Addiction

JAMES PARKINSON: Hey, James here. A quick note before we start - this episode mentions some heavier topics, including suicide, as well as addiction and depression. Okay, here’s the show.

JAMES PARKINSON: When was the last time you stayed up all night playing video games? For me, it’s probably been quite a few years, but there were definitely times as a teenager when I started a gaming session in the early evening, and was still going when the sun came up. Sometimes I may have been staying the night at a friends house, or at home by myself when my parents were away for the weekend. It’s not something I’m proud of, but yeah, I did it. I was a kid, and occasionally when I had a little extra freedom, I gave myself permission to really indulge.

JAMES PARKINSON: My experience isn’t a unique one, but for most people who play games, all-nighters or all-weekenders, are an occasional or rare activity. For the vast majority of us, games are a fun hobby that never become a problem. But for some, the ability to step away from games isn’t so easy. These are people who, for a variety of reasons, have become addicted.

CAM ADAIR: You know, I dropped out of high school, I never graduated, I never went to college. And I began to live my life in a place of trying to maximise the amount of time I had to game. And that began with, you know, cutting school and then cutting work and cutting relationships and just anything that stood in my way of being able to play games more often was something I was going to, to find my way around or get rid of. And I just wanted to maximise the amount of time I could play.

JAMES PARKINSON: The severity of a person’s gaming addiction is different for each individual. For Cam Adair, it was on the serious end of the scale.

CAM ADAIR: I actually didn't identify with, you know, quote-unquote, “addiction” to games for many years, until I actually had improved my life. But the point when I realised that, you know, gaming was obviously beginning to become a problem for me was during the night when I hit rock bottom.

JAMES PARKINSON: I’m James Parkinson. From Lawson Media, this is Gameplay, stories about video games and the virtual worlds that power culture and community.

CAM ADAIR: I started gaming when I was 11 years old, which today I joke is like a modern day miracle. Kids obviously start far younger these days. But I just remember, you know, my cousin who was older than me, I think he got a copy of Starcraft. And I just remember us walking to the store to get eggnog to come back and play Starcraft together. And yeah, then eventually Starcraft was a big game I liked to play, and CS 1.6 as well. And I just really enjoyed playing games, especially competition-based games. I was also a high level hockey player. So for me, gaming was kind of like the thing I did after school and after hockey, but especially during the summers, that's when I would start playing a lot more than usual.

JAMES PARKINSON: Cam grew up in Calgary, and before his teenage years, he had a pretty enjoyable childhood.

CAM ADAIR: I was actually a pretty happy, smiley kid, my nickname was actually ‘Smiley’, until about the sixth grade or so. And, yeah, just a very happy, friendly Canadian, I guess, and really liked to be around people and was very social, and also just very driven.

CAM ADAIR: But that changed when I was in the eighth grade. And I began to experience a lot of bullying, so around 13 years old, and that sort of, like, happy, energetic kid turned into one who withdrew a lot more and was more socially anxious and, you know, just kind of kept to himself. I didn't feel as safe in the world, obviously. And, you know, that kind of just caused me to isolate a lot more.

JAMES PARKINSON: The immersive nature of video games is a regular theme on this show, and of course our ability to escape to a virtual world isn’t inherently a bad thing. Considering the real world we live in, games can provide a much needed break, just like many other forms of entertainment, and we need some of that in our lives. But some people are more susceptible than others to getting lost in those worlds, particularly when their reason for escape is to avoid real problems in their lives outside of games.

CAM ADAIR: Gaming ultimately became my escape. And, you know, I think it's a combination of many different factors, obviously, one was I was being bullied. So gaming was a place where I could kind of get away. Escape obviously, from what was going on. But I also think gaming was a very safe place for me because I had a lot more control over my experience. You know, I didn't have to worry about kids bullying me as much online, you know, block them or mute them or go to a different game, go to a different server. Whereas I couldn't control what kids are doing at lunch hour at school. And so gaming became just a place where I felt a greater sense of control and a greater sense of safety.

CAM ADAIR: But also, the competition aspect of games for me, allowed me to continue to be ambitious and driven towards success...and you know why I feel it can have such a compelling pull for me, personally. The ability to compete and try and be the best is a motivation that can be very strong for me. And it's not just in gaming, it's everywhere. Like, I try and do well in business, I try and do well in my life. And there's just this inherent desire to improve or this ambition to succeed that drives me and gaming is obviously a very easy area to channel that sort of ambition. And so for me, competitive games more or less has always been what I've preferred.

