Andrew McNaughton LCSW, CADC, Symmetry Counseling Chicago

A recent Chicago Tribune article poses the question, “Are video games addictive?” The bulk of the article focuses on the experience of one young man, who described increasingly compulsive video game use to combat feelings of anxiety, depression, and isolation, and how he came to cope with his urges and find support with other problematic video game players. The rest of the article featured experts debating whether compulsive video game playing is an actual addiction disorder similar to alcohol/drug use disorders and gambling disorders, or if it is a maladaptive coping method for managing symptoms of mental health disorders such as depression, anxiety, trauma, and other disturbances.

The diagnostic criteria are essentially the same for all abusable substances, from tobacco to PCP. Substance use is likely problematic if it interferes with our ability to work or go to school, our relationships, our physical health, or our legal freedom. Impairment of daily functioning also strongly indicates a problem, as well as tolerance and withdrawal. Other than gambling, no other non-chemical compulsions are considered diagnosable disorders, according to the DSM-5.

If depression and anxiety can be a catalyst for a diagnosable substance use disorder, why are the same criteria not applied to other addictive/compulsive behaviors? Substance use disorder diagnostic criteria can be applied to nearly any compulsive behavior, and if said behavior is causing impairment and/or distress in our lives, then that behavior ought to be treated with the same seriousness as a drug, alcohol, or gambling addiction.

The question then is, how exactly do we treat these non-chemical addictions? For some behaviors, it may require achieving abstinence. There are 12-Step Groups for behavioral addictions such as Gamblers Anonymous, Pornography Addicts Anonymous, Computer Gaming Addicts Anonymous, and other compulsions where achieving moderation is unlikely, and one can eventually learn to cope with urges to engage in these activities.

What about compulsive behavior tied to everyday activities, such as consuming food? Compulsive overeating requires a different approach since we cannot just quit eating altogether. Managing this particular compulsion requires intricate planning to reduce risks of engaging in excessive and unplanned eating. This is part of the approach of Overeaters Anonymous and may be applicable to behavioral addictions centered around modern technology. While it may be necessary to abstain from compulsive and maladaptive video gaming, abstaining from all technology is nearly impossible. Use of modern technology can easily be a trigger to want to play video games, but it may be possible to manage urges through scheduling time throughout the day to check email and bank statements, pay bills, shop, etc., and then limit technology use to only essentials in a scheduled block of time.

This is just one possible approach that I am proposing to address a specific behavior. There is still little evidence for success rates of interventions for specific behavioral addictions. An alternative or supplement to 12-Step is the evidence-based SMART Recovery, which utilizes theoretical approaches that are proven to be broadly applicable for changing behavior. SMART’s Four Point Program offers a promising approach to overcoming behavioral addictions since the program’s emphasis is on thought and behavior change through self-management and personal empowerment techniques drawn from the Transtheoretical Model (also known as the Stages of Change), Motivational Interviewing, Cognitive Behavioral Therapy, and Rational Emotive Behavioral Therapy. Managing behavioral addictions may require openness to new approaches, as well as flexibility in finding treatment that suits our individual needs.

Symmetry Counseling has several certified addictions specialists on staff who can help you or someone you know address gambling, video games, compulsive spending, and other behavioral addictions, through a wide range of theoretical framework and clinical techniques.