IamA Harvard-trained Addiction Psychiatrist with a focus on video game addiction, here to answer questions about gaming & mental health. AMA!

How do you distinguish between someone who is addicted to video games and someone who plays them a lot because they really enjoy them?

The main difference is whether they interfere with your function or goals in life. I have friends who make seven figures and play 40 hours of games per week. They're happy with where they are.

I have other friends who play games for 60 hours a week, live in their parents' basement, and have big hopes and dreams, but never move towards them in a substantial way.

If your life isn't going in the direction that you want, and you're playing a ton of games, that's a problem.

Does that answer your question?

If your life isn't going in the direction you want, and you're not playing games, does that mean your other hobbies are an addiction?

Not necessarily. Do you think your other hobbies are the causative factor in why you're life isn't going the way you want? Sometimes life just doesn't go the way you want.

The real question is are you giving it your all, really trying?

Well, that's kind of what I'm wondering about gaming too. Gaming might not always be the cause of problems, but might be the way people deal with them?

Maybe initially, but it can quickly become a self-inforcing cycle

What /u/PureImbalance said.

Gaming can serve as healthy coping mechanism, just like alcohol or taking a vacation. I certainly destress by gaming at times. But for some people, it can transform from being a coping mechanism to a barrier to actually dealing with the cause of problems. That's when it becomes problematic.

Can you clarify the definition of a video game addiction? Would be the interference of video games in personal life whether it be professional advancement or relationships, etc.?

If it is causing a problem, it is a problem. Also, to be frank, if you think you might have a problem then you probably have a problem.

This guy basically said it. The main line that most psychiatric disorders cross is "interference with function." If it is causing some significant problem in your work, personal life, or health, it is a problem.

What's the difference in treatment of video game addiction compared to say heroin addiction?

Fantastic question.

Substance use disorders are usually different from behavioral disorders, in a neuroscientific sense. Substance use disorders, such as alcoholism or heroin addiction, are biological substances that artificially activate dopamine reward circuitry in the brain (among other circuits, such as suppressing or affecting your limbic system).

Behavioral addictions, on the other hand, have far more complex mechanisms, but also affect dopamine reward systems (which makes games fun). For example, many gamers derive a sense of pride, identity, and accomplishment from playing games. This is one of the things that pulls people so heavily into games. I have never met a heroin addict who is proud of all of the things he's done related to heroin use.

At the end of the day, both are addictions because they are harmful behaviors that prevent people from achieving what they want in life. Gaming, however, also has a lot of positive impacts on people's lives. I have friends who met their spouses through video games, and I've maintained a lot of wonderful relationships through gaming.

Does that sufficiently answer your question? It's quite a complicated one, and I can go into more detail about neurocircuitry.

EDIT #1: I see that I misread your question - what is the difference in treatment.

Some treatment is common, such as using cognitive behavioral techniques to help people understand what the driving forces behind their use is.

The biggest difference is that for the biological addictions, there are pharmacologic treatments: such as suboxone for heroin addiction, which provides a controlled form of opiate with an opiate blocker to prevent injection, or naltrexone to curb cravings and the reinforcing effects of alcohol. Nothing like this exists with video game addiction.

Lastly, video game addiction is a relatively new phenomenon, so I don't actually know of any scientifically validated treatments that exist. For example, the World Health Organization just classified video game addiction as a problem in 2018.

A sense of pride and accomplishment... Where have i heared that

Edit: wow My first Gold. Thanks stranger

Can you please elaborate?

Look at this thread. Most downvoted comment on Reddit history is from the official EA account.

https://www.reddit.com/r/StarWarsBattlefront/comments/7cff0b/comment/dppum98?st=JLDAE62Q&sh=c2238b3a

Oh god. I've sunk to an all time low if I'm saying the same things as the Battlefront folks to justify lootboxes.

Time for some self reflection.

Unfortunately, I do think it is true. I certainly felt like a badass by beating Dark Souls and Dark Souls 3. Felt a surge of joy and pride when I downed raid bosses in WoW, etc. Just because they hijack something from video games to make a sleazy buck doesn't mean it isn't true.

I don't know, I'm conflicted. I feel sleazy.

It seems to me that gaming addiction is probably very similar to gambling addiction. Have you looked into comparing them?

Very much so. Out of all the behavioral addictions, they are the only two that have a worthwhile profession. I think gaming and gambling are the most similar of the behavioral addictions, but learning about gambling hasn't really helped me very much with my patients. The entities, while the most similar to each other, are still quite different in my experience.

Your questions are incredibly insightful - may I ask what your professional training / background is?

I remember hearing that SSRI’s are sometimes used when quitting cigarettes. Has there been any research on using those drugs for behavioral addictions?

There may be research, but nothing that I'm familiar with or that's decisive. Pharmacotherapy is quite common for substance use disorders, the field is more untested for behavioral addictions.

Growing up playing quite a lot of video games I often equated video game playing to TV watching, and justified my lifestyle by noting that there was seemingly no social stigma against watching hours and hours of TV daily. In fact, since video games are interactive and brain teasing they should not have the social stigma attached (or TV should receive a social stigma... either way).

To you, do video game addiction and TV addiction have any meaningful differences?

Absolutely.

There is no sense of activity or identity within television. You don't watch television to interact with your Steam friends, and you don't work to create something in the television. Video games have strong social components (I, for example, invited a friend of mine whom I had been gaming with for 15 years to my wedding, despite never having met the guy) and identity components. People are proud to be good at a certain game, or to unlock certain achievements. They derive a sense of self and pride from their gaming that is absent in television.

The two are similar in that they induce regular spurts of dopamine into your reward circuitry, keeping people engaged for hours on end.

How do I get someone to realize they have an addiction?

Example: I play what I call “fiddle games”, something to wile away downtime. Sometimes I have a lot of downtime, sometimes not. Sometimes I’m checking emails, social media, but my device or phone is mostly in my hand. I can put it down and walk away though and not worry about my games for hours.

My mother however plays games constantly at home and misses out on conversations, dialogue in TV shows/movies and has to ask what’s going on, she will set a timer to remember when to do something in a game.

As she’s sitting there playing her games (ignoring me while I’m visiting) I’ll pick up my device and do something and she will immediately say, “You’re too focused on your games, you need to stop.”

I don’t know how to get through to her she’s as addicted or more than I am. She thinks because she’s 67 and playing Yahtzee and Words with Friends etc she’s not addicted.

TL/dr; I can’t convince my gaming addicted mother she’s addicted while she accuses me of being addicted.

This is a really good question, and a really hard issue.

The challenge here is to try to demonstrate her behavior without making her feel defensive. Also, she's probably projecting her own fears of being addicted onto you, which is why she accuses you of being addicted.

Here's a line of dialogue you can try:

"Hey mom. I've noticed that when I come over, you seem to enjoy playing Yahtzee a lot. I usually like to play Fiddle Game, because it is so ***. What do you like so much about Yahtzee?"

<Her answer, hopefully not defensive>.

"Yea, that sounds very fun. I was curious, do you think how much we use our cell phones impacts our time together?"

