The core of addiction – don’t blame the game

Games are not intrinsically addictive. No matter how hard game-makers try to make them grabby, games don’t represent an addiction in and of themselves.

If games were actually addictive as some claim, there’d never be any failed games.

The whole nature of psychological addiction is commonly misunderstood.

Addiction revolves around pain. The corollary is that relief and pleasure are also implicated, but pain is the core of addiction.

If your son or daughter is addicted to a game, it isn’t the game that’s important. They’ve lost control because of stress and emotional pain in their life. The game is the nearest thing to hand that assuages and distracts from it. It provides relief. Relief that they’re not able to get from other avenues, including yourself.

If you focus on the game as the problem, you’re letting your kid down, because you’re missing the reason for the problem. If you remove the game, they’ll find something else as the focus – because they need help and they’re not getting it. The addiction is the symptom, and not the cause.

Also, don’t mistake heavy use for addiction. Everyone’s different and some people can balance many hours of gaming with the rest of their lives and have no difficulties with it. Others can manage only a little. As a responsible parent it’s more important to observe if it is interfering or not.

If it isn’t interfering then there’s no problem.

If it the activity is interfering with important aspects of their lives, like schoolwork, then you need to look at what it is that your child is seeking escape from. It might even be you.

Find the problem, and help your son or daughter with the problem, and you’ll find that the addiction goes away.

The addiction is not the core problem. Addiction is a symptom.

Treating addiction is like treating any illness; While you need to also tackle the symptoms, you must never allow that to distract or divert you from treating the cause, otherwise you’re making the situation worse, not better.

Start by looking in the mirror. You might not actually be the problem, but that’s where you have the most agency – where it is most in your power to effect change. If you can provide your child the relief they need either directly or indirectly, they won’t continue to seek it out in forms addictive behaviour – in games or in anything else.

If you can’t, then they’ve got even bigger problems than you might have imagined.

12 thoughts on “The core of addiction – don’t blame the game”

  1. God post Tateru, and a pile of good thoughts in here.

    I will be picky, though, and disagree with your comment about Addiction revolves around pain. I do not know much about Psychological Addiction, but chemical addiction has very little to do with pain, and much more to do with the pleasure receptors in the brain.

    I definitely agree that a lot of ‘Computer (Game) Addition’ is actually avoidance behaviour. Using the computer to avoid/ignore/close-out the source problem is a classic behaviour, and is not limited to computer use.

    I know people who under that definition would be addicted to reading fantasy novels. The time spent reading is time when the root problem is not affecting them.

    1. A lot of progress has been made in the treatment of even physical addictions by treating them more as if they were symptoms of pain problems. And to be sure, withdrawal isn’t a comfortable process.

  2. “The whole nature of psychological addiction is commonly misunderstood.”

    As this post proves…

    Video-game/Internet “addiction” is actually better thought of as an impulse-control disorder, akin to pathological gambling, kleptomania or pyromania. These are complex disorders which develop from the interaction of multiple factors – neurobiological, psychodynamic, cognitive, social and environmental. To say “Addiction revolves around pain” is absurdly reductive, unless your definition of “pain” is so wide as to be essentially meaningless.

    I know that in Australia you are facing a Government with a ridiculous anti-game agenda, but I don’t think you do the gaming cause any favours by denying the fact that games, and MMORPGs in particular, have elements that may lead to problematic use in susceptible people. Those elements – the ability to promote feelings of mastery, increase confidence in social interaction and boost self esteem – are the same things that give the games their positive value of course, but they can set up cycles of dysfunctional behaviour, especially when combined with the variable reward schedules that are designed into the games to keep people playing. That’s not to say that games are harmful per se, just acknowledging that they can be one factor in a problem.

    As I mentioned above, game “addiction” has parallels with pathological gambling. Gambling addicts often have magical thinking, believing their problems will be solved by one big win or other lucky break. They find the hard, gradual work of therapy very difficult. Similarly, your suggestion to parents: “Find the problem, and help your son or daughter with the problem, and you’ll find that the addiction goes away” seems to underestimate how difficult this might be, as if a magical cure is just waiting to be discovered if only they would “[Look] in the mirror”. It tends to be a little more complicated than this – anyone who is worried about game “addiction” should probably seek professional help.  

    1. Impulse control disorders are… well, impulse control disorders. I wouldn’t classify them under the class of relief-oriented compulsive avoidance behaviours that generally typify the class of “addictions” that I’m talking about here. Really, the whole term “addiction” is a misnomer in more instances where it is used than not.

      However people who suffer from this particular class of compulsion most commonly speak in terms of pain and relief, and are successfully treated accordingly. Short version: If it’s not an impulse-control disorder (which should be much easier to spot and identify – even for a somewhat disinterested parent), then short-term spontaneous relief-seeking compulsive avoidance behaviours are generally symptomatic of stress or of emotional or physical pain. You should be seeing a professional, not throwing a CD into the trash.

  3. In what way are these behaviours “compulsive”? Bearing in mind the definition of a compulsion:

    (1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly 
    (2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive 
    (DSM-IV)

    Most clinical opinion regards internet/video game addiction as an impulse-control disorder. As it says in the forward to “Impulse Control Disorders”, edited by Elias Aboujaoude, director of the Impulse Disorders Clinic at Stanford University School of Medicine:

    “In the last decade, much needed attention and research have been focused on the group of psychiatric conditions termed “impulse control disorders,” or ICDs. Pathological gambling, compulsive shopping, kleptomania, hypersexuality, and Internet “addiction,” among other disorders, are characterized by a recurrent urge to perform a repetitive behavior that is gratifying at the moment but causes significant long-term distress and disability. Despite the high rate of comorbidity with obsessive-compulsive disorder, ICDs are now clearly distinguished from this disorder by a unique clinical approach for diagnosis and treatment.”

