Understanding and Dealing with Gaming Problems: A Q&A with a Therapist

There's tremendous confusion about the issue of "online gaming addiction." The media seem focused on "pro-gaming" and "anti-gaming" voices which have become increasingly hostile and polarized. It's natural to want to simplify, label, and categorize human behavior, but when we do that we risk missing the important nuances of what's really happening in specific cases. Where there are problems there are likely a variety of causes, and myriad possible solutions. It's complicated.

If there's one thing I'd like to communicate to people about the topic of "addiction", I'd have to say "it's about functioning." When clinical therapists are assessing whether or not someone is experiencing a problematic compulsive behavior they generally start by looking at how well the individual is functioning in life across a variety of domains. In order to live effectively in the world we need to maintain our physical health (nutrition, hygiene, exercise), establish and maintain a home environment (okay, how clean it has to be is somewhat flexible), and if we're adults, support ourselves economically and pay our bills on time. As young people we are expected to prepare to support ourselves eventually by becoming educated. If we're engaged in any behaviors that prevent us from functioning in those areas, it's clear that there is a problem to be further assessed.

It gets more complicated when we consider the issue of interpersonal relationships and what would often be termed "personal growth." Therapists tend to have a bias toward building positive and supportive intimate relationships in real life. In order to develop and maintain such relationships, quality time needs to be spent interacting in positive ways with loved ones and peers. Any activity that prevents or significantly interferes with that kind of quality time should be evaluated if one deems real life relationships to be important. People differ in potential and desire for intimate real life relationships however, and for some online friends may meet their needs. In many situations individuals may experience more intimacy with online friends than they do with those they know in real life.

Unfortunately many people, particularly those prone to compulsive behaviors, are not highly self-aware and have a hard time reflecting upon and regulating their own behavior. Children are not able to do this, which is why they have parents who regulate them. Adolescents do it sketchily. Adults vary according to many complex factors. Family and loved ones of an individual are apt to be the first to notice problems in functioning. But rather than filling out a questionnaire that asks things like "how many hours a week do you play online games?" in order to assess if someone has a problem, it might be more helpful to discuss the issues of "how well are you functioning in life overall?" and "are you living the kind of life you really want to be living?"

Any behavior that interferes with life functioning should be an area for further examination be it computer gaming or anything else. If you stop and think about it, these are questions we all should reflect upon frequently and with honesty. I must pause and ask myself "when I'm at the end of my life will I look back and feel good about the way I chose to spend my time?"

If you've spent any time around children, you realize they are not miniature adults. Their thought processes and perceptions are entirely different from mature adults. They lack the ability to delay gratification and need immediate rewards. They've not yet developed the capacity to appreciate ambivalence; issues appear to be black and white, good or bad. Young people struggle with impulse control, have limited ability to understand and regulate their emotions, and are easily overwhelmed by conflict. Most are unable to take the perspective of another.

This is why kids have parents. If left to their own devices they fail to bathe, eat properly, learn to get along with others, or develop a clear understanding of who they are. Most would certainly not go to school because the rewards for doing so don't come until far into the future, something they can't yet envision.

If we understand that kids are special cases, it's common sense that they need structure, support, guidance, and a variety of activities in which to develop competencies and feelings of success. Video games can bring opportunities for growth and success to kids; particularly when parents participate in the experience to some degree. Without balance or parental involvement however, problems can easily develop.

I suppose at this point I should confess it's not something I was able to pull off in raising my own kids, though I really tried to. I was functionally a single parent of three, working full time, and in their early years attending graduate school at nights. My kids were alone with television and their computers far too much. One of the difficulties in present day society is that parents are often exhausted and depleted. I think anxiety and depression in children are increasing. Kids are frequently left alone and under stimulated.

It's easy for depressed and anxious children to withdraw, escape, to become sedentary. They become developmentally stuck. This can happen from too much television viewing as well as excessive video gaming. This needs to be kept in mind when we look at the issue of young people and use of the media, whether we're talking about television, video gaming, or other use of the internet. It's easy to say "parents need to monitor kids and their computer use" but we don't live in an ideal world where this is realistically possible for many families.

I wouldn't presume to set predetermined specific rules about what is appropriate for a given family or individual. This is something that should be evaluated within the context of each individual family. However parents who are invested in doing a good job raising their kids will spend time evaluating when, where, and how much use of various media is good for their kids and what other activities need to be integrated into their lives. If this is monitored from the beginning it's easier to keep things from getting out-of-control as kids get older.

I have noticed that parents who enjoy their children and find activities they can participate in together report more academic success and fewer problems with compulsive behavior of all sorts, but this needs to start in their early years. And I'll repeat myself: parents can play games with their kids in a constructive and positive manner.

It's in the nature of the adolescent to rebel and reject most everything their parents say. If kids have been allowed unlimited access to the media when pre-adolescent, it's very difficult for parents to set limits when they become older. At this point professional help may be the best way to assess ways to turn a negative situation into a more positive one.

There's not much that's more complicated than making a loving relationship work over the long haul. People enter into relationships for intimacy, closeness, and with the expectations of meeting one another's needs. Any behavior that shuts one partner out and disrupts the primary bond is a problem. If computer gaming becomes habitual and uncontrollable it is apt to cause severe impairment in primary relationships.