Note that here, you're not actually saying that it is good or bad, you're inviting her to reflect about whether there is an impact. If she attacks you, saying that your cell phone use is a problem, then don't get pulled into defending yourself.

"I hear that you're saying that when I play Fiddle Games, it makes you feel unheard. Is that correct?"

"It also sounds like playing Yahtzee doesn't seem to impact our time together. Sometimes I feel like I don't have your full attention. Is that a fair way for me to feel, or do you think I'm blowing things out of proportion?"

Hopefully, that'll open the conversation somewhat. A couple of things to avoid:

-Don't make comparisons. Comparisons make people feel defensive.

-Ask for her opinion, and try to get an understanding of how she sees her cell phone use.

-Try to focus on your experience of things, instead of blaming her behavior. "I feel like when I come over, we're not able to communicate the way we used to. Is there anything either of us can do to improve the time we spend together?"

-When you set a frame of inquiry and curiosity, it increases the likelihood she'll be receptive instead of defensive. If you're curious, she's more likely to be the same. Human beings mirror each other. If you introduce yourself, the other person feels a strong compulsion to do the same. Set the right tone for the conversation and you'll have a better chance at engaging her.

Hope that helps. If it doesn't, you could always find a family therapist. It's harder to do than I make it sound.

Thanks so much for taking the time to speak with us! I have a few questions about this topic, which have mostly come from my own personal experiences.

1) are there any demographic groups are more prone to video game addiction? I’m curious if the risk changes across age groups or genders. If there is variation, do you have any ideas that might explain the differences?

2) Some people seem more prone to addiction than others; however, I’ve also noticed that some people are more prone to certain types of addiction. For example, I have friends who have struggled with their marijuana use, but have no trouble moderating nicotine consumption. I’m the exact opposite. This discrepancy seems interesting in the context of video game addiction, where people might have no trouble with drugs but have no control over gaming habits. In your experience, do you believe that people are prone to only certain kinds of addiction? Have you or anyone else in academia hypothesized a reason for this?

3) Lastly, what questions do you find most interesting in your field?

Amazing questions, all insightful and complex.

I'll start with #3 - basically all the questions being asked in this thread, especially yours.

1: Yes, men seem to be more prone to video games than women - for example, in the German study 8.4% of boys sampled met the criteria for video game addiction, versus an overall 5.0% when considering both genders.

Risk does change across age groups - there is overwhelming evidence that early exposure to substances (and likely video games) leads to a greater chance to be addicted. Developing brains are vulnerable, and adding artificial dopaminergic chemicals in the mix when you're 15 has a way higher chance of developing into addictive behavior than when you're 30.

For the gender variation, it's a fascinating subject, and one that I ask myself daily. 80%+ of the gamers I've worked with are men. I'm still trying to understand why (as the data suggests that while there is a gender difference, it isn't anywhere near 80/20).

One hypothesis I have is that boys are socialized to minimize their emotional expression, and thereby minimize their understanding of emotions. Over time, this develops into a state called alexithymia, or inability to understand one's emotional state. Men are socialized to be able to express one emotion: anger. Any other emotion is considered "unmanly." If you're crying, you should "man up" and "be strong" because that's what men are supposed to do. As boys learn to suppress emotions at an early age, I think that makes them crave experiences that allow them to experience and channel emotions, such as video games. Most men I work with have a lot of difficulty understanding that they feel shame or fear, they usually mask it as "frustration." They just know that they feel bad, and that games help them "destress."

But they never get to the underlying cause of why they're "stressed" (another acceptable state for men to be in), and so play games to "destress." But the fix is temporary, because they don't process the underlying emotion. So they play more, and more, and more.

Regarding #2, there is ample data (fMRI studies) that suggest different substances trigger dopamine reward circuitry for different people. Some people's brain's are just wired to light up like a christmas tree when drinking, others when doing heroin, others when doing pot (but marijuana is a bit more complex). There is strong evidence that this substance-dopamine circuit interaction is at least partially hereditary, given that alcoholism tends to run in some families, whereas opiate addiction runs in others.

If it is OK with you, I'll skip references for now to try to answer other questions. PM me in a day or two if you want additional reading material.

This is not video game-related but I'd like to ask you. I've been struggling lately with discerning whether or not I'm having/developing a porn addiction. Mainly I am unsure of what makes something truly an addiction in the first place. My idea of an addiction is when you feel an urge, a need, a craving. I honestly can't say I feel anything like that with pornography (other than the normal moments of high sexual tention or arousal). But on the other hand, it is worryingly easy for me to just decide I want to watch porn (out of pure boredom mostly, or lack of willingness to do something more productice) and just as hard for me to prevent that. That leads to periods of me watching porn even in multiple sessions for multiple hours a day.

TL;DR I don't feel a real craving for porn but it's really hard for me to control myself and it can get out of hand once I start enjoying it. Do I have an addiction?

It sounds something like an addiction. I'm not really able to diagnose people over reddit, but watching porn for multiple hours a day is outside the norm of experience (and I talk to a lot of people about porn). My suggestion is to find a mental health professional (you can contact your health insurance company for a therapist) and schedule an intake with them.

What I wonder about is why you're so bored? It sounds to me like porn is a hit of dopamine that keeps your brain happy. Getting a handle^{no pun intended} on your situation involves exploring why you're so bored, and unwilling to do something more productive.

I feel it's more like my brain seems to recognise it as the easiest, simplest way to get, as you said, a hit of dopamine and also entertain itself and fill up time. It's not that I don't have other things to do or think about, it's just that once porn comes to mind (or I run into something arousing) and I'm not currently engaged in any other activity, it's almost like the natural thing to do. Lately I often don't even feel like I'm even making a full conscious decision, it just kind of happens. The biggest problem is that it can get in the way of what I actually want or need to do.

This sounds problematic. It reminds of the evolution of addiction:

1) Phase 1 - When the substance produces a high. People feel good doing it.
2) Phase 2 - When the substance removes a low. People do it to feel less bad, but don't feel the good they used to.

3) Phase 3 - People do it and don't really know why. It doesn't make them feel good, and doesn't even remove the bad. They just can't stop.

Volkow's work in this area is absolutely brilliant.

While I agree it does resemble this, I also think my porn problem is largely a mere manifestation of my laziness, which is something I forgot to mention. I'm not trying to deny that this might be problematic, but I know that when I, e.g. go on vacation, I can easily do several days with barely even thinking about it. When my mind is healthily occupied, It doesn't present much of a problem. But it is in times when I'm at home, when I can't get myself to do something healthy or productive, when I'm generally being lazy, that's when the porn kicks in. Then it takes up more time and energy than it should and ends up messing up my day and my plans. The situations and motives vary, of course, but this is mainly what it looks like.

In my experience, people aren't truly lazy. Crazy, I know.

"Lazy" is an umbrella term that many gamers use to describe something far more complex. Much of the work that I do with gamers is in exploring what "laziness" really is. Sometimes it is being unable to break down a large goal into digestible pieces, sometimes it is a subconscious fear of failure.

