Video games are addictive, officially

Addiction and Recovery

By Bob Gaydos

Some young males may be addicted to video games.

What many parents the world over have been proclaiming for quite some time is now official: Some individuals -- mostly young males --- are literally, not just figuratively and annoyingly, addicted to playing video games. That is the determination of the World Health Organization, which after considerable study and debate, recently added gaming disorder to its International Classification of Diseases, a primary source of information for doctors worldwide.

The United Nations agency did not put a time frame (how many hours a day) on what would be considered addictive gaming, but rather, put video gaming in the same category as gambling addiction -- a behavior that becomes “a priority” and which the individual is unable to stop despite numerous negative life consequences. These include loss of a job, loss of friends, broken relationships, poor health, bad grades and other assorted issues that might arise for someone who played, say, Fortnite, the current video game rage, for 14 to 16 hours a day while neglecting work, school, food, sleep, family, friends, showers … real life.  

While this classification might seem overdue to some, it is not without controversy. For one thing, the W.H.O. zeroed in on video gaming, both online and offline, but did not include use of the internet and smartphones, which certainly are vehicles for obsessive behavior. For another, the American Psychiatric Association did not include gaming in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, choosing to call it a "condition for further study."

Some critics of the WHO classification suggest that gaming was targeted because of heavy lobbying by some countries, such as China and South Korea, which have large populations of video gamers and are desperately looking for help in treating them. But some mental health professionals say official WHO designation could improve public education, research, insurance coverage and development of treatment programs, which at the moment are scarce and expensive. They say including the gaming industry -- with its legion of experts on creating reward-and-reinforcement scenarios -- in the conversation can only help.

Not surprisingly, most creators of video games (who have an economic motivation to be considered) and their legion of players responded negatively to the classification, arguing with the methodology of some studies and saying the results have been far from conclusive. They also say studies on gaming are relatively new and note that some studies have shown benefits to playing video games, including improved thought processes (lots of strategy to figure out), greater motivation (lots of levels to reach and competition to be won), and improved memory and hand-eye coordination (essential for good gaming). In these regards, they say, gaming is akin to young people playing sports or joining clubs.

Finally, there is also disagreement among mental health professionals about whether the gaming is the cause or the effect of such common co-occurring disorders among obsessive gamers as anxiety and depression.

Still, whether it is an official mental health disorder or one deserving further study, no one argues that playing video games to the point that the player suffers negative consequences in other areas of life is good for one’s health. So, while the APA has not classified gaming as a disorder, it has come up with nine criteria for identifying it, should it make that official decision. They are similar to those used to identify other officially classified addictions:

1. Pre-occupation. Do you spend a lot of time thinking about games even when you are not playing, or planning when you can play next?
2. Withdrawal. Do you feel restless, irritable, moody, angry, anxious or sad when attempting to cut down or stop gaming, or when you are unable to play?
3. Tolerance. Do you feel the need to play for increasing amounts of time, play more exciting games, or use more powerful equipment to get the same amount of excitement you used to get?
4. Reduce/stop. Do you feel that you should play less, but are unable to cut back on the amount of time you spend playing games?
5. Give up other activities. Do you lose interest in or reduce participation in other recreational activities due to gaming?
6. Continue despite problems. Do you continue to play games even though you are aware of negative consequences, such as not getting enough sleep, being late to school/work, spending too much money, having arguments with others, or neglecting important duties?
7. Deceive/cover up. Do you lie to family, friends or others about how much you game, or try to keep your family or friends from knowing how much you game?
8. Escape adverse moods. Do you game to escape from or forget about personal problems, or to relieve uncomfortable feelings such as guilt, anxiety, helplessness or depression?
9. Risk/lose relationships/opportunities. Do you risk or lose significant relationships, or job, educational or career opportunities because of gaming?

Obviously, the more “yes” answers there are, the more likely the individual has a problem with video gaming, whether it’s labeled an official addiction or not. Denying it out of shame or guilt or fear won’t help. In fact, the WHO classification is intended to eliminate those obstacles and provide an avenue to help. If the video gamer has trouble stopping or cutting back, consider consulting a professional addiction counselor.

