Dr. Jack Kuo, who treats video game addiction at Promises Malibu, talks about the mental health threat posed by Candy Crush vs. MMORPG games such as World of Warcraft.
It seems that problem video gaming has made big news since the Flappy Bird free phone game soared to feverish use and its concerned designer pulled it from the app store. “Too addictive,” he said in February, provoking global group withdrawal. There has been an ongoing debate among academics and gamers — as well as medical and mental health professionals — as to whether excessive video gaming should be classified as a disorder. The angst felt around the world when Flappy Bird was removed from mobile app stores led to reports of iPhones with the app already installed selling online for $10,000 to $100,000. Some extreme fans on the game designer’s Twitter account threatened to kill him or themselves. Before Dong Nguyen pulled Flappy Bird on Feb. 9, the free downloadable smartphone app proved an unmatched success. In just weeks, it consumed people to such a degree that Huffington Post ran “Proof Flappy Bird Will Be the End of Humanity.” It featured nothing but screen shots of gamers on Twitter almost comically bemoaning its tyranny over their lives. “Ruined My Marriage” tweeted: “I don’t know how long I’ve had this game, an hour, eight hours, it could be days. Time works differently when you play it. My wife took the kids to her mother’s [home] two high scores ago. We argued about something but I don’t know what it was about. I was too busy playing Flappy Bird. I didn’t go into work today, but when my boss called, I ignored it and continued to play Flappy Bird. My phone is charging now, but I can still hear the joyful beeps in my head and the flapping of the bird at all times. I can’t sleep, I can’t eat, not until I’ve beaten my high score.” Given the reports of Flappy Bird and other gaming that swallows whole weekends and derails homework, socializing and even meals, we checked in with Dr. Jack Kuo, video game specialist for Promises Treatment Centers.
Q. Are these games akin to video games in terms of being addictive? Kuo: A big difference between casual games like Candy Crush and its ancestors is accessibility. In the distant past, playing video games meant putting quarters into an arcade machine. Later, this turned into playing on home consoles, which anchor you to your house with the latest models being the PS4 and XBox One. Nintendo’s Game Boy handheld console and its ilk liberated video games from the arcade or home and made them portable. Games like Candy Crush are the most recent and most popular video games ever for a number of reasons — the ability to play them on a smartphone makes them the most accessible games ever, while the fact that the game is free helped popularize it. In addition to being free and accessible, Candy Crush has many gaming elements as outlined in a Time magazine article, which make it compelling and addictive in the lay (versus clinical) sense of the term. Many people have lost countless hours and had some interpersonal problems as a result of Candy Crush. However, exceedingly few people have their lives ruined or significantly affected by casual games like Candy Crush. The most addictive video games, in a clinical sense, remain MMORPGs (massive multiplayer online role playing games) like World of Warcraft, which have led to enough clinical problems with addiction for the term video game addiction to have been considered for inclusion in the DSM 5. Q. Is video game addiction widely treated? Kuo: Yes. In the U.S. there are several clinicians/researchers like Kimberly Young, PhD, who have developed entire careers around writing about and treating Internet addictions including video game addiction. There are also a few U.S. treatment centers that feature video game addiction tracks, which are often 12-step abstinence-based programs blended with some outdoor wilderness approaches. The reSTART program would be an example of such a program. Worldwide, the treatment approaches vary by country considerably. The European programs I’m familiar with resemble those in the U.S. China has programs based out of former military camps that feature aversion therapy and some other approaches with questionable scientific basis. South Korea has the most cutting-edge programs due to the widespread nature of the problem there — the government has set up a number of treatment centers and research programs. Olganon (Online Games Anonymous) is a 12-step based program for both gamers and their loved ones, which offers information, support and groups. Olganon was founded by Liz Woolley, a mother whose son committed suicide while playing a MMORPG called Everquest (the World of Warcraft of that time). Q. How medically would such an addiction be classified? In 2007, the American Medical Association considered classifying video game addiction as a psychiatric disorder, to considerable press. Ultimately the AMA decided to hold off on the decision due to what it said was a need for further research into the matter. Such research is ongoing. Until then, video game addiction is best classified (along with other examples such as sex addiction) as a behavioral or process addiction. Under the DSM 4, such behavioral addictions are diagnosed as impulse control disorder NOS (not otherwise specified). Both Internet and sex addiction are included in the index of DSM 5 as meriting further study prior to inclusion. And would we at Elements treat it? Kuo: Absolutely. At Promises Malibu, both myself and Dr. [William] Huang have expertise in treating video game addiction and have done a number of presentations nationally and internationally on the topic (I believe there’s a DVD available of one such presentation). Currently we most often see it as co-morbid with patients presenting with substance abuse disorders.