Doctor Urges AMA To Classify Gaming Addiction

Doctor Mario writes "The AMA has issued a set of findings and recommendations (Word document) which follow a lengthy look at possible connections between gaming and violence, as well as gaming addiction. Ars Technica has a very good summary of the report, which suggests that gaming addiction is likely to be a subset of Internet addiction 'as it most frequently occurs in players of MMORPGs. In both of these addictions, the current definition is currently informal — the described symptoms actually most closely resemble pathological gambling, rather than an addiction. In either case, the report notes, "there is currently insufficient research to definitively conclude that video game overuse is an addiction."' The report also recommends that Internet and videogame addiction be included in a revision to the Diagnostic and Statistical Manual of Mental Disorders."

Comments

Hoping the Proposal is Rejected

[duerra]

It's probably a good thing if this gets voted down by AMA. Right now most of the states' laws that are being passed in their respective legislatures are being declared unconstitutional because it has not been demonstrated that video games pose a legit risk to children or their mental health. If the AMA votes through this proposal, we could start to see states pointing to this, and seeing the courts side with the states regarding the legislation that they are passing, which are all currently and consistently being ruled unconstitutional by the courts.

Re:Hoping the Proposal is Rejected

[krunk7]

There is a distinct difference between someone who is participating in escapist behavior and a particular substance or activity being addictive. In the first case, whatever the focus or expression of the escapist behavior is largely incidental. Take the video games away and the person will find some other way of escaping. That may turn out to be reading all day and refusing to interact socially, self cutting, huffing glue, or whatever else may appeal to their personalities. Further, it is very arbitrary in what we would term "destructive" escapism and "constructive" escapism. For example, the socially defunct or depressed teenager who chooses books is viewed as a studios bookworm even though the root cause of the behavior is not any different nor ultimately any more beneficial to the individual.

For anyone who cannnot clearly see the difference I have a case study. Take a completely average, well adjusted, completely within the bounds or normalcy guy or gal from the street. Now force them to injest considerable quantities of Nicotine, Alcohol, Cocaine or Heroin over an extended period of time. That "extended period" might only need to be a week or two. Now take it away. What happens? You got it, this completely well adjusted individual will go through severe withdrawal. It will be physical, it will be accompanied but not limited to a significant mental craving, and it will be extremely unpleasant and in some cases life threatening. Take the same well adjusted individual and force them to play Warcraft and nothing of the sort will occur. Nada, ziltch. Depending on his general disposition toward games they may even dislike it quite a bit and be very thankful and relieved when they're allowed to discontinue their doses.

I've known first hand a good amount of people with this so called "game addiction" and in every single case they were running from life not toward games. Conversely, I've interacted with people with real addictions and though many were running from life there was a not insignificant number who were just hard partiers who woke up one day and realized they had a monkey on their back that they couldn't shake without help.

If only these nut jobs who want to term anything and everything under the sun as "addictive" could be brought to realize the truth of this they'd see that not every negative human behavior can be blamed on an external cause.

Re:Hoping the Proposal is Rejected

[StikyPad]

There is a distinct difference between someone who is participating in escapist behavior and a particular substance or activity being addictive.

The difference between physical and psychological addiction are indeed distinct, which is why they have different names.

Take a completely average, well adjusted, completely within the bounds or normalcy guy or gal from the street. Now force them to injest considerable quantities of Nicotine, Alcohol, Cocaine or Heroin over an extended period of time.

That is an excellent illustration of the difference between physical and psychological addiction. Nonetheless, it does not disprove the existance of psychological addiction. That one is more valid than the other is debatable at best and, given the evidence to the contrary, disingenuous at worst.

I've known first hand a good amount of people with this so called "game addiction" and in every single case they were running from life not toward games. Conversely, I've interacted with people with real addictions and though many were running from life there was a not insignificant number who were just hard partiers

Just hard partiers?!? Hard partying is the very definition of escapism. You seem to be confusing isolation with escapism. While there may be an overlap, not all isolation is escapism, and not all escapism involves isolation. Moreover, there is nothing inherently wrong with escapism; the problem is taking things to excess, to the detriment of life obligations or personal development. Some people compulsively engage in escapist behavior, and have difficulty controlling their urges for various reasons.

