Diagnosis and management of video game addiction

Abstract

For many, the concept of video game addiction seems far-fetched particularly if their concepts and definitions of addiction involve the use of drugs. Despite the predominance of drug-based definitions of addiction, there is now a growing movement that views a number of behaviors as potentially addictive including many behaviors that do not involve the ingestion of a psychoactive drug (e.g., gambling, computer game playing, exercise, sex, Internet use). Such diversity has led to new all encompassing definitions of what constitutes addictive behavior.

Full text

Vol. 12 •Lesson 3
Diagnosis and Management
of Video Game Addiction
Mark D. Griffiths, BSc, PhD, CPsychol, FBPsS, FRSA
Dr. Griffiths is Professor of Gambling Studies, International Gaming Research Unit,
Psychology Division, Department of Social Sciences, Nottingham Trent University,
Burton Street, Nottingham, NG1 4BU, United Kingdom.
The author would like to thank Alex Meredith for his contributions to this lesson.
Introduction
There are many benefits that video game players get
from engaging in their chosen activity; these can be
educational,1,2 social,3,4 and therapeutic.5,6 However,
there is evidence that when done in excess, video game
playing can in some cases be addictive,7especially
online video game playing where the game never ends
and has the potential to be a 24/7 activity.810
Video Game Playing
as an Addiction
For many, the concept of video game addiction seems
farfetched particularly if their concepts and definitions
of addiction involve the use of drugs. Despite the pre
dominance of drugbased definitions of addiction,
there is now a growing movement that views a number
of behaviors as potentially addictive including many
behaviors that do not involve the ingestion of a psy
choactive drug (e.g., gambling, computer game play
ing, exercise, sex, Internet use).11 Such diversity has led
to new allencompassing definitions of what constitutes
addictive behavior.
The notion of “video game addiction” as being a
genuine addiction has started to have some credence in
the medical community. For example, in June 2007,
the American Medical Association (AMA) recom
mended that the American Psychiatric Association
reconsider its position with respect to the Diagnostic
and Statistical Manual of Mental Disorders (DSM) revi
sion in 2012;12 however, there are some problems with
this that have resulted in the AMA “backtracking” over
the issue of medical insurance.12 Some medical experts
define addictions—such as alcoholism—as diseases. As
a consequence, some sufferers receive insurance com
pensation for treatment. Given there is very little evi
dence that excessive or addictive computer gaming
leads to any permanent problems, then it could lead to
parents explicitly (or implicitly) encouraging their chil
dren to play to claim insurance money. This evades the
question, if it is classified as an addiction, how long will
someone have to play excessively to be diagnosed as
27
Keywords:
Video games • Excessive behavior • Addiction • Video game addiction interventions
Learning Objective
Clinicians will review the defining parameters of video
game excess and addiction; excess versus addiction; the
medical consequences of video game excess; the empirical lit
erature on excessive video game playing; and management of
video game addiction including advice,
guidance, and treatment.

Volume 12 Directions in Addiction Treatment & Prevention Lesson 3
28
addicted? It seems highly likely that insurance compa
nies would view such claims dubiously.
The Parameters
of Video Game Addiction
Research into the area of video game addiction needs to
be underpinned by three fundamental questions: (1)
What is addiction?, (2) Does video game addiction exist?,
and (3) If video game addiction exists, what are people
actually addicted to? The first question continues to be a
muchdebated question both amongst psychologists
within the field of addiction research as well as those
working in other disciplines. For many years, this
author has operationally defined addictive behavior as
any behavior that features all the core components of
addiction.11 It is this author’s contention that any
behavior (e.g., video game playing) that fulfills these six
criteria is therefore operationally defined as an addic
tion. In the case of video game addiction it would be:
•Salience: This occurs when video game play
becomes the most important activity in the
person’s life and dominates his or her think
ing (preoccupations and cognitive distor
tions), feelings (cravings), and behavior
(deterioration of socialized behavior). For
example, even if the person is not actually
playing a video game, he or she will be
thinking about the next time he or she can
play.
•Mood modification: This refers to the sub
jective experiences that people report as a
consequence of engaging in video game play
and can be seen as a coping strategy (i.e.,
they experience an arousing “buzz” or a
“high” or paradoxically tranquilizing feel of
“escape” or “numbing”).
• Tolerance: This is the process whereby
increasing amounts of video game play are
required to achieve the former moodmodi
fying effects. This basically means that for
persons engaged in video game playing, they
gradually build up the amount of the time
they spend online engaged in the behavior.
•Withdrawal symptoms: These are the
unpleasant feeling states or physical effects
that occur when video game play is discon
tinued or suddenly reduced, for example,
the shakes, moodiness, irritability, and so
forth.
• Conflict: This refers to the conflicts between
video game players and those around them
(interpersonal conflict), conflicts with other
activities (job, school work, social life, hob
bies, and interests) or from within the indi
viduals themselves (intrapsychic conflict
and/or subjective feelings of loss of control)
that are concerned with spending too much
time engaged in video game play.
• Relapse: This is the tendency for repeated
reversions to earlier patterns of video game
play to recur and for even the most extreme
patterns typical of the height of excessive
video game play to be quickly restored after
periods of abstinence or control.
Having operationally defined addiction, it is this
author’s view that video game addiction does indeed
exist but that it affects only a very small minority of
players (as we shall see later in this lesson). There
appear to be many people who use video games exces
sively but are not addicted as measured by these (or any
other) criteria. The third question is perhaps the most
interesting and the most important when it comes to
researching in this field. What are people actually
addicted to? Are they addicted to the interactive
medium of playing; the aspects of its specific style (e.g.,
an anonymous and disinhibiting activity); or the spe
cific types of games (aggressive games, strategy games,
etc)? This has led to much debate amongst those work
ing in this field.

