From Disney's 1995 Animated Short, "Runaway Brain"
On May 29th of this year, the World Health Organization officially recognized gaming addiction as a disease as part of their 11th revision of the International Statistical Classification of Diseases and Related Health Problems (a.k.a. "ICD-11"), and gave it the name "Gaming Disorder". I will not analyze the debate in detail because many other reputable outlets have already done so, with the article written by Ms. Kelli Dunmap over at Take This being by far the best (and neutral) I've found. But my extremely brief "layman's summary" of the debate is as follows:
What is WHO's "Gaming Disorder": When someone ends up playing games so much to the point that his/her life starts to fall apart, and this lasts for more than a year.
Why the WHO's decision is a good thing: People who really are addicted to games need help, but they won't be able to get that help properly until the WHO officially recognizes it as a medical condition.
Why the WHO's decision is a BAD thing: We don't fully understand this ... "thing" yet, and games are fundamentally different from opioid drugs. This move will merely create a "media/moral panic" around the world, causing many normal/healthy gamers to be falsely diagnosed as addicts.
The full debate is obviously much bigger, and there are counter-arguments and counter-counter arguments to each of these points. But, ultimately, whether or not the WHO should have added Gaming Disorder to ICD-11 is secondary to the real issue and (IMO) undeniable fact: Gaming addiction is a real thing. This blog is NOT about whether or not the WHO made the right decision. Instead, I will focus on our industry's current relationship with addiction in gaming, and what we as an industry can and should do about gaming addiction.
"EXP is the video game equivalent of crack"
The fact of the matter is, there has always been an addictive element to gaming. For a while, and at least until the mid-90s, games were "addictive" mostly only because they were fun to play. At some point, however, some games began incorporating game mechanics that introduced some of the addictive qualities of actual drugs.
I had been saying this half-jokingly since the late 1990s; "EXP is the video game equivalent of crack". What I meant by that was that you can add an EXP mechanic (i.e. where you earn "experience points" through gameplay and gradually "grow" your character/city/car/ship, etc.) to any game and make it more addictive.
X-Com (1994), Final Fantasy 7 (1997), World of Warcraft (2004) and Call of Duty: Modern Warfare (2006) were some of the games that I found myself playing much longer than a normal video game at the time. And this was not only because they were great games, but also because I just had to keep playing, and keep getting more of "that thing".
While I did not fully understand it at the time, there was a scientific / medical / psychological explanation to this all along; EXP mechanics directly interact with the Dopamine Reward System. This is also very similar to how many Social Media platforms are able to keep people "addicted" to them.
Kill an enemy, and a bright number pops up as a reward. Kill with a headshot, and an even bigger number pops up. Congratulations, you're now mentally addicted to Call of Duty!
And now, an industrialized ingredient
Over the last two decades, more and more games adopted this EXP mechanic, and nowadays it is actually harder to find a high-profile game that does not include this mechanic in some form. But the words "addiction" or "addictiveness" are rarely used explicitly by the creators. Instead, they are wrapped inside euphemisms such as "retention", "stickiness" or "engagement". But they all mean the same thing, right? They ultimately refer to how long the player plays the game.
Even action-focused games are now integrating "progression" mechanics traditionally reserved only for RPG games (Pictured: God of War & Nier: Automata)
Furthermore, and especially in this new age of Free-to-Play (F2P) games AND abundance of games overall, PLAYTIME has become the most valuable metric because revenues generated per player increases proportionately with their playtime. And that has required developers to find ways to maximize their players' playtime. From a F2P game developer's perspective, their willingness to "let people start playing the game for free" is only in exchange for the chance to make those players eventually spend more than they would have willingly paid up-front. In other words, the F2P business model DEMANDS games to be addictive.
As a result, these metrics are tracked as performance indicators, and developers hire data scientists and deploy machine learning, all specifically to maximize playtime. I personally know people whose job was to do exactly this, and have had candid conversations with them about some of the truly evil ideas that developers have explored (and used!) along the way. In fact, at times, even my own job requires me to do this. Guys, this is a real thing.
Note: Interestingly enough, someone recently posted a blog on Gamasutra covering exactly this. While it's not the most scientific writing on the subject, it's a refreshingly blunt acknowledgement of what's an otherwise taboo subject in our industry.