CAM ADAIR: I think the structured way that games are designed, really, for me can give me that opportunity to continue to see myself improving or my character improving. Whereas, in the physical world, I was really struggling to experience that because essentially, all the feedback I was being given around me was that I wasn't wanted. You know, people didn't like me or kids at school were being mean to me, but online it was more or less, if I was good at the game, then people would respect me or people would appreciate me, or they'd want to connect. Or I could find my, sort of, guild or clan online, right? And it wasn't so focused on aspects of myself I couldn't control. It was more focused on just my perception of who I was.

James Parkinson: How much of that was, you know, games being a comfort, and in contrast, how much of that was, like, just trying to get away from bullying and just getting away from the world?

CAM ADAIR: It was a mix for me, for sure. I mean, games certainly were a lot of fun. And I was having a blast playing, no doubt about it. When I turned the game off, my life was in a different place. And I think that contrast between your experience of the digital world and your experience of the physical world can be really stark. And there's even research that's now showing that if you're struggling with low self esteem in the physical world, then you can begin to become more attached to your digital world or your digital characters. And often those experiences are in stark contrast to what you're experiencing in the real world. And, you know that separation begins and can be quite problematic for some people. And so I think I'm definitely a good example of that, where online, you know, I was having a lot of fun. And when I was in the game, it was really great. Hence why I would play it for 15 or 16 hours straight and not even realise it or think I should do anything else. But then when I turn the game off, and I look around, my life is a complete mess. You know, I'm lying to my parents, I'm deceiving them, I've stopped going to school, I'm pretending to go to work, or I've lost a number of jobs. And the basic functions of my life were crumbling around me. That wasn't such a good feeling. And so I was very depressed and anxious. But that all kind of went away when I was playing a game.

JAMES PARKINSON: Cam’s situation grew worse over a period of about 10 years, until one night when he was ready to give up.

CAM ADAIR: And that night, I, you know, have actually wrote a suicide note and got to a point where, you know, I just didn't see a path forward for my life. And luckily, a friend had sent me a text and invited me to go see a movie, which was Super Bad, if people remember that movie. And all I remember is basically we hotboxed a car, went to go see the movie, and you know, I was just very stoned and like laughing at this movie and stuff. And all I can say is in that moment, it's like I saw my life from the third person, I was able to kind of zoom out and like see my life for what it was in that moment. And I just realised that, like, my life was in a very desperate and urgent place, and that I actually, mentally, no longer felt safe with myself. And I could no longer depend on myself to keep myself safe. I was actually a danger to myself, which was a very scary thought. And I realised that I needed to ask for help. I could no longer do it on my own or try and pretend that I could. And so I went home that night and asked my father to help me find a councillor. And he said, “yes”, and this councillor helped me begin to turn things around.

JAMES PARKINSON: Again, it’s important to stress that every individual experience of addiction is different. Cam’s story is just one example and not every case is at the same level of severity. But that also doesn’t mean it’s not problematic. So what do we mean, when we label behaviour as video game addiction?

HILARIE CASH: Essentially, any addiction and that includes video game addiction, is when someone engages in something that's highly pleasurable and stimulating to excess. So much so, that the changes that occur in the brain, actually create a situation in which they lose control. And because they've lost control of their own behaviour, they feel compelled, even though rationally they might say, “I really shouldn't be doing this”, but they feel compelled and they do it anyway. And then, over time because of that compulsion, there are negative consequences and in spite of the negative consequences, they still can't stop. So that applies to video gaming, or many other things as well.

JAMES PARKINSON: Dr Hilarie Cash is the co-founder and Chief Clinical Officer of reSTART Life, a company that provides therapeutic services for internet and video game addiction. And Hilarie has been working in this field since the mid 90s.

HILARIE CASH: It all started way back in 1994, when I had moved up here to the Seattle area and opened my practice, my private practice. And one of the earliest clients I got was a young man of 25, whose marriage was falling apart and he’d lost his job at Microsoft. He was in the process of losing a second job because he was addicted to a Dungeons and Dragons game. He just was classically addicted to it, he couldn't stop himself from playing it when he, you know, needed to be doing other things. So that opened a whole world to me that I knew absolutely nothing about. I didn't even own my own computer at the time. But I was really intrigued. And so I began learning, first from him, and then from other clients who were coming in, just over the course of the 90s, clients were coming in, getting into trouble in one way or another. For the young adults, it was almost always video games.

