Video game addiction is already a phenomenon recognized by the World Health Organization and the American Psychiatric Association. The question remains, though: could video games, Overwatch for instance, contribute to a drug or alcohol addiction? Lurking behind the question is some gamers’ use of various drugs with caffeine to stay awake and alert. The interplay of substance use and video game habits comes in several forms, especially involving stimulant use. Gaming has easily an addictive habit for many personality types. Addictionologists widely maintain that one such habit can spur another. Therefore, it would not be farfetched to find that video games could exacerbate substance use disorder.
More fundamentally, researchers still endeavor to better understand how any use disorder can fuel another. The issue is complicated by what experts still don’t fully understand, though. A primary example is whether any given use disorder is truly diagnostically separate from another psychiatric disorder. The psychiatric disorders in question are those most common among patients who experience substance use disorders. These most consistently include social anxiety disorder and major depressive disorder, among others.
Gaming disorder (or video game addiction) can easily co-occur with other behavioral disorders. In some cases people with gaming addictions use stimulants in order to stay awake and keep playing for long stretches of time, according to a 2021 study published in Computers in Human Behavior. Canvasing 526 respondents to an international survey in the U.S., about 42% of participants were found to rely on performance-enhancing drugs. That’s more than two out of five gamers.
All respondents were recruited for participation from 16 online forums or one of three in-person e-sports competitions. Performance-enhancing drugs in e-sports were found to include prescription stimulants and modafinil. The most common, however, were caffeine and energy drinks. Prescription stimulants like Adderall and Ritalin — and even caffeine — are commonly abused substances.
They’re also often used to treat attention deficit/hyper-active disorder (ADHD). The study did also find risk factors associated with ADHD among a notable portion of the cohort. Use of such substances is especially prevalent among gamers who livestream their play online. Some Twitch gamers, for example, have been known to play through entire series of games without stopping. This demands a full 24 if not 48 hours of nonstop gameplay.
Overwatch Pushes Avid Gamer to the Brink
Overwatch is a first-person shooter that has been a critically acclaimed, wildly popular title in the gaming sector since its 2016 release. Its pre-release, open beta phase gathered almost 10 million players. It has since been lauded for its animation style and immersive gameplay. The game collected over $1 billion in revenue in its first fiscal year. Its first three years garnered 50 million players. It’s been hailed as one of the best games of all time. Publications making the claim include IGN, Polygon.com and Popular Mechanics magazine.
One player, known on Twitter as @Fl4k_Drifter, got somewhat viral attention earlier this year for a video showcasing the extent of his or her addiction. The video, now deleted, merely showed the player hurling a laptop into a lake. This player explained it as a last-ditch coping mechanism against addiction. Drifter claimed to have a therapist who compared the addiction to one with cocaine.
“I have played this game almost every day of my life since it’s [sic] release,” @Fl4k_Drifter tweeted at the time.
Research on Gaming Addiction
As of 2011, a two-year study involved over 3,000 school-age kids in Singapore. The study targeted their video game habits but also assessed how those habits affected other clinically recognized, mental health conditions.
“When children became addicted [to video games], their depression, anxiety and social phobias got worse, and their grades dropped,” according to Douglas A. Gentile, a participating researcher on the project who ran the Media Research Lab at Iowa State University-Ames at the time. “When they stopped being addicted, their depression, anxiety and social phobias got better.”
What Gentile characterized as the cessation of addiction in his 2011 interview with Reuters was more or less the cessation of the habit, though not necessarily the control thereof. In essence, the study is an early example of evidence that video game addiction affects other neurological phenomena. However, critics from within the video game industry challenged that study’s findings at the time partly on the basis that the APA hadn’t yet recognized video game addiction as a legitimate use disorder. Obviously, that has changed.
Gaming Elements at the Heart of Gambling Disorder
The University of York’s Dr. David Zendle conducted two recent studies comparing aspects of video games to compulsive gambling disorder. One explored the link between video game loot boxes and gambling disorder. Loot boxes represent one of the most fundamental facets of video games. They are often hidden treasure chests containing items that help a player advance in the game. These items could be coins, weapons, or special powers.
They originated from classics like Super Mario Bros., where players discovered boxes containing mushrooms that made their character bigger. Another example would be Crash Bandicoot where boxes contained special abilities, extra lives or equipment. In each successive console generation, there has been some form of loot box. The same is the case for Borderlands, Diablo, Destiny, Halo, Overwatch and Tomb Raider franchises to name a few.
Loot Correlation with Gambling
This rudimentary part of gaming, among other features Zendle’s previous study found to interact with compulsive gambling disorder. His 2020 study thereafter followed up. It found that players who engage with these gaming elements are more likely to suffer disordered gaming. This is a more general condition in which a gaming habit yields significant distress.
