From your brain’s perspective, getting hooked on video games isn’t all that different from developing an addiction to gambling, social media, alcohol or drugs.
“They all work on our dopamine response pathways in very similar ways,” said Bradley Zicherman, MD, a clinical associate professor of psychiatry and behavioral sciences at Stanford Medicine.
The brain’s reward pathways are driven by dopamine, a neurotransmitter that helps power our enjoyment of essential activities such as eating and forming social and romantic bonds. Addiction hijacks these pathways.
For teens who play a lot of video games, that’s a real problem — both because the adolescent brain is especially vulnerable to addiction and also because video games are becoming better and better at supplying pings of dopamine.
When today’s parents were growing up, “this technology was developing, but it wasn’t as immersive as it is now,” Zicherman said. As a child and adolescent psychiatrist, he leads the Youth Recovery Clinic at Stanford Medicine Children’s Health, where the team treats young people aged 14-25 for a range of addictive behaviors, including video game addiction. He explained what families should know about the issue and how they can find help.
1. Video game addiction is growing
Instead of the pixelated graphics and tinny sound of, say, the original 1985 version of Where In The World Is Carmen Sandiego? — where a virtual world was easy to leave behind, once you’d spent a few minutes tracking Carmen’s henchmen to Bamako or Montreal — today’s video games are much stickier for young brains, with complex stories stretching across multiple levels, sophisticated sound and graphics, and options for interaction between many players. Zicherman and his team think this is contributing to more addiction.
The COVID-19 pandemic also may have played a role in the increasing prevalence of video game addiction, given that pandemic shutdowns interrupted healthier extracurricular activities and left many parents reluctant to enforce limits on screen time.
When he founded the Youth Recovery Clinic in 2019, Zicherman suspected that most patients would be referred for substance use disorder. Today, around a third are referred for screen addiction concerns, including potential addiction to both video games and social media.
If a teenager’s primary communication with their peers is through a gaming headset or chat, it’s problematic and a difficult habit to break."
— Bradley Zicherman
2. The signs, symptoms and consequences are familiar
Internet gaming disorder, first classified in 2013 with a provisional diagnosis as a mental disorder, has nine criteria, including preoccupation with gaming, withdrawal symptoms when gaming is taken away, and unsuccessful attempts to reduce or quit gaming. Patients who meet five or more symptoms within a year qualify for the diagnosis, and research into it is ongoing .
If the games are considered the “substance,” however, traditional criteria for substance use disorder also work well to identify who needs treatment, Zicherman said. It’s also important to consider whether patients are experiencing functional impairments in their lives, he said: “Is video game use leading to problems in family life, social life, academics, sleep? Is it reaching a point where someone is consistently neglecting other responsibilities?” Missing school, getting poor grades, skipping family meals in favor of gaming or refusing to have an electronics-free bedroom could all point to an addiction.
Because adolescence is such an important time for young people to build social knowhow, it’s also vital to think about the social fallout of gaming.
“If a teenager’s primary communication with their peers is through a gaming headset or chat, it’s problematic and a difficult habit to break,” Zicherman said. “It’s always going to be more convenient to put on a headset compared to making plans to see friends in person, but it’s not healthy; it’s a form of isolation.”
Such isolation increases risk for depression, and may leave teens vulnerable to predatory relationships with adults they interact with through online gaming.
3. It’s rare for them to acknowledge the problem
Some of Zicherman’s patients with screen addictions recognize from the start that they need help. For example, young people who overuse social media often tell him, “I’m on this too much,” he said.
“But with gaming, specifically, patients will usually say that the don’t think there’s a problem,” Zicherman said. When he asks how much time his patients spend gaming, reports from the teens and their parents are often wildly mismatched.
“Almost all my referrals are driven by parents,” Zicherman said. “For instance, they’re really frustrated that their kids are not going to sleep on time; I can think of examples where patients were often gaming until 3 or 4 in the morning. They can’t go to school or function the following day.”
Establishing trust with his patients is the first step toward getting everyone in the family to agree that an issue exists, so they can then develop a healthy family media plan, Zicherman said.
“Almost invariably, if we get a teen willing to buy into some changes with how their families are regulating gaming, setting limits for them, we see improvements in all facets of their symptoms — mood, anxiety, sleep, general functional status,” he said.
- Addiction
4. Pediatricians, mental health providers and schools can help
Helping an addicted young person reduce or eliminate their gaming is a gradual process. Families can start by talking to their pediatricians, who may be able to help devise family media plans and refer young people to local mental health experts.
Zicherman advocates that parents proactively regulate their kids’ media and screen use from a young age. When kids grow up with healthy limits on their screen time and content, they’re less likely to develop addictions to begin with.
Parents can also ask teachers and other school personnel for help. Many middle and high schools issue a Chromebook laptop to each student, which can backfire for kids with screen dependence.
“I hear stories about kids gaming in class,” Zicherman said. “If you alert them that your child is really struggling with using technology appropriately, the school can help implement different rules for your student.”
Mental health professionals can offer general support — valuable because many teens with behavioral addictions also struggle with symptoms of depression and anxiety — as well as addiction-specific counseling.
At the Youth Recovery Clinic, team members use motivational interviewing to connect with patients. “It’s the idea of trying to get the patient to affect their own change, to come up with their own plans and strategies,” Zicherman said, adding that it’s important to use a nonconfrontational approach to help teens realize that he is on their side.
“It can take months of visits before it seems like we have a rapport and the kid might trust me.”
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5. Treating it can relieve depression and anxiety symptoms
Once Zicherman and his colleagues establish trust with a patient, they work with the young person and his or her family on a shared plan. “We try to get the patient themselves to come up with their own strategies for reducing gaming or maybe completely abstaining,” he said.
Implementing these strategies usually boosts a patient’s mental health, Zicherman said. Although he sometimes prescribes medication for depression, anxiety or insomnia, he typically helps patients with video game addictions cut back on gaming first.
“When they do, I see improvements in all facets of their lives: mood, anxiety, sleep, general functioning,” he said. “That’s not surprising. You’re not regulating your body physiologically well if you are gaming all the time.”
Once they game less, patients sleep better, exercise more, and have time for positive, in-person social interactions — all of which can alleviate depression and anxiety.
The best part of the job, Zicherman said, is helping young people figure out how to make changes that improve their lives. “It’s a challenging population in tremendous need of help,” he said. “I find it really interesting and rewarding to assist them.”
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