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Videogame addiction rehab? Hype or help?

Websites claiming to treat Internet use and videogame addiction

Can you really trust the information found online?

by Cosette Rae, CEO

When reSTART opened its doors offering intensive treatment for clients struggling with Internet and video game addiction in 2009, we were the first in the United States to do so. Now, a simple Internet search turns up hundreds of websites, programs, advice lines, and referral networks all claiming to treat video game and Internet addiction, and every other behavioral problem currently being thrown around in the literature. Suddenly hundreds of programs have became experts at treating the problem overnight. While there are a few reputable programs and counselors who genuinely understand and use evidence based strategies to treat process addictions, countless others use keywords on websites to lure troubled individuals and family members to their help lines, and into programs that know little about how to treat Internet or videogame addiction. As troubling as this sounds, it's likely here to stay, and will likely grow more troublesome over time. 

First things first: Specialists matter

Aside from reSTART, there are a few key people and programs who have been working in the field for the past decade. For example, Kimberly Young started a hospital based Internet addiction treatment program at Bradford Regional Medical Center where patients with intense stabilization needs are offered care. This is a different approach than offered here at reSTART. Our retreat center program is designed and operated by specialists in the field of process addictions and mental health to provide a progressive step-down model of care beginning with a thorough digital assessment, 8-12 week digital de-tech, family education, life skills development and transition program, and ongoing sustainability, and maintenance. In addition to our program there are a few wilderness programs that have designed specialized tracks specifically for problematic users. However, that said, many programs claiming to treat digital media problems actually lump users in with substance abusing clients, and treat the problem like any other addiction. This "one-size-fits-all" approach may work in a few cases, but in reality, addiction to substances is a very different phenomenon than a behavioral addiction involving the Internet, videogames, or virtual reality. The primary goal for a substance abusing client is complete and permanent abstinence from the drug, or activity of choice. However, this is simply not possible in the digital age for problematic video gamers or compulsive Internet users. Therefore, it's critical that program team members understand why this approach may cause more harm than good, and knows how to respond accordingly. Sadly, many programs don't have specialized tracks designed for non-substance using clients. 

Second things next: Labels don't help

Using pejorative terms like addict, video game addiction, Internet gaming disorder, and the countless other terms being used to describe the phenomenon of excessive, frequent and varied digital media consumption does not encourage users in seeking help. In fact, it increases the likelihood of a user staying in denial. Hence, this is why our team discusses the concepts of sustainable use, at appropriate developmental stages, and in an environment of accountability as part of our program. Users resonate with developing their own plans, learning about the addictive nature of digital media, and come to terms with the ways digital media consumption is interfering with their quality of life, and the need for change. 

Third things third: If it walks like a duck, it may not actually be a duck

We've heard it all when it comes to how programs work with digital media users. For example,  one program shared with a member of our team: "kids will be kids-they're just going to use." Not so, we believe. Take two people who play video games. One user is able to maintain his/her grades, attends their classes, completes their homework, connects with family members, and engages often in beloved hobbies. The other, while engaging heavily in digital media use and/or video gaming, losses complete track of time, is absorbed in their virtual lives at the exclusion of all other outside influences, and continues using despite adverse consequences. Thus, thinking it's just an issue that kids will grow out of over time, while perhaps true in some cases, may actually lead to an increase in problematic use over time for clients served. Some programs claim that a 6-8 week high adventure without digital media will "fix" the problem. While a lengthy period of abstinence is a start towards addressing digital media issues, it is only a start. This thinking is similar in nature to thinking a person who is deprived of alcohol, is cured of their addictive behavior (otherwise known as the "dry drunk.") In the absence of treatment, once access to their "drug (or activity) of choice" is within reach, the higher likelihood they'll return to previous levels of engagement. Thus, when it comes to treatment, understanding the underlying issues, and having the resources to invite the right kind of change, is much more important than simply labeling something by it's appearance. 

Last things last: If you're not sure, just ask

When you, or someone you love is in crisis and you don't know where to turn, we hope you'll reach out and ask a reputable source who understands and specializes in the treatment or problematic Internet or video game use. As a general reminder, and one that we share with our clients. just because you read it online, doesn't mean it's true. 

For more information on treatment practices, review our scholarly article found here: Cash, H., Rae, C. D., Steel, A. H., & Winkler, A. (2012). Internet Addiction: A Brief Summary of Research and Practice. Current Psychiatry Reviews, 8(4), 292–298. doi:10.2174/157340012803520513


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Rating video games and the ERSB system

Rating video games

What do the ERSB ratings mean?

The entertainment ratings software board (ERSB) provides ratings for video games, apps and other software, as follows:

ECEARLY CHILDHOOD (EC) Designed for young children, typically aged 3 and over. 

EEVERYONE (E) Suitable for children and people of all ages around 6 years of age and beyond. There may be fantasy, minimal cartoon, or mild violence and infrequent use of mild language.

Sample addictive games in this category include:

  • Minecraft: Playstation Vita Edition

E10EVERYONE 10+ This content is designed for people ages 10 and older. It may contain fantasy, cartoon, or mild violence, mild language or/and minimal suggestive themes.

TTEEN (T) Suitable for people 13+, Video games and apps may contain suggestive themes, violence, crude humor, simulated gambling, minimal blood, and/or infrequent use of strong language.