    The key thing is “gratifying at the moment”. Game addicts generally find the actual gaming in itself unproblematic; it’s the associated fall-out that causes distress. Compulsions are not usually in themselves pleasurable.

  4. As it is commonly applied, the term psychological addiction covers at least three areas, only one of which would include IC disorders. Indeed, I think it’s a mischaracterization to lump some of these conditions under IC disorders where many patients observably respond better to therapies designed for chronic pain conditions and for traumatic or post-traumatic stress.

    While the DSM is a good starting point for therapeutic diagnosis and treatment, focusing (necessarily) on superficial symptoms, categorization is somewhat arbitrary and it is up to the professional to accept that it is a starting point and that each case must be handled with care and an appreciation of the unique causes of the individual patient.

    The key here is to investigate and treat causes while mitigating symptoms – because broad-stroke categorization of symptoms or individuals is, at best, superficial and, at worst, harmful.

  5. DSM catagories are hardly “arbitrary” – they’re drawn from decades of research and clinical experience – and they’re certainly not based on “superficial symptoms”, nor are they particularly “broad-stroke” – you won’t find any sweeping statements like “addiction revolves around pain” in the DSM.

    While it’s obviously necessary to treat each client as an individual, it’s also helpful to consider how that client is similar to cases you have seen before, or read about in the literature, so that you can take that experience into account when formulating a treatment plan.

    It’s a truism to say “The key here is to investigate and treat causes while mitigating symptoms”; you need a framework to do this within, and the published evidence, such as it is, shows the clinical utility of approaching  a problem like internet/game “addiction” from an impulse-control viewpoint.

    “… many patients observably respond better to therapies designed for chronic pain conditions and for traumatic or post-traumatic stress.” This sounds interesting – do you have any references for this I could read?

     

  6. Try Paul McHugh, Johns Hopkins. Maybe also Spitzer and First. The American Medical Association has (as I recall) a number of papers on the DSM and how it is necessarily an iterative and arbitrary set of classifications based on superficial symptoms, rather than on causes. In at least one copy that I’ve seen, that’s presented strongly in the foreword.

    While the relative merits of the DSM are somewhat out of scope, I’ll point out that it has become routine for patients to receive a formal diagnosis (per the DSM) that is actually at odds with their actual condition and symptoms (which, alas, further mars the statistical basis of the DSM to some degree).

    Regrettably, this has become necessary as therapies and medications have become tied to particular DSM categorizations, and professionals are not able to obtain therapies and medications for their patients that actually help unless they furnish a diagnosis that places the patient into the correct category.

    If you cannot get the treatment that works for your patient under their true classification, you classify them where they can get effective treatment instead. Unfortunately, that skews the information that is then used to compile future iterations of the DSM. It’s a systemic problem that does not itself admit of any present cure or remedy, alas.

  7. It is good to lift this topic now and again. The Western culture today has some privileged strata that allow people to indulge on addictions, as we all know. Therefore, seeking instant gratification has become even somewhat accepted as a norm, and this type of behavior is just about evangelized in popular media, much broader than just in online gaming. Someone mentioned fantasy novels. They could be 24/7 reality TV shows as well – whatever rocks your boat as they say. The problem area is much wider in Western culture than just the narrow scope of game addiction.

  8. Oh well, what would we psychiatrists argue about if we didn’t have classification systems? The DSM V draft is hot off the press (http://www.dsm5.org/) and guess what? They’re proposing to move pathological gambling out of “Impulse-Control Disorders Not Elsewhere Classified” and into “Addiction and Related Disorders”. Allen Frances, who chaired the DSM-IV Task Force, has listed this among his “19 Worst Suggestions For DSM5″ (http://www.psychiatrictimes.com/home/content/article/10168/1522341), a viewpoint with which I am tempted to agree. (McHugh’s position, in that 2005 JAMA article (http://jama.ama-assn.org/cgi/content/extract/293/20/2526) was that the descriptive approach of DSM IV should be replaced by an aetiological framework, and that was originally the plan for DSM V, but that ambition has been scaled back because the evidence to underpin it isn’t there yet.)

    As you say though, effective treatment is the main thing, and in my experience it’s the CBT approach developed by Kimberly Young (http://www.netaddiction.com/), which draws on an impulse control model, which is most clinically useful. There is published evidence to back this up too – see http://www.liebertonline.com/doi/abs/10.1089/cpb.2007.9971

    There was a paper from the International Gaming Research Unit at Nottingham Trent University last year which reviewed treatment approaches to videogame addiction (http://www.springerlink.com/content/46737751h814h306/), covering 12-step, CBT & MI, but nothing about a pain-orientated approach, which is why I was wondering if you had any references for that.

    1. “Oh well, what would we psychiatrists argue about if we didn’t have classification systems?” :) Well said. Actually, sometimes it seems to be “just about everything”, though I mean no denigration by that. It’s more a reflection of the competition between systems, symptoms, causes, therapies and research in — what is really — an exciting, dynamic and evolving field.

      I don’t have any specific paper references, alas. Just from seeing treatment actually performed and successful, and discussions with patients with a variety of grouped symptomatology. So, you should consider it ‘anecdotal’. From what I’ve seen, though, it seems to be a broadly effective strategy applicable to a number of underlying causes.

Comments are closed.