For example, many of the gamers I work with take a lot of pride in their intelligence. If they actually give their all and fall short, they'll feel stupid. Their sense of identity is built on their intelligence. This in turn, causes them to half ass stuff, because at least their ego has the excuse of "I didn't give it my all which is why I failed. It's not because I'm stupid."

Sound familiar?

Related question on the topic of laziness. I consider myself very lazy. Even from a young age I've always been very resistant to doing what I'm supposed to, homework, chores, etc, and instead playing games or reading books. It's been like this my entire life, and it's escalating now that I'm on my own. Yet I can't really bring myself to care beyond the day to day. I know I'm sinking into a pit, but it doesn't matter to me.

I have an initial appointment with a therapist in a month, but since you're right here I'll ask you too. How do I get better when I don't care about getting better?

Motivation is a really challenging thing to understand, and I think this paper is a good place to start.

A few different angles, in no particular order:

Like /u/totesgod said, there could be an ADHD diagnosis in there, but I tend to think that ADHD is over diagnosed and like to conceptualize people with two cognitive fingerprints, farmers and hunters.

• Farmers cognitively thrive on consistency and routine. Farmers wake up every day and methodically go through the day. They dislike change.

• Hunters' minds move faster than farmers, which is an important trait when you're out in the wilderness: constantly scanning for danger, constantly looking for food. They struggle when placed on a farm, but thrive in high-paced, dynamic environments. My guess is that if I stuck you in a startup environment with fresh challenges and a dynamic environment, you'd thrive. Games and books offer you dynamic situations and stress your intellect. When I work with gamers like you (and that's most of them) we try to figure out how to recreate the fluctuations and pace of gaming in the real world. You'd be amazed at how many high paying professions require people who are dynamic thinkers, and how few dynamic thinkers are in the work place (more on this later).

I'd recommend you try to find something like an internship at a startup, and try to plant yourself with some actual responsibility. You'll be amazed and how much your motivation will change.

A few other neuroscience considerations:

• It sounds like you may have a time-discounting problem - you intellectually know that doing homework is a long term positive, but your brain doesn't actually place value in delaying gratification. If you're young, chances are this will get better as your frontal lobes continue to develop (until you're about 30).

• If you're smoking marijuana, this is going to be hampering your motivational drive.

• If I was working with you, I'd explore what actually excites you.

Our current school system allows farmers to thrive, while making it very difficult for hunters. The pace is determined by the slowest student, which can be pure agony for a hunter mind. Most gamers I've worked with are very "hunter minded" - their minds are fast and dynamic. They grasp concepts quickly, and perform detailed analysis quickly. They struggle with follow-through. They can come up with a good solution, and start of strong, but then become easily distracted.

Unfortunately, spurts of brilliance are not well received by our society, so often times gamers just need to break in to a challenging job and they will far outperform expectations.

Jesus, can you elaborate on this phenomenon? Or direct me towards a reliable resource that can go into further detail on acknowledging and changing this process of thought? I am severely familiar with this and experience it on an almost daily basis - not only in video games, but with work and my daily routines (or lack of daily routines). I have never found a person that has been able to put this feeling into words so concisely. If you read this, thank you in advance :)

It comes down to ego.

When kids are young, they are often praised for intelligence. They learn that some things make them seem smart, and other things make them seem dumb. Their little brains are wired to perform tasks that other human beings like. That's how they learn to go to the potty, how they learn to share, how they learn everything basically: through positive reinforcement (well punishment and stuff too).

So what happens is the child develops a sense of identity that is based on positive reinforcement around intelligence. They also learn that that sense of intelligence can be put in jeopardy by trying something they aren't good at. When they do something competently, everyone around them praises them for it (positive reinforcement). When they try something new, they notice the lack of praise (absence of reinforcement). After all, if you fail, people won't think you're smart, right?

So over time, children learn to avoid challenges to preserve their identity of intelligence. The fascinating thing is that this avoidance becomes hardwired, and transforms into something like a fear of failure. And their pride or ego reserves the "excuse" of not really trying to preserve the sense of intelligence. They start to think, say, and believe things like "I could get a 4.0 if I wanted, but that shit is so beneath me so I'm not even going to try." Deep down, they probably know that if they try, a 4.0 may actually be hard to achieve.

As they become more avoidant, their self confidence diminishes, because they have only fragile successes that reinforce their intelligence. Deep down, they know they're not really doing anything hard, they're just doing stuff that makes them look smart. As their self-confidence diminishes, their ego actually increases.

• side note: think about the difference between someone who is confident and someone who is egotistical - completely different.

As the ego gets stronger, it feels the need to preserve itself, thus reinforcing the avoidant behavior.

Is that good enough for elaboration? I'm trying to weave together meditative philosophy with developmental psychology and not sure if I'm being clear.

I had been playing video games 10 hours per day everyday until I quit cold turkey for 5 months. Not a single game for 5 months. And the whole time all I could think about was playing games again. Then I started playing again, not as much as 10 hours per day, but I still want to. Am I addicted?

Here are the DSM-V's diagnostic criteria for Internet Gaming Disorder:

Repetitive use of Internet-based games, often with other players, that leads to significant issues with functioning. Five of the following criteria must be met within one year:

• Preoccupation or obsession with Internet games.
• Withdrawal symptoms when not playing Internet games. A build-up of tolerance–more time needs to be spent playing the games.
• The person has tried to stop or curb playing Internet games, but has failed to do so.
• The person has had a loss of interest in other life activities, such as hobbies.
• A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life.
• The person lied to others about his or her Internet game usage.
• The person uses Internet games to relieve anxiety or guilt–it’s a way to escape.
• The person has lost or put at risk and opportunity or relationship because of Internet games.
  

Do 5 of the above apply to you in the last year? Then you meet criteria. That doesn't mean you have the disorder, but increases the likelihood you're addicted. If you want a real answer, see a mental health professional.

It sounds like you're playing more than you want to. Does it interfere with you achieving your goals?

I'm just not doing what I want to do. Which is sit around all day playing games. I know it's bad but nothing else really feels as fulfilling. I graduated highschool a year early, I have a college degree, a full time job with benifits, and none of it is as satisfying as playing games. It doesn't stop me from getting things done, because I know when to stop, just nothing else makes me as "happy". Even though it isn't real happiness.

This is a tough spot to be in, but I've worked with people through it.

Chances are, your triumph / reward / achievement circuitry has been hampered by gaming. Human beings have an inherent reward system around overcoming adversity. Millions of years ago, the humans that traveled a little bit further in search of food, hunted slightly larger prey, and took larger risks were rewarded, which lead to human beings culturally supportive risk takers.

When people game, they start to feel that satisfaction or triumph through the game, and can start to feel that the rest of life is boring. The game creates artificial adversity, which feels very satisfying when you overcome it (Looking at you Dark Souls). It really feels like you accomplished something when you play certain games.

What you probably need to do is to really explore what your values are - what do you really care about? What are your goals? You seem to be stuck with complacency. You're not failing, but you're not moving forward either. What you lack in life is meaning and fulfillment, and those require introspection, reflection, and experience. Go out there and do something, anything, for the sake of new experience.

