#64. Six Reasons Why the Terms “Addiction” and “Disorder” Interfere with Understanding and Treating Problematic Internet Use

The analogy between problematic gaming or social media use and drug addiction is misleading and damaging.

David Wallace/Infinite Jest

Dear friends,

A few years ago, I took a walk in the woods with a psychotherapist I know, Mike Langlois, who enjoys video games and, as one of his specialties, works with clients who present with issues related to video gaming. (My favorite way of learning from people is to walk in the woods with them and ask questions as we walk.) I asked Mike, “So, how do you treat someone who comes to you saying he has a video gaming problem?” In answer, Mike described, in abbreviated form, a dialogue he might have with a client, which went something like this (note—I have checked with Mike, and he approves this memory):

Langlois: Tell me about yourself and why you are here.

Client: I’m a lazy slacker addicted to video games.

Langlois: What’s your favorite game now?

Client: Halo 3.

Langlois: What level have you reached in Halo 3?

Client: Level 9.

Langois: Wow! Level 9?! OK, we can rule out lazy. It takes hard work and concentration to reach Level 9 in that game. So, tell me what you mean when you say you’re “addicted” to gaming?

Client: People say I’m addicted. I spend too much time playing those games and not enough time doing other things.

Langlois: Ah. Now we’ve got something to work on. But, please, let’s not say “addicted.” That sounds too pathological and I’m not even sure it means anything in relation to video gaming. What you’ve got is a time management problem. Most of us have that, to a greater or lesser degree. We spend more time doing things we want to do at the expense of other things we maybe should be doing. So, if you agree, I’d be happy to work with you in figuring out how you might manage your time better, to put limits on your gaming and spend more time on other things that are important to you and the people you are involved with.

Sometime after that walk I downloaded Mike’s book entitled Reset: Psychotherapy & Video Games. Here’s a passage from it:

“I often hear gamers refer to themselves as “addicted” to video games, which is often a shorthand for an identification with the negativism they have picked up from popular culture and popular psychology. Even therapists who feign neutrality often convey this stereotype. … This stereotype presents the gamer as apathetic and avoidant of any work or investment. One thing we know about stereotypes is that they can be internalized and lead to self-fulfilling negativism, and I’ve come to hear gamers refer to themselves as lazy slackers. … Video games create experiences that can be challenging and frustrating, but engaging, nevertheless. This hard fun would not be possible if gamers were truly lazy or apathetic. And the level of detail that many gamers pay attention to is staggering, whether it be leveling a profession to 525 in WoW, unlocking every achievement in Halo 3, or mapping out every detail of the EVE universe. This is not apathy, this is meticulousness.”

Ever since 2018, the American Psychiatric Association (APA) has been considering adding Internet Gaming Disorder (their term for what others call video game addiction) to the next edition of their official diagnostic manual of mental disorders. The idea is highly controversial. Many researchers involved in studying the effects of video gaming object to the proposal. For example, shortly after the APA proposed adding this new “disorder” to their manual, 38 researchers signed onto a statement arguing against such an addition (here).

There is also, in recent years, a growing tendency to apply the term “addiction” to some people’s use of social media. To see how prevalent that tendency is, I just now conducted a search for articles with the term “social media addiction” in the title or abstract in an academic database of articles relevant to psychology (PsychINFO) and got 995 hits. The concept of “social media addiction” is controversial among researchers for the same reasons that apply to “video game addiction.”

In examining the controversy, I’ve become convinced that Mike Langlois and the many others who urge us to avoid the term “addiction” or “mental disorder” in relation to problematic gaming or social media use are correct. Here are six reasons why.

1. False Analogy to Substance Addictions

The term “addiction” has clear meaning when it comes to addictions to drugs are alcohol. You become physiologically dependent. After heavy prolonged use, you suffer clear, painful withdrawal symptoms when you try to stop. When authority figures describe heavy involvement with video games or social media as an addiction, many people assume it involves physical dependence, just like drugs. Indeed, some fear mongers (e.g. Kardaras, 2017) have promulgated the myth that video games or social media create addiction through the same brain mechanisms by which drugs such as heroin create addiction, for which there is no evidence. [If readers are interested, I will be happy to elaborate on this in another letter.]

2. Disempowering the Person Who Has a Problem

The term “addiction” connotes that the thing you are “addicted to” has power over you. You are weak and it is strong. This idea can become a self-fulfilling prophesy. Psychological research has shown repeatedly that people who have a sense of agency, of control, of empowerment, are much better at solving whatever problems they face than are people who have what psychologists call an “external locus of control,” that is, who feel they are controlled by forces outside of themselves. When Mike Langlois tells a client, “What you have is a time management problem,” he is telling them, “Hey, you can do this.” That’s the opposite of the implied meaning of, “You have an addiction.” Management is something you do; addiction is something done to you.