If only these nut jobs who want to term anything and everything under the sun as "addictive" could be brought to realize the truth of this they'd see that not every negative human behavior can be blamed on an external cause.

Aside from a few misguided extremists, nobody is laying the blame, or calling for a ban, on potentially addictive activities. Clearly the problem is with the individual. Nonetheless, it is useful to identify activities which the addictive personality will find seductive, if for no other reason than so they can be avoided *by those people*. You are correct that -- much the way anything can be called toxic -- in enough quantity, anything can be called addictive. However, there is clearly a scale of potential for addiction in activities, just the way there is a scale of potential for toxcicity in substances, and some people are clearly more susceptible to addiction, or toxins, than others.

On a side note, much like innate homosexuality, there is little to be gained from denying the existance of gaming addiction, a fact which calls into question the motivation of those who try to deny its existance. Many believe they are trying to deny a part of themselves. If there is no such thing as innate homosexuality, then they cannot be gay. Likewise, if there is no such thing as gaming addiction, then they cannot be addicted. Personally, I think the root cause is less insidious -- I tend to believe some people simply have a hard time understanding that other people experience life differently than they do, and they insist that their experience is the "correct" one. Both explanations are plausible.

Oh, Come on....

[Wintermute__]

I can quit anytime I want to.

I'm completely in control.

Re:Oh, Come on....

[smittyoneeach]

Slashdot, or the game?

Re:Oh, Come on....

[drinkypoo]

Slashdot, or the game?

Slashdot the game. There, fixed that for you.

I mean, you've got the unwashed masses (no karma bonus), the slightly privileged class (karma bonus), the undesirable element (karma anti-bonus) and the unmentionable class (anonymous cowards, emphasis on coward) not to mention the nobility (editors) and the monsters (also the editors) and the king (Taco).

Guess that makes OSDL god in this context :)

Addiction?

[IgLou]

Or is the percieved behavior actually the result of some obsessive compulsive tendency? I still find the idea of people being addicted to video games a stretch.

Re:Addiction?

[illumin8]

I still find the idea of people being addicted to video games a stretch.

The sooner you realize that the AMA is a business association of medical professionals that is dedicated to increasing the profit and revenue streams to their members, aka "doctors", the sooner you'll understand why we have these diagnostic classifications. I'm not saying that doctors don't help people on a daily basis, but the kind of money that can be made once one of these pseudo-sicknesses is classified as an actual disorder and is covered by health insurance is astronomical. Mental health treatment alone is one of the most expensive forms of health care around. It's in their financial interests to have everything we do be considered a "disorder" of some type or another. As in any case, follow the money.

Remember, there is a fine line between a "hobby" and "mental illness."

Re:Addiction?

[ceoyoyo]

Addiction is characterized by uncontrolled, compulsive use. Generally it has to be interfering with normal social functioning to warrant concern as well.

So if you watch TV or play games for a couple hours a night, but don't mind too much when you can't and it doesn't interfere with your life, that's not an addiction.

However, if you spend 48 hours straight playing a game and die of a venous thrombosis, or lose your job because you can't stand to miss your soaps, that probably is.

Re:Addiction?

[ObsessiveMathsFreak]

Amen. Feynman was right. There's little difference between ancient witch doctors and the modern the mental health profession. The major one being that modern psychoanalysts are a greater danger to free society.

Their criteria for declaring something a medial disorder is based on 1) rhetoric and 2) political correctness. Why did the AMA delist homosexuality as a medical disorder? Better yet, why was it classified as a disorder in the first place? In both cases the answer is that the AMA bowed to social and political pressure. More direct examples of this sort of thing can be seen when psychiatrists are called in by politicians and companies to label opponents or employees as insane. When the definition of a "disorder" is based solely and completely on a wordy, obscure, and vaguely written paper by a "prominent" author, you can basically tag anyone as being insane.

