GAME OVER: Assessment and Treatment for Videogame Abuse. Why Talk About Games? A Profile of Players

Transcription

1 GAME OVER: Assessment and Treatment for Videogame Abuse Peter Churchill Clinical Supervisor/Family Counsellor AHS Addiction and Mental Health Child and Adolescent Addiction & Mental Health Program Protection of Children Abusing Drugs (PChAD) Why Talk About Games? Video games are the dominant entertainment medium Successful games are extremely compelling, despite often disturbing content The norm of long hours of use has potential for a range of negative impacts Many clinicians say they are unfamiliar with games, and unready to discuss or assess use A Profile of Players 88% of North American youth play Over 50% of adults game; 1 in 5 game daily The average player is 35 More women over 20 than men under 20 68% of households play 23% pay to play online

2 American Association of Child & Adolescent Psychiatry (AACAP) While some games have educational content, many of the most popular games emphasize negative themes and promote: the killing of people or animals the use and abuse of drugs and alcohol criminal behaviour, disrespect for authority and the law sexual exploitation and violence toward women racial, sexual, and gender stereotypes Foul language, obscenities, and obscene Defeated Legislation: 1997: prohibit sale or exhibit to minors of images of graphic, bloody depictions of torture, sexual assault, cannibalism, mutilation, murder, and urination or defecations that occurs in a morbid or violent context - defeated 2002: prohibit sale or rental of adult video games to minors - defeated twice 2007: prohibit deceptive conduct in the rating of video and computer games - held up last 3 years The Sides Video game and internet addictions are established facts and serious health threats A profit driven industry is working to prevent impartial studies or responsible limitations of their practices Professionals have argued in the advance of solid evidence The media has created concern for parents that any excessive play reflects or will lead to serious problems

3 Why Youth Game Socializing Entertainment and Leisure Emotional Coping Excitement and Challenge Seeking Escaping from Reality Exploring Identity Positive Impacts of Play Pain Management Physiotherapy Verbal Ability Narrative Ability Coordination Social Skills Spatial Ability Identity Exploration Individuation Expel Energy Attention Shooters

4 Strategy & War Games Networks & Life Simulators Massively Multiplayer Online Role Playing Games (MMORPG) Appeal Features of MMORPGs The Kitchen Sink Persistence Multiplayer play Realism Absorption Rate Character development Customization

5 Where does Addiction live? There is something about certain games that increases the likelihood of problem play for some people There is something about certain people that increases the likelihood of them developing dependant or addictive behaviour patterns in some circumstances Addictive Symptoms in Gamers Risk Features High Risk Features Cognitive Salience Behavioural Salience Mood Modification Conflict Tolerance Relapse Excessive game play can lead to: Poor social skills Isolation Time away from family Time away from studies Lower grades Time away from other hobbies Reading less Exercising less Sleeping less Becoming overweight Aggressive thoughts Aggressive behaviours These impacts affect 11% of female players, and 20% of males

6 3+ hours TV per day at age 14 Attention problems Failure to complete homework Boredom at school Failure to complete high school Poor grades Negative attitudes about school Overall academic failure in high school later on Failure to go on to college Signs of Addictive Play Playing 25 hours per week or more Seeking selfconfidence through the game Irritated if unable to play for one day Excess time usage Social dysfunction/disruption Preoccupation Family/School disruption Time Killers Intermittent reinforcement Rewards = investment Consequences = frustration Multiplayer/Online Teamwork Competition Age and Skill Protect Children and Adolescents = highest risk

7 What would be normal? Hours Per Week Average Person Average MMORPG Player Online 18? Playing? 22 Watching TV 17 8 Total Electronic entertainment occupies 40% of the average person s time, 55% of the average youth s time Norms of use among MMORPG players Say MMORPGs are addictive: 20% Say they are addicted: 50% Played 10+ hours at once: 60% Say they play too much: Now: 38% Formerly: 18% Social benefits: 71% Play more than 30 hours/week: 20% Play more than 40 hours/week: 10% Play more than 70 hours per week: 4% What gamers say they sacrifice for play: Nothing: 23% Other hobbies: 26% Sleep: 18% Time with friends: 10% Time at work/school: 10% Time with family/partner: 10%

8 What Players Experience Detachment from real life: 31% Reduced Stress, Anger, Frustration: 31% Time loss/played longer than intended 35% Time loss is related to multiplayer play, advancement, and complexity Addictive Pattern: 12% of all players (Griffiths) 1. Do you frequently play most days? (Salience) 2. Do you frequently play for longer periods of time? (Tolerance) 3. Do you play for excitement or a buzz? (Euphoria) 4. Do you play to beat your personal high score? (Chasing) 5. Do you make repeated efforts to stop or decrease playing? (Relapse) 6. Do you become restless if you cannot play? (Withdrawal) 7. Do you play instead of attending to school related activities? (Conflict) 8. Do you sacrifice social activities to play? (Conflict) Pathological Use: 8% met criteria (6 or more) (Gentile) Preoccupation Escalation Failure to stop Restless/Irritable Escape Lying about time Stealing Skipping chores Skipping homework Poorer grades Needing money