Excess Versus Addiction:
Excessive activity and addictive activity are two very
different things (although admittedly they do over
lap on occasions). The difference between healthy
excessive enthusiasms and addictions is that healthy
excessive enthusiasms add to life, whereas addic
tions take away from it.11 Although all addictive
behaviors have idiosyncratic differences, addictions
commonly have more similarities. It has been argued
that video games and slot machines have more inher
ent similarities than differences (i.e., conceptually, psy
chologically, behaviorally, etc), and that (somewhat
paradoxically) video game playing can be described as
a nonfinancial form of gambling.13,14 This is one of the
reasons why so many researchers investigating “video
game addiction” use screening instruments adapted
from the gambling literature. As noted later in this les
son, treatment practitioners also treat “video game
addiction” using the same treatment techniques as
those used in gambling.15,16
Empirical Literature on
Excessive Video Game Playing
To date, there has been very little research directly
investigating video game addiction, and almost all of it
has concentrated on adolescents only.1726 Furthermore,
there are reports of behavioral signs of video game
dependency among adolescents. Dependency signs
reported include: stealing money to play arcade
games or to buy new games cartridges,14,18,19,27 tru
anting from school to play,14,18,19 not doing home
work or getting bad marks at school,19,22 sacrificing
social activities to play,19,28 irritability and annoy
ance if unable to play,19,29 and playing longer than
intended or experiencing time loss.19,28,30,31 Although
it seems that for a minority of people, especially adoles
cents, video games can take up considerable time and
that for all intents and purposes they are “addicted” to
them, the prevalence of such an addiction is still of
great controversy as is the mechanism by which people
may become addicted; this is one area which necessi
tates more research. The need to establish the incidence
and prevalence of clinically significant problems associ
ated with video game addiction is of paramount impor
tance. There is no doubt that clearer operational defini
tions are required if this is to be achieved.
It has been argued the only way of determining
whether nonchemical (behavioral) addictions (such as
video game addiction) are addictive in a nonmetaphori
cal sense is to compare them against clinical criteria for
other established addictions, such as drug or alcohol
addiction. However, most people researching in the
field have failed to do this, which has perpetuated the
scepticism shown in many quarters of the addiction
research community. The main problems with the
addiction criteria suggested by most researchers in
the field is that the measures used (1) have no mea
sure of severity, (2) have no temporal dimension, (3)
have a tendency to overestimate the prevalence of
problems, and (4) take no account of the context of
video game use. There are also concerns about the
sampling methods used. As a consequence, none of the
surveys to date conclusively show that video game
addiction exists or is problematic to anyone but a small
group of people. At best, they indicate that video game
addiction may be prevalent in a significant minority of
individuals (usually adolescents), but that more
research using validated survey instruments and other
techniques (e.g., indepth qualitative interviews) are
required.
Case studies of excessive video game players may
provide better evidence of whether video game addic
tion exists by the fact that the data collected are much
more detailed. There are case studies in the literature
that show that people who play video games excessively,
including those that play online,3237 seem to display
many signs of addiction.15 These case studies tend to
show that the video games are used to counteract other
deficiencies and underlying problems in the person’s
life (e.g., relationships, lack of friends, physical appear
ance, disability, coping, etc), but again, further work of
a more indepth qualitative nature is needed to defini
tively confirm the existence of video game addiction.
29
Diagnosis and Management of Video Game Addiction Griffiths

Symptoms of Video
Game Addiction
The symptoms of computer addiction and video game
addiction are quite specific and overlap. These include
both psychological and physical symptoms.
Psychological symptoms include:
1. Having a sense of wellbeing or euphoria
while at the computer or playing a video
game
2. Inability to stop the activity
3. Craving more and more time at the
computer or playing the video game
4. Neglect of family and friends
5. Feeling empty, depressed, irritable when not
at the computer or playing the video game
6. Lying to employers and family about activi
ties, and
7. Problems with school or job
Physical symptoms include:
1. Carpal tunnel syndrome
2. Dry eyes
3. Migraine headaches
4. Back aches,
5. Eating irregularities, such as skipping
meals,
6. Failure to attend to personal hygiene, and
7. Sleep disturbances or change in sleep pattern
(http:// www.computeraddiction.com/).
Online Versus
Offline Video Games
There has been speculation that online gaming may be
more problematic and/or addictive than offline
games.33 For example, Grüsser, Thalemann, and Grif
fiths10 investigated the addictive potential of online
video gaming. A selfselected sample (i.e., those who
volunteered to participate in the study) comprising
7,069 gamers, mostly male (94%), with an average age
of 21 years, answered two online questionnaires; 1 in 9
fulfilled at least three diagnostic criteria of addiction
concerning their gaming behavior. Addictive signs were
modelled on key symptoms of dependence syndrome
outlined by the World Health Organization and
included craving, tolerance, withdrawal symptoms, loss
of control, neglect of other activities, and other nega
tive consequences. Those gamers who displayed at least
three addictive signs were then compared with the
remaining gamers. The “addicted” gamers predictably
played for significantly longer daily periods of time.
They were also significantly more likely to report with
drawal symptoms and craving. Although these gamers
show some signs of addiction normally found in other
more traditional addictions, the results did not conclu
sively show that the gamers are genuinely addicted;
many gamers played excessively and displayed few neg
ative consequences. However, the 24houraday, nev
erending online games may provide a potentially addic
tive medium for those with a predisposition for
excessive game playing.
Medical Consequences
of Video Game Excess
For more than 25 years, the medical profession has
voiced a number of concerns about excessive video game
playing. Back in the early 1980s, rheumatologists
described cases of “Pacman’s Elbow” and “Space
Invaders’ Revenge” in which players suffered skin, joint,
and muscle problems from repeated button hitting and
joystick pushing on the game machines.38,39 Early
research by Loftus and Loftus39 indicated that two
thirds of (arcade) video game players examined com
plained of blisters, calluses, sore tendons, and numbness
of fingers, hands, and elbows directly as a result of their
playing. There have also been a host of case studies in
the medical literature reporting some of the adverse
30
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

