6 Criteria of a MMORPG Hussain & Griffiths (2009) Persistence always online Physicality a virtually real place Social Interaction engaging with others

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1 Video Game Use and Addiction Michael S. Lewis, MA, LPCC-S Ohio Dominican University MMORPGs Massively Multiplayer Online Role-Playing Game Roots are formed in 1970 s tabletop game Dungeons and Dragons Common games include World of Warcraft, Everquest I & II, Star Wars The Old Republic, Ultima Online, Runescape, Lord of the Rings Online, though hundreds exist. 11% of the gaming market but 80% of gamers Different than other games like: First-Person Shooters (Call of Duty, Halo) Open World (Skyrim, Grand Theft Auto IV) Social Network (Farmville, Words with Friends) Characteristics of MMORPGs Subscription-Based vs. Free-to-Play Designed to allow hundreds of thousands of users to play the same game at the same (over the Internet) Typically themed to a genre Players create avatars to represent them in-game and to interact with the game environment Open world Role-Playing Avatars take on some type of role that helps inform and prompt how the player plays Typically a fighter, wizard, healer, or hybrid For example, Everquest has classes of warrior, mage, wizard, monk, ranger, druid, bard, shaman, and rogue among others Additionally, players choose their avatar s race, gender, and cosmetic characteristics As players progress they can change other factors such as skill sets, spells, weapons, and armor These factors may or may not have an impact on gameplay but can change how they are viewed by other players 6 Criteria of a MMORPG Hussain & Griffiths (2009) Persistence always online Physicality a virtually real place Social Interaction engaging with others

2 Player Representation avatars Vertical Gameplay characters develop and change Perpetuity no end point Who Plays MMORPGs Accurate measures can be difficult due to anonymity Popular misconception of the gamer geek is no longer applicable Approximate measures suggest: 60-80% of users are male depending on the study Average age is 31 years old (range 12-65) 19% are % are married or engaged 74% are college educated mean household income of 84,000 >50% work full-time / 12% work part-time Average play = hours per week females more than males Mental and physical health differ MMORPG Population As a country, World of Warcraft would rank as the 75th largest country in the world between Zimbabwe and Greece In 1999 paid MMO players would compare to the population of Barbados in 2012 they are comparable to Australia All players (paid and free-to-play) is equal to the size of Germany Addictions Chemical Additions Alcohol, heroin, crack, etc. Process Addictions Gambling, sex, shopping, Internet, etc. Chemical vs. Process Addictions Addiction is a common catchall for compensatory behaviors with consequences easy to define or know it when we see it Chemical vs. process/behavioral/psychological addictions Tolerance & withdrawal Process Addictions In 2011, the American Society of Addiction Medicine formally added process addiction in their definition A chronic disease involving brain reward and motivation Characteristics of addiction include: Negative consequences related to use A pattern of use, remission, and relapse Inability to control use or abstain Cravings for use

3 Online Addictions Defined as compulsive overuse of the Internet (in its many forms) despite consequences characterized by building and release of tension Related heavy Internet use to Problematic Gambling First large scale studies estimated prevalence of heavy Internet use at about 6% of users Additional studies suggest as high as 15% College students appear to be in highest risk group at 13%- 18% Online Gaming Addiction Fastest growing process addiction Prevalence estimated to be 7-12% of gamers What defines online gaming addiction The Playing Time Myth Relationship to consequences Preliminary tests show on several measures that compulsive online gamers follow similar patterns as those who have other more familiar addictions. Jellinek chart gamers see similar patterns Brain activity and reactions suggest there is withdrawal syndrome present Physiological and psychological reactions irritability, anger, postplay depression Research is sparse and often contradictory Mostly qualitative until the past three years Quantitative research has surfaced - shed light on some of the issues such as demographics, relationship to addiction, diagnosis, treatment, and comorbidity Real world negative consequences linked to excessive online gaming Divorce, failure in school, neglect, hygiene, loss of job, etc. Similarities Compulsive (ingestion vs. behavior) Domain specific Cravings Tolerance & withdrawal Ego-syntonic to ego dystonic Consequences Differences Motivation to persist Chemical euphoria produces a reinforcement Connection to identity and self-worth

