learn that patients start with a thorough clinical assessment. "Because it's also not just about loss of control or harming one hour of your life – it's the full picture," says Bowden-Jones. That assessment looks to answer questions like: "What is driving the gaming? Is there a genetic history? Parents with addictions? Or a history of trauma and abuse that is driving you to escape through gaming?" she continues. Depending on a patient's needs, they can then get access to CBT therapy in either a group or one-on-one setting.
The clinic also plans to roll out family training sessions across schools in the future, to equip parents whose children who might need help. Bowden-Jones continues: "We're going to do some new things that will allow us not to rely on old ways of working to deal with a new illness." In the process, they hope to see "people who complain they have the problems but not just the severe problems".
Gaming addiction doesn't have to be a headline. The reality is that it's as commonplace as your friend who might drink a bit too much, or order a bag every Friday night. There are extreme cases, sure, but many of these addictions quietly tick along in the background. James says he needed support to turn his life around. But that doesn't change one fact common among addicts of every variety: "I still wake up thinking about games; go to sleep thinking about games – it's driving me crazy right now."