Is there such a thing as online video addiction? A cross-disciplinary review by Matilda Hellman, Tim M. Shoenmakers, Benjamin R. Nordstrom and Ruth J. van Holst was published in Addiction Research & Theory by Informa U.K. Ltd., in 2013. This research study is not a study in the sense of a stated hypothesis that is then quantitatively tested in an experimental setting.

Instead, this is an evaluation of addiction in general, online gaming addiction in particular, and an overall analysis of what had been determined about online gaming addiction through scientific research at that point in time. It is basically a cross-disciplinary evaluation of the available scientific literature, analysis of the information, and then a discussion of ideas stemming from that analysis.

While the intent of the meme maker is humor, there are online game players who frequently experience this kind of game absorption.

The researchers start out with the question of whether excessive online gaming can and should be considered an addiction based on what is known about it and also considering specific qualifiers used in diagnosing addictions. Adding to the discussion are contributions from neuroscience (or “brain science), and discuss the similarities and differences between substance addiction and behavioral addiction.

The introduction begins with a description of a work group (the Substance-Related Disorders Work Group) involved in the writing of the (at the time) forthcoming DSM-V. This group proposed combining substance use disorders and non-substance addiction into one category, with the reclassification of pathological gambling to the addiction classification group.

Likewise the work group proposed that other addiction-like behavioral disorders such as internet addiction would be added to this category in later editions of the DSM as further research is conducted and further information is added to the field. The idea behind this proposal is that the work group wishes to “scientifically conceptualize” excessive compulsive online gaming with addiction to generate cross-disciplinary review.

This kind of gaming seems to be less problematic unless one counts lack of physical exercise.

The authors noticed that scholarly research on the topic of online gaming as a type of internet addiction but this research was being done in different scientific fields. These fields are the social, cognitive, and neurobiological science fields all of which study different aspects of a topic. For instance social sciences studies behavior in a social context, cognitive studies thinking processes, and neurobiological the physical brain.

The researchers give a brief overview of the history of the concept of addiction and key theories of how addiction processes work, emphasizing that there is no universally accepted theory of addiction. This is important because how the concept of addiction is framed affects assumptions and study as well as how it can be classified, diagnosed and treated. Theories of how addiction processes work are also influenced by scientific field.

The gist of the major theories of addiction (none universally accepted) is that the brain has “reward centers” that are triggered by when an enjoyable stimulus is encountered. If the stimulus is a substance, an appetite is developed and there is motivation, attention, and memory that cause repeated ingestion in order to trigger the reward center. An addictive behavior can stimulate reward centers in a similar way.

In the case of a substance addiction, the substance as well as the motivation, attention and memory can make physical changes to the neural pathways of the brain. Current thinking with behavioral addiction is that the repetitive behavior stimulates the reward center of the brain, which also triggers motivation, attention, and memory, and therefore reinforcement of the behavior which continues to stimulate the brain’s reward center.

If you don’t get this meme, ask a gamer 😉

Theoretically, this means that repetitive behavior that stimulates the brain’s reward center could have the same effect as a substance. Both trigger the brain’s reward center, and repetitive triggering of the brain’s reward center changes the neural pathways in the brain, changing the brain’s motivational, attention, and memory reinforcement toward continuation of the behavior much like continuing to acquire and ingest a substance.

Because the different fields of study (social, cognitive, and neurobiological) make use of different methods and tools of study, they come at their topics from very different perspectives. The authors believe that in the case of online gaming addiction, a multiple perspective approach (explanatory pluralism) would be especially useful. They note this kind of approach has been useful in studying certain types of psychiatric disorder.

Next the authors break down their study of the scientific literature regarding excessive or problematic online gaming into three areas: the first is problematic online gaming in a social context, followed by an examination of scientific literature dealing with whether it should be considered an addiction or not. Last, they go over the scientific literature provided by the field of neuroscience.

Clearly not true, there is a empty plate and knife in that shot. However, it may be true they have been subsisting on sandwiches for weeks.

In these three sections the researchers also highlight areas where the scientific literature from the sociological, cognitive and neurological fields while divergent in terms of methods and tools, may indicate that a cross-disciplinary examination from all three fields is truly needed and warranted for a more holistic perspective into problematic online gaming as a behavioral addiction.

The comparative literature review is extensive; the social context section clarifies that problematic online gaming includes different types of online games, rather than specifically Massively Multiplayer Online Role-playing Games (MMORPGs). However it does clarify that the games in question are played over the internet through a mechanism that allows players to connect with other players.

The literature from the social field indicates that MMORPG players do tend to spend more hours per week playing than players of other types of online games, but not every MMORPG player that plays for the same number of hours is doing so for the same psychological motivational reasons. In short, problematic gaming is a socially learnt behavior; when the gaming takes the place of social gains offline.

The literature indicates that when it comes to compulsive internet use, MMORPGs seem to have a much more powerful effect on the attention of players. One study suggests this is because of anonymity, social identity creation, and ability to raise a player’s self-esteem. The section further informs on research findings for reasons by age, culture, and gender for problematic gaming such as depression, poor low esteem and life satisfaction.

I used to hear this frequently when I lived with gamers. It usually followed lag caused in-game deaths.

In the psychological field (cognitive) section, scientific research findings are detailed from the perspective of similarities and differences with substance addiction along a wide range of behavioral and cognitive factors. Given the various findings of the individual research studies as analyzed, the researchers concluded that the core addiction criteria should be: withdrawal, relapse, tolerance, and behavioral salience.

In the neuropsychological field there are few studies of online gaming addiction but a large number of studies of substance use disorders; enough so that there are a “variety of neurobiological models”. These models indicate that as the reward center of the brain is over-stimulated, cognitive function erodes and the person becomes unable to control use. These studies are then related to the few studies of problematic gaming.

In short, while there are methodological issues in study comparisons, there is evidence that the areas of the brain that are impacted by substance addiction are also impacted by excessive problematic online gaming. The researchers detail the methodological issues in detail, specifying neurobiological evidence linking pathological gambling and online gaming, and pathological gaming to substance addiction similarities.

The discussion section contains the synthesis of the researchers arguments which include calling for more neurobiological research of substance addiction, pathological gambling, and excessive online gaming. They also criticize the disease model of addiction because the similarities are “superficial at best” though they note that some medical diseases more closely resemble addiction than the other way around.

True story, I briefly played a single MMORPG but gave it up when I started going to university for my degrees. I was never really comfortable with how time consuming they can be.

Ultimately, the researchers agree that problematic online gaming behavior is similar enough to be compared with substance addiction. They also conclude that behavioral addiction mostly differs from substance addiction in numbers; substance addiction is more widespread. Depending on the outcome of future research may depend on whether addiction as a whole should be “de-medicalized” as a concept.

This was a fascinating study for anyone interested in addiction in general, but especially if one’s interest is in substance, gambling, or online gaming (MMORPG in particular). If you are interested, you can find the abstract here and get the full text of the article by making a request of the authors: Research Gate Is there such a thing as online video game addiction? A cross-disciplinary review.