What to know about video game addiction

S1: I'm Andrew Bracken and this is Screen Time , featuring conversations about technology and kids in today's digital age. My kids are addicted to their screens. It's a common phrase many parents lament , and one that I myself have used. But what does screen addiction actually look like and what can we do to spot it ? Or better yet , prevent it ? Doctor Clifford Sussman is a child psychiatrist who specializes in treating internet and video game addiction. Here's my conversation with Doctor Clifford Sussman.

S2: Uh , even as a child , I was playing a lot on my PC and in the arcade , and I got so into it I learned how to develop and code my own video games , so I knew just how great they could be. I was into solving puzzles. I was into exploring it and having adventures. As I got older , I learned more about the mind and the brain and the that the mind and the brain could also be puzzles. Um , you know , it drove my fascination to learn more about it. And when I became a child psychiatrist and I went into private practice about 16 years ago , I started noticing that a lot of parents were coming to my office and telling me that their kids were addicted to video games. Young adults would come freshman in college who had dropped out because they were on their screens. Too much would come in , and I'd start to recognize that this was more and more of a problem. You know , when I actually interviewed these parents and and these patients , I would find that they were having a lot of the same problems that I would see in patients on my addiction rotations and training. So I started to study how the brain is affected by using screens a lot. I wound up doing some review articles in that area , reviewing imaging studies of how the brain is affected by excessive use of video games , and how that's related to how the brain is affected by use of things like drugs and alcohol and gambling , and started seeing a lot of similarities. So eventually I decided that there was such a demand for this. And for help with this , I decided that I was going to treat people who had this problem as as part of their primary complaint for seeing me. And so that became really my main focus of my practice.

S1: So you mentioned the role the brain plays here.

S2: You're getting something that you also get from other addictive things. Everything that gets us hooked , everything that we have trouble stopping , usually has an effect on what we call the reward system of our brain. And the reward system of our brain is driven by a neurotransmitter called dopamine. Now dopamine is released when we get what we want , when we want it. And the key there is when we want it. It's not just about what you're getting , it's about how fast you're getting it. And so the faster you get what you want , the more dopamine is released. And that's a bigger factor than how good the quality is of what you're getting. Video games , they give you instant and continuous stimulation. And because we have faster connections now , and because we have devices that are accessible to us at all times , the gratification has become even more instant and more readily available to us no matter where we are. And the more that's happened , the harder it is for people to separate from their games. So dopamine plays a role in that. And the more you're on , the more dopamine gets released and the more you release dopamine continuously over , say , days and weeks , hours on end each time , the more you get desensitized to dopamine. Right now in drugs and alcohol , we call that tolerance , right ? Like so you need to drink more , for example , to have the same effect if you drink a lot. It's the same way with video games. Like if you play a lot , you need to play more. And it's harder to stop because you get a desensitization to that dopamine and you start to seek it more.

S1: So you made this kind of connection between addiction to video games , similar to other types of addictions that you've you've seen in your practice and the World Health Organization officially classified gaming disorder. I think it's called as a recognized edition in 2019. Yeah. Can you talk about what video game addiction looks like from a clinician's perspective ? Yeah.

S2: Yeah. From a clinician's perspective , what you see are problems like change in your academic performance for the worse. You will see problems with relationships. You'll see people missing school or dropping out of school. You'll see preoccupation with games where it takes up all your attention and you're not able to focus on other things. You'll see health problems. You'll see psychological problems. And of course , you'll see , like the very common types of behaviors that go along with seeking your next hit , so to speak. In other words , with trying to get back on a screen as fast as you can. Just like you might see in an addict trying to get to their drug. So you might see some dishonest behaviors. You might see lying a lot about screen use. and a lot of my patients I see stealing large amounts of money from parents to enhance their gaming experience.

S1: You mentioned you grew up playing video games , but video games have changed a lot. Yeah , right. And you just mentioned , you know , seeing patients spending their parents money , I mean , just the money involved and the monetization , almost like gambling features are a pretty common , that's right , feature in most of the most popular video games being played today.

