Category Archives: Addiction

Methamphetamines, cravings and relapse: in Second Life

UCLA have undertaken a fascinating study within Second Life, using it as an immersive environment to replicate scenarios around methamphetamine use and the triggers those scenarios provide in relation to cravings and potential for relapse.

Read the full details here, plus there’s a short introduction video here. The preliminary outcomes of the study showed that the simulation is proving more effective for cue exposure than traditional methods such as videos and use of drug paraphernalia such as needles, syringes and preparation implements. There’s planned future research on looking at what treatments work best to reduce cravings, using the simulation as the benchmark measurement.

Aside from the obvious benefits this approach is going to bring for improved treatment interventions, some other key points need to be made:

Simulation is more than hospitals: There tends to be a focus on the use of virtual worlds to simulate hospital and paramedical environments. Those aspects are very important, but being able to replicate community environments where problematic behaviours occur, is an equally rich vein to mine as a health professional.

Virtual can be better than real: One of the preliminary outcomes mentioned was that the simulation demonstrated better cue exposure than just interacting with drug paraphernalia. This seems a little counterintuitive, but with illicit drug use in particular, the environment surrounding the use is a pivotal component, so replicating such an environment, if done authentically, is going to beat a counselling room with syringes and spoons every time. There is an enormous number of health issues where the same applies, meaning that not only can costs of interventions be lowered in some circumstances, but efficacy can also be improved.

World of Warcraft Addiction: send in the field teams

Wow-July2009 The UK’s Telegraph newspaper has run a very interesting article on the issue of addiction and World of Warcraft.

The key quote for me from the article, from Consultant Psychiatrist, Dr Richard Graham:

He has called on Blizzard Entertainment, the company that makes World of Warcraft, to waive or discount the costs associated with joining the game so that therapists can more easily communicate with at-risk players in their preferred environment.

It’s not an unusual perspective in addictions, but I have some doubts in the efficacy of it in relation to World of Warcraft. If the aim is purely initial engagement, then this could be a successful approach. It’s unlikely the intention is to provide actual treatment, As mentioned by Dr Andrew Campbell in his recent interview with me, there’s not a lot of evidence to support treatment within what is the primary stimulus for the issue.

At the end of it, it’s also hard to imagine Blizzard coughing up a bunch of free accounts for practitioners – it’d potentially be a PR nightmare. Also, the health professionals may stand out a little if they don’t understand the dynamics and social etiquettes of the game. Of course, the only way they can do that is by spending time in-game. Perhaps there needs to be a Blizzard-sponsored WoW training program for health professionals?

Interview: Andrew Campbell – Director of Prometheus Research Team, University of Sydney

Update (July 2014): I had the opportunity to check in with Andrew and he’s confirmed the below interview still represents the state of play in regard to the opportunities gaming can bring. Additionally, he recommended a resource he’d been involved in which outlines the use of technology in promoting young people’s wellbeing. You can access that here.


Over the past couple of years I’ve had the opportunity to chat with Andrew Campbell on a couple of occasions. As Director of the Prometheus Research Team, Andrew is heavily involved in the area of mental health and technology. I’ve always been struck by Andrew’s objective view of gaming and virtual worlds, which he rightly sees as simultaneously providing significant opportunities and challenges.

I caught up with Andrew to discuss his work and perspectives on mental health, gaming and immersive virtual worlds.

DH: Can you describe the main focus of your clinical work?

AC: The main focus of my clinical work is divided into two categories. Firstly, research. My primary job is an academic researcher and teacher in the field of Psychology. I conduct research particularly in the area of Cyberpsychology, which is the study of how technology is impacting human behaviour, both in good and bad ways. Secondly, I am a general practice psychologist who specialises in child and adolescent mental health and behavioural problems. My clinical work to date has been focused on treating children with ADD/ADHD, anxiety and depression, conduct problems, as well as parental counselling and family therapy.

DH: What led your career to the stage it is at today – what got you into the issue of mental health and technology?