My point is that, we game developers KNOW we have ways to make our games more addictive. And we use them. Perhaps with some moral reservations, but we do it nonetheless.
And this is only the tip of the iceberg. Games can be addictive even when someone does not intend it to be, and even without any "EXP mechanic", because "all addictions (whether chemical or behavioral) are essentially about constant rewards and reinforcement", and games can provide plenty of them.
I installed Flappy Bird again just to take this silly screenshot, but it took me almost ten minutes because AGAIN I couldn't stop playing it... (And this game doesn't even have any EXP mechanics)
Note: Over two decades later, I now think my "EXP is like crack" analogy might have been too harsh. These days, I feel that a comparison to sugar might be more appropriate; EXP and sugar are both seemingly-innocuous ingredients that can lead to serious health/mental issues if consumed excessively for an extended period of time. At the same time, I cannot shake the feeling that EXP mechanics' mentally addictive qualities can be far more powerful than sugar's. The truth probably lies somewhere in between sugar and crack (but hopefully closer to the former)...
So, we know that there's an addictive ingredient being added to games from the supply-side. But how is it actually playing out with the consumers?
It'd be one thing if everyone is maintaining a healthy gaming habit, but we know that's unfortunately not the case. While there is still an ongoing debate over the extent and seriousness of gaming addiction, there is no question that these people who are helplessly addicted to games do exist. In fact, there have been plenty of cases over the years where people got addicted to the point of self-destruction (relationships, financials, etc.), and even death.
An Asian Epidemic?
By the way, I'd like to share one observation that might provide some context for why this debate is playing out in this specific way; it is because, at the moment, this is a mostly "Asia-driven" debate.
The WHO's annual expert meetings to debate this issue since 2014 all took place in Asia (Tokyo, Seoul, Hong Kong and Istanbul). It's been the Asian countries that have suffered from the earliest and most high-profile cases of gaming-related deaths (most notably, the 2004 and 2005 deaths, both occurring at Korean PC-bangs), and it's those same Asian countries that have already implemented some of the most draconian/militaristic solutions in place (more on this later).
Why is this? Without a doubt, it is in part because Asian parents simply (culturally) don't like their kids playing video games, and I'd argue that the fact that debates in that region focus entirely on the impact to kids (even though it is young adults between the ages 18 to 24 that are struggling the most with gaming addiction) is strong proof of this. However, in my opinion, this is also directly related to the fact that the Asian gaming markets have for the last two decades been dominated by F2P games, and thus more severely impacted by this issue than their Western counterparts. (In other words, a higher % of gamers are addicted in Asia today)
But, while today's debate might be driven by "Asian parents", the issue (and looming threat) is universal. Even in America, 41% of teenage boys already admit that they play a bit too much video games. Hopefully only a small minority of those kids are actually clinically addicted to games, but this is still an indication that the number of addicts is probably substantially greater than zero percent.
And as more F2P games find success and penetration among in the Western markets, the likelihood of Western gamers suffering from gaming addiction will increase as well. ... or at least that's my hypothesis.
Gaming addiction is a thing. Let's not fool ourselves.
Given all the above, how can anyone honestly claim that gaming addiction is not a thing, or that games are definitely not addictive?
To be fair, one of the most convincing arguments against the existence of gaming addiction (for me) is that excessive gaming is only a symptom of other mental health issues, and I believe this was reflected in the ESA's response as well: "(The WHO's decision) recklessly trivializes real mental health issues like depression and social anxiety disorder."
However, according to experts, "comorbidity (i.e. two or more conditions being present at the same time) is more often the rule than the exception." In other words, both can be true; someone can have some other form of mental health issue AND be addicted to video games at the same time. To put it more bluntly, we should not scapegoat mental health issues.
Either way, and whether or not the WHO was right to include GD in ICD-11, as long as the facts are that (1) some games can be addictive, that (2) some people get addicted to them to the point where it becomes an issue for them and those around them, and that (3) there are people who are actually seeking help, we MUST at least acknowledge this; gaming addiction is a thing.