3. Stereotyping the Person Who Has a Problem

As Mike Langlois notes in the passage I quoted from his book, the term “video game addict” evokes a negative stereotype. So does the term “social media addict” (though it’s a different stereotype). Many very healthy and happy people spend lots of time playing video games or engaging with social media. Whether or not the gaming or social media engagement presents a realistic problem, some may incorporate the negative stereotype and believe it is a problem or, worse, that they themselves are defective in some way. In that case they suffer not from the gaming or the social media use but from the stigma unfairly attached to those activities. There is no reason why people shouldn’t feel as good about playing video games as chess masters do about playing chess, or why people shouldn’t feel as good about communicating and learning through social media as they do about communicating and learning through other means.

4. Implying that the Behavior is Causing the Problem When It May Be a Consequence of the Problem

Research repeatedly shows that some people who play video games a lot, or who use social media a lot, suffer from anxiety or depression (as do some people who don’t do these things). The “addiction” or “mental disorder” terminology, which pathologizes the behavior, makes it sound like gaming or social media use is the cause of the problem. Longitudinal studies, however, reveal that very often, arguably most often, the anxiety or depression precedes the heavy gaming or social media use.

Such research indicates that gaming or social media use can be coping behaviors for dealing with anxiety or depression. Far from causing the problem, they are ways that the suffering person is coping with an already existing problem. They may play games as a way of relieving their depression or anxiety or escaping some stressful situation, or they may be on social media as a way of finding remedies for what is bothering them or connecting with others when they are too depressed or anxious to connect in person. If the depression or anxiety is extreme, such individuals may properly be diagnosed as having a disorder—Major Depressive Disorder or Generalized Anxiety Disorder—but it would be highly misleading to say they have a gaming or social media disorder. In these cases, trying to reduce the gaming or social media use might be more harmful than helpful. What these people need is help in identifying and dealing with the real causes of their depression or anxiety.

5. Demonizing the Activity and Promoting Bans, Especially for Kids

The idea that video games and social media are “addictive” gets incorporated into the moral panic push (see Letter #62) to ban them for people under a certain age. We prevent kids from buying alcohol or cigarettes (not very effectively), so—the argument goes—we should ban them from social media or some video games. Some crusaders even go to the extreme of saying we should prevent kids from having smartphones at all.

The demonizing leads to exaggeration of the harm that some kids have experienced from these activities and a tendency to ignore the value kids get from them. As a society, we have an almost knee-jerk tendency to deprive all kids of something because it has been a problem sometimes for some kids. We have long been depriving kids of freedom to play and explore independently outdoors because sometimes (rarely) something awful happens because of such freedom (see Letter #53). Now some people want to deprive kids of freedom to play and explore on the Internet. This is one more way of disempowering kids. “You can’t be trusted with this; your brain is immature and inadequate.” This way of looking at kids, I have long argued, is at the core of the mental health problem for kids in recent decades (see here). We assume they are fragile and incompetent, and the assumption becomes a self-fulfilling prophesy. When I was a kid (pardon the expression), adults didn’t ban us from playing independently outdoors, in fact, they pushed us out, but they did teach us safety rules. That’s what we should be doing today with respect to both the outdoors and the Internet. Teach safety rules.

6. The Problem of Diagnosis

If you are going to call something a mental disorder, then you need some way of diagnosing it. The APA has developed, on a trial basis, a questionnaire for diagnosing Internet Gaming Disorder, which appears to be obviously inadequate. Research studies using this questionnaire have produced wildly varying estimates of the percentage of regular video gamers who are “addicted” to gaming, ranging from as low of 0.6% (6 in 1,000) to as high 6% (some, with very loose interpretations, say even higher), and it is not at all clear that those who are diagnosed with the questionnaire have a serious problem. [If readers are interested, I would be happy to discuss the questionnaire and why it is problematic in a future letter.]

Concluding Thoughts

In most of my letters, I try to document ideas and arguments with citations to relevant research studies. I didn’t do that here, because I wanted to summarize in brief and readable form the main reasons for rejecting the “addiction” and “mental disorder” jargon in relation to Internet activities. A long article full of research citations could be written on each of the six points I’ve listed, and such articles have in fact been written on most if not all of them. Depending on reader questions and comments, I may follow up with more detail on one or more of the “reasons” I’ve described here in future letters.

As always, I invite you to comment. Your questions, thoughts, stories, and opinions are valued and treated respectfully by me and other readers, regardless of the degree to which we agree or disagree. Readers’ comments add to the value of these letters for everyone.

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With respect and best wishes,

Peter

Reference

Kardaris, N. (2016). It’s ‘digital heroin’: How screens turn kids into psychotic junkies. New York Post, August 27, 2016.