Is My Child Addicted to Gaming? An Interview with Gaming Addiction Specialist Dr. Clifford Sussman.
Many of us (myself included) have kids who LOVE their video games. For many kids video games are less a silly passtime and more a way of life; a place to meet friends, explore identity, play and escape from the stress of real life. But did you know that the video gaming industry has surpassed the film industry, television industry and even sports industry in revenue in the past few years? With the ease of downloads and many games being distributed for free, video games are poised to integrate into all aspects of our lives and our children’s lives. For many this will be a fun and welcome addition to the world of entertainment, but these extremely stimulating and instantly gratifying games, with their psychologically manipulative methods of keeping users hooked, have many parents worried.
So I wanted to speak to an expert in the field of gaming addiction to learn more about the reasons why gaming has such a hold on our kids, what worrisome behavior to look out for, and how to help kids develop a healthier relationship to gaming. Dr. Clifford Sussman is a child and adolescent psychiatrist and psychotherapist who has been a pioneer in recognizing and treating internet gaming disorder since 2008, long before it became recognized by the World Health Organization as an official diagnosis. He is a frequent educator and presenter on this topic and trains other clinicians as well. As a programmer, software developer, and gamer himself, he is dedicated to helping people achieve healthier, more balanced relationships with digital technology.
JS: Can you explain to us what it is about video games specifically that makes them so addictive?
CS: It's probably best to first define what addiction really is because I think a lot of people just throw the term around. Addiction means that you can't stop doing something, even though it's causing you problems. So it's like you're doing something in a compulsive enough manner that it's not allowing you to function in other aspects of your life.
So the first quality that video games have, which all the addictive drugs have as well, is instant and continuous gratification. It is very unusual for someone to get addicted to something that doesn't give them what they want exactly when they want it.
The next thing is how easy it is to access it. You know, you can get access to video games quicker than you ever could before, because they are right on your device in your pocket wherever you go. When kids were learning at home during the pandemic they were already on the computer they game on for their classes. So delay and gratification was much less and people gamed a lot more. Actually that easy access is a lot more important than the content of the game itself. You add delay to anything and it becomes less addictive.
In addition there is the variable ratio reinforcement. The way I would explain that, is that it's the unpredictability factor - meaning, you don't know what you're gonna get next. Scientists have proven that if you get the same reward for an action, each time predictively, you don't do it nearly as much or as fast, and it's much easier to stop doing it. With gaming there are all sorts of ways in which the rewards are not consistent and this keeps players engaged. The same concept is used in social media - if every post was exactly what you wanted it probably would not be as addictive, ironically.
Lastly, video games have become enhanced for socializing. Meaning, there's built in social media to video games now that it’s all multiplayer gaming. So you’re throwing in a peer pressure component to it, and for those who may not be great at socializing in real life, you level the social playing field.
JS: So it's sort of like video games are really feeding some of our most primal, basic desires as humans, right? To continually seek pleasure, gratification or comfort and to connect with people.
CS: You're right. Yes, video games do appeal to those primal drives - at least the quality in them that makes them more addictive. That's not to say that there isn't a lot of appeal to our pre frontal cortex - the more developed part of the brain - as well. Games are filled with puzzles that you have to think your way through. But again, that's not the part of the brain that's lighting up in addiction.
JS: I’m curious, are there any particular kinds of kids or people who are more at risk for developing video game addiction more than others?
CS: Yes. Kids with ADHD, autism, depression and anxiety are at a higher risk. Correlation doesn't prove causation, but I would suggest that if you just think about the types of issues these kids struggle with there is a very logical reason why they would be drawn more towards video games.
JS: Is it all about brain chemistry?
CS: Most things in psychiatry are a mix of nature and nurture. In most cases addiction is a mixture of biology and psychosocial factors. Of course it’s also true that addiction runs in families. We know that it is inheritable. But while it certainly is in part a biological problem, you could see how someone might want to be on a screen simply to escape the thing that's making them anxious.