JAMES PARKINSON: Cam Adair was in his early 20s, by the time he’d reached his lowest point. And although his addiction had taken hold of his life, he was able to reflect on his situation and make a decision to quit video games altogether.

CAM ADAIR: The reason my relationship with gaming needed to change was that the night that I decided to continue to live, I made a commitment that if I wasn't going to end my life, I was going to do the complete opposite, which was to truly try to live my life to the fullest, to realise my potential, and I knew that in order to do that, I would have to stop playing games. Not because I'm against gaming, or I think gaming is bad, or I don't think that people who play games aren't pursuing their potential. But for me, I knew that if I was playing games, I would never want to do anything else. I would never want to work. I would never want to hang out with other friends. I would never want to pursue a relationship, or a family, I would just have no motivation for any of those things because gaming allowed me to experience the maximum of my life in a very structured way of thinking about that. And so if I was going to pursue other ambitions or try and get my life together, I had to stop gaming, and I had to let it go. And that's what I did.

James Parkinson: That must have taken a lot of courage, for you to recognise the place you were in, to really admit that to yourself and to ask for help.

CAM ADAIR: I think for a lot of people asking for help is a huge act of courage. It's very easy to not ask for help. It is very vulnerable and is not the easiest thing to do. For me, I think at the time it was how desperate my situation was. And I'm very fortunate that my parents and my father, especially, have always reminded me that if I needed help, I could go to them. And I could ask and that they would be there. And I knew I could trust them. And so in that moment, when, you know, I had this huge epiphany that, you know, my life was in a seriously bad place, I went home and I asked my father to help me, and I knew that he would be there. And I think that not everybody has that. And I'm very lucky I did and I truly believe that that saved my life.

JAMES PARKINSON: Just as the severity of addiction can vary, treatment may look different for different people as well. For Cam, seeing a counsellor was the first step in his recovery. He went to a professional he trusted - because they were the councillor of his best friend - and they gave him the task of getting a job. Cam’s first attempt didn’t go so well, never turning up to his first shift. Then his councillor gave him an ultimatum; get and keep a job, or go on antidepressants. Cam felt that antidepressants weren't the best option for him, personally. So he tried again, and managed to get a job in retail.

CAM ADAIR: It wasn't easy. I can share a lot about it. The first thing was that I missed 22 out of my first 27 shifts. And the only reason I wasn't fired, I joke, was like divine intervention, because I missed so many shifts. And every time I’d actually go to work, the manager would be like, “dude, what the heck, you didn't show up for work again?”. And I would just always explain that, like, I was going through a lot, I was having a really hard time transitioning, and just, please don't fire me. And, you know, I'll eventually get through this and I'll be okay. And I'll be great. Like, I'll work very hard. And I did. Eventually I did get through that period of time, and I do believe that, you know, I worked very hard for that company. But the reason I wasn't going to work was I was actually having panic attacks before work every day, to the point where I'd actually be vomiting in the shower. And just the anxiety I was experiencing, transitioning from, kind of, the world I had created, playing video games and just being in my room and that whole experience, to having to go and be like a responsible adult was such a major shift. And I just was having a hard time with it. And yeah, I'm very fortunate they didn't fire me. And it's another example of like along the way, I had some more or less stranger, have my back, in a way that I don't really know why, but they did and it made a big impact on my life.

JAMES PARKINSON: In getting his life back on track, and finding new hobbies and passions, Cam also wanted to put some of his energy into helping others. During his recovery, he’d look for resources online, only to find misinformation and bad advice, from people who clearly didn’t understand video games or what it was like to be addicted to them. He knew there must be other gamers with similar experiences, who also needed help but didn’t know where to look.

CAM ADAIR: So I wrote this article. It was basically like, you know, “I'm a real gamer, here's my gaming history, here's all the leagues I played in, in CS, here's what I achieved in World of Warcraft”. Like, "this is what I did, I'm a real gamer, and I decided to quit, and here's what I learned”. You need to find new activities, you need to connect with other people. You need to schedule your day, you know, here's some other things to do. And I just started to hear from, like, tens of thousands of other people, who would Google for that. And they would email me saying, like, “I'm struggling with gaming, and I want to quit”, and like, “can you help?”. And all I did was try and create a space for those of us out there who feel like they're struggling with gaming and they want to stop, or they want to shift their relationship to gaming in some way. Be able to do that and to be able to help each other. And that started with a forum, and eventually a YouTube channel and eventually a website called gamequitters.com. And it's just kind of evolved from there. But the premise of it has always been just people who resonate, trying to support each other. And it's never been about being anti gaming or saying that all gaming is bad. It's just been trying to help gamers be able to live their lives in more healthy and balanced ways.

