Spending hours in front of a screen does not, by itself, make someone addicted to gaming.
A player can spend long periods gaming, streaming or using social media without losing control or suffering serious consequences, while another person who spends less time online may see school performance decline, relationships deteriorate or psychological distress begin to take over.
That distinction is becoming increasingly important as researchers, parents and policymakers try to determine where intense engagement ends and harmful behavior begins.
For behavioral addiction researcher and psychologist Maeva Flayelle, there is no simple numerical answer.
Speaking about the challenges of identifying problematic gaming behavior, Flayelle said there is no fixed number of hours that separates healthy gaming from addiction.
“There is clearly no consensus on this matter,” she told Anadolu.
“There is no quantitative threshold to determine what is too much related to gaming,” Flayelle added.
She said some people may spend large amounts of time gaming, streaming or using social media without experiencing harmful consequences.
“You can have really highly engaged people in gaming, streaming or social media use, yet they don't encounter any negative consequences or they don't have any loss of control with that,” she said.
At the same time, Flayelle said someone who spends less time gaming may still experience significant problems.
“You can have people who will game a bit less, but who will have significant psychological distress and functional impairment in some domains of their lives,” she said, citing work, personal relationships and social relationships as examples.
“So, this is not a question of hours or amount of hours. This is really a question of outcomes and consequences in people's lives,” she said.
Loss of control key warning sign
Flayelle said one of the main distinctions between ordinary gaming and problematic behavior is whether a person can continue to control how they engage with games.
“We can draw the line when people start to lose control over the time they spend gaming,” she said.
Repeated unsuccessful efforts to reduce gaming can also indicate a problem, she added.
Flayelle said the situation becomes more concerning when gaming is accompanied by “psychological distress” and negative feelings such as “guilt or regret.”
“Yet, we start to enter this problematic area,” she said.
Loot boxes deserve regulatory attention
Flayelle also pointed to the way video games are designed, particularly the use of loot boxes, as an area requiring closer scrutiny.
“We know more and more that loot boxes can cause some issues and cause some prolonged involvement with potential loss of control,” she said.
She said regulatory developments are already taking place and argued that current evidence gives policymakers reason to pay attention to the feature.
“With the evidence that we have today, loot boxes seem to be a design feature for which we should have attention in regulatory terms,” she said.
Young people ‘a vulnerable group’
Young people require particular attention because of their stage of development, according to Flayelle.
“Of course, young people are a vulnerable group,” she said.
“We need to pay attention to them because, in terms of brain maturity, we still need to develop, notably for functions that underlie decision-making and self-regulation,” she added.
Flayelle said parents should not focus solely on screen time but should look more closely at what their children play, how they play and whether gaming is affecting other areas of their lives.
“Parents should monitor which games they play and how they play, and most importantly, they need to monitor whether there are some negative outcomes again in their lives,” she said.
She pointed to social isolation and declining school performance as possible warning signs.
“If you have a young individual who starts to isolate himself in the bedroom, always playing, there are no more social relationships, or the school grades are really decreasing,” she said.
“These are warning signals that parents should pay attention to.”
Researchers seek greater access to gaming data
Flayelle said gaming disorder has received increasing attention from policymakers and regulators following its official recognition by the World Health Organization.
But she said researchers also need greater cooperation from gaming companies.
“What we need most today is probably to be able to enter a dialogue with the industry, with the gaming industry,” she said.
Researchers need access to industry data to improve studies of gaming behavior, she said.
“We would need, as researchers, to access their data to improve the research that we conduct on those behaviors,” Flayelle said.
She added that gaming companies also need to take greater responsibility.
“They also need to acknowledge that they probably should take greater responsibility for the way these video games are designed to prevent harms for users,” she said.
Medication and psychotherapy
While Flayelle focused on identifying and preventing gaming-related harm, psychiatrist Jon Grant addressed how behavioral addictions can be treated once they become problematic.
Grant said researchers have conducted several double-blind, placebo-controlled trials over approximately 25 years examining treatments for behavioral addictions.
“I think the evidence base is good; it's not great,” Grant said.
Behavioral addictions differ from substance-related disorders because they do not involve consuming an external substance, raising questions about what medication should target.
Grant said treatment may depend on whether a patient is dealing only with the problematic behavior or also has other co-occurring conditions.
“If the person has no other problems, you can target the behavior itself,” he said.
“If they have these other co-occurring problems, that might mean that they may need two different medications or a slightly different medication based on whichever the co-occurring problem is,” he added.
Grant said he would like medication to become part of standard treatment alongside psychological approaches.
“I hope that they become a standard treatment along with psychotherapy,” he said.
“If we believe that these behavioral addictions are serious, then it seems as if we should do everything possible to help people with them.”
For Grant, that means clinicians should not necessarily view medication and psychotherapy as competing treatment options.
“And if that includes a combination of medication and psychotherapy, why wouldn't we do both?” he said.