It's a pity. There's some good work done in the sphere of mental health. People helping trauma victims based on studies of objective data being the best example. But most of the field is weighed down by extremely abstract humanities doctorates posing as scientists. The situation isn't helped by the neuroscience community waving about brain scans with no concrete idea of anything that's going on, and devouring the first scrap tossed to them by the entrenched ideas of psychoanalysis.

Bottom line, we need to stop treating psychiatrists and psychologist as scientists. They're not. At best they are practitioners, like doctors, or humanities researchers, like historians, though frankly that's a disparagement to both those groups. In the main the mental health community consists of amateurs posing as professionals. Their opinions should hold no weight in a court of law. The fact that the do is undermining our system of justice.

Re:Addiction?

[Reality Master 101]

So my question is, why isn't anyone doing something about your mom in laws behavior?

That's like asking, "why don't they take the bottle out of the alcoholic's hands?"

It's not that simple when you're dealing with an adult making their choices.

Seriously...

[Valdez]

Does this open the door to collecting disability pay/insurance for losing your job after too much WoW?

Does anyone know how non-accidental disabilities... like drug addictions... are handled in such cases? I've never been a drug addict, but surely you can't collect disability pay for it.

Politically Expedient Research

[unlametheweak]

Instead of projecting mental conditions onto physical entities and behaviors like gaming, people should spend more time just trying to understand addiction and obsessive compulsive behavior in general.

Just studying addictive personalities however is not as sensational or politically expedient as the more sensational avenue of linking games to violence and anti-social behavior. I'm sure a researcher can get more money by studying the latter.

It's Not An Addiction

[Nymz]

If you can still breakaway to post on Slashdot.
Hmm, does the AMA say anything about Slashdot addiction?

It's a habit, not an addiction.

[Threni]

Like smoking a spliff, or listening to music, or getting laid. There's no physical dependancy. You might feel a bit pissed off if you can't have what you're used to, but that's about it.

Re:It's a habit, not an addiction.

[wframe9109]

I hate when uneducated folk try to make this argument.

An addiction to something you find pleasurable may not have a few negative withdrawal effects, but EVERYTHING else is the same, including the PHYSICAL changes in the brain.

I wish I could provide a compelling argument for you, but you obviously have no background in neuroscience, and would thus have no idea what was being argued.

why an addiction?

[Lurker2288]

Presumably addiction here means that playing games stimulates the pleasure centers in the brain, which leads players to play more in order to sustain the dopamine rush (or endorphins, or whatever). But can anybody explain to me why this is any different from, say, somebody who loves playing soccer, or playing piano? I know people who get cranky if they don't go to the gym at least once a day--are they addicted? What makes gaming (or gambling, for that matter) an addiction?

Here's your tinfoil hat thought of the day: at least one major drug company is currently working on drugs intended to treat nonspecific 'compulsive' behaviors, and the list of populations they're targeting includes gamblers, overeaters, and gamers. Bit creepy, or is it just me?

Ugh

[fastcoke11]

Violent video games are a healthy outlet for the natural violent thoughts and feelings that occur in every human being. There IS a correlation between violent people and violent video games, but most people see this in the wrong light. It's a symptom, not a cause. Violent video games do not make people more violent, but one should be worried if observing an unnatural propensity to play violent video games that stretches beyond the game.

So I guess my point was that people, in general, have this completely backwards. It comes down to whether or not a person can see the difference between fantasy and reality violence. When one cannot tell the difference, it is indicative of something other than an overabundance of video gaming.

Re:Ugh

[Notquitecajun]

"...it is indicative of something other than an overabundance of video gaming."

I'll go out on a limb here and call it bad parenting.