JAMES PARKINSON: Game Quitters filled a need for those struggling with addiction. It gave them perspective on their own situations, helping them to realise that they’re not alone. Cam shared a few stories with me, about people who have managed to quit games and improve their lives, in part, thanks to the support provided by the site. As for the wider gaming community, there’s often some resistance, when it comes to having a mature conversation about video game addiction. So how do we change that? And how much of that responsibility lies with the industry, when the games they make are designed to be addictive? That’s after the break, on Gameplay.

[ AD BREAK ]

JAMES PARKINSON: Talking about addiction is never easy. Obviously, I’m not here to demonise games. And neither is Cam Adair or anyone who actually understands this issue fully. But we do need to move that conversation forward and in 2019, the World Health Organisation made a decision that’s helping to do that. They officially recognised video game addiction as a disorder.

CAM ADAIR: So the World Health Organisation did classify gaming disorder as a real mental health condition. And it's defined by a pattern of gaming behaviour, characterised by three things; impaired control over gaming, increasing priority given to gaming over other activities - to the extent that gaming takes precedence over other interests - and continuing or having gaming escalate, despite the occurrence of negative consequences. So if someone has gaming disorder, it means that they are continuing to game, despite severe negative consequences in their life. And that can be evaluated across many different areas. But that could be school, work, relationships, physical health, mental health. And it does not mean that just playing video games means that you have a problem. It also doesn't mean that playing video games a lot means that you have a problem. It's more about what's happening in your life as a result of your gaming. And it comes into effect in 2021, and overall, it just means that gaming disorder being classified begins this conversation for professionals into understanding more about what gaming disorder is. It encourages more research to be done on it, it encourages professionals to take this issue seriously and become trained on it. And it also encourages gamers to take it seriously. But World Health, also, when they made this declaration, they also declared that not all gaming means you have a problem. And unfortunately, that aspect of what they shared was kind of lost in the noise. And so I think it's a very important moment for people in the mental health community. And it's an important moment for the gaming community. But overall, it just will help to encourage more research and more training, which is good for everybody.

JAMES PARKINSON: Despite the WHO’s classification, there is still disagreement among some mental health professionals. In 2013, gaming addiction was mentioned in the Diagnostic and Statistical Manual of Mental Disorders - or DSM-5 - basically, the bible used by psychologists and psychiatrists to diagnose mental health conditions. The DSM referenced gaming disorder as a condition that may be observed, but warranted further research to determine if it’s actually an addiction, or just a symptom of an underlying problem.

CAM ADAIR: It's also important when we're talking about this issue, that although addiction has many similarities between different aspects of addiction. So whether it's drugs or alcohol or gaming or gambling or sex, I do think it's really important that we don't compare them. Because if you were to give someone a choice, “would you rather be addicted to gaming, or be addicted to heroin?”, of course, you would choose gaming. And you would probably be right to choose gaming, right? Like we're not here trying to compare gaming addiction to heroin addiction. But that also doesn't mean that people who struggle with gaming addiction don't have very severe or very problematic issues and that they deserve help. And I think that's where it's very important that we're mindful about the conversation. Because some people out there are using words like “digital heroin”, or that gaming is as addictive as heroin, and it's completely ridiculous. It's not helpful. And it just further disrupts the opportunity for us to have a conversation about this issue. And there are families and gamers out there who are really struggling.

JAMES PARKINSON: So, just how extensive is the problem, and who’s being affected?

HILARIE CASH: The answer to that question is it varies very widely.

JAMES PARKINSON: More research in the field is crucial, and the hope is that the WHO’s classification will see a big shift in that. Right now, Hilarie Cash says it’s still lacking some maturity. Although, the figures we do have, back up the consensus that playing video games isn’t problematic for most people.

HILARIE CASH: Anywhere from 1.5% of the general population, up to 13% of the general population. Among eight to eighteen year olds, those numbers seem to hover around eight and a half percent, that's American research. In the young adult American population, the research seems to vary between about 13% and 19%, seem to meet criteria for addiction. So you can see it really varies.