I'd also recommend working with a CBT professional if you can find one.

Good luck, and shoot me a PM in a week or two if things aren't working out.

I work in mental health and I’m so happy to see a psychiatrist who is passionate about what they do. Thanks for this AMA, I’ve found it enlightening and you’ve shared some great resources. Any more articles you’d like to share that are helpful? I support people with major mental illnesses in the community and come across a huge variety of issues. I’m always interested in expanding my knowledge.

I have a google drive with over 300 articles... most of the ones on actual video game addiction aren't that great.

We understand so much more about substance use disorders (in terms of neurocircuitry), so the best ones I have are on those. PM'd you access to my google drive.

Has anyone ever actually quit Runescape?

This goes beyond my experience - can anyone help me out and answer this one?

What can parents do for children at an early age to curb potential video game addiction?

What can parents do for children that are already addicted to video games? Just limiting the play time does not seem to help.

Are there specific types of games (MMOs, sport games, minecraft, etc.) or platforms (PC, console, phone) that seem to be more addicting than others?

Fantastic and difficult question.

Two things come to mind:

1) Understand the Driver for Gaming

First try to understand what need the game is filling for the child. If, for example, a kid plays games because he has social anxiety, it will be very difficult to stop the gaming unless you address the underlying social anxiety. Take for instance, a 13 year old who is going through puberty and feels really awkward at school. You have to work on whatever awkwardness pushes him to withdraw into gaming to really be successful. Remember that most behavioral addictions serve some kind of purpose, such as suppressing negative emotion, helping people cope, or by stimulating dopamine. Addressing the underlying purpose is crucial for behavioral addictions.

2) Develop a Competing Interest

When I work with gamers, they frequently have desires or abstract goals such as "get rich" or "find a girlfriend" but they don't have a truly competing interest, or reason not to game.

For example, when you're trying to convince a patient to quit smoking, providing them with information about how smoking causes COPD, lung cancer, heart disease, and early death doesn't actually change behavior. What changes behavior is a competing interest. Ask a patient whether they ever want to see their son get married, or ever want to meet their grandchild, or see their granddaughter graduate from college. Those evoke competing interests for patients to combat the nicotine addiction in smoking.

For your kids, try to give them a reason to not game. Give them something else engaging & challenging to do. Many of the adolescents I've worked with game because it's challenging and available, and school works at a snail's pace. I can go into more detail about this - there's a lot to it.

Hope that's a start.

What do you say to parents who accuse kids of being addicted when factually they're not? Anything we can use to show the parents that their antagonistic accusation and restless tension actually cause real addiction?

Fantastic question!

I'd start by trying to understand why they feel their kids are addicted. Video games have evolved so fast that the older generation can't really understand them. Try to engage them in conversation to understand what their fears and concerns are first.

"Help me understand why you think I'm addicted to video games."

When they answer, do not defend or justify your actions. Focus first on understanding. Explore further with them. Ask them what they think your life will be like a year from now, two years from now, five years from now.

Also, consider the possibility that the parents may be right. Denial isn't restricted to substance use disorders.

What if the parent is tiger mom like the one in that show Child Genius? How do you make someone like her realise the kid needs a break or they will break?

This goes wayyy beyond gaming man. I'm Indian by background, and Asian and South Asian parents have a completely different set of values from Western values. Excellent grades, excellent schools, excellent job, lots of money.

Happiness, meaning, fulfillment, fun, marrying for love - all that shit doesn't matter.

You're on a long and hard road if you've got tiger parents. Try your best to earn their respect, and then use that respect to try to help them understand that you're your own person. It's a slow process, and takes time. Hopefully they love you, and if you can demonstrate that you're not fucking up your life, they'll listen.

If you're feeling super stressed about it, PM me and we can talk.

Edit 1: Or better yet, find yourself a therapist. It may be seen as weak, but it'll sure as hell scare the shit out of them! Ha ha ha.

Is it possible for people who have attended Harvard to start a conversation without mentioning that they went to Harvard? What can I do to help them overcome this social personality disorder?

I'll take the bait!

Go to Harvard and then maybe you'll figure it out?

Your turn to flame.

Do you feel like there’s a stigma surrounding mental health, considering a lot of people just yell 'man up', and how do feel we could end the stigma?

Absolutely. This is a huge problem. Just thinking about this problem makes my head hurt.

Stigma is especially bad for men - 80% of suicides in the United States are men. According to the CDC, about 30,000 men kill themselves every year. Why are men killing themselves at such an alarming rate?

Stigma has a lot to do with it. Men are not socially allowed to be victims. Men who have mental health problems are considered weak. Even more insidious, some of the men I've worked with who face true injustice or toxic relationships are branded as mentally ill to invalidate their complaints. For example, many women I've met are very accepting of men's struggle with mental health on paper, but would never date an individual man who has a mental health problem.

What this means is that if men are struggling, they don't have a voice to seek help, so they suffer in silence. Our society claims to favor equality, but the number of resources for women's mental health and men's mental health are nowhere near equal. Overall, it is hard to create change in our society, but I think it starts with a few brave men vocalizing that they are struggling, and other men supporting them, even if the rest of society doesn't.

Can you highlight some red flags of video-game addiction? When should one start to worry about one's own potentiel addiction?

To really answer this question, I need you to help me out:

Take out a piece of paper.

In one column, write the words "I care about..." and then make a list of things you care about.

In the next column, write the words "My goals are to..." and then make a list of your goals.

Next to each of your goals, write down how many weeks it is going to take you, at your current pace of progress, to complete each one.

At this point, type in your answers (or PM me in a few days if I don't get back to you) in this thread, and we can examine them. Or just take a look at the piece of paper and make a judgment call - "Am I OK with this?" If you are OK with it, fantastic, low potential for addiction. If you aren't OK with it, your gaming is problematic.

How would you know if you or your loved one has an addition to games, or just really likes playing them?

For example: My friend plays smartphone games for hours a day. Her phone is always in her hand. It doesn’t affect her work and doesn’t seem to affect her relationships, much. It’s the “joke” that she is missing out on things because her face is always in her phone, but her immediate family doesn’t seem to mind. I’m fairly certain someone would see the 4-8 hrs of cumulative time she spends a day and be concerned, though.

This is a great question, and highlights the shortcomings of the term "addiction." In my experience, gaming has a continuum of impact on people's lives, and "addiction" is a binary term that doesn't do the problem justice.

In your friend's case, I'd ask her what she actually cares about in life, and what she wants her life to look like. Does playing cell phone games 4-8 hours per day move her towards her goals and fulfill her values? Some of the people I work with don't appear to be addicts at all: they have high paying jobs, own homes, but fall short in just one dimension of their life: whether it be physical health or relationships. No one could really make a fair argument that they're an "addict" and their life is going nowhere, but games prevent them from dating more, being healthier, or (most commonly) writing that sci-fi or fantasy screen play / novel that they've always wanted to.

I think that's a problem, and chances are, your friend has something along those lines.

Thank you for your reply. I work in healthcare, so I get the addict stereotype. Although, it tends to be more cut and dry. I like the addition of the life goals. Except, now I apparently have an addiction too. I have a whole list of things I could get done if I got off my phone, turned off the tv, etc. I don’t like this AMA anymore. Haha!

