Why are video games so addicting

Why do some young people sit for hours in front of computer games instead of worrying about real life? There are three reasons for this

Young people show a particularly strong tendency to excessive gaming behavior. But not all computer games are equally dependent, three factors are particularly important.

It was only when Mark * had to drop out of his mathematics studies that he realized that his life had gotten out of hand. Instead of attending lectures or studying for his exams, the 20-year-old played video games on the computer, day after day, week after week, month after month. “There were weeks when I just slept, ate and played,” he says. That was seven years ago.

Mark is not an isolated incident. A meta-analysis of several studies from 2017 showed that, depending on the country and diagnostic method, up to 27 percent of adolescents can be classified as dependent on computer games.1 "We estimate that around 10 percent of young people in Switzerland are addicted to video games or at risk of addiction," says Franz Eidenbenz, head of the Radix Center for Gambling Addiction and Other Behavioral Addictions in Zurich. In the general population, 2 to 3 percent are affected.

Last year the WHO included computer game addiction (“gaming disorder”) in the latest edition of the ICD-11 diagnostic manual. Characteristic of the disease is therefore persistent or recurring gaming behavior in which the player loses control over the extent, gives up other interests and activities and continues to play more and more despite the negative consequences for his life.

Soon he was playing through the nights

With Mark it was a gradual process. When he was 14, he bought his first game console. He mainly played "Pokémon Perl" on it. At 16 he got his own PC, on which he passed the time with “Empire Earth”, a real-time strategy game from the nineties in which players lead their own civilization through human history. Then followed «Minecraft», «Anno 1404», the Windows train simulator and many more. Soon he was playing through the nights, only going to sleep in the late morning hours and sometimes locking himself in his room for 24 hours without eating or drinking because he was ashamed in front of his flatmates. But he kept playing.

"With the inclusion in the ICD-11, the computer game addiction has received the disease value that it deserves from the clinician's point of view," says Eidenbenz. The Swiss government is currently working on a new law that will in future better protect minors from violence, sex and other unsuitable content in films and video games. The law provides for uniformly regulating age limits and corresponding controls for video games. The Addiction Association demanded that the specific addiction potential of various games be taken into account when indexing. But is it really possible to distinguish addictive games from more harmless ones?

Irregular rewards are risky

According to experts, there are three factors that particularly increase the potential for addiction. This includes a strategy to keep the players involved in a game for as long as possible. It was first described in behavioral research in the 1950s and 1960s. At that time, the Harvard psychologist Burrhus Frederic Skinner showed that laboratory animals repeat an action, for example pressing a button in their cage, most frequently if they are rewarded for it irregularly. Experts speak of an intermittent reinforcement plan. "This reward strategy is used in most online role-playing games," explains Klaus Wölfling, head of the outpatient department for gambling addiction at the Mainz University Medical Center.

The addictive potential is even higher if games have a gambling character, says Wölfling. This is increasingly the case with free-to-play games, i.e. games that are offered free of charge. The game is structured in such a way that the player quickly experiences success at the beginning, but at some point does not get any further. Then he gets the offer to spend money to overcome the hurdle with the help of certain game objects, so-called items. With “Pokémon Go”, for example, 20 Pokéballs cost 100 Pokécoins. This can be used to capture wild monsters. The 100 coins cost 99 cents. Such purchases are usually settled with microtransactions via the mobile phone contract or PayPal. In the long run, however, thousands of euros can come together.

Betting on items can also enhance the gambling character of a game. With skin betting, for example, players can bet items on the results of computer game championships. In addition, in some games you can purchase so-called loot boxes, a kind of surprise bag for items. "This is an effective way of buying a gambling ticket," says Wölfling. In Belgium, loot boxes are therefore now subject to the Gambling Act.

In online video games, the potential for addiction is fed by another source: social feedback from the gamer community. In games such as “World of Warcraft” or “League of Legends”, the players can exchange ideas via text or voice chats and follow the game level of their partners and opponents.