effects of playing video games.40 These have included
auditory hallucinations,41 enuresis,42 encopresis,43
wrist pain,44 neck pain,45 elbow pain,46 tenosynovi
tis—also called “nintendinitis,”4750 handarm vibra
tion syndrome,51 repetitive strain injuries,52 and
peripheral neuropathy.53 Admittedly, some of these
adverse effects are quite rare, and “treatment” involved
nonplaying of the games in question. In the cases
involving enuresis and encopresis, the children were so
engaged in the games that they did not go to the toilet.
In these particular instances, the children were taught
how to use the game’s “pause” button. Although this
simple intervention appears to somewhat trivialize the
condition, it should be remembered that in these cases
the video games had such an engrossing effect that the
children ignored normal and necessary bodily functions.
Finally, it is worth noting that Spielberg54 says
there are three factors that have hindered research into
gaming addiction by mental health professionals:
1. The speed at which the gaming industry
progresses means that both the format of
games and the technology they exist on
moves forward faster than therapeutic tech
niques can be researched and established.
2. Video game addiction costs very little to
start and maintain, in comparison to other
addictions.
3. Video game playing is seen by most people
as harmless entertainment played by all gen
erations in a family. The only way that such
attitudes will change in relation to the more
extreme negative detrimental consequences
(i.e., that excessive video gaming can be
viewed as an addiction) will be through
increased research and education.
Management of Video
Game Addiction
To date there have been very few empirically published
accounts of treating video game addiction, although
there are many overviews providing advice and guid
ance to parents and practitioners;39,55 the next sections
review the available evidence from both empirical and
nonempirical sources.
Practical Advice and Guidance
about Video Game Addiction
When dealing with children who are avid gamers, Grif
fiths55 advocates that parents and practitioners should
begin by finding out what video games children are
actually playing. If they have objections to the content
of the games, they should facilitate discussion with chil
dren about this, and if appropriate, have a few rules.
Parents and practitioners should aim toward a few goals
with children. They should:
• Help them choose suitable games which are
still fun
• Talk with them about the content of the
games so that they understand the differ
ence between makebelieve and reality
• Discourage solitary game playing
• Guard against obsessive playing
• Follow recommendations on the possible
risks outlined by video game manufacturers
• Ensure that they have plenty of other activi
ties to pursue in their free time besides the
playing of video games
Griffiths55 reports that parents and practitioners
need to remember that in the right context video games
can be educational (helping children to think and learn
more quickly), can help raise children’s selfesteem, and
can increase the speed of their reaction times. The ques
tion most asked by parents and practitioners is: “How
much video game playing is too much?” To help answer
this question, Griffiths55 devised the following check
list. To assess if the child’s video game playing is getting
out of hand, one must ask, does the child:
• Play video games almost every day?
• Often play video games for long periods
(over 3 to 4 hours at a time)?
31
Diagnosis and Management of Video Game Addiction Griffiths

• Play video games for excitement or “buzz”?
• Get restless, irritable, and moody if he or she
can’t play video games?
• Sacrifice social and sporting activities to
play video games?
• Play video games instead of doing his or her
homework?
• Try to cut down video game playing but
cannot?
Griffiths asserts that if the answer is “yes” to more
than four of these questions, then the child may be
playing too much. If a child is playing video games too
much, Griffiths55 suggests the following:
•First of all, check the content of the games.
Try and give children games that are educa
tional rather than the violent.
•Second, try to encourage video game playing
in groups rather than as a solitary activity.
This will lead to children talking and work
ing together.
•Third, set time limits on children’s playing
time. Tell them that they can play for a cou
ple of hours after they have done their
homework or their chores—not before.
•Fourth, follow the recommendations by the
video game manufacturers (e.g., sit at least 2
feet from the screen, play in a welllit room,
never have the screen at maximum bright
ness, and never play video games when feel
ing tired).
•Finally, if all else fails, temporarily take away
the games console and then give it back to
them on a parttime basis when appropriate.
Online Support Forums
Online support services for addictive behaviors are
becoming increasingly popular,56 with some specializ
ing in very specific addictions such as gambling.57,58 In
the process of researching this lesson, the author found
evidence of a variety of online forums designed by and
for the use of those affected by excessive game playing.
Some of these are parentrun groups, whereas others are
run by professional organizations (see Appendix 1 for
some popular online help forums). These forums com
monly provide practical advice and experiential case
accounts. Much of the advice seems to be based on
behavioral reward and punishment systems, such as
allowing children to earn “game time” once their chores
are completed. It seems that forums such as these have
gained quite a following. At the time this lesson was
written, the membership of the Everquest Widows Web
site stood at 7,300 members, and it had also been the
subject of empirical research.8
It has to be noted that most of the Web sites run by
nonprofessional groups use “video game addiction”
implicitly without ever explaining what it actually
entails. One of the better explanations by the National
Institute on Media and the Family59 stated:
Like other addictions, the video game has
replaced friends and family as the source of a
person’s emotional life. Increasingly, to feel good,
the addicted person spends more time playing
video games. Time away from the game causes
moodiness or withdrawal.
The National Institute on Media and the Family
Web site (see Appendix 1) provides a series of articles
on gaming presented from an intelligent and balanced
perspective. This more balanced approach advocates a
collective responsibility for excessive or addicted gam
ing (from children through parents to the games com
panies themselves). Another example is the Mother
Nature Web site (see Appendix 1). Their approach is to
give pragmatic advice with respect to moderating chil
dren’s playing of computer games using a behavioral
paradigm with socialization as a reward mechanism.
This includes (1) developing an incentive system, (2)
setting limits on playing time, (3) scheduling “reality
breaks” to chat to family members about nongame
events, (4) making it a social occasion and inviting
32
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

friends over, and (5) joining in to share time together
and so the parent can moderate what games are played.
This appears to be a good system for those children in
the early stages of excessive playing but might not work
so well for outright addicted players.
More recently, the OnLine Gamers Anonymous
organization has been formed. This is a recently formed
selfhelp Web site dedicated to stopping people from
excessive or addicted gaming levels (see:
http://www.olganonboard.org/index.php). The treat
ment philosophy is based heavily on the Minnesota
Model system of the “12 Steps” (see Table 1) and is
used by such groups as Alcoholics Anonymous and
Gamblers Anonymous. As with other 12step pro
grams, OnLine Gamers Anonymous appears to have
no formal “therapeutic” techniques but offers support
for people trying to give up gaming themselves. Many
offline 12step programs rely on a system of regular
(and sometimes daily) attendance, so research into
whether online Web sites such as this actually makes a
difference to addicted gamers would prove valuable in
determining a treatment strategy.
It is clear that online forums and groups have the
potential to fulfill an important role in allowing geo
graphically diverse individuals a chance to share experi
ences and opinions, to give and receive advice, and to
offer and receive support. Many provide a balanced
perspective and should be applauded for this approach,
but at the same time there exists a greater proportion
whose “scare tactics” serve only to fuel fears and indeed
likely drive excessive gamers and those affected by them
even further apart.
Gaming Addiction
Treatment Clinics
There is growing concern in relation to the need to
develop treatment programs for online computer game
addiction. The Smith & Jones Clinic (SJC) in the
Netherlands claims that it has been taking on an
increasing number of young people with gaming addic
tion.60,61 The SJC treatment for gamers follows an
abstinencebased program that was designed for alco
holics and drug addicts; for treatment to be successful,
gaming addicts must never play a video game again.
Gamers undergo treatment away from their families in
a residential setting, although the final stages of the
treatment may involve family therapy; the SJC also
helps gamers develop their social skills.
Because online video game addicts cannot reason
ably avoid computers in their daytoday lives, they
have to learn to use them responsibly. This means no
gaming whatsoever. The SJC believe that allowing
gamers to play for a limited time a day is akin to alco
holics saying they are only going to drink one beer. The
SJC approach (as with the 12step program) aims to
show gamers that they are powerless over their addic
tion.62 The SJC teaches gamers “reallife excitement” as
opposed to the online excitement they get from playing
33
Diagnosis and Management of Video Game Addiction Griffiths
Table 1
The Twelve Steps (as Applied to Video Game Addiction)
Step 1 We admitted we were powerless over gaming—
that our lives had become unmanageable.
Step 2 Came to believe that a Power greater than
ourselves could restore us to a normal way of
thinking and living.
Step 3 Made a decision to turn our will and our lives over
to the care of this Power of our own understanding.
Step 4 Made a searching and fearless moral and financial
inventory of ourselves.
Step 5 Admitted to ourselves and another human being
the exact nature of our wrongs.
Step 6 Were entirely ready to have these defects of
character removed.
Step 7 Humbly asked God (of our understanding) to
remove our shortcomings.
Step 8 Made a list of all the persons we had harmed and
became willing to make amends to them all.
Step 9 Made direct amends to such people wherever
possible, except when to do so would injure them
or others.
Step 10 Continued to take personal inventory, and when
we were wrong promptly admitted it.
Step 11 Sought through prayer and meditation to improve
our conscious contact with God as we understand
him, praying only for knowledge of His will for us
and the power to carry that out.
Step 12 Having made an effort to practice these principles
in all our affairs, we tried to carry this message to
other compulsive gamers.