4 Etiology Cognitive- Behavioral Model Features core components of addiction Salience Mood modification Tolerance Withdrawal Conflict Relapse Davis (2001) went a step further suggesting maladaptive thinking/coping patterns were part of the core issue (overgeneralizing, catastrophizing, minimizing, etc) Neuropsychological Model Not fully substantiated but appears that dopamine levels rise in behavioral addicts much the same as physiological use Brain neuropathways of reward and motivation Primitive drive to pleasure/away from pain Internet use Euphoric experience Numb experience Repeated use/tolerance Maladaptive coping styles Compensation Theory Internet used as a way to cope with deficits in self-esteem, identity, relationships, other perceived or real weaknesses Loneliness scales, Social intimacy Anonymity protects/frees the user Escapism Situational Factors Increased reliance on Internet use during times of life change or development usually associated with increased stress Divorce, change in job, going to college, etc. Viewed as a stress response adaptation No one model exactly fits Continued effort to create a catchall but appears that differing theories may be better attributed to more specific uses (gaming, gambling, sex, etc.) Further research needed to better understand motivational factors, family history and dynamics, personality, and comorbidity play roles Motivation to Play What draws people to play these games? What perpetuates continued play despite consequences? Motivations to Play 3 Primary Motivations for Play Yee s Typology Achievement

5 Advancement, Mechanics, Competition Working to progress avatar to be optimized Top level Best armor and weapons Accomplish hard to reach feats Virtual Skinner Box always a reward around the corner Social Socializing, Teamwork, Relationships Team up with other players to quest together Join guilds for many reasons Meet new people Become intimate with others Create and maintain a vast social network Correlated with extended play time but not necessarily dependency Immersion Discovery, Role-Playing, Escapism, Customization Exploration of the huge game world Role-play the player s avatar to others Closely identifying with the personification created online More closely correlated with dependency particularly escapism sub-component Dualistic Model of Passion Posited by Vallerand, et al (2003) derived from Self-Determination Theory (Deci & Ryan, 2000) Attempt to understand why some become addicted to behaviors while others do not People self-select activities that feel comfortable and fulfill psychological needs (autonomy, relatedness, & relatedness) Behaviors become part of one s identity (a runner vs. running) Two types of passion Harmonious Passion Freely chosen and willingly engaged in behavior Can be desired but also let go Behavior does not persist in unreasonable circumstances or despite consequences Obsessive Passion Behavior is controlled Driven by values, needs, self-esteem, desire, and connection to identity Internalized and becomes part of the personality

6 Behavior persists despite consequences or circumstances that are unfavorable or even dangerous Current Study Diagnosis Disagreement amongst professionals as to if this may qualify as an addiction Currently not on the list to be added to the DSM-5 but was under consideration Gaming Addiction is being viewed as a subset of general Internet Addiction or Problematic Internet Use no clear definition yet Current best diagnosis Impulse Control Disorder NOS Conceptually, it will fall into the compulsive-impulsive spectrum of the DSM-5 3 subtypes: excessive gaming, sexual preoccupation, /text messaging All share 4 components Excessive use Withdrawal Tolerance Negative consequences Comorbidity Online Gaming Addiction is highly correlated with: ADHD Substance abuse issues Bipolar disorder Obsessive-compulsive disorder Additionally have lower than average self-esteem and social skills Denotes the need for holistic and comprehensive treatment plans Assessment Young (2009) developed the Internet Addiction Diagnostic Questionnaire for online/internet addiction that relates specific to DSM-IV chemical addiction criteria Kim & Kim (2010) - developed the Problematic Online Game Use Scale - a specific assessment for online gaming addiction Vallerand (2010) developed a scale for dualistic model of passion which has been linked to addiction Treatment Models Cognitive Behavioral Therapy Teach clients to monitor thoughts and identify triggers Teach alternative coping skills Behavioral components

7 Computer and non-computer behavior observation Specific or generalized use Treatment Models 12 step program Online Gamers Anonymous Dedicated inpatient and outpatient facilities are beginning to be built devoted specifically to Internet and technology based addictions If no therapist that specializes in this discipline is available and no treatment groups are near some general 12 step treatment facilities are willing to take online/technological addiction clients Several concerns and considerations Other types of therapy or techniques recommended Social Cognitive Theory learned self-regulation Cognitive Behavioral Therapy Systems Therapy Diagnosis and treatment of comorbid disorders Support groups Psychopharmaceutical Skills training Holistic wellness Emotional regulation Stress management