These three factors, intermittent reinforcement plans, gambling character, and social feedback, determine the addictive potential of a video game. This is the result of a review in 2017.2 The authors recommend that video games such as "World of Warcraft", which are currently released from the age of 12, be reassessed using a catalog of 14 criteria. For example, it should be checked whether the unpredictability of rewards increases in the game, whether there are near-wins that delay the rewards, or whether there are negative consequences if the player takes a break.

How addiction arises in the brain

If such risk factors are combined, they can hijack the brain's reward system in the long run. The system is part of the so-called basal ganglia, a structure that controls whether an action planned by the cerebral cortex is carried out or not. The decision depends, among other things, on whether the action has previously been rewarded, for example when a player has mastered a challenge. Then the reward system modulates the synaptic connections in the basal ganglia in such a way that they allow the action the next time. The effect is particularly strong with unexpected rewards, which proves the power of intermittent reinforcement plans.

"Excessive consumption of video games can influence the reward system in such a way that the player begins to only look for rewards in the video game," says Wölfling. Mark can confirm that. The real world became less and less important in his life. “I knew my way around my train simulator, I felt good there, I could do something,” he says. But that also prevented him from worrying about what he could achieve in the real world. At some point it was only a matter of avoiding the guilty conscience by playing.

In 2017, after several attempts, Mark achieved a bachelor's degree in mathematics. But when he wanted to look for a job, the addiction hit back with full force. “Instead of looking for a job, I sat in front of the PC for a whole month,” he says. It was then that he realized that he could not get away from it on his own. He sought help. He found it in a three-month stay in a clinic for addictions. There was no access to computer games, but sports, conversations with other addicts and behavioral therapy. It was only this radical cut that brought something, says Mark.

Effective therapy

Behavioral therapy has proven itself for a long time in Internet addiction - in addition to computer game addiction, this also includes excessive consumption of social media or pornography on the Internet. A study recently published by Wölfling and his colleagues in the journal “Jama Psychiatry” also confirmed its benefits.3 In the randomized clinical trial, the researchers examined the effects of a 15-week cognitive behavioral therapy. They assessed the extent of the addiction and the success of the therapy using, among other things, a tried and tested questionnaire, the Assessment of Internet and Computer Game Addiction Self-Report (Aica-S). After the therapy, the Aica values ​​in the treated group were more than halved on average. In 50 of 72 patients (69.4 percent) they even fell below the threshold for addictive behavior. In a control group without treatment, this was the case in only 17 of 71 patients (23.9 percent).

That is a nice confirmation of the practical experience, says Franz Eidenbenz. Symptoms are often improved after just a few sessions, and treatment can be completed after four months in simple cases. With the appropriate motivation, around two thirds of the therapies are successful. "Overall, behavioral addictions are just as demanding in terms of treatment as substance-related addictions," adds the expert. In difficult cases in particular, the “internet gaming disorder” is often linked to other disorders such as depression, ADHD or social phobias, which must also be treated.

In terms of prevention, he believes it is unrealistic to be able to control the behavior of players through age restrictions and controls. Most game providers are globally active and offer their products via internet platforms, he says. Teenagers know how to get hold of the games. In order to raise awareness at an early stage, however, it would be helpful if there was a technically justified reference to addiction risks. Basically, a social discussion about the opportunities and risks of video games must be carried out on a broad basis. “Games are now a cultural asset,” he says. Depending on how they are designed, they also have learning and motivational potential. "We shouldn't be hostile to computer games, but rather research the games further, use their potential and minimize the risks," says Eidenbenz.

Mark has meanwhile consistently banned computer games from his life. He gave his PC to his brother. He is currently completing an internship at a Swiss railway company. “In the end, the real railroad is more worthwhile than the simulator,” he says.

* Name changed by the editor.

1 Psychiatry and Clinical Neuroscience 2017; 2 Expertise for the Federal Ministry of Health (PDF); 3 «Jama Psychiatry» 2019.