JS: How would you say a parent can tell if their child is addicted to video games or even to social media? What are some of the signs to look out for?
CS: Some of the biggest signs that I get called about are aggression, isolation and major declines in academic performance. Often kids become very irritable whenever they're not playing. So they'll have these long binges followed by wanting to be very socially isolated and will become very unpleasant to be around. There are kids who will threaten their parents that if they take away their games, they will kill themselves. But, another thing about the term addiction that I think is kind of misunderstood is that you can be very addicted or you could be a little addicted. It's really a continuum.
JS: What do you recommend for parents who suspect their child may have a video game addiction?
CS: First you may need to consult a professional. If you do go see someone like myself, I'll often recommend a dopamine detox, which usually lasts at least a week or more - I would say up to a month of not having any access to high dopamine activities.
JS: In order to rebalance the brain chemistry and get it back to a healthy balance, right?
CS: Yeah, exactly. On a neurochemical level, what you're doing is restoring dopamine receptors. It's like a reset, although it's useless if you don't follow it with other phases. So if you just go back to the same environmental cues, you're going to relapse. I'll take that time to have the parents change a lot of how they structure things around the house, but I'll also prepare them for a phase two which is externally regulated by the parents - a balanced use model. Then the third phase - teaching self regulation - which is what you're aiming for before kids go off to college.
JS: What about those kids who don't really meet the criteria for addiction, but seem pretty obsessed with gaming nevertheless?
CS: Right. So maybe they're just much lower on the addiction spectrum. You might describe a kid as dependent on video games because they're playing a lot, but they seem to have it all together. You know, they have friends they're doing well in school. For a kid like that, they still might get some help just because they may be at higher risk of having problems later on. I do a lot of work with parents teaching them how to set limits. When you start with limits when your kids are still young they're at lower risk of developing an addiction.
I have a working hypothesis that if you set limits early on you're developing two important skills.
You're developing the ability to delay gratification and a skill I’m calling “early termination.” Which basically just means being able to stop before you want to.
JS: One of the things that I talk to parents about is that once your kids get to the middle school years, it's a good time for them to start practicing some of those time regulation skills themselves. That’s not to say that parents shouldn’t continue to keep an eye on it, but for example, I'm starting now to have my kids (10 and 12 yrs old) set their own time limits before they get online. I don't want to be the one who's telling them all the time, because eventually they need to build those habits and they need to be able to do it themselves. And my sense is that that's gonna take quite a few years
CS: Yes, and that’s also a place where you can employ positive reinforcement. If your kid times themselves and they get off at the right time that they agreed to without you needing to prompt them, then that's an opportunity to give them some kind of reward or a token towards something.Those are great opportunities for catching kids doing the right thing!
JS: To wrap things up, can you give me some of your top tips for parents to help them set up their kids for success when it comes to gaming?
CS: These are [some of the] healthy screen use guidelines that I will share with parents, although I emphasize that a healthy balance may be different in different families and different children.
Structure is critical to a balanced life. A consistent schedule with plenty of offline activities, commitments, and routines, allows for minimal unstructured time. The less unstructured time in each day, the less need to follow the rest of these guidelines.
Environmental accommodations may help preserve offline time, such as tech free zones and tech zones within the house.
Meals should be spent screen free
Every block of screen time* should be followed by another block of offline time of similar length. This allows dopamine receptors to recover and trains delayed gratification.
Each block of screen time should be limited to a consistent length of time (it is recommended to use two timers, one for the child and one for the supervising guardian).
Lastly, parents should get help if a child or teen’s excessive use results in significant negative consequences, such as aggression, suicidal thoughts, sleep deprivation, absence from school, other substantial decline in functioning socially, academically, or occupationally, or physical and mental health problems.
To get more tips and find out more about Dr. Sussman’s work please visit: https://cliffordsussmanmd.com