AC: In 1997 I was finishing my undergraduate degree in Psychology and Education at The University of Sydney and decided to spend some time in the United States working as a teaching assistant at a few universities. I became captivated with work being done by a handful of academic psychologists in the US at the time who were focusing on how the internet was going to be a revolution to impact human behaviour and society at large.

Campbell_Andrew I read everything I could get my hands on at the time to do with online relationships, virtual societies and even gaming communities that were developing international reputations and new cultures in cyberspace. I asked myself at the time ‘could this be the start of a new movement in human enrichment?’ and set forth to find out the good and the bad (and the down-right terrible) aspects of spending a lot of time engrossed in an online world, be it chat, gaming, shopping, finance, politics etc. Thus, my interests turned toward career aspirations to develop psychological research and an applied track record in the use of information communication technology and the use of other technologies in helping the ‘human condition’.

DH: Arguably the number one and two areas of broader public interest with mental health and technology is gaming and violence and addiction. What percentage of your work is spent dealing with actual or perceived issues in those areas?

AC: To date, my clinical work as a generalist psychologist in child and adolescent mental health has only touched lightly on these issues. I have mainly dealt with traditional mental health concerns of parents over their children, but of those clients I have seen about gaming violence and addiction, I’ve noted that the parents themselves do not know anything about the games their children are playing. They tend to have a view that all games are violent or addictive. Given this, I normally direct parents to learn more about what their kids enjoy about their game in order to learn more about behaviours they may be modeling from the game. For example, two of my client’s parents had no idea that strategic games such as ‘Age of Empires’ actually have huge cognitive and historic learning benefits. The game is akin to modern day chess, with historical lessons of ages past. Other games that promote team play
increase problem solving skills in a collaborative environment, therefore promoting team work and clear communication strategies.

Adversely, some team playing games are based on a violent theme, such as the popular game ‘Counter Strike‘. Overall, through my work I’ve found that parents do have concerns about violence and addiction to games, but really do not have an understanding of games themselves. This is troubling in an age where gaming is increasing in popularity across generations and content is still not regulated well by Government or other ‘watchdog’ agencies. As such, parents need to be cognisant of the types of games out there – their pluses and minus points – and be involved in selecting and learning about the titles with their children in order to curtail negative behaviours related to certain genres.

DH: The issue of technology and its influence on behaviour has been around for decades, with the TV / Film and violence link being hotly debated for most of that time. Before we get onto gaming / virtual worlds, is there yet any empirical agreement on TV/Film and violent behaviour?

AC: As surprising as this may sound, no, there is not any empirical agreement on TV/Film and violent behaviour in contemporary society. Incidents such as the Columbine School Massacre and more recently, the Virginia Tech shooting have led psychologists to argue for renewed policies censuring violent films and TV shows from minors and suggestible personality types. Although games are becoming a popular target for connecting atrocious violent crimes to the perpetrator, TV and Film are still front runners in the causation of violent behaviour in, not just the younger population, but the population in general.

DH: The popular media perception of gaming is that there is at least an anecdotal link between the regular playing of violent games and violent real-life behaviour. From your work, have you seen any evidence of this?

AC: Unequivocally, no! To say that violent games or even violent TV/Film is causation for a violent crime is ludicrous. I won’t go so far to say that violent games, TV or Film have zero impact on violent crimes, but to look at it as a sole causation does not address the pathology of the individual to begin with, let alone motive to carry out the behaviour that may lead to a crime. Ergo, playing a violent game is no more likely to trigger someone’s violent behaviour than eating your favourite food is going to motivate you to become a chef! In my private practice, any child who has presented with conduct disorder or oppositional defiant disorder, or even anger management problems, may or may not have been a gamer – however – all have had pathology and environmental problems that
have led to their disorder that are more consistent and pervasive than just playing a violent video game a few hours a day.

DH: Is there actually an argument that gaming can have an ameliorating effect on real-world behaviour and if so, is there research supporting this?