Good. In our dopamine-rich environment, it is too easy to forget that short term enjoyment actually gets in the way of what we care about. That's not your fault - apps, games, reddit, are all designed to keep us engaged, they hijack our neurocircuitry to keep us clicking. The deck is stacked against you. Good luck.

Wait are you saying the most common thing gaming addiction is preventing is people writing sci-fi /fantasy screenplays and novels? What are you saying here?

Not really the most popular, but surprisingly common. There are plenty of video gamers who have problems with multiple dimensions of their life.

I've spoken to so many gamers who have their life in order, except for creative pursuits. Making money is important, so people do it. Having a relationship is important, so people do it. Staying healthy is important, so people do it. But writing that sci-fi/fantasy novel? There's no pressing need for it, so people sacrifice that goal to the easy dopamine of gaming.

Does this mean that most gamers accomplish all of the above? No. What I'm saying is that of all the gamers I've talked to, the least number have succeeded in creative pursuits, whereas a decent number will end up with a good job, relationship, etc.

Sorry for being confusing.

The only thing that worries me on this is how crooked most phone games are. Usually they develop a system to try to get people to buy stuff from the game and then design a game around this systems. They are shadier than most carnival games.

Absolutely.

Game designers are using more experts like behavioral economists and statisticians to pull gamers in more and make them spend more money (looking at you Lootboxes and random reinforcement schedules).

God help us if they ever do deep psychological explorations like I have to understand why people actually play games.

Thank you for taking the time :)

Which games had you struggling the most during college? Do you still play video games?

Ha, my favorite question so far because it makes me reflect about how much I love gaming.

I used to play a ton of Diablo II and War 3 back when I was failing out of college. I still love playing video games, but played very few during medical school and residency. I've now got kids that take precedence over gaming time (but I'm trying to teach my 3 year old to play Mario Kart).

Nintendo Switch has been an amazing console - the portability allows me to play half an hour here or there, probably a total of 1-2 hours per week.

I started a subreddit focused on helping men improve their mental health: /r/malementalhealth

Would you be interested in making a post there where people can ask questions or get information?

That sounds awesome man. I'm happy to support the work you're doing in any way I can.

I'd be honored to answer questions or offer information.

I work with a growing number of men, and frankly it's kind of scary how isolated they are and how much they are suffering. There's something going on with men right now, and it isn't good.

I'm not sure what it is, but I think it has something to do with the movement toward's women's rights have made it difficult for men to advocate for men without seeming to be opposed to women. Women's rights is fantastic, and I'm in favor for gender equality, but it's possible that the pendulum has swung too far with things like the Google Memo.

The news used to talk about MMO addiction a lot, now it's all about cell phone game addiction. What's the breakdown of game addiction between genres, or are most gaming addicts addicted to any kind of game? Is there a difference between what leads people to get addicted to different types of video games?

There is a difference.

People are attracted to different kinds of games for different reasons. People who are addicted to MMOs tend to derive a sense of identity through the MMO - their virtual persona becomes more important than their real life persona. They have friends in the MMO that are just as important as real life friends. They take pride and enjoyment in downing raid bosses. Our brains are wired to appreciate triumph over adversity. All across cultures and history, humans who face difficulty and survive are viewed positively. MMOs hijack this triumph circuitry, by creating this artificial difficulty which leads to a sense of accomplishment when you inevitably overcome the boss (which the game is designed to let you do - you're supposed to win in the end).

This is different from the player who plays a MOBA or FPS for 10 hours a day. In this case, they tend to use the spurts of dopamine from kills or victories in the game to suppress negative feelings. These players derive some sense of identity from gaming, but in my experience working with 100+ gamers, there are differences in the drives of each type of player.

University of Toronto is doing some fascinating work about gamer personality types:

reference 1

Brain Hex is a personality model that separates gamers based on what they look for in games. It's almost like classes in an RPG. Very cool.

Source

At the end of the day, I'm simplifying, but somewhere in the ballpark.

Are there any instances where furthering a video game addiction was a net positive compared to other behaviors the patient was engaging in?

I was working with one patient who was a chronic "nice guy." One of these guys that invests a lot into a platonic relationship with girls, and then gets frustrated when he tries to move out of the friendzone. We started to explore the real value he gains from relationships he had through online gaming, and he tabled some of his doomed attempts to trick girls into liking him. He's got a girlfriend, and is doing OK now. So that's something.

How much would you charge me if I requested you tell my wife that I do not play ENOUGH video games, and my treatment calls for more TotalWar Warhammer2?

One upvote? PM me her number and time zone and I'll call her tomorrow.

For two upvotes, you can get a signed doctor's note on McLean Hospital / Harvard Medical School letter head.

Have you, in your studies, noticed a correlation between depression/anxiety and excessive video gaming? If so, does treating the underlying disorder often fix the addiction?

There is definitely a correlation between video game addiction and other problems like depression, social anxiety, and other substance use disorders (marijuana addiction in particular).

Treating the comorbid disorder doesn't necessarily fix the addiction, but it really makes treating the addiction easier.

And by the way, why do you assume that depression/anxiety is the underlying disorder, rather than the gaming addiction underlying the depression?

How far did your GPA fall during your addiction? And how were you able to recover your GPA enough to be accepted into Harvard?

The same way you climb a mountain: one step at a time.

I was on academic probation for 1 year, after getting less than a 2.0 during freshman year. I got my shit together for the second half of college, and worked my ass off to do well on the MCAT.

I applied to medical school twice and didn't get in, then did a post-bacc program, after which I got accepted to Tufts University School of Medicine.

Worked my ass off in medical school, and ended up matching in a Harvard residency program, where I spent four years learning psychiatry.

Are video game addiction and social networks addiction are somewhat similar? Or completely different?

My sense is that they are quite different. The academic psychological and psychiatric communities are struggling to understand a whole new wave of internet behaviors: video gaming, social media, cell phone use, internet use, and pornography.

I suspect there is some overlap between these, but also significant differences. For example, social media addiction seems to be more prevalent in women, whereas video game addiction is more prevalent in men. We're still in our infancy in understand how all of these things relate.

Sorry I can't give you a better answer... we just don't know, and I've focused mostly on video gaming so don't have as much confidence to talk about social media.

Here's an interesting paper, I haven't read it yet, but will when the AMA is over.

This paper suggests that there are emotional regulation deficits in social media addiction, which is likely true of video game addiction as well.

My brother is completely addicted to video games to the point that he doesn't do much else. We need to drag him out of the house to get him to do anything, or even bribe him.

My parents have just accepted that that's how he is and he's said he likes being addicted, but I'm very concerned for his health on multiple levels.

Is there anything I can do? What do you recommend?

How old is he?

Can one manage their addiction and still be in more control of what they do? (getting good grades, sleeping, etc)

I'd reframe your question to "can you be a healthy gamer?" I absolutely think so. At that point, it really isn't an addiction. My goal for the gamers that I work with isn't to stop playing video games, it is to move forward in the rest of their lives. The amazing thing is that once you do a solid day's work, and cook a delicious, healthy meal, gaming is even more fun.