games—such interventions have included taking the
gamers to a club to go dancing, gokarting, and para
chute jumping. The SJC philosophy is to get gamers to
see that they can achieve the same level of excitement in
the real world.
The SJC is not the only gaming addiction clinic in
existence. There have been an increasing number of
stories in the news about the opening of gaming addic
tion treatment clinics in South East Asia, as gaming
addictions seem to be on the increase there. According
to a report by the Korean government, 2.4% of the
population are addicted to games.63 This report also
indicates that mental health counseling bears a heavy
stigma in Korea; in one case discussed in the report, the
father of a child addicted to gaming refused to
acknowledge his son had a problem for 3 months, even
though he had borrowed substantial amounts of money
from family members to support his addiction.63 Simi
lar accounts have also appeared in China.64 Reports
such as these indicate cultural concerns and differences.
Carjaval65 noted that only males are currently being
treated in clinics such as the SJC, and there is some
speculation that a masculine desire to control and
manipulate events may be behind this gender disparity.
Marc Valleur, Director of the Centre Médical Marmot
tan, a public clinic in Paris that is treating an increasing
number of patients seeking assistance to quit online
gaming, is not sure why they are only attracting men
for treatment; he suggests that a rigid hierarchy in the
games may satisfy a masculine urge for control.65 Jason
Rocca, Executive Director of the International Game
Developers Association (based in San Francisco) says
that “these socalled addictions” are more to do with
the person than with the games.65 He claims that
gamers who have issues in their personal life will proba
bly withdraw themselves into this world, which is a rich
community for interaction.
However, preliminary research by Grüsser and col
leagues10 suggests most “hardcore” gamers in World of
Warcraft do not play excessively or addictively to attain
control. Control is merely a means to an end, and with
out it they would unable to achieve their higher goals of
being the best persontoperson fighter, the best raider,
and so forth. This suggestion also highlights a lack of
understanding that currently exists within some
research communities about gaming itself.
China recently introduced an antionline gaming
system and a few clinics as a response to the growing
problem of excessive playing of online games there.66
The system allows for 3 hours a day of gaming without
penalties, but after 3 hours the values of items won in
the game starts to decrease. After 5 hours of gaming per
day no experience or benefits can be accrued. This sys
tem was clearly designed by those who know “how to
hit players where it hurts,” so to speak. However, with
out further details of how the program operates, it is
hard to evaluate whether this would work effectively
given that people might be able to create multiple
accounts (with characters in each account) to get
around the blocking. Such a system will also require
monitoring and evaluation and would be much less
effective in countries where the government allows a
greater level of personal freedom.
Press reports indicate that China’s system to curtail
excessive game playing only applies to adult gamers.
However, the Chinese solution was predictably unpop
ular with gamers and led to a mass exodus from one
server to another server when first implemented.66 The
Chinese system also includes: (1) banning teenagers
from cybercafes, (2) limiting online gaming sessions,
(3) boot camps, (4) psychological counselling, and (5)
electrocution.67,68 There is little detailed information
about the treatment technique used in these therapy
centers. The “electrocution” technique is apparently
more akin to acupuncture, but it is still hard to see how
that might help. It could be that it is a type of aversive
therapy where they shock players while they are playing
computer games—but this is entirely speculative on the
part of the author.
Behavior Therapy and
Cognitive Behavior Therapy
Some treatment specialists such as Orzack69 believe
that the most effective method to deal with video game
addiction is cognitive behavior therapy (CBT), which
teaches individuals to identify and eventually solve
34
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

