WHEN CHINA’S government censors books, bars “effeminate men” from television or spoon-feeds Communist Party dogma to schoolchildren, liberals agree that its behaviour is shockingly repressive. But when in August it banned children from playing video games for most of the week, liberals who happened to be parents were in two minds. Yes, restricting the under-18s to an hour of gaming a day, on only three nights a week, was rather drastic. But perhaps it might be good for them?
China’s government argues that video games are addictive. This fear is not new. Two decades ago players of “Everquest”, an early online game, ruefully dubbed their hobby “Evercrack”. Gaming-addiction clinics have spread from China and South Korea to the West (Britain’s ritzy Priory clinic treats gaming addiction as well as staples such as sex, shopping and cocaine).
Now the World Health Organisation (WHO) has lent support to the Chinese position. On January 1st the latest edition of its International Classification of Diseases (ICD), a manual widely used by doctors and health-insurance firms, comes into force. For the first time it recognises an affliction it calls “gaming disorder”.
It is tempting to dismiss all this as just another moral panic about an arriviste form of entertainment. Twenty years ago games were condemned for making players violent, when there is no evidence that they do. But the argument matters, and not just to parents exasperated by their offspring’s preference for “Fortnite” over maths or old-fashioned social interaction. Newzoo, a consultancy, puts global video-game revenues at $170bn in 2020, far ahead of music or cinema, and growing quickly.
The idea that computer games can be addictive stems from a change in how psychologists understand addiction. For many years it required a physical substance, such as nicotine or morphine, on which a patient could become hooked, says Rune Nielsen, a psychologist at the IT University of Copenhagen. That began to change in the late 1990s, with the idea that people could become addicted to pleasurable behaviours as well as drugs.
For one such behaviour, that definition is fairly uncontroversial. “Not many people these days dispute the idea that you can become addicted to gambling,” says Mark Griffiths, a psychologist at Nottingham Trent University. But, he says, that line of thinking also “opens the theoretical floodgates” to defining all sorts of other fun activities as “addictive” in ways that stretch most people’s understanding of the term. Besides gaming, Dr Griffiths studies addictions to exercise, sex and work. One paper, published in 2013 (not written by Dr Griffiths) surveyed keen tango-dancers and found that around 40% might qualify as “addicts” under the new paradigm.
Besides gambling, which was already included in the ICD, video-gaming is the only behavioural addiction on the WHO’s list. Diagnosis relies on compulsive use and negative consequences. Like other junkies, those suffering from “gaming disorder” put their next hit over most other activities, even if that it causes harm in other parts of their lives.
That a few players develop unhealthy relationships with their pastimes seems hard to argue with. Psychologists describe gamers who forgo sleep, offline relationships and work. Rows with families are common. Many call themselves addicts, and struggle to kick their habits. Hilarie Cash, the clinical director of re START, a game-addiction clinic near Seattle, says many of her patients arrive having been expelled from school or university, after gaming swamped their schoolwork. The vast majority, she says, are male. “I get phone calls from people saying that video games have ruined their life just as much as gambling,” says Dr Griffiths, who says that the evidence on video-gaming is much stronger than for other behavioural addictions, such as to sex or work.
But the concept is still fuzzy. And even researchers who agree that games can be addictive in a medical sense disagree over how common such addiction is. Dr Cash reckons 10% of Americans may meet some of the diagnostic criteria. Dr Griffiths says that even a rate of 1% is surely far too high. “If that were right, there would be a clinic in every city,” he says. Rune Mentzoni of the University of Bergen in Norway thinks that games probably can be addictive, yet he worries that some diagnostic questionnaires rely on loaded questions. “Sometimes you’re asked if you play games to get a break from negative thoughts or feelings,” he says. “But for other pastimes, like painting or exercise, that would be seen as a perfectly healthy behaviour!”
One possibility is that obsessive gaming is a symptom, or coping mechanism, rather than a disorder in its own right. “At least half those with gaming problems have a depressive disorder. Another third have anxiety,” says Andrew Przybylski of the Oxford Internet Institute. “There have always been people who are a bit socially awkward, and interested in systems rather than other people,” says Dr Nielsen. In the past they might have taken up chess or model railways, he says. That does not mean either activity is addictive in itself.