If it were respected then it wouldn't be an issue

[MMInterface]

I think the real issue here is that playing video games isn't something that is respected as a valid use of people's time. This realization makes much of the video game addiction issue unravel. If a person spent just as much time playing or watching sports it wouldn't be considered an addiction even if they neglected other aspects of their life. If a person sat around reading novels it wouldn't be considered an addiction but throw some pictures in there and some bubbles around the words (comics, manga) and suddenly its considered and unhealthy obsessive hobby. For every person that spends all their time playing video games there are many more that spend their time watching tv or movies. Video games are singled out because of lack of respect and the perception that only kids should play them. Work is another good example. People use the term workaholic but in most cases the practice is encouraged and respected, yet it is more likely to end a marriage or cause children to be emotionally neglected and it is much more common. Mentally none of these addictions are any different aside from public perception and what the feeble minded media decides to single out.

Finding a definition will already be impossible

[Opportunist]

But we're still at the point of defining addiction. When are you an addict? When you do something for a certain time per day? When you don't want to stop doing this and do something else instead? When you start thinking that this thing is more important than your job? When you would, facing the choice between your loved one and this thing, would choose the thing? When this thing becomes more important than meeting your friends and socializing? When you miss critical appointments, maybe even with your doctor, to pursue this thing?

If so, I'm addicted to living.

Ok, that was a blatant one, but it should show that different "things to be addicted to" deserve different definitions. You can't just say "When you do something for X hours you're addicted to it, no matter what it is". When I drink for 3 hours straight I'm most likely on the floor. When I run for 3 hours I'm hopefully near a hospital. When I play for 3 hours I'm mostly relaxed.

Then there's very different kinds of people. I spend about 60 hours a week reading assembler code. Am I addicted to movs and nops? No, I'm employed. It's my job, and I like it enough that I do actually do the same after I go home. Could I stop? I do every year for a month, and I barely miss it. There's so much else to do.

Maybe if there's nothing else anymore that interests you could be a suitable definition. But then again, there are quite a few very healthy people who have a narrow field of interests. Otherwise, I am pretty sure there are millions if not billions of people addicted to TV.

The whole "addiction" theme already fails at its definition. Of course, the subject line is false. They WILL come up with some kind of definition. It will be as arbitrary, indifferent and false as pretty much every other definition of addiction.

Obligatory Penny Arcade

[Jarjarthejedi]

http://www.penny-arcade.com/comic/2006/05/08

I'm not playing right now

In all seriousness games aren't an addicting substance. I've played games for a long time now, on and off. I've never found it difficult to stop playing, never needed any sort of help. I often find it hard to keep playing a game after playing it for more than a week or so. Maybe some people are getting addicted to game, and those are probably the same people who can get addicted to just about anything thanks to some deeper psychological problems. Last time I checked games don't put chemicals in your system that make you need to play them, they're simply an enjoyable past time that people want to partake in.

Next thing you know someone'll look at a bookworm and claim books are addicting because they were unhappy at being able to read their favorite book, or a moviegoer unhappy at being barred from seeing a movie, or, you get the idea...

Re:Obligatory Penny Arcade

[StikyPad]

Next thing you know someone'll look at a bookworm and claim books are addicting because they were unhappy at being able to read their favorite book, or a moviegoer unhappy at being barred from seeing a movie

While I don't think game addiction necessarily needs a distinct category in the DSM, there is a difference between the hobbies you mention and potentially addictive activities. Namely, the latter involve persistant and compelling reasons to engage in the activity. Aside from delayed gratification (which can be more satisfying than instant gratification anyway), there typically isn't a downside to waiting to see a movie or read a book. In a MMORPG, on the other hand, there are countless disincentives to allow the real world clock to tick without accumulating /play time. Granted, these aren't immediately obvious to the novice who may have no problem stopping play, but I've never met a smoker who was addicted after his first cigarette either. From the low levels, the disincentive is to prevent peers from out-leveling you (or perhaps the satisfaction of outleveling them yourself). As you progress in the game, the disincentives turn to missed "rare" opportunities and potential ostracism for failing to help the group. In short, MMOGs are dynamic environments which people can and do miss out on by failing to play. In contrast, books, movies, model-building, and so on are static and exhibit little to no disincentive to ignore them.

