Clinician Urges Colleagues to Engage on Problematic Video Gaming Behavior

At a time when many leaders are urging the public to listen to scientific experts for sound information about serious health risks, a New Jersey clinical social worker says it's time for addiction professionals to heed growing evidence of the legitimacy of video game addiction.

Frank Greenagel, co-author of the new book Video Game Addiction 101, would like clinicians to get involved on two fronts: advocating the inclusion of video game addiction as a disorder in the next update of the DSM, and finding training opportunities on this subject and bringing that knowledge back to colleagues.

“There are professionals who have problems with this in their own families who are still at a complete loss,” Greenagel tells Addiction Professional.

Greenagel, who admits he once was skeptical about the risks associated with gambling in general and Internet gaming specifically, believes it is critical for the American Psychiatric Association to follow the lead of the World Health Organization in the latter's designation of “Internet Gaming Disorder” as an illness. That decision remains controversial among some professionals and researchers who believe other nations' leaders have mistakenly pathologized behaviors they find unacceptable. But Greenagel and his co-author, therapist and researcher Andrew Walsh, cite in their book numerous scientific findings suggesting similarities between compulsive Internet gaming and other addictions.

“This needs to be diagnosable,” says Greenagel, who teaches at Rutgers University's Center of Alcohol Studies and School of Social Work. “People don't get trained until it is. Also, it won't get research dollars. And people won't be treated, or only the wealthy and the very aware will be.”

Why clinicians should pay attention

Greenagel suspects many professionals don't take video game addiction seriously because players aren't suffering fatal overdoses from their pursuit of choice. So what happens is people play the “what's worse” game of comparing conditions.

However, he says clinicians need to be aware that many people in early recovery engage in excessive video game activity during their first couple of years of sobriety. “There are people who use video games as a crutch,” Greenagel says. “That's not what recovery looks like to me.”

The book states that in a 2018 survey, 66% of Americans over the age of 13 identified themselves as gamers. The stereotype of gaming mainly being the territory of the socially awkward young male playing games in his parents' basement doesn't play out in the research: Up to 45% of gamers are women, and 43% are age 36 or older.

Elevate by Psych Congress Spotlight: When Technology Usage Becomes an Addiction

The book outlines the history of video games and how game designers have monetized the technology to fuel compulsive behavior. Their effort to mimic the casino industry by creating “loot boxes” that allow players to acquire coveted items for their favorite games has generated billions in revenue while exposing players to the same sensations compulsive gamblers experience. Family members often have no idea that these features exist to fuel their loved one's on-screen activity.

The book offers much advice to clinicians who encounter patients dealing with problematic gaming activity. Greenagel relates an anecdote in the book that demonstrates the importance of building rapport with the patient, explaining that a young man with whom he worked wouldn't engage until Greenagel asked specific questions about the man's character in the popular game World of Warcraft.

“Serious gamers may have spent years feeling misunderstood,” the book states. “They may feel that their parents and teachers 'just don't get it.' They may be frustrated and angry that others tell tham that it is ridiculous to spend real money on customizing their character's avatar in a game. Whether you are a parent, administrator, or a therapist it is important to have at least some base understanding of games.”

The book includes an 11-item questionnaire that Douglas Gentile of Iowa State University developed as a screening tool for video game addiction; Gentile in 2009 conducted what is considered the most comprehensive U.S. study of youths and video game addiction. Affirmative responses to more than half of the questions, which include “Have you tried to play video games for shorter durations of time but have been unsuccessful?” and “Have you played video games as a way to escape problems or negative feelings?”, suggest an individual who is struggling with video game addiction.

Dearth of treatment options

Despite the expanded research available on this overall topic, much of it from overseas where Greenagel says leaders are far ahead of the U.S. on prevention strategies, few tailored treatment options for problematic video gaming exist in this country.

The book relates the experience of Matt, a self-described digital addict in recovery who has found success despite initially following a treatment program that was designed for alcohol and drug addiction. Matt cites his 12-Step group participation and his experience in recovery hosuing as pivotal to his progress. But individuals may find it difficult to identify support groups and housing arrangements that are welcoming to those with a primary video game issue.

Greenagel and Walsh have decided to step in by establishing an outpatient treatment program that, while addressing all addictions, intends to focus on video games and gambling. The New Jersey Family and Addiction Institute opened in Morris County last year.

“I'm looking at taking on former students and colleagues and training them up,” Greenagel says. “There's a need out there.”