“These findings suggest that the relationship between gaming and problem gambling is more complex than people think,” Zendle told Science Daily. “When we go beyond loot boxes, we can see that there are multiple novel practices in gaming that incorporate elements of gambling. All of them are linked to problem gambling, and all seem prevalent. This may pose an important public health risk. Further research is urgently needed.”
Dopaminergic Reward System
The concept of the loot box has evolved significantly as game design has grown increasingly advanced. The basic concept, however, is that players gain something of value every time they encounter a certain object in the virtual world. Game designers deliberately use such systems to engage players’ reward systems in the brain. A traditional example would be the square boxes in the original Super Mario Bros. that eject either a mushroom, flower, leaf or star.
Red mushrooms make Mario grow larger; green mushrooms give him an extra life so he can start over on the same stage if he dies. Flowers give him the ability to throw fireballs. Leaves give Mario a tail, which enables him to fly for ill-explained reasons. Stars make Mario impervious to things that would typically hurt him. This creates a degree of mystery that intrigues players. Each item is also a different way of rewarding the player with the illusion of power by making the game slightly easier. These things also simulate a false sense of achievement.
Slots-Style Loot Systems
As with gambling, these boxes are like slots in that the effort to extract their contents are minimal at best, yet the reward suggests to the brain a level of affirmation more often associated with having done something well. In truth, happening upon a box is engineered to happen on every stage multiple times, and what valuable item one receives from any box is determined merely by luck of the draw.
This is why a German 2015 study found video games to contain “elaborate reinforcement and reward schedules that have the potential to maximize motivation.” In other words, how well games utilize these kinds of systems can easily manufacture the motivation to continue playing. That study cited other neuroimaging studies to establish that video games were already suspected to influence the reward system in the brain.
Hidden Treasures for the Sake of Reward
An early example of how this evolved would be the more layered loot system in the Spyro the Dragon series. Each level on a Spyro game is dotted with treasure chests from which one gets a variable amount of vibrantly colored gemstones. However, the same gemstones can also be reaped when defeating enemies of any kin so long as those specific enemies have not been defeated before.
The first Spyro game was also among the first generation of games to introduce what are now familiarly known to gamers as “easter eggs.” In Spyro’s case, these were actual dragon eggs in the possession of fast-running thieves whom the player must catch to collect the egg. The eggs serve no purpose, however, other than completion of the task of collecting them all throughout the game. Without getting all of them, a game completion percentage that glares the player in the face every time they pause will never reach 100%.
Easter eggs are now prevalent in games like Call of Duty, Grand Theft Auto, Infamous, Spiderman and countless others. The reward is simply in the form of game completion. Even by beating the game, one doesn’t truly complete the game until collecting all the easter eggs, and no longer are these actual eggs. In Grand Theft Auto, for example, it could be floating horseshoes. In Spiderman, it could be New York landmarks of which the player must take pictures to get credit.
One of the most unique examples is Metal Gear Solid whose easter eggs are actually hidden references to other games in its franchise or even other franchises and movies. The reward in that case is merely catching and being able to appreciate the reference. A reference may even be made to Hideo Kojima himself, creator and director of the series.
What Does All This Suggest?
In general, this means that more elements of gaming than previously thought, may contribute to compulsive habits for the same reasons that gambling does. Take this information with the consistent outcomes of those who undergo rehab treatment programs for substance abuse disorder but don’t stop drinking alcohol. More and more addictionologists are embracing the understanding that sobriety isn’t necessarily the goal for everyone who goes into treatment and that it doesn’t have to be. However, it is still a common occurrence, they warn, that many fighting addiction to one substance end up using another as a crutch.
For Father’s Day 2022, we interviewed Dustin Wasson who chronicled his history with substance abuse disorder. His story inspires others in earlier stages of their own recovery processes because his love for his children made him commit to seeking help. However, while he did well with his first stint in rehab, he stumbled thereafter through a stage of denial regarding the alcohol use disorder he developed in the process. It wasn’t until he could face the truth about it that he reentered treatment. Today, he’s the executive director of Praxis by Landmark Recovery of Fort Wayne in Indiana.
Addiction replacement is an incredibly common and widely studied obstacle to recovery. In trying to stay away from meth, one might begin to over-indulge in alcohol. During recovery from cocaine use disorder, a person might develop an overeating disorder. Addiction replacement is a phenomenon that shows us how one addiction can feed another with a change of life circumstances as a medium between the two.
If you’re a gamer and you think you or one of your friends have succumbed to substance abuse disorder, visit Landmark Recovery or call us at 260.368.2029.