Note also both the similarity between, and integration of, gambling and MMOGs. Each exhibit similar characteristics: They are ostensibly social activities. They never end; there is always another potential goal*. They offer steady but random rewards and punishments. There also appears to be a large overlap of gamblers and gamers: From "guess the number," to full-blown casinos in Second Life, gambling is ever popular among the gaming population.

I'm not making a value judgement on any of these activities -- I enjoy gambling, and I've enjoyed years of MMOG playing -- but to say that they are no different from avid reading or moviegoing is disingenuous. If they were not fundamentally different, they wouldn't be so seductive, and it's not difficult to see how people can be drawn in to MMOGs to the detriment of all else.

* The fatal flaw in many MMOGs is that they do, in fact, run out of goals if a player is dedicated enough, which is why high-level guilds tend to have a high turnover of players who become disillusioned once they actually "have it all."

Non-Word version

[jam244]

http://docs.google.com/Doc?id=dhjjdf9j_5c2cch4

Civ

[lonechicken]

Civilization at 19 years old: "One more turn! Even if it means I'll miss class and fail!"

Civilization IV at 34 years old: "One more turn! Even if...ZZZZzzzzzzzz"

See, I'm cured.

Caged Animals

[ControlAltDelete]

I'm so sick of this "gaming addiction" crap. If they really want to understand the problem, perhaps they should stop labeling it as a disorder on such a surface level, lacking any insight or thought whatsoever, and really try to figure out why these kids decide that it's a better life to stare at a virtual world in a computer than to actually participate in society outside of the virtual world.

Maybe they'd discover something about humans: namely, that we've caged ourselves up in an over-regulated, overprotected society where all of the natural animal aspects of our existence are gone. We no longer hunt for our own food, we no longer are required to be physically active, we are no longer small groups of closely interacting people, but rather nameless figures in cages.

And they wonder why people get "addicted to gaming".

We're animals, and when animals are caged, they do crazy things - like gnaw off their own tails, or shake uncontrollably, or become overly violent.

Good thing we only cut ourselves, kill each other, and sit in dark rooms with nothing but a computer and an internet-based fantasy world.

Re:I'm waiting for the stories ...

[ceoyoyo]

How about playing in a cyber cafe until you die?

People predisposed to addiction CAN get addicted to all kinds of things you might not expect. Should we write them off?

Re:I'm waiting for the stories ...

[AxemRed]

People with addictive personalities can get addicted to anything that they find enjoyable. It seems a little crazy to me to make name a distinct medical condition for anything that is fun.

Great!

[drxenos]

Does that mean I can get a permit to park in handicap spots? Hey, drug addicts can (or could last I heard).

Re:I'm waiting for the stories ...

[compro01]

agreed.

it should be under a more general descriptor like "addictive personality disorder" or something rather than coming up with 2^n differant description for what is the same thing at the core.

I see merit behind it, but doubt it's usefulness.

[kinglink]

I see this becoming like ADD and ADHD, where a few of us actually have it to the point where when we are an adult we can't shake off some of the tendencies. But then then it was classified as a major problem, and all of a sudden EVERYONE has it, and those of us who actually have it (not just appear to have it) get screwed. Suddenly it's Normal to have it, and that it's "ok" to have it, when half the people I saw with ADD were just suffering from normal adolescents that they weren't even growing out of because it was "ok" that's what made me understand what bullshit is. That was the point I told my psychiatrist to go to hell, and dealt with the problem myself because no external source could give it me. I still have some of the tendencies but the fact is I've dealt with them rather then just accepted them and most people don't realize I ever had an issue with it (and it was a severe case).

