Recently, the tragic case of the young British man who died of a blood clot deep in the midst of a mammoth twelve-hour gaming session hit the news. The risks of a sedentary lifestyle are well-noted, but in the world of addiction, the absence of a substance or chemical in any life-threatening scenario is worth talking about, and re-evaluating our position on how addiction works.
In the United States, the 2013 edition of the Diagnostic Statistical Manual, the go-to handbook for mental health professionals in the US, was the first to include gambling addiction among its list of mental ailments. Gambling, like gaming or excessive internet usage, features no chemicals or addictive substances, but does appeal to the reward centres of the brain. As observed by researchers in Iceland, people with pathological behaviours enact these behaviours in spite of adverse consequences because they provide solace when something is lacking in their life. Sometimes, this is incidental: people who, for example, crave social acceptance, might find the teamwork and communication aspects of massive multiplayer games such as World of Warcraft or Counterstrike rewarding, particularly if those are noticeably absent from that individual’s off-screen life.
However, some game designers adopt a more sinister strategy. Requiring an unpredictable number and sequence of actions to unlock a reward (lighting up the brain’s reward centre) encourages more frequent engagement. Research tells us that provision of rewards at variable ratios and intervals reinforces behaviour. It’s not unlike training a puppy. Players are guaranteed a long-term reward for their commitment to the game, interspersed with rare items (or social rewards, such as congratulations for successful missions) at random intervals. This reinforces the gaming behaviour, and, for people vulnerable to addictive behaviour, can lead to gaming addiction. Games such as Pokemon GO! are explicitly designed with this behavioural theory in mind. Even social media such as Facebook and Instagram provide these variables reward intervals – think the little red flag that pops up with a notification of someone reacting to a photo, comment or video you’ve shared, or a new message from a friend.
In ultra-connected Asia, South Korea, Japan, and China already have “boot camps” invented to combat the rise of gaming addiction and get afflicted youths outdoors developing skills. In the US, where gaming and internet addictions are picking up steam, there is reSTART, a high-end rehab in the Pacific Northwest. At reSTART’s live-in facility, residents relearn how to function in a social environment. They are taught in explicit, behaviour-repeating exercises the social norms that come to many of us naturally: when to ask questions in conversation, for example, or how to set up real-world social interactions. For many of the men committed to reSTART, their gaming addiction was triggered by a traumatic life event, like the death of a parent or the collapse of a relationship. We know that emotional trauma and prolonged feelings of isolation are major factors in the development of substance-based addictions, but it appears that this is the case for addictive gaming behaviour, too. Certainly, Li Yan, of Xu Xiangyang education and training centre (“boot camp” for internet-addicted Chinese teenagers) believes “They feel emptiness in their hearts. They can’t live up to their parents’ expectations. So they go to the internet cafe.” Replace “internet cafe” with “pub” or “drug dealer” and you’ve a very familiar story to millions of people affected by addictive behaviour.
So what about Australia? Although much of SMART Recovery Australia’s work is with people struggling with alcohol or other drug issues, I do frequently encounter people dealing with Internet addiction. I should note that, although people who want to manage their drinking or drug use are often the ones who come to us seeking help, when it comes to Internet addiction it’s far more common for me to speak to a parent, friend, or case worker than to the individual themselves. About 13.4 million Aussies spend at least eighteen hours of each day online. At the very least, simple mathematics tells us they aren’t getting nearly enough sleep at that rate of use. We might visit Facebook at least sixteen times per week, but what is that costing us in terms of our off-screen relationships?
Clearly, when people feel isolated, traumatised, or marginalised, behaviour – whether it was the odd drink on the weekend, a bet on the football, or playing online games – can become harmful and addictive. Knowing this, and treating addiction as a social, health-based issue, is what forms SMART Recovery Australia’s approach, and why our meetings are so successful for so many Australians.