There is also help available online from those who understand the problem because they’ve been there:

-- On-line Gamers Anonymous, a 12-step, support and recovery organization “for gamers and their loved ones who are suffering from the adverse effects of excessive computer gaming”: olganon.org

-- Computer Gaming Addicts Anonymous (CGAA), “a recovery fellowship, based on the model of Alcoholics Anonymous”: cgaa.info.

Whatever you do, be honest. If you or a loved one are talking about it, if it is a cause for concern, if it has caused problems, then it’s a problem, official addiction or not. Don’t wait for the debate to be resolved.

It’s all in the game

• About 2.6 billion people play video games worldwide.
• Two-thirds of American households include video game players.
• The great majority of those who play video games do not display addictive behavior.
• Young males log more hours weekly on video games than do young females.
• The Entertainment Software Association says annual worldwide revenue for the industry should reach $180 billion by 2021.
• Fortnite: Battle Royale, the current hot video game in which 100 players battle to be the last one standing on the island, recently earned a reported $300 million in one month. It has a reported 40 million-plus players, some of whom are obsessive. The game is free to play, but players can buy add-ons (weapons, tools, resources, etc.) to enhance their chances of victory.

 bobgaydos.blogspot.com

Test your knowledge on addiction

Addiction and recovery

By Bob Gaydos

The more things change, the more some other things seem to stay the same. This is particularly true in the field of addiction and substance abuse. With (a) an opioid epidemic sweeping the nation, (b) a growing nationwide movement to legalize the use of marijuana for medicinal and even recreational use, and (c) a growing consensus that the “war on drugs” has failed, a new administration in Washington seems determined to stick to the old, law-and-order approach to addiction.

This suggests that, while we may be in the midst of an unprecedented technological revolution, some of us may still be operating with outdated information. That’s why, from time to time, I devote a column to facts about alcohol and drug addiction. After all, if we’re going to treat it as a war, or as a crusade against a major health issue, we should know what we’re up against.

And, since Americans love quizzes, I’ve put one together to test your addiction IQ. It’s updated from one I offered a few years ago. Quizzes may be fun, but obviously this is a serious issue. The questions and answers are based on reports and other published materials of the National Center on Addiction and Substance Abuse.

What’s your addiction IQ?

1. a) 10 million; b) 20 million); c) 40 million; d) 60 million Americans 12 or older have substance abuse problems.
2. a) 15%; b) 25%; c) 50%; d) 75% of all high school students have used addictive substances, including cigarettes, alcohol, marijuana or cocaine.
3. More than a) 50%; b) 60%; c) 75%; d) 90% of people with a substance problem began smoking, drinking or using other drugs before age 18.
4. a) 26%; b) 36%; c) 46%; d) 56% of children under age 18 live in a household where someone age 18 or older is smoking, drinking excessively, misusing prescription drugs or using illegal drugs.
5. Seven in 10 people with the chronic diseases of high blood pressure, major depression and diabetes receive treatment. How many people who need treatment for substance problems receive any form of care? a) 1 in 10; b) 2 in 10; c) 3 in 10; d) 5 in 10.
6. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking for women as: a) 3; b) 7; c) 10; d) 12 drinks in a week.
7. The NIAAA defines risky drinking for men as more than: a) 12; b) 14; c) 16; d) 20 drinks in a week.
8. Among people with a prescription drug use problem, nearly: a) 25%; b) 30%; c) 50%; d) 75% have another substance problem.

    9. Of every dollar state and federal governments spend on substance problems: a) 2 cents; b) 5 cents; c) 10 cents; d) 25 cents goes to prevention and treatment.

True or false

   10. Having a high tolerance (feeling less effect from the substance with continued use) is a sign that the person is not addictive.

   11. Because they use substances at lower levels than men, women typically progress from substance use to addiction more slowly than men and experience the health consequences of substance use, such as death, cancer, heart disease and memory problems, less intensely than men.

   12. Addiction, substance use and abuse are the largest preventable and most costly health problems facing the U.S. today, responsible for more than 20 percent of deaths in the U.S.

   13. Addiction, substance use and abuse cause or contribute to more than 70 other conditions requiring medical care, including cancer, respiratory disease, cardiovascular disease, HIV/AIDS, pregnancy complications, cirrhosis, ulcers and trauma, and account for one-third of all hospital in-patient costs.

   14. Total costs to federal, state and local governments of addiction, substance use and abuse are at least $468 billion per year – almost $1,500 for every person in America.