We have the same situation with autism currently. So many kids are being diagnosed with them, but is it merely a case of a genetic defect that is all of a sudden present in them or is it a case of a diagnosis that is just too broad and doesn't realize the term "borderline" really should be "is similar but not really". Personally the research and the cases I've seen seems to be the later. That doesn't mean there isn't autism, but the severe cases are getting grouped with the "normal" cases of anti-social kids who have imaginary friends (imagine a kid having that?)

Even the behaviors involved with the identification of the conditions are often at odds with itself.

But even this makes me believe gaming addiction is ripe for another "autism" where there's people with serious problems (read "people who play themselves to death", aka the two Korean gentlemen I read about 6 months ago.) who really do need help, will once again get clumped in with anti-social people who'd prefer to play a game than go to a bar. Do I play games more than I should? Yeah, but I do it rather then going out all night and partying. Losing a job because you're playing WoW is an issue, but preferring to have fun playing games doesn't qualify as a disorder, just as reading too many fiction books isn't one. Sadly the AMA tends to broaden their definitions too much to if you play more than 2 hours of games a day you're sick and need help.

Re:how about the dealing with real violence ...

[kilgortrout]

I think you are closer to the truth than you suspect. The medical establishment likes stupid things defined as diseases and addictions for a very good reason - once something is classified as a disease or an addiction, medical insurance coverage is triggered and they get paid. That's why you see a proliferation of human activities being reclassified as diseases and addictions when before we just considered these people fuckups.

Comparing it with Alcohol Classes

[Durrok]

If you get a PI, DUI, or possession charge in Indiana the court puts you on probation for a year and makes you take anywhere from 8-40 hours of classes. I received a PI and had to take 20 hours of these "Prime for Life" classes. Among many things, they explain the various stages leading up to physical addiction with alcohol and marijuana and I can definitely see some similarities between "WoW addiction" or addictions of any kind. Here is a quickly adapted WoW addiction phase table

Phase one: Take it or leave it

You can stand to be without it and while you do enjoy when you do get to play you only do it when you have free time that you might have spent playing other games. Your odds of ever getting to 70 are pretty low and are likely to have a few low level alts.

Phase two: Anticipation

You look forward to playing WoW when you are leaving work or places where you cannot play. You spend some downtime when you can't play the game looking up some items or character builds and other information about the game. You probably talk about WoW with some friends or co-workers who play. This would be your normal player of WoW who will likely hit 70 some day, make some twinks, and even join a light raiding guild. If anything else comes up with friends, work, or family you will /quit without thinking twice and go spend time with them.

Phase three: Occupation

You spend almost every waking moment thinking about WoW in some fashion. Typically work and social life are impacted as you re-prioritize your choices and life around WoW. You probably join a raiding guild and have set times everyday when you login and play. WoW is the only game you spend any serious time playing. Anything that interrupts those things will highly annoy you and you are likely to alienate yourself from others who do not play as to minimize distractions. Relationships with friends and family begin to become strained. You have 2-3 70s and clock in at least 30 hours a week.

Phase four: Complete Psychological Addiction

Note: This would be physical addiction for drugs

Your life is WoW. Every activity in your life revolves around it. You might seek out a job that gives you the best hours for raiding, pass up on promotions that would interfere with it, or even quit your job altogether. Your friends and family rarely see you and you grow distant from everyone who is not a member of your guild. Health and productivity go down the toilet after weeks and weeks of little sleep and complete occupation with the game take its toil. You lose many of your friends and any relationships where your partner does not play WoW as well. You may leave your guild as they are no longer "hardcore" enough for you and either start your own or join a very serious raiding guild. If not you are likely a guild leader or very high up in your guild.

Maybe I should start a "Prime for Gaming" support group. :P

Television addiction?

[kris2112]

The average american watches 4.5 hours of television a day.

Is that an addiction or a mental illness?

Or is that acceptable because the boomers grew up with it, but not with video games?

Re:how about the dealing with real violence ...

[nomadic]

Doctor's salaries and lawsuits are both just scapegoats for the high cost of medicine in the U.S. It's the HMOs, drug companies, and insurance companies who deserve most of the blame.