AC: Yes, a number of studies have shown wonderful results helping people to ameliorate either behaviour or, in some cases, the management of pain. My own research has looked at how biofeedback video games that encourage the player to control a task on a screen using their breathing technique, has led to improved attention and relaxation strategies in ADD/ADHD children. Other research has shown that virtual reality games that are immersive can actually help in the treatment of PTSD. One of the best breakthroughs in serious games has been the treatment of burn victims from the current Iraq and Afghanistan wars. These patients have to undertake pain dressing changes and skin grafts. During these procedures, the patient plays a game called ‘Snow world’ which immerses them in an environment that triggers their subconscious into believing they are in a cool and calm environment that distracts them from the pain of the treatment they are receiving. The research in all these examples is very new, but compelling. It is beginning to influence the game developers in entertainment to consider the market for ‘serious games’. This has already commenced with popular programs such as the Nintendo Wii releasing Wii fit and associated sports programs to tackle obesity.

DH: In regards to addiction and online gaming or virtual world environments, what’s your overall take?

AC: My overall take on addiction is that it is possible in either the virtual world or gaming environments online. What needs to be clarified is what aspects of these activities and functions are ‘addictive’. To say we are addicted to the Internet is like saying we are addicted to shopping – what items are we addicted to? The internet houses many areas of interest. It is obvious to posit that sex addiction offline could also be met online, as could be gambling. But gaming offline vs gaming online has different stimulus effects I would theorise.

Also, virtual worlds – what do we gain in socialising in these worlds that we don’t in our offline world? Is there such a thing as addiction to socialising?! Most likely not, because socialising is part of being human. Therefore, what is the attraction to these worlds that stimulates us highly enough to spend hours online engaging with strangers vs. meeting strangers in the offline world? The answer probably lies somewhere between the functions of pursuing anonymity, creativity, cerebral connections and/or reducing the chance of being socially awkward – all reasons one person may prefer the online world.

DH: If addiction is only quantifiable in a small component of the population, is that component larger or smaller than other behaviours such as substance use, gambling etc?

AC: I think if we look at gaming addiction in comparison to substance use, for example, we can quickly conclude that substance abuse is both physically and psychologically damaging and perhaps more wide spread globally across ages, genders and cultures. But the damage of gaming addiction is growing in certain cultures, such as in Asia where gaming is an accepted pasttime for all ages and genders and thus could be on the rise without society realising it since it is not an illegal behaviour or even an invasive or obviously destructive past time compared to drug taking.

prometheus However, it is psychologically damaging both in psychosocial relationships, employment responsibility and accountability and can even affect our general health to a large degree. You might therefore say that although substance abuse and gambling are faster and
harder-hitting addictions, gaming addiction is fast becoming a contemporary societal problem that is slow to build in destructiveness,
but easier to ignore.

DH: For those who do require actual treatment for addiction, what’s your take on the use of online treatment when the issue is related to online behaviour i.e. addressing the traditional view that you can’t use the mechanism for facilitating addiction to treat the addiction itself.

AC: One of the earliest therapies provided online by Psychologist, Dr Kimberly Young, was treatment for online addiction. She began this service, online, in the early 1990’s. Although it has been a growth industry for Dr Young and others who believe in her treatment modality, I personally find it to be flawed therapy and lacking in best-practice evidence. Addiction, be it to specific functions of the internet, gaming, substance abuse, gambling etc, is an extremely difficult pathology to treat, let alone treat well. Therefore, all scientific practice indicates that addiction therapy should be done in a face-to-face or group counselling environment. It requires ongoing resource support utilising mentors, friends and family. It is something that may (but only in very specifically suitable cases) use the internet as a support tool, but in all other regards addiction, especially to internet functions and gaming, should be done away from the primary stimulus.

DH: With growing immersiveness in gaming and in virtual worlds more broadly, what do you see as the mental health challenges and opportunities?