JAMES PARKINSON: The research, and the trends from reSTART Life, also skews more towards boys and young men who are experiencing addiction.

HILARIE CASH: We've been around for 11 years, and we have, in that time, had ten women come, and lots of men. So certainly, it does seem to be more a problem with men.

JAMES PARKINSON: Now, while there tends to be fewer women who experience video game addiction there isn’t enough research to confirm why that’s the case. Hilarie could only speculate, but she says it may be that women just tend to be more social, meaning they’re not falling into that trap as easily.

HILARIE CASH: I think that's a protective factor, because one of the pieces, really interesting pieces of research that has been confirmed again and again, is that there's a strong, very strong correlation with the amount of time spent online and increases in depression and anxiety. So I just think guys are getting, you know, because they're spending so much time in front of the screen, and not enough time socialising, face-to-face. I think this is why they're falling into deeper problems.

JAMES PARKINSON: Through his work on gamequitters.com, Cam was able to shed some light on this as well.

CAM ADAIR: From Game Quitters, and the audience that has been on there, I can share that the audience is about 95% male. And so over the last five years, I've seen an increase of female gamers coming forward asking for help, but it's still, you know, a fairly low low number. One aspect of this that research has found is that, the perception of gamers as being male has occasionally caused research to be biased towards it. So research has mostly focused on researching males, and not female gamers. And that's, you know, part of why the research then becomes a little bit, has a male bias to it. And, you know, female gamers may not be represented in the research, as much as they could be.

JAMES PARKINSON: Another factor, Cam says, is that some women who are seeking professional services may be coming forward for help with underlying issues, like anxiety or depression. And if psychologists aren’t screening for gaming addiction itself, they might not be getting the full context.

JAMES PARKINSON: As we’ve covered so far, people become addicted in different ways and for a variety of reasons. There’s often those underlying problems, but also, we all have different personalities and different relationships with games, that may contribute to whether you’re susceptible to addiction.

CAM ADAIR: Yeah, so there’s different types of gamers. So there's a recreational gamer, there's the social gamer, the escaper, the achiever and the hardcore gamer. And many people may have a blend of both. So for instance, I'm very much the hardcore gamer, which is the blend between the achiever and the escaper. But other players, you know, maybe they're a social gamer. They just like to play games to socialise, and kind of connect with the other people. They're not really as focused on competition or as focused on escaping, they're just really trying to be social. And other players, they really like to just escape to a new reality. They're not very competitive. And some other gamers are the complete opposite. They're just competitive, and they're not really trying to escape. They're just trying to be the best. And so understanding more about how you game and what you're motivated by and what needs gaming is fulfilling for you can be helpful to just frame what you may want to be mindful of in your life. So for instance, if you're gaming to escape, well, maybe developing some other coping strategies might be helpful to moderate your gaming. Like going to the gym or going to yoga, meditating, or reading books or just finding new ways to relax, and not having gaming be the only way that you relax. Or understanding what you're trying to escape from, and working on that. So maybe it's low self esteem, or maybe you've been bullied, and there's some trauma there. And you could work on that. And that would help reduce the need for gaming to be a sense of escape. And instead it could help shift you more towards just playing because it's fun or playing because you like to explore new worlds or playing because you like to compete.

JAMES PARKINSON: The types of games you play could also be a contributing factor in getting more pulled into a game. For example, an MMO or an open world RPG might command more of your time, compared to some more casual games. But that doesn’t mean less involved games can’t be addictive. And that’s the other thing at play here, which is undeniable - games are designed to be addictive. Here’s Hilarie.

HILARIE CASH: You know, I always think of it - I think of the elements that get them hooked as kind of layers of reward. Of course, first and foremost, there is this aspect of intermittent reinforcement, which means the unpredictability of reward. And that is just built into games and is very carefully designed into games. And so that, in and of itself, is carefully designed and a very powerful draw to people. But aside from that ratio of reward, there are also all of these other elements. So, you know, the visuals of video games can be extremely compelling, and the music associated with them can be extremely compelling.

HILARIE CASH: That very first client I told you about, I mean, he was playing a Dungeons and Dragons game that was text only, even though he was completely addicted to it. It was text only, it didn't even have graphics. So, you know, just think about that, compared to now. So the games themselves have become more immersive, and you know, and more and more sophisticated in the design of those addictive elements. And then you have, smartphones are just, I think, have added enormously to the addictive nature. No matter where you are, if you've got your smartphone and let's say you're a video game addict, you can, you know, go on Twitch or YouTube or whatever platform you like to go to, to watch others gaming, or to play some game yourself, that'll keep, you know, those parts of the brain that are involved in your addiction active and stimulated. You don't ever have to really be away from your gaming interest, in some fashion.