their underlying problem(s), and then to learn coping
skills to prevent relapse; the treatment may also be
accompanied by medication. In addition, Orzack rec
ommends support groups for other people affected
(e.g., family members). CBT can identify problematic
cognitions that may underlie the reason why a person
uses video games as a psychological crutch, but is
unlikely to cure addictive playing on its own as the
behavior is likely to have biopsychosocial antecedents
that require more multimodal treatment interventions.
Orzack claims that for most players, recovery
involves looking at the issues underlying the game
habit. Using a CBT approach, gamers examine the
emotional motives that prompt them to play a game
excessively and look for alternate ways to satisfy those
needs. Orzack says the goal of therapy is to get people
to realize there is a psychological underpinning to their
behavior and that gamers need to take control of
changing it. Additional techniques include motiva
tional interviewing to set positive goals, making con
tracts to specify video game use, and the development
of other recreational pursuits. Orzack advocates that by
looking at the motivating psychological factors and get
ting clients to acknowledge and change these, long
term improvements can be made.
Young70 uses CBT as a primary focus but also as an
adjunct to other treatment interventions (such as inter
personal psychotherapy techniques) to moderate online
usage and to address underlying psychosocial issues
often coexistent with this addiction (e.g., social phobia,
mood disorders, marital dissatisfaction, job burnout,
childhood sexual abuse). Young says that therapy
should use (1) time management techniques that help
the client structure and regulate online gaming sessions
and (2) strategies that help gamers to develop alterna
tive activities that take them away from the computer
(e.g., more time with family, engage in hobbies, or exer
cise programs).
According to Young,70 Internet addicts (including
online gamers) typically suffer interpersonal difficulties
such as introversion or have limited social support sys
tems in place, which is in part, why they turn to virtual
relationships as a substitute for the lack of real life social
connection. In other cases, because of their addiction,
they have lost significant real life relationships such as a
spouse, a parent, or a close friend. Interpersonal ther
apy is a brief form of treatment that focuses on educa
tion use to improve interpersonal functioning. Specific
interventions include encouragement of affect, com
munication analysis, modelling, and roleplaying to
establish new ways of interacting that address role tran
sitions and interpersonal deficits. Young also advocates
use of a 12step group to assist addicts in finding ade
quate support and sponsorship that enable recovery.
Finally, Young says that couples counselling may be an
essential part of recovery among online addicts whose
marital and familial relationships have been disrupted
and negatively influenced by Internet addiction. The
therapeutic techniques appear to be based on CBT,
skills training, and humanistic techniques. The reasons
for using these are:
•Cognitive behavior therapy: Used for under
lying psychological conditions such as social
phobia, and so forth
•Skills training: Used for various life training
activities such as time management, finding
other rewarding activities, and developing
core life skills
•Interpersonal therapy: Used for developing
personal skills and social functioning
•Couple therapy or family therapy: Used for
addressing problems caused between part
ners and family
Therapeutic interventions such as these appear to
provide a coherent and wideranging therapeutic pro
gram, which given its breadth, would be likely to work
well. It is also assumed that the treatment program
would be individually tailored for each client. However,
the use of a 12step program appears to sit uncomfort
ably (at least at a philosophical level) with various psy
chotherapies with primary perspectives that each indi
vidual is responsible for his or her own mental state.
One of the problems with accepting that people are
35
Diagnosis and Management of Video Game Addiction Griffiths

“powerless” over their addiction means that it removes
free will and responsibility for their actions and could
potentially allow them to adopt a “victim” mentality.
However, because there is little information available as
to the precise procedures adopted by such clinics, it is
hard to establish the extent to which these procedures
are followed.
Woog71 advocates the use of behavioral techniques
using gaming as a reward mechanism (i.e., video game
play being contingent on completing other daily activi
ties), along with punishments for transgressions (e.g.,
cancellation of gaming magazine subscriptions). His
treatment protocol for gaming addicts is to get players to:
• Acknowledge their level of play and accept
responsibility for their actions
• Reduce the amount of time that they play
video games
• Increase the number of prosocial realworld
activities
• Use the game as reward for engaging in the
treatment protocol
• Get treatment for underlying mood disor
ders (e.g., depression, anxiety, etc.)
Motivational Interviewing
One therapeutic approach that has been used by some
clinical psychologists known to the authors is motiva
tional interviewing (MI). MI borrows strategies from
cognitive therapy, clientcentered counseling, systems
theory, and the social psychology of persuasion and
contains elements of both directive and nondirective
therapeutic approaches. Because gamers are often
coerced into therapy by a third party (concerned parent
or partner), the first task of a therapist is to motivate
clients to change something about themselves. Miller
and Rollnick72 are the main proponents of such an
approach and advocate that MI is primarily about the
motivational aspects of changing people’s behavior in
the therapeutic setting, an area that is most salient to
those people who engage in addictive behaviors. The
underlying theme of such a therapeutic approach is the
issue of ambivalence, and how the therapist can use MI
to resolve it and allow the client to build commitment
and reach a decision to change.
Miller and Rollnick argue that motivation is not a
personality problem and that there is little evidence for
an addictive personality. Such assertions are integral to
MI’s theoretical basis. The focus for MI highlights Pro
chaska and DiClemente’s73 wellknown sixstage “wheel
of change,” which seeks to explain how people change
either with or without a therapist. These stages consist
of precontemplation, contemplation, determination,
action, maintenance, and relapse. The method
employed in MI consists of using a mnemonically
structured (A–H) list of eight effective motivational
strategies (giving Advice, removing Barriers, providing
Choice, decreasing Desirability, practicing Empathy,
providing Feedback, clarifying Goals, and active Help
ing). This is intertwined with the five general principles
of MI (expressing empathy, developing discrepancy,
avoiding argumentation, rolling with resistance, and
supporting selfefficacy). Such a cognitive clientcen
tered approach does seem to hold clear possibilities in
the rehabilitation of addicted gamers, but as yet there
are no reported studies of use in this field.
Treatment of Video
Game Addiction:
Empirical Case Studies
To date, there have been very few published accounts of
treating video game addiction. Kuczmierczyk, Walley,
and Calhoun16 reported the case of an 18yearold col
lege student who had been playing video games 3 to 4
hours a day at an average cost of $5 a day over a 5
month period. Kuczmierczyk et al assumed that
compulsive video game playing was conceptually
similar to pathological gambling and used a cogni
tivebehavioral modification approach in their treat
ment. Using a combination of selfmonitoring, Galvanic
Skin Response (GSR) biofeedbackassisted relaxation train
ing, invivo exposure, and response prevention, a 90%
36
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