Not sure if this falls under your jurisdiction since it's not primarily a video game-centric problem, but what's up with gacha games on the mobile market? Do people have more of a tendency to get hooked on those because of the gambling aspect rather than the games themselves? Is the introduction of increasing in-game purchases for traditional video games blurring the line between the two?

The gacha games and loot box mechanics exploit a psychological aspect of humans called a "random reinforcement schedule."

There is a guy on reddit, /u/arsonbunny, who posted a great summary of how Battlefield II is basically a virtual skinner box. The comment was deleted for some reason, I hope it is OK to repost a part of it here (since he does an amazing job of explaining it):

The entire game is created to be just a lure to get you into a virtual gambling Skinner Box. Just like in the famous Skinner Box experiments, you can be manipulated into doing the digital equivalent of hitting a response lever by feeding money into the microtransaction store, exploiting human psychological quirks with positive and negative reinforcement tricks that built into the progression system.

Basically, humans are more likely to engage in an action if the reward system is uncertain. It's the same thing with slot machines. Since human beings tend to have a memory bias towards positive events, and tend to forget negative ones, over time, we have the impression that lootboxes are actually really fantastic.

For info on the original skinner box.

Belgium declared lootboxes as gambling.

Are you seeing a correlation in rising video game addiction with the advent of the e-sports industry?

Fascinating question.

Am I seeing a correlation? Absolutely. Remember that correlation simply implies a relationship between two variables. For example, my age correlates with the growth of the E-sports industry.

Is there a causation? It is unclear, as the growth of the gaming industry as a whole is a big confounding factor.

The gaming industry is just getting more and more massive every year. I think that raw growth is responsible for the rise in video game addiction and the E-sports industry both. More people are playing games, so I think we're getting more pro-gamers and more video game addicts.

There is probably some direct causation, as there are probably 15 year old kids who think if they practice every day, they can go pro. And they aren't necessarily wrong. It is a lot like kids who play basketball have dreams of becoming the next Lebron James.

Do you think the prominence of micro-transactions is going to have a significant effect on your practice?

Oddly enough, not really. You'd think that since there's a gambling element, and people get addicted to gambling, that lootboxes would be a part of my practice.

Microtransactions tend to be very profitable because 1-3% of the player base are what game devs call "whales" and spend thousands of dollars on microtransactions. Those whales are able to spend thousands because they tend to be rich. For example, I have a buddy from med school who will spend $2-5k on loot in games per year, but he makes $340k, so it's no big deal. Some doctors buy fancy cars @ $80k, he just buys video game stuff because that's what he likes.

Most people who struggle with addiction are having trouble launching a strong professional career, so they tend to not have too much money for microtransactions.

I could be wrong though... time will tell.

If I can't play a game and I miss it, am I addicted or is that normal?

If it's a good game, normal, I'd think.

When I moved from Texas to Boston I could no longer eat Schlotzky's, and I'm pretty sure that just means I'm a normal human being.

You played runescape, right? ;)

-Current runescape addict

Thank god, no. I'd probably be destroyed if I did.

Are you excited for Cyberpunk 2077?

Hells yes, still finishing Witcher 3 expansions.

your thoughts about correlating violence and video games?

See my reply above: https://www.reddit.com/r/IAmA/comments/9asjht/iama_harvardtrained_addiction_psychiatrist_with_a/e4xx5uf/

Are certain factors more strongly correlated with a game's addictiveness than others (i.e. genre, multiplayer vs singleplayer, solo vs team, mobile vs pc vs console, etc....)? How do lootboxes and other lottery style features impact the addictiveness of a game?

If you happen to have hard numbers that would be ideal.

What kind of hard numbers are you looking for? A quantitative score for how game genre correlates with "addictiveness?" I don't think that exists, but the idea is intriguing.

Regarding Lootboxes, I answered another question here: https://www.reddit.com/r/IAmA/comments/9asjht/iama_harvardtrained_addiction_psychiatrist_with_a/e4ydmy3/

Regarding different kinds of games: https://www.reddit.com/r/IAmA/comments/9asjht/iama_harvardtrained_addiction_psychiatrist_with_a/e4xtnkl/

If those answers aren't satisfactory, please let me know what questions remain and I'll do my best to answer them.

Does fortnite cause ligma?

There's strong epidemiologic evidence that is Ligma affects only people from Sugond. Source

How much will it cost to cure me?

Just time - yours and mine. PM if you are serious about wanting to change your life and are willing to commit 16 hours - 1 hour a week for sixteen weeks.

Serious question:

Why is it whenever I meet someone from certain schools, UPenn, Harvard, Yale etc. I always find out what school they went to before they tell me their name?

I ask this in all seriousness.

Since it's a serious question, I'll give you a serious answer.

I'm doing an AMA because I have a message that I think needs to be spread. Literally 10-30 million people are suffering in the United States from video game addiction, and the mental health community has no idea how to help them. The old paradigms of addiction based on substance use disorders do not really apply. Video game addiction is a completely different beast, and needs a completely different strategy. In order to reach the widest audience possible, I'm inserting Harvard at the beginning of my post because people will take me seriously, and I hope they'll take my message seriously. And I hope my message will help people, because it doesn't like anything else is.

If you met me at a party, you'd never hear me mention Harvard, that I'm a physician, or a psychiatrist. I joined reddit in 2012, and I'm pretty sure this is the first time I'm mentioning my professional affiliation.

What are some of the interventions you use?

How do you discover and address the root cause of the addiction?

What tools/resources would you advise people look into who are looking to cut back on their gaming time?

I use a combination of psychodynamic & cognitive behavioral therapies, with a healthy dose of meditation and stress management skills. I only use medication if there is a co-occurring illness, like social anxiety or depression.

Discovering the root cause of addiction usually takes between 1-8 hours of individual therapy, and addressing it takes somewhere in the same time frame.

For tools, there really aren't many out there, because video game addiction is a relatively new thing within the psychiatric community.

The best thing out there is CGAA. The other thing I'd recommend is meeting individually with a therapist or psychiatrist to explore the issue.

What are your thoughts on the social stigma around playing video games, does that affect video game addictions, and if so, how?

E.g. Does "hiding" your hobby change how often you indulge in it?

I feel like video games are in a weird spot in that the video game industry makes more than movies or music, and more people play games than not (in the US at least), yet video games are still somewhat stigmatized and undesirable to varying degrees. I'm just curious if and how social-factors influence addictions and if you had any thoughts on this. Thanks!

Social stigma around video games are certainly an important factor. Many of the gamers I work with started forming an addiction due to being "unpopular." When they were in school, there were certain symbols of status, such as athletic performance, looks, and being from a family with money. So gaming became culturally associated with rejects. As the gaming industry has grown, there are now mainstream games, which have become more socially acceptable. We're not quite at the phase where gamers are perceived as just as normal as everyone else, but we're damn close. Walk around and you'll see more people advertising as gamers through the t-shirts they wear, decals on cars, etc.