    15. Addiction can’t be a disease because it is caused by the individual’s choice to use drugs or alcohol.

Answers: 1(c); 2(d); 3(d); 4(c); 5(a); 6(b); 7(b); 8(d); 9(a).

10: False. High tolerance is a warning sign of a possible substance problem.

11: False. Women generally progress more quickly than men in addiction and suffer more intensely.

12, 13 and 14: True. Just putting out some perspective on the scope of the problem.

15: False, according to National Center on Addiction and Substance Abuse: “While the first use (or early stage use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of his or her behavior. Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices, such as diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.”

Keep score yourself. The only way to fail is to ignore the issue altogether.

* * *

More info:

www.centeronaddiction.org.

www.niaaa.nih.gov.

bobgaydos.blogspot.com

Addiction and Recovery

It’s a disease, not a moral failing

By Bob Gaydos

Dr. Benjamin  Rush

There’s a week for everything in this country, some serious, some not so: National Handwashing Awareness Week; Celebrate Your Name Week; Fix a Leak Week; Mental Health Awareness Week; Freelance Writers Appreciation Week; Nurses Week; National Kraut Sandwich Week; National Indoor Plant Week.

One of the more serious ones -- National Drug and Alcohol Facts Week -- recently passed with little notice. However, there was a useful, informative blog about the week on the recordonline.com news site. It was written by Dr. Judith Branche, of Cornerstone Family Healthcare’s Center for Recovery in Newburgh. Dr. Branche is Board Certified in Addiction Medicine.

One paragraph in the blog especially struck home with me: “(A) significant problem is the lack of understanding of the problem for what it truly is. Therefore, I would like to take this opportunity to explain what a substance use disorder really is. Addiction is a chronic disorder of the brain which affects brain chemistry in a significant way. This may be a new concept for many who believe that drug addiction is no more than a moral failing or a character defect that a person should be able to overcome if he or she puts their mind to it. Nothing could be further from the truth.”

Amen, amen, amen. I’ve been writing on this topic for about a decade. In my opinion, this remains the biggest problem with regard to alcoholism and addiction -- that many, probably a majority, of people do not buy the disease concept. This includes  many government officials who are in a position to help lessen the harmful impact of the disease. They look upon it as a law and order issue, rather than a health issue.

So we declare a war on drugs and throw the addicts in prison along with the pushers. Diabetics don’t get locked up for being victims of sugar. More to the point, executives of food companies who load their products up with sugar under dozens of other names don’t get arrested for fraud or posing a public health risk. They get bonuses. Their customers who wind up addicted to sugar get insulin and a new diet plan. Follow it, or get sicker.

Addicts, alcoholics who want to fight their disease have to first fight insurance companies to get coverage for treatment, probably have to “fail” at outpatient treatment if they want in-patient rehab and then hope they are lucky enough to find an in-patient slot. Winding up in prison is a whole lot easier.

The tricky thing about the disease of addiction is that many of those who have it do commit crimes while under the influence or in search of money to get more drugs. Alcoholics do drive drunk and kill or injure others. This is where moral judgments take over, understandably. But while their disease may explain their actions; it does not excuse addicts from the consequences. Still, in paying the price, addicts should at a minimum also be offered a chance at treatment. It’s possible to get clean and sober behind bars.

Of course, much of the damage addicts do is not of the criminal variety. It is of the personal variety, often directed at those who care most about them. Living with an active alcoholic can be like living in a volcano -- unpredictably eruptive. Indiscriminately destructive. Loving the addict and hating the disease, as Al-Anon suggests, is excellent advice, but no one says it’s easy. It takes a lot of practice and patience and it does not mean accepting or enabling unacceptable behavior. But if more people tried it, I believe the disease concept would become more real and the stigma attached to the disease would lessen. That would help those seeking recovery and the people closest to the addict would be better able to deal with life, regardless of whether the alcoholic/addict was active or not.

Of course, the addict has to accept the disease concept as well if he or she hopes to having meaningful recovery. Simply abstaining from using through will power often makes for a more miserable person who is just not drinking. Rather than saying, "I'm an alcoholic and I can't drink for the rest of my life," the alcoholic can say, "I have a disease that makes it mentally and physically impossible for me to drink safely." Obviously, the alcoholic can drink anytime he or she wants, but the treatment for the disease is abstaining and finding some other source of solace, serenity, strength to deal with the rigors of life.