As far back as 2005, the Korea Agency for Digital Opportunity and Promotion (KADO) was already reporting solid increases in people seeking gaming addiction-related counselling
But first, allow me to clarify my own views:
Not all games are addictive to the same degree, and many are arguably not addictive at all
Just because someone plays games for a long time, it doesn't necessarily mean they are addicted to games. This is the WHO's stance as well
Some addictive elements have more to do with external factors (such as the in-game community / peer-pressure) than the game itself
In other words, every game is different, and Gaming Addiction is not an issue that affects every game equally. Games could be compared to food that uses sugar as an ingredient; some are harmless, some are not good, and some are plain bad for you. Yet the FDA does not exist to ban all foods containing sugar. And I completely reject the notion that games, as a medium and activity, is inherently more addictive than other entertainment mediums such a movies, sports or sex.
So it is important that we push back against any attempts to wholesale categorize games as addictive. And it is even more important that this is understood correctly by everyone (especially parents & politicians!!). We must not allow games to be used as another political wedge issue / prop, and tolerate the spread of misinformation.
The "Moral Panic" counter-argument
I need to address the "moral panic" argument, which appears to be the biggest concern by many folks, and particularly those in the games industry. Some folks appear concerned that this will stigmatize gaming, and enable some to scapegoat video games, similarly to how references to sex and violence in games in the early 90s caused a huge headache for game developers/publishers as people tried to blame video games for broader social issues.
There is certainly a good basis for this argument. In fact, what they've speculated is already happening; some politicians are happy to use the mere announcement of WHO's ICD-11 as proof and opportunity to claim that video games are addictive, and that this justifies their actions to regulate, ban or tax video games. Below are just some of the recent examples:
Example 1: Mere weeks after ICD-11's ratification in May, Jordan banned PlayerUnknown's Battlegrounds, presumably because of a WHO study that classified the game as "a violent game leading to addiction and social isolation". Except that such WHO study does not even exist.
Example 2: During a headed public debate that took place in Korea in May regarding the WHO's move, a politician repeatedly made false claims to justify her stance that video games are addictive and must be taxed.
Example 3: Even in NPR's coverage of this development, the very second sentence of the article grossly (but perhaps unintentionally?) misrepresents the significance of the WHO's decision by saying "...video games have just become an internationally recognized addiction" even though that is not at all what the WHO's decision means.
So, while I believe their concerns are 100% valid, looking at the larger picture, I do not believe they are proportionate to the actual risk.
First, ICD-11 does not actually go into effect until January 2022, so there is still plenty of time to establish clearer guidelines for diagnosing Gaming Disorder.
But to look at another angle, despite this debate having taken place within the WHO since at least 2014, it's still over TWO years before folks can formally receive medical help for their gaming addiction. In Korea's case, their version of the ICD (called the KCD) won't be updated until 2025, and goes into effect from 2026. To put things into perspective, that's TWENTY-TWO years after the first gaming addiction-related death in Korea!
My point is that these things move very slow, while people who desperately need help (i.e. effective treatment and insurance coverage) await the system to catch up. How many more years will do we need to ignore them just so that the rest of us can continue playing to our hearts' content without worrying about being falsely accused of being addicts?
Besides, what makes people think that we can actually avoid a moral panic in the first place? The moral panic is likely going to happen either way, in my opinion. In fact, one could argue that it has already arrived in some parts of Asia, with the Western markets right behind them (Even the UK's The Sun carried an article in 2014 titled "Gaming as addictive as Heroin"). Yet the lack of an informed and proactive debate would only make that panic worse, and allow misinformation to poison any debate before it can even begin. So, I hope that those who were opposed to the WHO's decision can at least agree that continued studies and research will only help with this issue.
The Sun's "Gaming as Addictive as Heroin" article from 2014
Finally, when we were fighting the "games cause kids to become violent" debate/accusation in the 90s, we were a burgeoning industry that was still trying to figure out its place in the world. But, two and a half decades later, things are wildly different today. We should not be so defensive on this topic that we can't even admit plain facts (i.e. that gaming addiction exists) out of fear of being stigmatized. It's 2019, and gaming is finally THE global mainstream past-time now. So let's act like it! ;)
Mr. White, fighting that good fight for us in 1993. Please also note how young our representative was back then. If a similar hearing were to happen today, it might be someone 20 years older than him sitting in that chair.