I just went to The International 8, a massive Dota 2 tournament, and many of my friends were telling their RL buddies for the first time that they were going to a video game tournament. They were met with some skepticism, but some curiosity and interest, as Esports like Overwatch are featured on prime time ESPN. It's quickly becoming cool to be a gamer.

As things become mainstream, I think the social reject path to become a video game addict will become less common.

Do you think there is any validity behind the idea that playing video games with violent content (guns, battle, blood, etc.) can cause children to become more violent as they develop?

Unfortunately, yes. I used to believe that violent video games do not correlate with violence indicators, and I still want to. But there is now decent quality evidence that violent video games lead to increased feelings of aggression, thoughts of aggression, and desensitization towards violence. Source

However, there has been no link between violent video games and criminal behavior.

TL;DR: Violent video games increase violent thoughts and feelings, but evidence is lacking as to whether they actually increase violent behavior.

Importantly, is there evidence of a long term effect, or just an immediate effect that might be down to a form of priming?

It's a meta-analysis, so I'm not sure about the specific studies. Many studies will look at things 3, 6, or 12 months out, but very few look past that.

The other problem is that most people are still playing at 3, 6, 12 months out, so even though it seems "long term" could still be a priming effect - which I definitely think is a factor.

Wow. That’s interesting! Thank you for taking the time to answer my inquiry.

Most welcome.

What’s the difference between a gaming addiction and any other hobby that consumes the same number of hours per day? Like art, drawing, music, reading, etc.

Nothing! This is why video game addiction is kind of a stupid term. I tend to think of "problematic gaming" and "healthy gaming." If you're doing everything you want in life and things are going smoothly, don't worry.

Some people may argue that if you spend hours learning to draw, you're gaining a valuable skill, which is true. But there are people who play 80 hours of video games a week and aren't addicts. We call them pro-gamers. They can make 6-7 figures.

But pro-gamers can still be unhealthy gamers, in the same way that an investment banker who works way too many hours is living an unhealthy lifestyle.

Problematic gaming, addiction, professional gaming - it isn't black and white. That's what makes it so exciting and fascinating.

Do you have any advice for an undergraduate going into psychology first year? Im interested in developmental, behavioural and positive psych and very interested in doing research in the later years.

I had social anxiety and video game addiction growing up but I can confidently say I conquered both.

Here In Ontario Canada, they are saying that psychiatry is in demand. Im more interested in psyche/clinical rather than psychiatry. However Im not interested in treating patients with medication. Is there alternative methods of treatment and workflow that a Psychiatrist stems differently then a psychologist or clinical psyche? Idk if that makes sense but basically I have a posh understanding and view of psychiatry because my mother is clinically depressed and sees a Psychiatrist and is prescribed drugs but there is no actual progress being made and it bugs me how you can prescribe drugs but ultimately never remedy the problem. Obviously they are needed to treat very specific conditions or imbalances. Please enlighten me!

For general advice, I'd say you're off to a great start asking questions! Continue to stay curious and explore. It's great that you recognize you have a personal bias toward a field due to personal experience - this kind of self reflection is a good sign that you'll be successful as a therapist.

Psychiatrists are medical doctors, that can use both psychotherapy (ie, psyche stuff) and psychopharmacology (and is some cases even things like surgery or ECT) to help people with mental health problems.

Psychologists are mostly trained in psyche related treatments (psychotherapy), although in some parts of the world can prescribe medication due to the high demand.

If you're interested in the psyche and the mind, I'd say go for a PhD or PsyD. If you're really interested in the connection between the body and mind, or neuroscience, consider going the MD route.

Good luck! I hope you're able to help people in a better way than the people helping your mom.

Thanks for the reply! Im very much interested in Psychotherapy! Forgot to mention. This is why I am pursuing Psychology in the first place. Im also very influenced by eastern philosophy particularly taoism and buddhism. Ultimately I would like to put into practice, western psy and eastern philosophy.

Im very excited about the field of psychology. I dont know what the future holds. I dont know how well I will do in research as I am not verse in stats however Id say Im highly motivated to make discoveries and bring new ideas forward.

Alsoooooo very influenced by movement philosophy (ido portal) body and mind, energy. I would like to adopt this into the realm of psychotherapy somehow.

And lastly, I am interested in sound therapy as I have been producing music for several years and have gotten into modular synthesis and ambient music.

I have a lot of influences and I believe in myself hehe. Hopefully I can bring it all together somehow.

Ps- I will be volunteering in my local hospital real soon and opted to be place in the mental health department. We’ll see how that goes :P

Ps again - Imo, I think the in game rewards from video games, milestones and achievements may interfere with your sense of achievement outside the realm of games and potentially replaces any reward you may be getting outside your house. I think video games are similar too porn in that sense of stimulation and dopamine. I think pre existing factors also play a huge role. If you have all the time in the world as a kid and you are around other kids playing games, its hard not to be sucked in. And once your in, there are so many variables that come into play. I think the point where you first start playing games and your state of being might provide insight into addiction.

I could talk forever, this is a messy reply haha!

Awesome! There is a growing interest in Eastern philosophy in psychotherapy.

I spent about seven years studying meditation, yoga, and Ayurveda (traditional Indian medicine) before going to medical school. I also trained as a reiki healer, but stopped practicing due to the lack of convincing evidence to support its use (at least compared to yoga or meditation). I do a lot of meditation with my patients, and they all like it a lot.

Your instincts about gaming are spot on. You've got a bright career and it's likely a part of your dharma to help people in this way.

Good luck! Let me know if I can help in any way.

what do you find make people become addicted?

in drug addiction there is definitely a correlation between depression and other mental illnesses and looking for that escape as a coping mechanism, is it similar in gaming addiction? what other elements make people cross that line between a hobby and an addiction besides the time spent?

Someone crosses the line into becoming an addict when gaming is the only tool that works to fulfill a basic need.

Consider the kid who is bullied, and has no outlet for his feelings. He goes home and starts playing a video game, and starts to feel better. Over time, he subconsciously uses video games to soothe his negative feelings. The more he plays, the more he loses out on other learning opportunities to manage negative feelings (going out with friends after school, joining boy scouts, math club, etc). Over time, the only way he has to manage feelings becomes gaming. The more he plays, the more his life starts to fall apart, and the more his life falls apart, the more he has to game to cope. That's how an addict is born.

Gaming addiction does have a high correlation with other problems, such as Major Depressive Disorder, Social Anxiety Disorder, or other substance use disorders (Marijuana and Alcohol being the most common).

Have you noticed any trend in which game people are addicted to?

I dont know if you are aware of the game "Rust"? Ive spent over 3000 hours playing, and often 20 hour sessions. The game is almost like a job. I can imagine many people playing these kinds of hours. So, im curious if this is "common"?

I would inagine other popular ones to be wow / runescape

It depends on the person. MMOs are very addictive, as are FPS, MOBA, even stuff like Minecraft. It seems to depend on the person.

I talk a little bit about it here:

https://www.reddit.com/r/IAmA/comments/9asjht/iama_harvardtrained_addiction_psychiatrist_with_a/e4xtnkl/

If you still have questions after reading that, let me know.