AC: Research right now is looking out how we can harness immersive environments, be they virtual worlds or games, for tackling problems in health, behaviour and education. The challenges we face at the moment are actually not to do with the quality of the environments being delivered to consumers over the internet or through off-the-shelf games, but more through the cost of developing serious games or health purpose virtual worlds by the commercial sector. In addition, we are facing a health professional vs tech industry challenge in trying to have these two expert bodies effectively harness the ideas that are scientifically based delivery of health interventions. In short – the health professionals need to learn more about the tech industry and vice versa. Once this bridge is finally built, I believe we will be entering a new error of technology consumerism – games for wellbeing and ICT for personal health management.

Book Review: The Multiplicities of Internet Addiction

Johnson – The Multiplicities of Internet 2a1

Nicola Johnson from the University of Wollongong in Australia, recently released a book titled The Multiplicities of Internet Addiction – The Misrecognition of Leisure and Learning. It’s an engaging read, not least for the very objective look it takes at the concepts of internet addiction and framing the issue within the realities of a net-connected society that has changed immensely in the past twenty years or so.

Bourdieu’s Theory of Practice is the frame for the qualitative study of eight New Zealander teenagers and the illumination it provided on the perception of technology use amongst those who’ve know no different (digital insiders), those who haven’t (digital newcomers) and those who are plain not interested (digital outsiders). Additionally, there’s some fascinating discussion on how expertise is being developed by digital insiders and how this expertise is at best partially gained from the traditional educational institutions in place at present.

It’s the elaboration of the experiences of these eight teens that allow Johnson to weave in a great deal of the substantive research that’s occurred into the nature of addiction in regard to online activity. There’s no assertion of internet addiction as non-entity, just a much smaller subset of use than usually claimed. As contributing writer Feldspar Epstein has written previously in relation to heavy use of virtual worlds by people with disabilities:

Can you imagine telling someone with no legs to forsake their wheelchair? How about someone with a pain disorder? Are you going to tell people with crippling mental disorders that they are not allowed to take drugs to normalize and enable them? Are you going to tell deaf people they can’t use Teletype in place of the telephone?

Each of these technological advances were radical in their time; some of them were seen as being destructive, to society or to the individual. It’s hard to imagine any of these people being denied their enabling technologies in today’s first world society (one hopes). I hope to live in a future where my enabling computer habits are accepted.

Johnson’s assertions based on a thorough exploration of the literature, reveal a similar conclusion: internet addiction does exist, but when the preconceptions of digital newcomers and digital outsiders are removed from the equation, the prevalence of internet addiction seems pretty limited indeed. As Johnson concludes:

Digital outsiders (and some digital newcomers) find it unfathomable to understand the preoccupation that digital insiders have with their online lives. Because it is not what they did in times gone by, they find it difficult to understand the value, worth and social capital received by avid users in what appears to be an unhealthy obsession. As I have argued, these practices are not only misrecognized as obessions or addictions, but they are misunderstood.

This book’s research base means it’s more likely to be consumed and digested by those who are doing research or study in the area themselves. Which is a shame, as the discussion deserves wider recognition and debate. Work like this balances out some of the excesses on the mainstream media side of the equation. It’s only a lack of dissemination of this perspective that will ensure the sensationalism camp prevails for some time to come.

You can purchase this book from our online bookstore, Amazon direct or direct from the publisher.

China: name registration for gamers

As reported on Ars Technica, China are taking some interesting steps to battle MMO addiction. Ignoring the hyperbole around the issue, it poses some interesting discussion points around the role of governance in regards to virtual worlds.


In the tightly controlled society of China, compulsory registration is rightly or wrongly more achievable than most other countries. Even then, once widespread registration is achieved, what happens next? Who determines what level of MMO use constitutes addiction? How much money needs to be expended on monitoring registered users that could be spent on treatment and prevention services to stop the issue occurring in the first place and to support the small percentage of MMO players who are truly addicted?