reduction of playing was observed and continued to be
observed at 6 and 12month followup examinations. In
addition, the patient reported a more satisfying interper
sonal life, had developed an interest in the martial arts,
and was significantly less anxious and withdrawn.
The only other reported case of treating a video
game addict was that of Keepers.15 A 12yearold boy
was brought by his mother for psychiatric help because
her son was playing videogames for 4 to 5 hours a day
at an average cost of $30 to $50 a day over a 6month
period. The amount of money spent significantly
exceeded the boy’s disposable income, and he had been
stealing and truanting from school to play. Keepers
reported that the boy was physically abused by his
father (as was the mother). He was placed in a residen
tial treatment center and given family therapy. During
therapy the boy remained reluctant to discuss his home
situation or his parents. In an effort to uncover some of
his feelings, the boy was asked to design his own video
game. Using video games as a vehicle for communica
tion, the boy was gradually able to talk about the fear of
his father and his feelings of helplessness. Family ther
apy was again undertaken with the eventual outcome of
parental separation and return of the boy to his mother.
At 6month follow up, no recurrence of the boy’s diffi
culty was noted. Keepers also considered his patient’s
behavior to be reminiscent of pathological gambling.
Multimodal and
“Alternative” Treatments
Davis74 outlines a range of diverse treatment tech
niques, from many different behavioral techniques,
including both operant conditioning (i.e., negative
reinforcement through denial of privileges, and removal
of the ability to play), and aversive classical condition
ing (i.e., electric shock treatment), selfhelp groups
(modelled on the 12step programs), and psychophar
macological intervention (e.g., use of antidepressants,
antipsychotics, and tranquilizers). There was no evalua
tion of whether any of these treatments worked, and
there are ethical dilemmas about whether some of these
treatments should be given in the first place (e.g., aver
sive conditioning). There is also the argument that
many of these interventions treat the symptoms (e.g.,
behavioral and pharmacological treatments) and not
the underlying problem of why these individuals are
playing to excess in the first place. There are also other
unevaluated and somewhat alternative “treatments” for
video game addiction such as subliminal therapy (see
http://www.subliminaltherapy.com/conditions/gamead
diction.html) that offers hypnotherapy through CDs
for antianxiety, antidepression, and confidence, and the
“Sedona Method” (see http://www.sedona.com/lp
video games.aspx). From the promotional information
on the Sedona Method Web site, it would appear that
the technique uses some form of cognitivebehavioral
intervention, although the details are limited:
• By simply stopping and recognizing what is
going on you are already interrupting the
problem. Next decide to let go of the feeling
that is motivating you to do something you
know you will later regret. With the Sedona
Method, whenever you feel you are losing
control you’ll repeat a series of simple ques
tions that will allow you to release. When
you let go of negative thoughts or feelings,
you will instead be filled with a sense of
empowerment, confidence and freedom—
everything.
It is also worth mentioning that there are a number
of commercial products that restrict or block access to
gaming sites such as Time Boss, a control system that
allows parents to limit the amount of time that their
children spend playing a game (see http://www.nicekit.
com/parentalcontrol/addictions/videogameaddic
tiontreatment.html).
Although these various methods may or may not
work, it appears that the increased concern over video
games has resulted in a booming commercial industry
for their treatment. With respect to treatment there
appears to be increasing awareness of the problem, as
indicated both by sites referring to treatments and
those simply identifying the problem. The Chinese
techniques appear to use some behavioral techniques,
but other mechanisms seem to have no therapeutic
37
Diagnosis and Management of Video Game Addiction Griffiths

models to sustain them, for example, boot camps.
Without further information it is difficult to assess
either their techniques or chances of success. Within
some Web sites, however, there is an implicit assump
tion that gaming addiction is akin to other addictions
and as such, they advise the adoption of the 12step
programs. However, the lack of scientific consensus has
not stopped commercial companies trying to make
money, and it would be fair to say that the sensational
ist media accounts have created perfect conditions for
any pseudoscientific treatment to sell itself as the cure
for “game addiction.”
Conclusions
In reviewing the literature on video game addiction at
the outset of this lesson, it is clear from the case studies
and medical reports displaying the more negative conse
quences of video game playing that they all involved peo
ple who were excessive users of video games. From sur
veys in this area, there is little evidence of serious acute
adverse effects on health from moderate play. Adverse
effects are likely to be relatively minor and temporary,
resolving spontaneously with decreased frequency of
play, or to affect only a small subgroup of players. Exces
sive players are the most at risk from developing health
problems, although more research appears to be much
needed. The need to establish the incidence and preva
lence of clinically significant problems associated with
video game play is of paramount importance. There is
also no doubt that clearer operational definitions are
required if this is to be achieved. Taking all factors and
variables into account and by considering the prevalence
of play, the evidence of serious adverse effects on health is
rare. An overview of the available literature appears to
indicate that adverse effects are likely to affect only a very
small subgroup of players and that frequent players are
the most at risk for developing health problems. Those
that it does affect will experience subtle, relatively minor,
and temporary effects that resolve spontaneously with
decreased frequency of play.
Worldwide, there are currently very few practitioners
that specialize in the treatment of video game addiction,
and this may be because there are so few players who are
genuinely addicted to playing video games. However, as
highlighted in the first half of this lesson, the Internet
may be facilitating excessive online game playing. Since
the mid1990s, almost all of the writings on treatment of
video game addiction have focused on online video game
addiction, and it is this variant that appears to cause the
most problems for users.
There are some specialist addiction treatment clinics
(e.g., in Holland, China, Korea, United States), but
details of the therapeutic programs have not been pub
lished in the academic literature. It would appear that
most of the treatment clinics use a diverse range of inter
ventions, as do those individual practitioners that have
written on the issue (in academic journals and Internet
published articles). The programs appear to be split into
two camps—the first being a total abstinence model
(e.g., Smith & Jones Clinic) and those who believe the
problematic gaming behavior can be relearned (Woog).71
In addition, there are individuals such as Young70 (Cen
ter for OnLine Addiction) and Orzack (Computer
Addiction Services), who use multimodal elements but
do not necessarily advocate total abstinence or modera
tion.
All the treatment programs aim to increase prosocial
skills through social activities and replacement of time
spent on the computer with real life activities. In addi
tion, they all provide some form of personal “talking”
therapy to address individual issues such as depression
and anxiety. They also integrate management skills such
as goal setting and time keeping so that players can estab
lish control over their behavior.
Woog outlines some strong behavioral components
such as the use of the computer as a reward for good
behavior and punishment when excessive gaming is
indulged in. In the right treatment schedule, this system
could be very powerful and allow the player to relearn
appropriate gaming behaviors. The Smith & Jones
Clinic and Young use the use of an adapted 12step pro
gram that advocates abstinence, although the extent to
which this is applied to all their gamers is unclear. It
could be argued that those who participate in 12step
programs are not getting therapy at all—they are simply
avoiding the addictive stimulus through the testimonials
38
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