JAMES PARKINSON: Over the past decade or so, we’ve also seen the rise of addictive game mechanics, like loot boxes, that only reinforce those elements of reward. Immersive graphics and music is one thing, but the inclusion of loot boxes and in-game purchases is a very deliberate kind of design. Here’s Cam.

CAM ADAIR: Games have transitioned to be more, almost like a social network, where you know, the more time you spend on the game, the more opportunities there are for you to purchase in-app purchases, or micro-transactions. And thus, the entire business model has transformed into one of engagement and monetisation. And that has further increased the problematic characteristics of games. You know, I think that the industry itself is in a very tricky position, because on one hand, you know, the whole function of the game has turned into, you know, engagement and monetisation. But those functions also come with major risks of people becoming addicted to them, and then becoming compulsive.

CAM ADAIR: You know, FIFA Ultimate Team is one of the best and clearest examples of problematic loot box mechanics. I can't remember the exact percentage, but I believe it's around 30 or 40% of revenue for FIFA comes from FIFA Ultimate Team. It's a huge percentage. And also that's because the way the FIFA Ultimate Team mechanic works is hugely problematic. But it's also hugely profitable for EA.

JAMES PARKINSON: This is where the tension within the games industry exists, because profit is the incentive for developers to continue using these addictive elements in their games. They work. And it’s why there’s often push-back around the addiction conversation. So how much responsibility does the industry have?

CAM ADAIR: I think the industry, still, is not doing enough or even close to enough. And ultimately, you know, what their responsibility is, I guess depends on your ethics and morals or, you know, what you view is your role in society. But games are obviously designed - you know, I'll use the industry terms here, “to be engaging and to be fun”. But what do those words mean? They ultimately mean to have you play the game, and to be engaged and to be in it, and increasingly to get you to spend more and more money. And then there becomes this responsibility of like, what's the industry going to do to keep people safe? What the industry should be doing, I think, needs to go beyond just things like warning labels. The industry has a lot of data. And they could be sharing that data more with independent researchers to really actually study people who are struggling or to really study, like, what is happening in games for people who are developing problems. Because currently, one of the biggest industry talking points against this issue is that there isn't enough high quality research to support it, which first of all isn't true. But to understand that point, it's very convenient for the industry to make that argument when they're not sharing any data with independent researchers to actually understand what's going on with this issue. And instead, researchers have to depend on things like self-report studies, because they can't get access to gaming data. And so I think it's a good example of where, on one hand, the industry is making an argument against an issue. But the very basis of that argument exists because the industry is also refusing to participate in understanding this issue.

CAM ADAIR: I don't think it's good enough. I certainly don't think it's good enough in today's modern age, and I think the industry can do a lot more to be able to support people who are struggling, while also continuing to make the fun games they have, the fun experiences, the worlds that you can’t experience in any other way. They can continue to do that. But it begins with them taking responsibility, as the first line of defence.

JAMES PARKINSON: Another suggestion Cam made was some sort of pop-up that could act as a pattern interrupt, and offer players a link to support services or resources, when the game notices you’ve been playing for an extended length of time. This kind of thing has already been done in places like Instagram, when people search for known suicide hash tags. We know that consoles and other game platforms already track the time we actively spend playing, so it’d be simple to implement.

JAMES PARKINSON: And there’s even greater potential for change in one of the most rapidly growing areas of the industry - esports.

CAM ADAIR: I believe strongly that esports is the best platform to advocate for healthy, balanced gaming. I'm also an advocate of gaming being an opportunity to be a career or of esports being an opportunity for people who want to pursue it. I'm certainly not against esports in any way. Players pursuing esports will be playing a lot. They'll be playing with an intense focus. And for many of them, they will have that as a major passion and as something that they're pursuing very intentionally with a high degree of talent. And there's obviously many players out there who will be pursuing esports from a place of rational thinking, that they can make it. And the reality is that making it in esports will be extremely challenging, the competition will be extremely high. And what will separate you as a player will not just be about how much you play or how good you are, but about your brand-ability, your capacity to network effectively, your ability to be healthy, mentally and physically, and emotionally, your relationships. It will have so much to do with things outside the game than just inside the game.

