Playing a game for 10 hours straight. Staying up late into the night to get to the next level. Skipping classes, work deadlines, and dinners with friends.
This kind of behavior may seem like hardcore gaming culture, but it actually may be more harmful—and pervasive.
Last year, the World Health Organization added gaming disorder to a draft of its latest revision to the International Classification of Diseases. Gaming disorder is defined as “impaired control over gaming,” which applies to people for who make gaming such a high priority than impairs important aspects of their lives.
The addition of gaming disorder will likely come as little surprise to doctors who have worked with patients with gaming addictions. But to the larger public, the issue has still largely escaped attention.
WHO doesn’t use the term addiction. But the behavior can cross into it, according to doctors familiar with the condition, when someone is unable to do things like maintain relationships or keep up with school or work.
Dr. Kenneth Woog, a psychologist in Lake Forest, Ca. who now treats gaming addiction, says he was initially unsure whether it was a real problem.
“In 2002, a lot of people laughing at it and scoffing at it, saying it was ridiculous,” he says. “But after doing my research in 2003 and 2004, I was pretty much convinced. I’d seen a few more clients and after I surveyed mental health professionals across the United States, I became convinced that it could be a real thing.”
Dr. Alok Kanojia, a psychiatrist based in Boston who also works with patients dealing with gaming addiction, notes that the problem can be difficult for some to accept because it’s more complicated than other addictions. There are chemical brain responses to alcohol, for example, that don’t exist with game addiction, he said.
That also means treatment is approached in a different way. That typically means taking a softer approach than abstinence.
“I think sobriety for gamers involves understanding why do you play the game?” Kanojia says. “To understand the drives behind the game, and to try to replace those drives with healthy alternatives.”
He adds that, in most cases, it’s entirely possible to play games and benefit from the experience. Both Kanojia and Woog say they continue to enjoy playing games and see numerous benefits to them.
Kanojia notes that video games are where children today go to socialize outside of schools. The malls of today exist online in games like Fortnite, the popular game that involves hunting down other players until you’re the last one standing.
Rather than removing video games entirely from someone’s life, like is typical for alcoholism or drug addiction, Kanojia says he largely works to find a balance for his patients. That means they can play for several hours a week, for example, as long as gaming doesn’t overtake their lives. However, there can be some cases in which playing games is no longer possible.
In addition to setting limits, treatment for gaming addiction often means continuing to see and work with a mental health professional. The continued work involves finding new, healthier alternatives to fill the time once filled by playing games and reversing the negative effects gaming has made on their lives.
In more drastic cases, some find themselves entering in rehabilitation facilities, either for technology addiction or gaming specifically, which have gained more traction in countries like China and South Korea.
Woog additionally advises the importance of addressing the issue early. Gaming addiction often starts in adolescence in situations in which a child isn’t given proper boundaries for playing, he says. This often isn’t because of bad parenting, either. In many cases parents are unaware.
“It’s really rigged against the parents,” Woog says. “It’s a new world. We have to empower them to be able to establish limits in their home based on their values.”
The problem is then easily exacerbated when players leave home, either to live on their own or to go to college. The stress of a new situation and the pressures of school can cause players to succumb to addiction.
It’s a scenario Kanojia knows intimately. Before he began working on treating gaming addiction, he found himself playing consistently in high school before his gaming reached a breaking point in university.
“I basically had less than a 2.0 GPA after two years of college because I was just playing a bunch of video games every night,” Kanojia recalls. “I was on academic probation, really trying to figure out what was going on and didn’t understand why some days I would wake up and be able to go to class and then other days not.”
He continued: “I remember freshman year, I had a Spanish final, and I woke up in the morning, then like looked at my clock and just decided not to go to class and take my final. I ended up failing the course.”
After being put on academic probation, Kanojia says left school and spent several months in India studying yoga and meditation.
“I started to study myself, and figure out how games interact with me, what is it about the game that I really like, why can’t I wake up in the morning?” he says.
Eventually, Kanojia returned to school before attending medical school and studying psychiatry.
However, traveling to another country isn’t necessary.
Woog has advised patients to use a specialized gaming computer that limits how long they can play. He and Kanojia also recommend that parents take an active role in monitoring playing by their children and how much they can spend on microtransactions, or small in-game purchases, so that it doesn’t spiral out of control.
For adults living on their own, Kanojia suggests focusing on their goals and what they want their lives to be like. Then, they should consider whether those things are possible with how much they’re currently playing video games.
Some gaming companies have already made efforts to curb gaming addiction by building in reminders to users to take a break. It’s something Nintendo, whose audience tends to skew a bit younger, has implemented for several years now.
Nintendo of America president Doug Bowser emphasized to Fortune that many of the company’s games on its Switch console have code written into them that reminds players to take a break. There are also parental controls that can limit the amount of time children can play.
“It’s a great conversation, and I think the industry will become stronger as we have this conversation,” Bowser said. “I don’t think it’s my place to judge how other companies should behave and what they should be doing, but I am pleased to see what Nintendo’s doing in this area and how we’ve been approaching it.”
Above all, both doctors emphasize the general public should become more aware of the issue without stigmatizing gaming.
“I still play video games and I still enjoy video games,” Kanojia says. “I don’t think that they’re inherently evil or anything like that, but just like any other, I think people can get addicted to all kinds of things.”