of other exaddicts. Because there is very little empirical
research into the longterm effectiveness of these pro
grams it is hard to establish the credibility of these clinics
or their techniques. The cognitivebehavioral model is
both better researched (although with reference to differ
ent disorders), has tried and tested therapeutic tech
niques, and is underpinned by a verified psychological
theory. Overall, further research is required to establish
the therapeutic efficacy of any and all treatment pro
grams directed at excessive gaming.
39
References
1. Griffiths MD. The educational benefits of videogames. Educ
Health (Abingdon). 2002;20:47–51.
2. de Freitas S, Griffiths MD. Online gaming as an educational
tool in learning and training. British Journal of Educational
Technology. 2007;38:536–538.
3. Cole H, Griffiths MD. Social interactions in massively mul
tiplayer online roleplaying gamers. Cyberpsychol Behav. 207;
10:575–583.
4. Hussain Z, Griffiths MD. Gender swapping and socialising
in cyberspace: an exploratory study. Cyberpsychol Behav.
2008;11:47–53.
5. Griffiths MD. Video games and health. BMJ. 2005;331:
122–123.
6. Griffiths MD. The therapeutic value of videogames. In: Gold
stein J, Raessens J, eds. Handbook of Computer Game Stud
ies. Boston: MIT Press; 2005:161–171.
7. Griffiths MD. Videogame addiction: fact or fiction? In:
Willoughby T, Wood E, eds. Children’s Learning in a Digital
World. Oxford: Blackwell Publishing; 2007:85–103.
8. Chappell D, Eatough VE, Davies, MNO, Griffiths MD.
EverQuest—It’s just a computer game right? An interpreta
tive phenomenological analysis of online gaming addiction.
International Journal of Mental Health and Addiction.
2006;4:205–216.
9. Ng BD, WeimerHastings P. Addiction to the Internet and
online gaming. Cyberpsychol Behav. 2005;8:110–113.
10. Grüsser SM, Thalemann R, Griffiths MD. Excessive com
puter game playing: evidence for addiction and aggression?
Cyberpsychol Behav. 2007;10:290–292.
11. Griffiths MD. A “components” model of addiction within a
biopsychosocial framework. Journal of Substance Use. 2005;
10:191–197.
12. Khan M. Emotional and behavioral effects, including addictive
potential, of video games. Report of the Council on Science
and Public Health (CSAPH Report 12A07). www.ama
assn.org. Accessed May 17, 2008.
13. Griffiths MD. Amusement machine playing in childhood
and adolescence: a comparative analysis of video games and
fruit machines. J Adolesc. 1991;14:53–73.
Diagnosis and Management of Video Game Addiction Griffiths
Appendix 1
List of Online Support Forums
for Excessive Video Game Playing
• http://parents.berkeley.edu/advice/teens/gameaddiction.html
• http://www.mediafamily.org/facts/facts_gameaddiction.shtml
• http://games.groups.yahoo.com/group/spousesagainsteverquest/
• http://health.groups.yahoo.com/group/EverQuest-Widows/
• http://www.childrenfirst.nhs.uk/families/experts/c/computergame_addiction.html
• http://www.wowdetox.com/index.php
• http://www.mothernature .com/Library/bookshelf/Books/ 50/116.cfm

14. Griffiths MD. The relationship between gambling and
videogame playing: a response to Johansson and Gotestam.
Psychol Rep. 2005;96:644–646.
15. Keepers GA. Pathological preoccupation with video games. J
Am Acad Child Adolesc Psychiatry. 1990;29:49–50.
16. Kuczmierczyk AR, Walley PB, Calhoun KS. Relaxation
training, in vivo exposure and responseprevention in the
treatment of compulsive videogame playing. Scandinavian
Journal of Behaviour Therapy. 1987;16:185–190.
17. Shotton M. Computer Addiction? A Study of Computer Depen
dency. London: Taylor and Francis; 1989.
18. Griffiths MD, Hunt N. Computer game playing in adoles
cence: prevalence and demographic indicators. Journal of
Community and Applied Social Psychology. 1995; 5:189–193.
19. Griffiths MD, Hunt N. Dependence on computer games by
adolescents. Psychol Rep. 1998;82:475–480.
20. Fisher SE. Identifying video game addiction in children and
adolescents. Addictive Behaviors. 1994;19:545–553.
21. Parsons K. Educational places or terminal cases: young people
and the attraction of computer games. Paper presented at:
British Sociological Association Annual Conference; 1995;
University of Leicester.
22. Phillips CA, Rolls S, Rouse A, Griffiths M. Home video
game playing in schoolchildren: a study of incidence and
patterns of play. J Adolesc. 1995;18:687–691.
23. Griffiths MD. Computer game playing in early adolescence.
Youth and Society. 1997;29: 223–237.
24. TejeiroDalguero RAT, Moran RMB. Measuring problem
video game playing in adolescents. Addiction. 2002;97:
1601–1606.
25. Hauge MR, Gentile DA. Video game addiction among adoles
cents: associations with academic performance and aggression.
Paper presented at: Society for Research in Child Develop
ment Conference; 2003; Tampa, FL. http://www.psychology.
iastate.edu/faculty/dgentile/SRCD%20Video%20Game%20
Addiction.pdf. Accessed May 17, 2008.
26. Gentile DA. Video game addiction: is it real? http://
www.harrisinteractive.com/news/allnewsbydate.asp?NewsID
=1196. Accessed May 17, 2008.
27. Klein MH. The bite of Pacman. J Psychohist. 1984;11:
395–401.
28. Egli EA, Meyers LS. (1984). The role of video game playing
in adolescent life: is there a reason to be concerned? Bulletin
of the Psychonomic Society. 1984;22:309–312.
29. Rutkowska JC, Carlton T. Computer games in 12–13 year
olds’ activities and social networks. Paper presented at: British
Psychological Society Annual Conference; April 1994; Uni
versity of Sussex.
30. Wood RTA, Griffiths MD. Time loss whilst playing video
games: is there a relationship to addictive behaviours? Inter
national Journal of Mental Health and Addiction. 2007;5:
141–149.
31. Wood RTA, Griffiths MD, Parke A. Experiences of time loss
among videogame players: an empirical study. Cyberpsychol
Behav. 2007;10:45–56.
32. Griffiths MD. Does internet and computer “addiction” exist?
Some case study evidence. Cyberpsychol Behav. 2000;3:211–218.
33. Griffiths MD, Davies MNO, Chappell D. Breaking the
stereotype: the case of online gaming. Cyberpsychol Behav.
2003;6:81–91.
34. Griffiths MD, Davies MNO, Chappell D. Online computer
gaming: a comparison of adolescent and adult gamers. J Ado
lesc. 2004;27:87–96.
35. Griffiths MD, Davies MNO, Chappell D. Demographic fac
tors and playing variables in online computer gaming.
Cyberpsychol Behav. 2004;7:479–487.
36. Wan C, Chiou W. Psychological motives and online games
addiction: a test of flow theory and humanistic needs theory for
Taiwanese adolescents. Cyberpsychol Behav. 2006;9:317–324.
37. Wan C, Chiou W. Why are adolescents addicted to online
gaming? An interview study in Taiwan. Cyberpsychol Behav.
2006;9:762–766.
38. Rushton DN. “Space invader” epilepsy. Lancet. 1981;1:501.
39. Loftus GA, Loftus EF. Mind at Play: The Psychology of Video
Games. New York: Basic Books; 1983.
40. Griffiths MD. Gambling and Gaming Addictions in Adolescence.
Leicester: British Psychological Society/Blackwells; 2002.
41. Spence SA. Nintendo hallucinations: a new phenomenologi
cal entity. Psychology and Psychotherapy: Theory, Research and
Practice. 1993;10: 98–99.
42. Schink JC. (1991). Nintendo enuresis. Am J Dis Child. 145,
1094.
43. Corkery JC. Nintendo power. Am J Dis Child. 1990;144:959.
44. McCowan TC. Space invaders wrist. N Engl J Med. 1981;
304:1368.
45. Miller DLG. Nintendo neck. CMAJ. 1991;145;1202.
46. Bright DA, Bringhurst DC. Nintendo elbow. West J Med.
1992;156:667–668.
47. Reinstein L. de Quervain’s stenosing tenosynovitis in a video
games player. Arch Phys Med Rehabil. 1983;64:434–435.
48. Brasington R. Nintendinitis. N Engl J Med. 1990;322:
1473–1474.
49. Casanova J, Casanova J. Nintendinitis. J Hand Surg. 1991;16:
181.
50. Siegal IM. Nintendonitis. Orthopedics. 1991;14:745.
51. Cleary AG, Mckendrick H, Sills JA. Handarm vibration
syndrome may be associated with prolonged use of vibrating
computer games. BMJ. 2002;324:301.
52. Mirman M, Bonian VG. “Mouse elbow”: a new repetitive
stress injury. J Am Osteopath Assoc. 1992;92:701.
53. Friedland RP, St. John JN. Videogame palsy: distal ulnar
neuropathy in a video game enthusiast. N Engl J Med. 1984;
311:58–59.
54. Spielberg I. The challenges of stopping gaming addiction.
http://www.treatmentonline.com/treatments.php?id=204.
Accessed May 17, 2008.
40
References
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3