9 What about games is addictive? 1. Video games impact imagination and fantasy life, i.e. people who play to excess have poor imaginations. 2. Video games impact arousal levels, i.e. people who play to excess do so for arousing or tranquillizing effects. 3. Those addicted have dependent or addictive personalities, i.e. they play to excess due to their personality, not due to the game. 4. The addiction is some feature of play itself, i.e. people who play to excess enjoy the physical act of playing or play only when they are bored, etc. What about games is addictive? The physiological argument: Game play causes dopamine transmission in the Nucleus Accumbens This system is believed to be the basis of reinforcement, and the chemical explanation for craving It is the same mechanism that has been seen with most substance abuse problems, and with gambling Pleasure Decay Whoopee Skiing Food Nature Reading

10 Links to Violence A strong body of research evidence links children s exposure to media violence with subsequent increases in their aggressive and violent behaviour. Many experts argue there is no causality, at best shared etiology. Violent game play is linked to an increase in aggressive behaviour and decrease in cooperative behaviour in social situations; Most apparent in children under 10 Effects were generally short term The Gambling Link 45.5% of Alberta youth gambled last year; only 5.5% met problem criteria Gamblers playing videogames more likely to: Play for long hours See themselves as excellent players Experience dissociation, arousal, relaxation Criteria for Concern: How can we determine whether play is an issue? Self-reports PVP Survey Hours of Use DSM-IV Criteria Griffiths Gentile Impacts to Major Life Areas (MLAs) Risk and Protective Factors

11 Assessment Questions for clients: Age of onset Preferred type of play Hours of use & changes in usage Escalation, tolerance, specialization Benefits and costs of use Impacts to MLAs Assessment continued Remember to probe for: Pleasure decay Gambling Current intention Client s assessment of severity Depression/Anxiety OCD Hours alone don t explain Youth who meet addictive criteria play 2x much as other youth (24 hours/week) Amount of play itself is not correlated to addiction Attachment to gaming is not correlated to addiction Amount of play is not connected to poor grades Meeting addictive criteria is connected to poor grades

12 Problem Video Game Playing (PVP) Survey 1. When I am not playing with the video games, I keep thinking about them, i.e. remembering games, planning the next game, etc. (Preoccupation) 2. I spend an increasing amount of time playing video games (Tolerance) 3. I have tried to control, cut back or stop playing, or I usually play with the video games over a longer period than I intended (Loss of control) 4. When I lose in a game or I have not obtained the desired results, I need to play again to achieve my target (Loss of control) 5. When I can't use the video games I get restless or irritable (Withdrawal) Problem Video Game Playing (PVP) Survey 6. When I feel bad, e.g. nervous, sad, or angry, or when I have problems, I use the video games more often (Escape) 7. Sometimes I conceal my video game playing from my parents, friends, teachers. (Lies and deception) 8. In order to play video games I have skipped classes or work, or lied, or stolen, or had an argument or a fight with someone (Disregard for physical or psychological consequences) 9. Because of the video game playing I have reduced my homework or schoolwork, or I have not eaten, or I have gone to bed late, or I spent less time with my friends and family (Family/school disruption) Major Life Areas (MLAs) Family relationships Social life/friendships School Work Leisure Mental Health Physical Health Finances Legal Concerns Spirituality/Values

13 Risk and Protective Factors in Treatment Parental Monitoring Social Skills Pro-social activities available used Grades Age Peer Behaviour Family History Family Discord School Disconnection ADHD Link Videogame may self-medicate children with ADHD Play releases dopamine and requires visual working memory Methylphenidate (e.g. Concerta) may treat videogame addiction in ADHA patients Time playing, inattention, and hyperactivity were all reduced with a 30 mg dose ADHD and excessive play may have a common etiology American Academy of Child and Adolescent Psychiatry (AACAP) Limit your child s video game playing to 1 2 hours per day Watch for signs that gaming is interfering with socializing, academics, or family time Allow play only after all homework is complete Encourage participation in other activities Consult a qualified mental health professional

14 American Medical Association (AMA) Review ratings Educate physicians on risks Educate families on appropriate use 1 2 hours total screen time, games included Heavy use > 2 hrs/ day Support parents to monitor content and restrict use Fund long term research on videogame and internet abuse Encourage the inclusion of videogame addiction as a DSM-IV disorder Effective Treatment Tools For Parents and Teachers Limit type of play Promote social skills Promote social activity Know the friends Monitor bullying Limit duration of play Promote physical activity Monitor play Monitor grades Effective Treatment Tools For Health Professionals Experiential, activitybased treatment Substitution of alternate activities Increase awareness of use Addictions Treatment Increase awareness of impacts to MLAs Elicit alternate goalsetting Share social norms Family Therapy

15 Summary 1. Entertainment has changed, and isn t likely to change back 2. Patterns of use for many match established patterns of addiction 3. Understanding the appeal and rewards of games is critical for engagement, assessment and treatment 4. As with most use, a culture of recovery depends on ownership without blame