CAM ADAIR: That is even further the case when it comes to streaming. Because so much of how you earn money as a streamer is about brand and relationships and networking and your health. Because streaming for ten to twelve hours a day is extremely exhausting, not very realistic, and has major implications on your life. But I think it's very important that the esports infrastructure is being implemented with safe gaming in mind, and things like warning signs at esports tournaments or commercials about keeping games a safe activity. You know, for high school players before the season, they should be receiving some training on keeping gaming to be a healthy passion and not a problem. Like, these are things that have to take place.

JAMES PARKINSON: As gamers, we have a part to play in all of this too, from how we spend our money, to the way we talk about addiction within the community.

CAM ADAIR: Unfortunately, you know I think still to this day, the gaming industry or just the gaming community at large, is still very triggered by the conversation around video game addiction. And maybe that's someone listening to this. Maybe you were very defensive before listening to this episode, and that's okay, like, you know, I understand why it happens. You know, gaming has been under attack for a long time, especially by the media. And so it's made gamers very defensive.

CAM ADAIR: And so I think it's very important that we have this conversation, I think it's very important that the gaming community is pushing back on the industry about this. But the gaming community also has to stop spending money on these mechanics, because ultimately that's really going to be the way that companies start to pay attention. And for people who are listening to this, who work in companies or who work in the industry, you're the most important voice because you have opportunities to be influential, and I hope that you take that opportunity. And that you are also advocating for, you know, more safe gaming.

JAMES PARKINSON: If you take anything away from this episode, let it be this; people who suffer from video game addiction need understanding and they need support, just like any other behavioural addiction or mental health condition.

CAM ADAIR: Pretty much every gamer knows someone who probably plays more than they should, or plays a lot, and is maybe struggling in their life in some way. And I think it's important that in the gaming community, that we're creating a space where if someone is struggling, that we want them to be able to receive support, and whether that's because it's a gaming problem, or it's depression, or it's some other mental health challenge, let's encourage people to seek help, and let's encourage them to receive support, and have people trained properly to do it. Because if people are out there and they're struggling, and we continue to deny that gaming addiction is real or to deny that people have problems with gaming, we're denying people's lived experience. And we're also stigmatising them from being able to seek support, which further harms their life. And we also encourage professionals to not take this issue seriously or to not be trained on gaming properly, which then creates further problems when people actually try to seek support. And so I think it's very important that as the gaming community that we are the first line of defence for people who struggle, and if we see someone struggling, whether it's gaming or it's something else, let's encourage them to seek support. And let's encourage the gaming industry at large to do their part.

JAMES PARKINSON: For a lot of people who are addicted to games, especially in the most severe cases, the road to recovery can be extremely challenging. Our devices and the internet have become so intertwined in our lives that the temptation is always there. Going cold turkey isn’t easy but it can be a helpful part of that process, and certainly was for Cam. He says he had frequent cravings to play games, so he’d try to minimise his exposure, and found other activities to keep himself busy. Others are fortunate to have local camps or retreats they can attend, to get them started on the right path in their recovery. ReSTART Life is based in Washington, and their program begins with a detox.

HILARIE CASH: The first place they come to is a small ranch. And there are horses, goats, chickens, a dog and cats on this ranch. And it's a beautiful setting, you know, really, very relaxing, quiet, comfortable. You know, the physical log house is beautiful. And they spend about six weeks there. They have no access to screens. So this is the period when they really are detoxing, and what detoxing means is that their brains, which have been overstimulated with the gaming and other internet content, their brains - because of the overstimulation, have withdrawn the receptors that pick up dopamine and other neurochemicals, which we all need in our lives. And so there's this period called the withdrawal, when their brains are putting back the receptors, to pick up normal levels of these neurochemicals. And it's not a pleasant time for most people.

JAMES PARKINSON: The initial adjustment is tough, but after a few weeks that starts to change. During their time at the ranch, the participants receive therapy sessions and counselling. But they also take part in a range of activities, like reading, doing chores, learning to play instruments, and taking care of the animals on the ranch. This detox process essentially resets the brain and prepares them for the next stage of treatment, if they choose to continue. Hilarie says that a lot of people suffering from addiction also present either under or overweight. So as they progress through the program, healthy eating and exercise is also an important part of therapy.