55. Griffiths MD. Videogames: advice for teachers and parents.
Education and Health. 2003;21:48–49.
56. Griffiths MD. Online therapy for addictive behaviors.
Cyberpsychol Behav. 2005;8:555–561.
57. Griffiths MD, Cooper G. Online therapy: implications for
problem gamblers and clinicians. British Journal of Guidance
and Counselling. 2003;13:113–135.
58. Wood RTA, Griffiths MD. Online guidance, advice, and
support for problem gamblers and concerned relatives and
friends: an evaluation of the GamAid pilot service. British
Journal of Guidance and Counselling. 2007;35:373–389.
59. National Institute on Media and the Family. Computer and
video game addiction. http://www.mediafamily.org/facts/
facts_gameaddiction.shtml. Accessed May 17, 2008.
60. CourtenaySmith N. The frightening new addiction: com
puter gaming. Daily Mail, November 29, 2006.
http://www.dailymail.co.uk/pages/live/femail/article.html?in
_article_id=419514&in_page_id=1879. Accessed May 17,
2008.
62. Rauh S. Detox for video game addiction? CBC News, July 3,
2006.http://www.cbsnews.com/stories/2006/07/03/health/
webmd/main1773956.shtml. Accessed May 17, 2008.
63. Faiola A. When escape seems just a mouseclick away: stress
driven addiction to online games spikes in S. Korea. Washing
ton Post, May 27, 2006. http://www.washingtonpost.c
om/wpdyn/content/article/2006/05/26/AR2006052601960
.html. Accessed May 17, 2008.
64. SebagMontefiore, P. China’s young escape into the web. The
Guardian, November 20, 2005. http://www.guardian.co.uk/
technology/2005/nov/20/news.china. Accessed May 17, 2008.
65. Carjaval D. Virtual gamers with addictions cause plenty of
real concerns. International Herald Tribune, June 12, 2006.
http://www.iht.com/articles/2006/06/11/business/addict12.
php?page=1. Accessed June 30, 2008.
66. Dickie M. China moves to zap online game addiction. Finan
cial Times, August 23, 2005. http://www.ft.com/cms/
s/2/89ea206a13f311daaf5300000e2511c8.html. Accessed
June 30, 2008.
67. Chapman, M. China “electrocutes” teen web addicts.
Vunet.com, February 26, 2007. http://www.vnunet.
com/vnunet/news/2184143/chinaelectrocutesinternet.
Accessed May 17, 2008.
68. Williams I. Chinese gamer dies after 15day session.
Vunet.com, March 1, 2007. http://www.vnunet.com/
vnunet/news/2184523/onlineaddictgameshimself.
Accessed May 17, 2008.
69. Orzack MH, Vouse AC, Wolf D, Hennen J. An ongoing
study of group treatment for men involved in problematic
Internetenabled sexual behavior. CyberPsychology and Behav
ior. 2006;9:348–360.
70. Young K. Addiction to MMORPGs: symptoms and treat
ment. http://www.netaddiction.com/articles/articles.htm.
Accessed May 17, 2008.
71. Woog, K.M. Gaming addiction. http://www.wooglabs.
com/gaming addiction.pdf. Accessed May 17, 2008.
72. Miller WR, Rollnick S. Motivational Interviewing: Preparing
People to Change Addictive Behavior. New York: Guildford
Press; 1991.
73. Prochaska JO, DiClemente CC. Transtheoretical therapy:
toward a more integrative model of change. Psychotherapy:
Theory, Research and Practice. 1982;19:276–288.
74. Davis D. Video game addiction scale. http://domdavis.com/
2008/02/04/videogameaddictionscalewithabridgedfore
word/. Accessed May 17, 2008.
41
References
Diagnosis and Management of Video Game Addiction Griffiths

9. Which of the following medical conditions has
not been reported as a consequence of excessive
video game playing?
A. Visual hallucinations
B. Repetitive strain injury
C. Enuresis
D. Handarm vibration syndrome
10. All of the following represent central problems
with the criteria for video game addiction
measures, except:
A. Have no measure of severity
B. Have no temporal dimension
C. Have a tendency to underestimate the preva
lence of problems
D. Take no account of the context of video game
use
11. To date, most treatments of video game
addiction tend to be based on the treatment
philosophies of:
A. Alcoholism
B. Heroin addiction
C. Pathological gambling
D. Exercise addiction
12. All of the following were mentioned as methods
for treating video game addiction, except:
A. Online support groups
B. Cognitive behavior therapy
C. Motivational interviewing
D. Sensory depravation
Questions Based On This Lesson
To earn CE credits, answer the following questions on your quiz response form.
Volume 12 Directions in Addiction Treatment & Prevention Lesson 3
42