Antonius J. van Rooij

Compulsive Internet Use: The Role of Online Gaming and Other Internet Applications

PURPOSE Increasing research on Internet addiction makes it necessary to distinguish between the medium of Internet and its specific applications. This study explores the relationship between time spent on various Internet applications (including online gaming) and Compulsive Internet Use in a large sample of adolescents. METHODS The 2007 (N=4,920) and 2008 (N=4,753) samples of a longitudinal survey study among adolescents were used, as well as the 2007-2008 cohort subsample (N=1421). Compulsive Internet Use was predicted from the time spent on the various Internet applications in two cross-sectional multiple linear regression models and one longitudinal regression model in which changes in behavior were related to changes in Compulsive Internet Use. RESULTS In both samples, downloading, social networking, MSN use, Habbo Hotel, chatting, blogging, online games, and casual games were shown to be associated with Compulsive Internet Use. Off these, online gaming was shown to have the strongest association with Compulsive Internet Use. Moreover, changes in online gaming were most strongly associated with changes in Compulsive Internet Use over time for the longitudinal cohort. CONCLUSIONS A clear relationship was shown between online gaming and Compulsive Internet Use. It is further argued that a subgroup of compulsive Internet users should be classified as compulsive online gamers.

Internet addiction in adolescents: Prevalence and risk factors

As new media are becoming daily fare, Internet addiction appears as a potential problem in adolescents. From the reported negative consequences, it appears that Internet addiction can have a variety of detrimental outcomes for young people that may require professional intervention. Researchers have now identified a number of activities and personality traits associated with Internet addiction. This study aimed to synthesise previous findings by (i) assessing the prevalence of potential Internet addiction in a large sample of adolescents, and (ii) investigating the interactions between personality traits and the usage of particular Internet applications as risk factors for Internet addiction. A total of 3105 adolescents in the Netherlands filled out a self-report questionnaire including the Compulsive Internet Use Scale and the Quick Big Five Scale. Results indicate that 3.7% of the sample were classified as potentially being addicted to the Internet. The use of online gaming and social applications (online social networking sites and Twitter) increased the risk for Internet addiction, whereas extraversion and conscientiousness appeared as protective factors in high frequency online gamers. The findings support the inclusion of ‘Internet addiction’ in the DSM-V. Vulnerability and resilience appear as significant aspects that require consideration in further studies.

Error processing and response inhibition in excessive computer game players: an event-related potential study

Excessive computer gaming has recently been proposed as a possible pathological illness. However, research on this topic is still in its infancy and underlying neurobiological mechanisms have not yet been identified. The determination of underlying mechanisms of excessive gaming might be useful for the identification of those at risk, a better understanding of the behavior and the development of interventions. Excessive gaming has been often compared with pathological gambling and substance use disorder. Both disorders are characterized by high levels of impulsivity, which incorporates deficits in error processing and response inhibition. The present study aimed to investigate error processing and response inhibition in excessive gamers and controls using a Go/NoGo paradigm combined with event‐related potential recordings. Results indicated that excessive gamers show reduced error‐related negativity amplitudes in response to incorrect trials relative to correct trials, implying poor error processing in this population. Furthermore, excessive gamers display higher levels of self‐reported impulsivity as well as more impulsive responding as reflected by less behavioral inhibition on the Go/NoGo task. The present study indicates that excessive gaming partly parallels impulse control and substance use disorders regarding impulsivity measured on the self‐reported, behavioral and electrophysiological level. Although the present study does not allow drawing firm conclusions on causality, it might be that trait impulsivity, poor error processing and diminished behavioral response inhibition underlie the excessive gaming patterns observed in certain individuals. They might be less sensitive to negative consequences of gaming and therefore continue their behavior despite adverse consequences.

How can we conceptualize behavioural addiction without pathologizing common behaviours

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

A critical review of "internet addiction" criteria with suggestions for the future

Aims: In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome. Methods: Three popular models of IA were discussed: Griffith’s components model; Young’s Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field. Results: The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans. Conclusions: We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents

Abstract Aims: The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use. Methods: Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking). Results: Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users. Conclusions: It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers – specifically boys – showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

Video Game Addiction Test: Validity and Psychometric Characteristics

The study explores the reliability, validity, and measurement invariance of the Video game Addiction Test (VAT). Game-addiction problems are often linked to Internet enabled online games; the VAT has the unique benefit that it is theoretically and empirically linked to Internet addiction. The study used data (n=2,894) from a large-sample paper-and-pencil questionnaire study, conducted in 2009 on secondary schools in Netherlands. Thus, the main source of data was a large sample of schoolchildren (aged 13-16 years). Measurements included the proposed VAT, the Compulsive Internet Use Scale, weekly hours spent on various game types, and several psychosocial variables. The VAT demonstrated excellent reliability, excellent construct validity, a one-factor model fit, and a high degree of measurement invariance across gender, ethnicity, and learning year, indicating that the scale outcomes can be compared across different subgroups with little bias. In summary, the VAT can be helpful in the further study of video game addiction, and it contributes to the debate on possible inclusion of behavioral addictions in the upcoming DSM-V.

Video game addiction and social responsibility

In recent years, several studies have demonstrated that at least a small group of gamers has trouble controlling their online video game playing. Excessive amounts of time spent on playing online video games can be severely disruptive to school, work, and “real life” social contacts. It seems that online games, especially multiplayer online role playing games, are more often associated with video game addiction. Drawing parallels to other industries–such as gambling–which are heavily regulated, the issue of social responsibility of the video game industry is explored. Presently, online video game publishers provide neither referral services nor customer care with regards to video game addiction. In our opinion, a dual approach is necessary. Firstly, consumers should be informed about potential addiction risks that can be attributed to playing online video games. Secondly, game publishers should implement proper referral services. Providing customer care and referral services might be in the best interest of the video game industry at this point, as it may very well prevent revenue restricting governmental intervention. Therefore, taking action on the issue of social responsibility will benefit both the customer–who will be informed and properly referred–and the game industry alike.

Treating Internet Addiction With Cognitive-Behavioral Therapy: A Thematic Analysis of the Experiences of Therapists

In 2009, one of the major Dutch addiction care organizations initiated a pilot program to explore the possibility of using an existing Cognitive Behavioral Therapy and Motivational Interviewing based treatment program (‘Lifestyle Training’) to treat internet addiction. The current study evaluates this pilot treatment program by providing a qualitative analysis of the experiences of the therapists with the treatment of 12 self-proclaimed internet addicts. Therapists report that the program, which is ordinarily used for substance dependence and pathological gambling, fits the problem of internet addiction quite well. Interventions mainly focused on controlling and reducing internet use, and involved expanding (real life) social contacts, regaining a proper daily structure, constructive use of free time, and reframing beliefs. Therapists further indicated that the treatment achieved some measure of progress for all of the 12 treated patients, while patients reported satisfaction with the treatment and actual behavioral improvements.

Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.