S2: They've also figured out that the more elements of variable ratio reinforcement you can put in your games , the more addictive they're going to be. Now variable ratio reinforcement basically means random left to chance. So it's a psychological term that was used to describe how behaviors get rewarded. Meaning that for example if you take a mouse and you have it , press a lever to get food , but you only give the food at random lever presses and not on every lever press. That's called variable ratio reinforcement , as opposed to just giving it every time. And then that randomness , turns out , will make the mouse press the lever a lot faster and for a lot longer. When you stop giving the food and you see the same thing in the slot machines in Vegas , where you see people just pressing the lever over and over again and not being able to stop. So , so gaming has gotten more online , right ? And it's gotten more social. And it's also , like you said , it's incorporated more elements of gambling the way you see social media and gaming fused together more now , where gaming is a way of socializing that not only adds to the allure of gaming because it's also satisfying people's desire to connect with other people. But it also brings in social media industry techniques for getting people hooked. In gaming in general , there's a lot of random elements , but social media companies have perfected it to the point where they have things like endless scrolling. People talk about algorithms all the time , and how there are these algorithms to keep people on , but the algorithms don't deliver you everything you want to see every time in your post. They actually deliver you some things you want and some things you don't want , and that adds an element of variable ratio reinforcement.

S1: You kind of mentioned this blurring between video games and social networks. Some of it I think is probably like you said , games are much more online now and they have a lot of social features embedded in them. How is playing video games or video game addiction.

S2: There's so many ways that gaming has become more social with with people playing on their headsets and playing with each other , and multiplayer gaming has completely transformed the gaming industry and evolved it to the point where that's , you know , very widespread , but also and a huge money making industry , but also known as the most addictive form of gaming. That's multiplayer gaming. Perhaps one of the reasons being that you have the added peer pressure of meeting your friends and not wanting to get off , just like something that drives social media , of course. But just in your question about comparing social media to gaming and addiction to those things , keep in mind that the World Health Organization hasn't officially recognized social media addiction like the way they've recognized gaming disorder. And I think a big reason for that is because they haven't. There's just not as much research out there on social media , and that could change very soon into the future. But , you know , that kind of leads to the question of what addiction is in the first place , right ? Like , how do you even define addiction ? And addiction is really defined as not being able to stop something despite all the problems it's causing in your life. So if you go by that definition , there really can be social media addiction , right ? And if you go by that definition , it's you can also have more severe or less severe addiction based on how severe the problems are. A lot of people get confused about that , and they think that , you know , you're only addicted to social media or gaming. If you if you do it a lot , you know , if it's frequent , but it's not about frequency or how much you're doing it , it's about how much it's affecting the functioning in the rest of your life.

S1: I guess one question that I keep coming back to is our harms from excessive screen time and video games.

S2: You know a lot of these things. You're right. We we don't know all the answers on um , because we we still have to study these things and their long term impact. But theoretically , it should be reversible because just like you can become desensitized to dopamine and seek dopamine , which translates into , you know , seeking , uh , gaming , you can also become desensitized to it. Uh , just the way someone with alcohol dependence needs to drink a lot. Um , if they were to stop drinking , that tolerance would go back down again. We know tolerance is reversible. And in fact , I often recommend to a lot of the families I work with that they do what I call a dopamine detox where they take like three days off from all screens , and a lot of parents will report to me by , usually by the third day , that , you know , their kids are not seeking screens as much. And in many cases they're doing much better in a lot of aspects of life. And just three days , you know , of course , at the same time , those problems will come right back if you go right back to the same behaviors in the same environment. And then a lot of what I recommend is what I recommend , not just to people addicted to gaming , but to everybody , which is just like healthy , balanced use of technology.

S1: So then , you know , obviously this three day detox is just a piece of a treatment. Can you talk more about treatment and what you find works with your patients ? Yeah.

S2: So so to follow up on the three day detox thing , I mean , detoxing in my opinion is not sustainable , meaning that you can't really have abstinence from screens , right. Like you can't have people just indefinitely not use their screens or even just not use high dopamine activities. It's just it's virtually impossible in today's world. So ideally , the goal of long term treatment is to find a balance between what I call high dopamine activities , which are activities that are , you know , as we were saying before , instantly and continuously stimulating , which would include things like video games , social media , but also , you know , other online activities like streaming video and surfing the web and online shopping and online gambling. Of course , you know , any of those high dopamine activities , as I call them , needs to be balanced out with what I would call low dopamine activities , which are activities that delay your gratification , that require patients to do things like , you know , arts and music , and of course , the obvious ones like doing homework and , you know , doing exercise in general , things that require more patience. You know , more traditional book reading. You know , you don't just get to go right to the good part. You have to , you know , patiently work your way to it. If you can balance those two behaviors , then you know , that's a much more healthy way to use screens. And so a lot of the treatment plans may involve finding a way to structure your life. So you have that balance.

S1: You can find more resources on all things Kids in tech at our website , KPBS. Meantime , what questions do you have when it comes to your kids and screens ? My email is Screen Time at KPBS. I'm Andrew Bracken. Thanks for listening.