JAMES PARKINSON: As you might imagine, this kind of treatment isn’t cheap. The intensive phase of Restart’s program starts at around $550 dollars a day. That price goes down the further you go, but for a lot of people it isn’t realistic - and there aren’t many other places like it around the world. But there are other options.

HILARIE CASH: The smartest thing they could do is to not try to do it on their own. It is really hard, I would say nearly impossible to conquer a problem like this in isolation. Find professional help if you possibly can. Either in addition to that, or instead of that, find a 12 Step group that you can feel comfortable in. A 12 Step group that will embrace you, even though you're a gamer, and you're not, you know, some other kind of addict that they might be. But they still will embrace you, and somebody’s willing to sponsor you. You can find a recovery community and really get tremendous help. 12 step communities are one place, not the only place, but they are one place where you can get that kind of connection. And many therapists run therapy groups, and those can be really excellent as well. But if nothing else, reach out to people you trust and ask them for advice and support, while you try to figure out how you're going to conquer this.

JAMES PARKINSON: So what are the warning signs? How do you recognise if a friend, your child or even you have a problem with games?

CAM ADAIR: If gaming is the only thing that you’re doing, or if you’re finding yourself beginning to get rid of other things that you would normally do, because you’re just trying to maximise the amount of time you can game - that’s a warning sign. Especially if that involves you getting rid of things like your normal life responsibilities; work, school, relationships. Those are falling by the wayside, that's typically the big warning sign that you want to look for, and ideally, stepping in before it gets severe, before there's a rock bottom is highly recommended.

JAMES PARKINSON: The more recognition and research for video game addiction the better and more accessible professional treatment will become. Health insurance companies will have to start covering it, just like other mental health conditions, and more therapists will be trained to treat it effectively. Cam is actually working to solve that very problem through his company Intenta. They’ve created a clinical training program for mental health professionals.

CAM ADAIR: So far, the feedback has been really incredible. And it's a huge milestone for me, personally and professionally. And it's just something that I'm very excited about to have in the world because, at least now, to a reasonable standard, clinicians and professionals working with gaming can have better training and have a better understanding about gaming dynamics and culture and community, to be able to support clients that they're working with. And just more clinicians can be trained so people can receive support in other areas around the world, where maybe they weren't able to before.

JAMES PARKINSON: Cam’s work in this field is far from done. He hopes to reach a point where his projects and his message extend beyond himself. But that single decision to change the course of his life, has not only seen huge personal growth for Cam, it’s impacted countless others.

CAM ADAIR: [81:53] I'm proud of who I am today. I'm proud of how I show up in the world. There’s still so much work for me to do. Obviously, the advocacy work and Game Quitters and Intenta has brought a lot of fulfilment to my life, to be able to have my career also have a social impact is just something that's very important to me and is a huge part of my values. But more than anything, it's knowing that there's other people out there who have been able to be positively impacted. Those stories are always very meaningful to me, whether it's gamers or it’s families, or it's someone else, just for them to know that they're not alone, and that support is available, and there's a lot of people out there rooting for them. And whether it's about gaming, or it's just about mental health, or it's about just anything in life, I really hope that everyone achieves what they want and is able to get to a similar place in their life.

JAMES PARKINSON: If this episode has brought up any issues for you, or someone you know, there is help available. You can find direct links to support services in the description of this episode, right there in your podcast app. We also provide further reading and links to all the research we use for every episode of the show, and for this one, we have a ton of resources. So if you want to learn more about video game and internet addiction, beyond what we could fit into this story, there are books, websites and so much more, all listed on this episode’s page of our website, gameplay.co.

JAMES PARKINSON: Many thanks to Cam Adair and Hilarie Cash. Hilarie is the co-author of Video Games And Your Kids: How Parents Stay In Control. And you can learn more about Cam’s work at gamequitters.com and intenta.digital.

CREDITS

JAMES PARKINSON: Gameplay is a production of Lawson Media. This episode was written and produced by me, James Parkinson. Research and pre-production by our student intern, Dom Hennequin.

JAMES PARKINSON: The Gameplay theme was composed by Breakmaster Cylinder, our artwork is by Keegan Sanford, and other music in this episode comes from Breakmaster Cylinder.

JAMES PARKINSON: You can follow the show on Twitter, Facebook and Twitch at gameplaypodcast. And if you want to talk games and discuss the show with me and fellow listeners, join us on Discord. You’ll find all those links, and more, on our website: gameplay.co. Thanks for listening.‌‌