The new rules of the game
While psychologists argue about terminology, it is also worth looking at incentives. Buying a video game used to be a one-off transaction. Developers had no insight into how—or even whether—customers played their games. But these days, many of the most popular games rely on a “freemium” business model, in which the game itself is cheap or free and money is made from in-game purchases of things like extra lives or virtual clothing. Newzoo reckons 73% of the industry’s revenues in 2020 came from free-to-play games (see chart).
That model ties revenue directly to playtime. Many such games are therefore designed—often with the help of professional psychologists—to be as compelling as possible. Designers speak of building games up by nesting and layering smaller “gameplay loops”. These are quick-fire tasks—like shooting an enemy or constructing a new building—that reward players with points, in-game items or even just a quick glow of satisfaction.
Developers mine the psychological literature for insights. One well-known result, first shown in rats in the 1950s, is that semi-random rewards (where completing a task may sometimes provide nothing, sometimes a small payout and occasionally a big one), are more compelling than predictable ones. That insight is used in almost all game design. “Candy Crush Saga”, a popular pattern-matching game, gives players extra rewards for finding unusual combinations on the board, providing an unpredictable but enjoyable reward when the tiles fall in the right place.
A more overt tactic is to punish players who do not log in regularly. “Adopt Me”, a subgame in “Roblox”, in which players care for virtual pets, provides in-game benefits to players who log in at least every 15 hours. In “Farmville”, players who neglect their virtual crops will see them wither—though they can be revived for a price.
Other tricks are designed to persuade players to convert playtime into purchases. Virtual items are bought with in-game currencies, such as gold, crystals or the V-Bucks used in “Fortnite”. Studies of people using foreign currencies suggest that unfamiliarity helps them spend more freely. (This is one reason, says Dr Mentzoni, why casinos use chips.) Players who run out of lives in “Candy Crush” can wait half an hour before playing again, or pay money to dive straight back in. In 2018 King, the developer of “Candy Crush”, told Britain’s Parliament that one player had spent $2,600 on lives and other in-game perks in a single day (though, to be fair, the digital goodies did last him seven months).
The analogy with gambling can be seen most clearly with “loot boxes”—virtual treasure-chests that contain a randomised assortment of in-game goods. The “FIFA” series, for instance, offers a mode in which players build a football squad from players they find in virtual packs of cards that can be bought with real money. Dr Mentzoni has calculated that, assuming average luck, in the 2018 edition of the game it would take around €10,800 ($12,200) to assemble the best possible team.
Some firms load the dice with user-retention in mind. In “Hearthstone”, from Activision-Blizzard, a big game publisher, players again collect cards, this time representing dragons, orcs and the like, with which they do battle. Unlucky players will have the odds adjusted behind the scenes to boost their chances in future purchases.
Moreover, all these features can be tweaked using analytics data, harvested from a game’s players. Developers can run experiments with everything from difficulty curves to the price of different in-game items and see the effects on user-retention or revenue. King extols the use of data to help “make our titles irresistible”.
From the few not the many
Hard data are tough to come by. But for most players, the impact of this psychological engineering seems limited. Most freemium gamers spend nothing. Documents from a recent court case show that 70% of revenues on Apple’s App Store came from games. Most of that, in turn, comes from a small cohort of big spenders. And the video-game industry is hardly the only one to use psychological hacks to boost sales. “It’s not an accident that the milk is always at the back of the supermarket while the chocolate bars are near the tills,” notes one games-industry veteran.
Nonetheless, politicians—and not just in China—are beginning to worry. Belgium and the Netherlands have declared that loot boxes should be regulated as gambling. New rules in Britain, the world’s fifth-largest market, require protection for players under the age of 18. WHO recognition is likely to boost diagnoses of gaming disorder, regardless of its true prevalence, because it gives doctors an official diagnostic code to record it.
A few developers will quietly confess to unease about how their products work. In a talk at the Game Developers Conference in 2019, the Oxford Internet Institute’s Dr Przybylski worried about the industry’s defensiveness, and warned his audience to brace for new rules, sin taxes and fines. He has argued—with limited success so far—that games firms should give academics access to internal data, hoping this might settle the question of whether games really can be “addictive” in a medical sense.
In the meantime, there are tentative efforts at self-regulation. The Entertainment Software Association, an American trade body, points to parental controls offered by smartphone firms like Apple and Google, which can limit play time or spending. UK Interactive Entertainment, another trade body, runs an education campaign called “Get Smart About PLAY”. The problem with self-regulation, of course, is that it can be interpreted as admitting that at least a few customers do have a problem. ■
This article appeared in the International section of the print edition under the headline “Can you get hooked on video games?”