That's not an easy decision either. But the more society talks about addiction as a disease, not a moral failing, the sooner, I believe, we will see more positive results in fighting it.

(Author’s note: While the opinions expressed are solely mine, they are based on discussions with hundreds of alcoholics, addicts and professionals in the substance abuse field.)

bobgaydos.blogspot.com

Who says so?

• American physician Benjamin Rush (1745–1813), who signed the Declaration of Independencence, is often cited as the first who understood drunkenness to be what is now called a "loss of control" and possibly the first to use the term "addiction" in connection with this meaning. He wrote: “My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.’” He said, "Habitual drunkenness should be regarded not as a bad habit but as a disease," describing it as "a palsy of the will."
• Between 1980 and 1991, medical organizations, including the AMA, established policies on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice." In 1991, the AMA endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Source: WIKIPEDIA

So, you think you’re just a ‘heavy drinker’? Try this

My latest Addiction and Recovery column

By Bob Gaydos

“I’m not an alcoholic. Alcoholics have to go to those meetings. I’m just a heavy drinker.”
Maybe yes; maybe no. Either way, if you’re having this conversation with someone else, or just with yourself, it’s likely there are issues lurking that are related to your consumption of alcohol. As rules of thumb go, the one that says: “If drinking is causing problems in your life, it’s a problem,” is as reliable as it gets.
For those who describe themselves as “heavy drinkers,” it would probably be useful to know what health experts mean when they use the term, as well as possible risks involved in that pattern of behavior.
The Centers for Disease Control recently issued a report on heavy drinking which defined it as 15 or more drinks per week for men or eight or more drinks per week for women. That raised the limit by one drink per week in each case from standards issued by the National Institute on Alcohol Abuse and Alcoholism. But, as some professionals in the field would say, if you’re counting drinks, there’s already a problem.
Of course, it’s important to know what is meant by a drink. A standard drink, according to the NIAAA is 1.5 ounces of hard liquor or brandy, 12 ounces of beer and five ounces of table wine. All alcohol has the same effect, regardless of the form. If your “standard” drink is larger, the total drink count will be higher. And, possibly, the risks.
It’s true, some people can drink more than others and not have problems as a result. It’s also true that at least 40 percent of Americans drink little or no alcohol at all. But for anyone describing himself or herself as a “heavy drinker,’’ the NIAAA says it matters how much you drink on any one day and how often you have heavy drinking days.
        Among those who have one heavy drinking day per month, the agency says one in five, or 20 percent, already have alcoholism or alcohol abuse. One heavy drinking day per week raises the odds to one in three. Two or more heavy drinking days per week, makes it 50 percent, according to the NIAAA.
        And so what? says the “heavy drinker.” I have a job. My family loves me. I’m young. Alcohol is good for the heart. I get good grades. I don’t drink any more than my friends do. If it becomes a problem, I’ll cut back.
        Again, maybe so. But also again, it’s good to know the risks involved with heavy drinking. There’s nothing new here. Heavy drinking increases the chances of being injured or killed in auto accidents, fires, drownings, or being the victim of an assault or suicide. It poses greater risk of liver disease, heart disease, depression, stroke, sexually transmitted diseases and more. It can pose a risk to the baby if a woman drinks during pregnancy and, just as with alcoholism, alcohol abuse -- or heavy drinking -- can cause legal problems, trouble in relationships and failure to meet responsibilities at work, school, home, etc.
        If you’re serious about wanting to know if you’re just a heavy drinker -- someone who can successfully manage his or her alcohol intake and even curtail it -- rather than someone who “needs to go to those meetings,” the NIAAA offers a test, as it were.
       For one week, with dinner, have one standard drink of wine or beer. Or if you prefer, one standard drink of hard liquor or brandy before dinner. That’s it. Nothing else. No changing drinks from day to day. The NIAAA says people who can take it or leave will have no problem. Alcoholics flunk.
       As always, the idea is not to judge or condemn, but rather to take an honest look at one’s drinking in the hope of avoiding or eliminating problems that can arise from the abuse of alcohol. A heavy dose of honesty can be the best medicine when substance abuse is in question.

rjgaydos@gmail.com