Games people play: The next-generation addiction

Over the years, addictive behaviors have gradually extended from substance use to seemingly harmless behaviors. As one said from Parle-G to PlayerUnknown’s Battlegrounds (PUBG), a paradigm shift in games to the virtual web, people have been losing themselves in the online world, and the most worrisome aspect is that our Gen X is the one that seems to be most affected.

Earlier, one could see a child playing around with wooden toys, exploring new sights or gaining social insights by making friends and relations, but all this seems to be getting lost with the advent of technology where YouTube, social media, and online web games have taken over a child's concept of fun and games. Over the last decade, use of gaming stations as a main mode of primary recreation has immensely increased in our teens.¹ Both International Classification of Diseases (ICD) and Diagnostic and Statistical Manual classification systems have raised alarm over internet gaming disorder and others as areas of clinical interest warranting a closer look to what this world is actually heading to. ICD-11 for mortality and morbidity statistics has included gaming disorder (6C51) as one of the mental/behavioral disorders under the category of disorders because of addictive behaviors.²

Epidemiological research over the last few years on disordered gaming in youth reported low prevalence ranging from 1.4% to 5.9%, which could have been due to nosological limitation along with its detrimental outcome needing further investigation.³ Multiple studies have raised concerns with alarming findings of high risk of psychiatric comorbidities in those afflicted with “internet gaming disorder.” Video gaming is considered to enhance attentional and visual spatial skills but has taken over a negative turn where our youth not only get addicted but also jeopardize their time in social engagement, outdoor games, other recreational activity, or any other types of skill-building extracurricular activities.⁴ Research has also found the users more vulnerable to risk of substance abuse, self-harm, low mood, sleep problems, and even disruptive behaviors.⁵ Negative outcomes such as lower social support and health-related quality of life, antisocial behavior, anger control problems, emotional distress, decreased self-esteem, attention deficit hyperactivity disorder, social phobia, decreased satisfaction with life, low self-efficacy, poor academic performance, denial as a coping strategy, nicotine use disorder, depression and anxiety, interpersonal problems, and impaired psychological well-being have been consistently reported.³ A wide variety of games and basket of genres are identified, for example, casual browser games, first-person or ego-shooters, massively multiplayer online role-playing games, and simulation games or hybrid forms.⁶ One wonders about what catches the attention of the child in Blue Whale and Human Embroidery where harm to self is the game; in addition, online betting in video games is becoming a new norm, making them dangerous.

Some of the theories postulated for online game addiction are escapism from reality, lack of impulse control, or euphoria linked to brain pathways of games and sports, along with release of dopamine, reward-seeking behavior, and reinforcement with adrenaline rush.

Behavioral changes over the years have even infringed upon sexual behaviors and addiction. With the advent of virtual reality, access to pornography has become easier. Terms like ‘sex,’ ‘love,’ and ‘porn’ arrive at the fore by a single type and click on the computer. Sexuality has become recreational and even imperative.⁷ Estellon et al. talk about sexual behavior and its compulsive component as a convergence point between psychoanalysis and neuroscience. So, are we looking into another possible deviant entity of behavioral dependence? Compulsive sexual behaviors (CSBs) have been identified as paraphilic and non-paraphilic. Paraphilia has long been identified as a disorder and included in the classification system, but very few get to be identified or treated. They are recognized only in extreme situations when there are legal implications.⁸ Black et al. reported that CSB has its onset primarily in late adolescence, and specific mood states often trigger their sexual behavior (96%), most commonly sadness or depression (67%), happiness (54%), or loneliness (46%).⁹ Presence of comorbid psychiatric disorders such as depression, substance abuse, and impulse control disorders is also common. Negative consequences such as unwanted pregnancies, high risk of Sexually Transmitted Diseases (STD), HIV, social and family impairment, and high risk of suicide have been reported.¹⁰ Sexual addiction is a recognized but an underexplored entity with limited empirical data to explain it. Adolescence is a vulnerable age-group where sexually explorative behaviors are expected, but with the unlimited access to digital media, offering portability, access, and visually explicit depictions of sexual acts in high definition leaves nothing to the imagination.¹¹

Management strategies for behavior addiction range from pharmacotherapy to psychotherapy but have their own nuggets of success and warrant an individualized approach to get better outcomes.¹² Pharmacotherapy with antidepressants, antipsychotics, and mood stabilizers, and in case of CSB, even antiandrogens, has been tried and reported in anecdotal case reports. Most success has been achieved with psychosocial interventions and cognitive behavior therapies. Even psychoeducation and family/couple's therapy have been found to be effective, but again, all treatments are in their primitive steps and need patient-centered approach for successful results.

Technology revolution is expected to make things better, but with the growing advances, one can always ponder about the reality of that. Virtuality has become more real than reality. People are no more interested in building true relationships face to face and prefer having unlimited virtual friends over social media. Recreational activities such as online gaming are considered as a normal behavior and are in vogue especially among the next generation. A kid is usually subjected to taunts by his/her peers if he/she is not connected to the online sphere. This really puts out a question “What is our future if not a slave of technology?”