Note: Speaking of which, even the claim that video games are the cause of gun violence has since been debunked repeatedly, with facts that "during the years in which video games soared in popularity, youth violence has declined to 40-year lows" providing ample evidence to fend off any moral panics on the subject of "video games & violence". We would only benefit from similar studies and experts specializing in gaming addiction.
The industry at the crossroads
Ultimately, I believe that we, as an industry, have two choices ahead of us:
Acknowledge gaming addiction exists, our own culpability in it, and start making efforts to better-understand and address it
Remain in the defensive, and continue denying our own contribution to gaming addiction. And wait till governments and societies to come up with their own "solutions".
We've actually already seen early glimpses of what would happen if we go with option 2. The notorious Chinese boot camps as well as those in Korea, and the aforementioned PUBG ban in Jordan are not "solutions" that a properly informed person would come up with (at least not in my opinion).
An addiction treatment center in Beijing, running an EEG test to scan a patient's brains. Whether or not this is the right solution, this image still makes me cringe... [credit: Getty Images]
Yet this is what's happening because there's a serious shortage of substance matter experts properly debating and addressing this issue. So, we really don't want to default to option 2.
What we need to do instead is provide leadership in this debate and search for a solution for this real problem. Otherwise, we're leaving it to the least qualified people (i.e. old folks who were born and raised during a time when video games were not considered an acceptable past time) to come up with the solution (i.e. laws, taxes & penalties). Come on, nerds! What do you think will really happen?!!
Amusing as this moment was at the time, in hindsight, these hearings marked Facebook's loss of control over the narrative and the public's trust. Facebook has recently agreed to a $5 billion settlement with the FTC., and in July a new bill was introduced in the senate to "ban addictive social network features". And this is probably only the beginning of congress' retribution cycle.
Time to face our music!
So, let's move beyond debating "Are games drugs or art?", and instead start talking about things that can actually contribute to the issue:
What exactly IS gaming addiction?
The WHO's definition is still inadequate, and if left as broad as it is, can lead to massive misdiagnoses.
We should study & define it much better, ensuring that the distinction between addiction and passion is clear.
THEN, educate the public accordingly
What causes the addiction?
Specific game mechanics?
EXP mechanics (i.e. progression systems)
Gatcha mechanics (i.e. loot boxes)
Communities (in-game) & peer pressure?
Sense of mastery and achievement?
What is the actual extent of this problem?
Just how serious is this anyway? Is it an actual epidemic affecting a serious number of people, or just a tiny minority?
Depending whom you ask, the numbers vary wildly:
0.3~1.0% University of Reading study
8.5% of American youth Iowa State University and National Institute on Media and the Family
10% to 50% of teenagers in Korea according to "estimations" by Korean medical professionals
Does it really impact younger people more severely, or are adults equally susceptible?
Preventive measures?
What can we do to prevent gaming addiction from becoming a problem in the first place? And which methods are actually effective?
Restricting Playtime, like what Tencent has been doing, or Korea's 2011 Cinderella Law?
Limiting Spending? Implement an individual cap? Some form of "progressive tax/penalty" for any excess revenues?
Restricting/Banning Features, like those new loot box bans & policies being implemented by governments and platform holders as we speak?
Play/Revenue Data Transparency? How much time and money people actually spend is currently kept secret by each developer, but some level of transparency would help curb and catch blatant outliers more effectively
[Bonus] Is there anything we (as Devs, Pubs and the industry) can do about this?
Perhaps a ratings system similar to the ESRB, PEGI or IARC, or integrating this into existing age ratings processes?
There is wide perception that it's particularly the kids that are being harmed, and that as long as we keep these games away from kids, we've done our job. This line of thinking was also reflected in a comment by Sony CEO Kenichiro Yoshida's back in May, and seems to be the underlying assumption behind most measures either taken or being discussed today.
But is this really enough/appropriate considering that it's the young adults (age 18-24) who are struggling with the issue the most, yet would not be restricted at all by our current age rating systems? (i.e. people over 18 can buy any game)
A research/watch-dog organization funded (and run?) by the industry?
