Since its release, parents, educators and health experts have issued warnings about the addictive nature of Fortnite Battle Royale, currently the most popular multiplayer online video game in the world – and those concerns are valid. Gaming Disorder is real. The World Health Organization now recognizes Gaming Disorder and defines it as a pattern of digital or video gaming behavior characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences. An estimated 2.2 billion people worldwide play video games and, while there are no hard numbers specific to Fortnite, research suggests as many as 4% of those who play video games -- or 90 million people worldwide – are addicted.
The phenomenon of online addiction isn’t unique to gaming. With the advent of the mobile phone, digital usage has become almost exponentially more prevalent, and addictions related to the use of social media, online gambling, online shopping and other compulsions have all increased. Impaired control, prioritization, escalation or continuation of use despite negative consequences are the criteria we use to classify addiction, no matter the substance. The symptoms and behaviors of those with digital addiction mirror those of other process disorders such as shopping, gambling or sex. Therefore, at Caron we look at the issue of Gaming Disorder as part of what we classify as Internet and Video Game Use Disorder (IVGUD).
So is Fortnite as addictive as heroin? My short answer – yes.
What makes the digital world so addictive?
Video games and other online entertainment are designed to get us hooked. They do this through intermittent reinforcement. The pleasure center of our brain is activated when we win, and the reward from the increased dopamine makes us want to do more. But if we win so often that it becomes a sure thing, then our brain can become bored – you can’t eat key lime pie four times a day. For this reason, the games are designed so that you win only once in a while. Part of the joy of playing is the anticipation of winning, and each loss is just a goad to try for another win, and our brain chases the rush of dopamine we receive from the next virtual win.
Social media also works this way. Facebook purposefully sets your newsfeed so that you see a random assortment of posts in addition to those of your friends. It keeps you guessing about what you are going to see next as you continue to scroll.
For most people, this is can be a good bit of harmless fun, but others – because of their genetic predisposition, psychological and emotional makeup, and the circumstances of their lives – they become obsessed with the online world.
“Digital disorders” aren’t just for teens
There is a belief that IVGUD primarily affects teen and young adult males, but the issue is more pervasive. For example, with gaming, males under the age of 18 do play the most (18%), but gaming is popular among all ages and genders. The average gamer is 35-years old, and 41% are women. For women, the age group that plays games the most online are those aged 50 or over (13%).
While the issue of teen and young adult gaming gets the headlines, there should be just as much concern and support for the 45-year-old living alone, who is living digitally, with most of their relationships through Facebook or other social media outlets. Their life may also have some of the same dynamics. They may have a job and therefore can pay their rent, but they may also be lonely, depressed, or emotionally bankrupt.
We also see this online obsession in many of our older patients, who are dealing with losses in their lives and turn to the online world for solace. Their digital addiction is going to look very different from that of an 18-year old. Perhaps it is expressed as compulsive online shopping rather than playing Fortnite, or they strike up an online friendship with someone in another country who asks them to wire thousands of dollars, but the compulsion to spend time in the digital world can be just as devastating.
That’s why I prefer to talk about IVGUD, because it can affect anyone of any age, gender, or background.
Possible warning signs of an Internet and Video Game Use Disorder (IVGUD)
Some warning signs for IVGUD are:
- Changes in behavior
- Spending more and more time online
- Spending money or other resources to get the same enjoyment they used to
- Letting other areas of their life diminish
- Stealing or selling things to pay for their online activities
- Reduced contact with family and friends
- Lack or loss of romantic or emotional relationships
- Job loss
These are the cluster of symptoms and behaviors we ask about in any use disorder. Sometimes the problems with digital addiction are neglected because the person is also using marijuana or some other substance, and the behavior is attributed to a substance use disorder, when it is actually online activities driving the problem. This speaks to the need for thorough and comprehensive assessment.
Treating Internet and Video Game Use Disorder
Despite the prevalence of devices in our lives, IVGUD, like other substance use disorders, is treatable. A residential model works well for digital addiction, paralleling work done for similar process-driven disorders. It begins with a digital detox to allow the brain to start healing and re-establish its own dopamine pattern again, and then slowly reintroduces appropriate technologies.
The data collected over the last 50 years for other process driven disorders suggests that the longer someone with IVGUD is engaged in clinical services, the more likely there will be a positive outcome and lifelong recovery.
There are also almost always comorbid psychological issues accompanying a digital addiction. These can be anxiety or depression, or it might involve more complicated issues such as autism spectrum disorders, bipolar or obsessive-compulsive disorder (OCD). There is a very high correlation between these issues and IVGUD and will also need to be accurately identified and treated during treatment.
Transition back to life and work
In today’s world, it’s nearly impossible to live without touching the digital world. Abstinence from technology is not practical, nor is it the goal. The goal in treatment is to help someone find a balanced way to incorporate appropriate technology into their life while countering that with off-screen time. It’s important to keep their lives firmly in the real world in a way that meets their emotional and social needs.
Finding that balance is a very individualized process, because what may be problematic for one individual may not be for another. If the person’s job depends on using the Internet and other digital sources, then part of their treatment will involve reintroducing some of those things to evaluate whether they are able to balance a healthy life in the real world with their work in the digital world. That’s the reason that we talk about a treatment continuum of at least 3 to 6 months, because we want someone to re-engage with the digital world before treatment is over. We don’t want them to become triggered and not have access to the resources that could help.
The good news is that there are effective ways to treat IVGUD successfully.