I am an 11 year old an play 3-4 hours a day. Is that bad?

Maybe.

What else do you do during the rest of the day? Are you physically active? How are your grades? Do you help out around the house? Do you read?

Gaming for 3-4 hours a day isn't necessarily bad. I'd be more concerned about what you're missing out on because you're gaming.

Eternal wisdom.

I wonder, how do you define an addiction? One definition of alcoholism is that you require x drinks each day of the week. I assume for gaming addiction it is more focused on how much time is lost?

Personally I also believe that addiction also should be determined with how much it impacts you and your surroundings.

There is a lot of debate around what defines a video game addiction. I tend to focus on "problematic" vs. "healthy" gaming.

I'm sure a lot of people go through this almost every year but when school starts back up again but whag do you recommend get out of our nasty habit of playing video games the same way we did in the summer (I.e way more than we should)?

I'm not quite sure... What did you do last year?

Is gaming addiction more a result of social anxiety or a broken socioeconomic structure that limits ones potential to experience a meaningful daily life?

Both - I don't think it is more one than the other.

While it may seem like our socioeconomic structure is broken, there are things that are possible today that have never been possible before. For example, I'm just sitting on my ass and spouting whatever I know about video game addiction, and my message is able to reach hundreds (thousands? I'm not sure) of people. That wasn't possible 10 years ago.

I challenge you to think a little bit about whether you truly can't live a meaningful daily life because of a broken socioeconomic structure. Sure, you may need a shit job to pay back inflated student loans, and housing prices are through the roof. But are you really telling me that there isn't anything you can't do to create meaning in your life?

I was inspired by Tom Happ. He just made a game called Axiom Verge all by himself, and it was amazing. That's possible because of avenues like Steam Greenlight, which are allowing individuals to express creativity and find meaning in ways that simply weren't possible 50 years ago.

I am a recovering heroin addict. Do you believe addiction is hardwired into our brains and dna? Or is it a learned behavior?

Both. Addiction is usually the intersection of a biological vulnerability and a life circumstance.

There is ample evidence that people who become addicted to heroin have a different dopamine response based on mu receptors in the brain. Opiate addiction also tends to run in families, suggesting a hereditary component.

But addiction is complex. What starts as a biological vulnerability turns into a learned behavior through reinforcement.

I'm sorry that you've been dealt a crappy biological hand in life, and respect that you're in recovery. Strong work man, keep it up. You're a beast and don't forget it.

I'm late to the party. Hopefully you're still answering questions. What's something I could be doing to take back control of my life? I often feel like video games are holding me back from exacting on my potential. But it's the only thing that lets me feel l can exist in a state free of stress.

Learn to tolerate a state of stress. That's the amazing and damning things about video games, is that they take you to a magical place where you're focused and one pointed, the rest of the world falls away.

But the problem is that the rest of the world is still there, and is full of uncertainty.

Video games are certainly holding back your potential, because they don't really allow you to express your potential. They allow you to express only what the game lets you express, and that same stuff is expressed by every other person playing the game.*

Practically, do you have any options to do any fun stuff outside of gaming? Go for a hike? Learn how to make sushi?

You can also find a therapist to help you work through that stuff and regain control of your life.

• Esports is a different beast.
  

Which video game have you noticed has an addictive affect most like that of a cocaine and/or opioid addiction? In other words, which video game acts essentially like a potent addictive drug?

I've seen pretty bad addiction with many different games, but MMOs have a way of really taking over people's lives.

Do you still play videogames?

When I can. I just went to The International 8, a massive DOTA 2 tournament, which was amazing.

I think video games can be a fantastic positive force. For example, I'm still close friends with people who I went to high school with because of gaming together.

I also like how truly nonjudgmental gamers are - once you get past the initial flaming you and wanting to f*ck your mother phase, they don't care if you're tall or short, pretty or ugly, fat or swoll, rich or poor, white or black. Gaming is truly blind in a way that no other part of society is.

Is video game addiction a habitual addiction where it essentially becomes a bad habit, or is there a significant chemical component in the brain?

Er, a habit involves a chemical component in the brain. When different neurons activate at the same time, they become linked. For example, when I'm learning to brush my teeth, I have to consciously open my mouth, and move my hand holding the tooth brush to my mouth. I then have to move my hand and mouth together.

During this process, there are neurons that control my mouth movements and different neurons that control my hand movements. As they get activated at the same time, the chemical connection (and over time, even the physical connection) between them grows. Once those chemical and physical connections become very strong, you now have a habit.

If you want to play around with this, I recommend brushing your teeth with your non-dominant hand. You'll quickly discover how hard it is to do things that your neurons are not habituated to.

This is an answer to your question, but I wonder if I got bogged down in the language of your question. Were you looking for a different kind of answer?

Here's a good article about food addiction that explores the neurocircuitry (and therefore chemical signaling) of the brain.

Here's a good paper that offers an overview of neuroscience of play. Bonus points because the first author's email address is @ihobo.com.

What are some of the dangers of video game addiction?

Video games can keep you from progressing or growing in your life. They can also keep you from fully enjoying life. Video games are entertaining & fun, but rarely provide a sustainable sense of meaning and accomplishment.

How does one break the thought loop and get going?

It is different for every person. Just like any adversity in life, it requires reflection, self understanding, and dedication.

But since that answer doesn't help you at all, concrete recommendations:

• Learning how to meditate. Meditation increases your frontal lobe's ability to inhibit your amygdala & limbic system, which allows you to plan and execute better. Hyperactivity of the amygdala is also associated with procrastination, whereas strong frontal lobes are inversely correlated with procrastination.

• Finding a therapist or psychiatrist who does Cognitive Behavioral Theory to help you understand the relationship between your thoughts, feelings, and actions.

What recommendations do you have for people who feel they can’t live without playing video games?

Keep playing video games. Just do other stuff too. If you feel you can't live without games, fine.

• But do you need to play games every day? What about 6 days a week?

• Do you need to play games 10 hours a day? What about 8?

• How hard would it be to cook one healthy meal a day? Or go to the gym once a week?

Change happens gradually. The crazy thing is that gamers are so good at analyzing, that they see how much change needs to happen, and then get demoralized because the problem seems so big.

One step at a time, really the only way you can do anything in life.

What are your recommendations for parents of kids who like to play computer games?

I didn't quite understand your question: Are you asking what parents who have kids who are gamers should do, or what parents who are gamers should do for their kids?

what is the most overlooked symptom of identifying someone who is addicted to video games?

The most overlooked symptom is someone who claims they are in control of their emotions, but feel intense anger or frustration in the game. People who rage in games usually have some other underlying pain. Just think about it for a second: is the game really so important that it's worth completely going crazy over?

Chances are, people who get super pissed off in games are channeling frustrations from other parts of their life - which is why it can be so addictive. They need the release, because they have no other way of processing their emotions.

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Help me understand what makes you think games make young men "so violent?" What do you mean by "so violent?"

Video game addiction doesn't exist - how does it feel to have wasted your life?

Can you help me understand why video game addiction doesn't exist?