Now I have seen relationships break up over compulsive surfing (the kind in the ocean – not just the internet), compulsive spending, and certainly compulsive gambling. Computer gaming can be especially problematic because the virtual world is accessible 24/7; game play can continue endlessly, day or night, and because there are so many reinforcers structured into many games there's tremendous incentive to keep playing. You can't put the game on "pause" to go share dinner with the family, or to put the kids to bed.

I hear a lot of common complaints. "She plays the game every night after work; we don't have dinner together anymore and her game friends mean more to her than I do." "He stays up all night and plays all weekend long; we don't talk, have sex, and he ignores the kids." It's not uncommon to hear of people who stop bathing on a daily basis.

Of course a partner is going to become upset. Initially there's a feeling of loss which quickly moves to frustration, then anger. Positive communication ceases and the overall tone of the relationship becomes negative. The partner who is gaming compulsively tends to become defensive and angry, in fact identifying the negativity in the relationship as just another reason to escape into the fantasy realm of the game where she/he can experience the sense of respect, control, and the associated dopamine rush of satisfaction that takes place in the game. Denial becomes entrenched. "Problem? I don't have a problem …"

The partner becomes increasingly isolated, hurt, and angry thus establishing the proverbial vicious circle.

The first thing I'd suggest to the partner of a compulsive gamer is to find a supportive environment to sort out your own feelings. The pain can become absolutely overwhelming and contribute to a growing sense of depression, hopelessness, and loss of joy in life. A good counselor can help you sort out what you are feeling, and then examine what options there are. If therapy is not a possibility for you, there are online support groups which can be helpful.

If I had to simplify the best approach to take in this type of situation I'm reminded of the classic term in addiction treatment called "hitting bottom." When a person is engaged in a compulsion that has taken over their lives they are not looking at life realistically; they are not considering the consequences of their actions. It takes a severe, abrupt, life changing loss to bring them back to reality. When you hit bottom, you come back to reality – hopefully.

You can compare this to a person who begins a pattern of abusing alcohol. Initially they may have two or three drinks, get in their car to drive home, and they get there safely. There are no consequences. They may do this a dozen times, and eventually progress to four or five drinks, as if they are unaware that they are impaired and taking life threatening chances. Often it takes only one car accident, or a DUI arrest for them to wake up and admit "I've got a problem and I've got to stop." Nothing like a night in a drunk tank laying on a cold concrete floor to give someone a message about natural consequences. It's a harsh and necessary wake up call, and a logical consequence of their actions.

So the best treatment for someone with a habitual and destructive compulsive behavior is a hitting bottom experience. It's not quite as dramatic as a DUI arrest when we're talking about computer gaming, however when you stop preparing your partner food, buying his/her groceries, doing all the laundry, and waiting around the house hoping he/she will share some free time with you it starts to "bring the bottom up" so to speak. There is no need to beg, nag, cry, or allow yourself to become depressed over the situation. Let the consequences be natural. If your partner is not taking care of business, let the consequences pile up and overwhelm them. Don't enable. NEVER make the dinner and deliver it to the computer. Do your own laundry and let his/hers pile up into a huge smelly pile until there are no clean clothes.

Get out of the house, make other friends, and get your own needs for a social life met in other places. Leave the gamer to his/her game. Do your own thing. Detach. You may find that your partner notices the change and responds by taking a more realistic look at the situation....or maybe not. But at least he/she won't blame you for acting like a miserable nag.

Sadly in some cases the message isn't heard until you've gotten fed up and decide to leave the relationship. I still recommend professional help in sorting this out, as there is no easy and clear path. Empty threats are not productive and still come off as nagging, so there has to be a realistic action plan and it should be communicated that you are serious. At this point the compulsive gamer may be more motivated to consult a professional with you. If not, I like the advice the old sage Ann Landers used to give: "are you better with him/her or without?"

It's a time for lots of reflection, and feedback from wise friends you trust. Ultimately if someone chooses a relationship with a game over intimacy with you, it's time to decide if this is how you want to live your life.

Hard stuff indeed.

Things to do:

With a child:

• Set clear limits regarding computer use and enforce them. Internet use is a privilege not a right.
  
• Be a good role model in living an active and balanced lifestyle.
  
• Build a positive and loving relationship enjoying a variety of activities together, as much as it's in your power to do so.
  

With an adult:

• Communicate in a caring and constructive way about your concerns and sense of loss or disappointment. Do this as long as the individual is willing to interact with you in a positive manner.
  
• Make specific requests ("It would make me very happy if we could spend three evenings together and at least one day on the weekend").
  
• Allow natural and logical consequences to occur for irresponsible behavior.
  
• Take care of your own needs for social and emotional support; find recreational activities that make you happy.
  
• Encourage consultation with a professional therapist.
  
• Realize that ultimately you cannot control another person and in the process of detachment a sense of loss occurs. Find support for yourself.
  

Things not to do:

• Don't be a broken record – venting anger and nagging doesn't help. You can state your feelings without communicating in a rageful way.
  
• Don't pay for a problem gamer's broadband connection (or other bills) yourself.
  
• Don't pay monthly game subscription fees for a problem gamer.
  
• Don't do anything that makes it easier for her/him to maintain an irresponsible lifestyle.
  
• Don't threaten to leave unless you are serious. Be very clear about what your needs are.