Ars Technica in their article make a pretty uninformed call by stating “the problem has gotten so severe” – there’s no way of knowing how large the Chinese problem is, or whether the main issue is the Chinese Government’s perception that there’s a problem. That perception could be based on some non-health issues like needing to maintain control and a lack of insight of what MMOs offer.

Like any addiction, there’s an enormous number of idiosyncrasies and challenges that aren’t resolved effectively by top-down, generic approaches. Registration per se may not be inherently undesirable, but basing policy on stereotypes and fear isn’t likely to achieve a lot of good.

What do you think? Is registration likely to bring some benefits or is it just another blunt mechanism of control?

The rise and rise of the Game Widow

This article in the Canadian publication, the London Free Press, describes in detail a couple of case studies of gaming addicts. The case studies themselves paint a fairly standard picture of someone with a compulsion for intensive gaming, though some effort has been made to provide balanced coverage of the issue.

The premise of the article is the establishment of a support service for gaming addicts in London, Ontario – apparently the first such group in Canada. What caught my eye was that the wife of one of the addicts described in the article, Wendy Kays, has written a book called Game Widow. (we’ll hopefully be reviewing the book soon).

The term ‘game widow’ has been around for years and it’s increasingly resonating with the broader public. It further emphasises the need for more research in the area as well as a vigilance toward not typecasting all gamers as addicts. Terms like ‘game widow’ also accentuate the gender divide in some gaming genres. There are surely ‘game widowers’ out there but they’re likely to be in a distinct minority.

One final comment to the author of the article – online roleplaying did not begin with Everquest in 1999.

Vietnam’s online addiction courses

I noticed this interesting news article at the Thanh Nien Daily.

Essentially, it’s an intensive course running on weekends for two months. On the face of it it seems a useful option for those with issues impacting their lives detrimentally. Looking a little closer though, and the alarm bells start ringing. Take this for example:

During treatment, teens will work with psychologists and health experts to improve their self esteem; develop other interests and teamwork skills; and learn how to avoid temptations.

There’s some big assumptions there on self-esteem and the approach seems very conservative: ‘avoiding temptation’. It’s a tone that will appeal to parents but one that’ll concern the actual target group. The even more obvious question is: who is assessing that the teen is addicted? What assessment criteria are being used?

On the positive side, there does seem to be a little more than the 21st Century equivalent of an AA meeting:

Also included in the program is a “Box of Emotion” where each student is encouraged to write out their emotions and thoughts since the beginning of the program. The box will be opened in the course’s sixth week with participation from the students’ parents.

The treatment approach seems to be one of reality checking with some real-world skill building:

“Most online game addicts fail to face the real world but want to become ‘heroes’ in the virtual world,” Lien said. “[Through the program] we hope to bring them back to the real world and help them discover their own abilities.”

There’s even some good old community and family work involved:

Parents also take part in other social activities with their children like washing their own shirts to donate to disadvantaged students through charitable organizations.

Will it work? Possibly, though to some participants it will feel like hell on earth for the duration. My main concern is defining where intervention actually needs to occur. Forcing people into treatment where there’s no true issue is not a lot different from sending someone to prison for jaywalking.

One ex-gamer’s perspective on MMO addiction

The individual ex-addict’s perspective has always held power, no matter the source of the addiction. In the MMO gaming sphere, a recent addition to the blogosphere is Run by a 40-year old Canadian guy and 44-year old Dutch woman, it’s a blog in its early stages but it does give some interesting personal insights from a Christian and 12 Step perspective.

Thanks to Adrian Bott at Massively for the heads-up. If you know of other sites providing personal addiction stories with a virtual world context, we’d love to hear from you.

I can quit anytime…

One MMO player’s perspective on addiction. A worthwhile read – nothing new or groundbreaking but it at least engenders some self-examination. On key piece of social research in the future will be work days lost to MMO game playing.
I’m aware of a few people who’ve called in sick to play World of Warcraft or Dungeons and Dragons Online – how about you?