Sets general guidelines, best practices, and clearly defines and discourages "bad behavior" by developers & publishers
Possesses the ability to enforce and levy fines for developers and publishers who do bad things (as defined by this watchdog)
These are all questions that SOMEBODY will have to think about and answer eventually, and probably soon. These are not simple questions, and the issue will only grow worse as time goes on. So, let's face it before it becomes an actual epidemic, and empower the experts to solve these issues instead of leaving it up to some political party, parents association or religious group. IMO, it is only a matter of time before those groups start intervening more forcefully.
It's not all doom and gloom though. This issue itself isn't actually new, and there are already groups that have been making great progress toward understanding Gaming Addiction, and exploring effective ways to address them.
In fact, only a few weeks ago, researchers in Germany published a story demonstrating promising results from a new video game addiction treatment which focuses "(not on) abstinence, but a readjustment of the patients’ relationship with computers, the internet, and video games." So, there are definitely experts in this field already who can help us move this conversation forward in positive ways.
Our collective blind spot
That said, most of the folks involved in these efforts so far do not appear to be game developers. And the solutions available out there are intended for AFTER someone is already "too addicted" and needs help. Yet there is another side to this equation; the games' addictiveness themselves, which are BY DESIGN more often than not (as mentioned earlier). If we are to be truly honest with ourselves, we should also be looking at some of our game design & monetization practices. Because the fact that we can benefit (at least financially) from a gamer's addiction to our games is a GLARING MORAL HAZARD, and I suspect that this is creating a massive blind spot for us as an industry.
Facebook's ongoing drama surrounding their carelessness with data privacy is certainly one parallel we could draw from. But perhaps a more apt parallel (though many will detest this) can be drawn from the current Opioid crisis in the US and the drug companies' culpability and denial, or even the NRA's long-standing position that mental illness is the (sole) cause of mass shootings in the U.S. These are all examples of for-profit organizations turning blind eyes to real problems in favor of protecting their business interests ($$), and textbook definitions of Moral Hazard. They also happen to become horrible optics later on for their respective industries, and I really don't want us to become that industry everybody blames and hates a few decades from now.
Check out these horrible optics from the current Opioid crisis coverage. This could be us one day! (...yay?)
I am hoping we are better than these other industries. But greed is universal, so perhaps I shouldn't keep my hopes too high...?
Our greatest challenge yet?
It is worth noting that the games industry has actually been very proactive for a different-but-related ongoing debate; Loot Boxes. In that debate, the industry has taken the lead in educating regulators (the FTC), as well as showing a willingness to self-regulate, with all major console manufacturers vowing to update their policies to curb abuses of the Loot Box mechanic. And even though the industry only started taking action after governments started threatening bans & regulations, I have to say it is doing as good of a job as one can expect.
However, I have a feeling the industry will have a much harder time grappling with the game addiction issue because it is fundamentally different from the Loot Box issue in the following ways:
It's not about a single game mechanic or feature which could just be removed (like EA and Blizzard did in Belgium); the issue is instead caused by the core structure/design of our games
It's an issue that impacts drastically more games
(At least for now) It's the PC and Mobile games that are the greatest offenders, and it is much harder to control these platforms unlike consoles which the platform holders can control directly through compliance
As the challenge and stakes are both greater with the issue of gaming addiction, there's a strong possibility that the industry will not be able to react as quickly as it has with Loot Boxes, and eventually allow this to fester into a much greater problem.
But the last time we as an industry faced this kind of major "moral" issue (i.e. the 90s' sex & violence in video games debate), we dealt with it properly by (1) acknowledging that some games may indeed contain violent and sexual content that may be age-inappropriate, and then (2) proposing the solution: to create a system by which our games' "violent and sexual content" can be reviewed by a third party and rated appropriately for potential consumers (i.e. the ESRB rating). That finally allowed the public debate to move past emotionally-charged misinformation campaigns, and I believe it will be our turn rather soon to do something similar for the gaming addiction debate.
Whenever that anxiety creeps in, just remember, we survived this. ;)
And... who knows? Just like how that 90s crisis gave birth to the first industry-wide body (i.e. the ESA & E3) and since allowed us to coordinate and achieve greater things as an industry, perhaps this will finally bring us together to form a truly industry-wide and world-wide consortium / network / association (including more than just the AAA players) to help address our shared big issues such as these. A gamer can hope, right?
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