Sample addictive games in this category (by no means exhaustive):

  • Battlefield 2: Modern Combat
  • Battlefield 4™
  • Battlefield™ Hardline
  • League of Legends
  • World of Warcraft: Mists of Pandaria, Cataclysm, Wrath of the Lich King, The Burning Crusade
  • World of Tanks

Sample games with simulated gambling

  • Citizens of Earth
  • James Bond 007: Blood Stone
  • Street Racing Syndicate

MMATURE (M) Suitable for people 17+, these games and apps may have contain gore and blood, violence, strong language or/and sexual content.

Sample addictive games in this category include:

  • Call of Duty: World at War, Advanced Warfare, Modern Warfare 2, Modern Warfare 3, Ghosts, Black Ops II, Black Ops Declassified
  • Game of Thrones - Episode 3: The Sword in the Darkness
  • God of War III Remastered
  • Life is Strange - Episode 2: Time Out
  • Payday 2: Crimewave (FPS)
  • Mortal Kombat
  • Middle-Earth™: Shadow of Mordor™ (RPG)
  • Quake 4, Quake II
  • Rune
  • The Elder Scrolls Online: Tamriel Unlimited Imperial Edition
  • Tales from the Borderlands: Episode 2 - Atlas Mugged
  • Wolfenstein: The Old Blood (FPS) 


ADULTS ONLY (AO) Designated for adults 18+, these video games, apps or software may contain prolonged scenes of intense violence or/and graphic sexual content and nudity.Note: Category assignments may be based on a video game's or an app's minimum requirement for age.

Sample addictive games in this category include: 

      • Fahrenheit: Indigo Prophecy Director's Cut: PC CD ROM
      • Grand Theft Auto: San Andreas
      • Leisure Suit Larry
      • Thrill Kill

 Terms defined

  • Alcohol Reference - Reference to and/or images of alcoholic beverages
  • Animated Blood - Discolored and/or unrealistic depictions of blood
  • Blood - Depictions of blood
  • Blood and Gore - Depictions of blood or the mutilation of body parts
  • Cartoon Violence - Violent actions involving cartoon-like situations and characters. May include violence where a character is unharmed after the action has been inflicted
  • Comic Mischief - Depictions or dialogue involving slapstick or suggestive humor
  • Crude Humor - Depictions or dialogue involving vulgar antics, including “bathroom” humor
  • Drug Reference - Reference to and/or images of illegal drugs
  • Fantasy Violence - Violent actions of a fantasy nature, involving human or non-human characters in situations easily distinguishable from real life
  • Intense Violence - Graphic and realistic-looking depictions of physical conflict. May involve extreme and/or realistic blood, gore, weapons and depictions of human injury and death
  • Language - Mild to moderate use of profanity
  • Lyrics - Mild references to profanity, sexuality, violence, alcohol or drug use in music
  • Mature Humor - Depictions or dialogue involving "adult" humor, including sexual references
  • Nudity - Graphic or prolonged depictions of nudity
  • Partial Nudity - Brief and/or mild depictions of nudity
  • Real Gambling - Player can gamble, including betting or wagering real cash or currency
  • Sexual Content - Non-explicit depictions of sexual behavior, possibly including partial nudity
  • Sexual Themes - References to sex or sexuality
  • Sexual Violence - Depictions of rape or other violent sexual acts
  • Simulated Gambling - Player can gamble without betting or wagering real cash or currency
  • Strong Language - Explicit and/or frequent use of profanity
  • Strong Lyrics - Explicit and/or frequent references to profanity, sex, violence, alcohol or drug use in music
  • Strong Sexual Content - Explicit and/or frequent depictions of sexual behavior, possibly including nudity
  • Suggestive Themes - Mild provocative references or materials
  • Tobacco Reference - Reference to and/or images of tobacco products
  • Use of Alcohol - The consumption of alcoholic beverages
  • Use of Drugs - The consumption or use of illegal drugs
  • Use of Tobacco - The consumption of tobacco products
  • Violence - Scenes involving aggressive conflict. May contain bloodless dismemberment
  • Violent References - References to violent acts

 If you'd like to know more about what's contained in each video game, ERSB has a free mobile app which allows users to look up games or an app's rating. 

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Nuanced treatment options for video game addiction

When video game play becomes excessive

Specialized treatment is critical

Treatment options for people struggling with problematic video game play is limited in the United States. In the past 6 years, reSTART has been the leader in specialized care for people struggling to manage their use. However, times are changing and all types of programs are emerging which claim to treat video game addiction. Many programs state that video game addiction can be treated just like any other addiction. While addictions in general share many similarities, namely, in the way they influence brain chemistry, there are many important differences. It is these differences that set the reSTART program apart from other programs. Over the past decade, we have worked alongside clients struggling with problematic Internet and video game dependence which has taught our team many important principles, and guides the work we do.

In working with problematic Internet and video game players, one of the most critical components of care is the ability to create a culture of understanding, coupled with a keen ability to connect with the user's experience. Several themes emerge when working with video game users. What follows are a few beliefs shared by users, which if misunderstood, impedes treatment, such as:

 Don't tell me that I need to get "real" life. Let's be honest, playing video games is real, and video game players do not differentiate between their online game play, and offline lifestyle. Video game play is a real experience that is stimulating and rewarding to users. In fact, heavy users dreams are influenced by gaming to the point that it may be hard to differentiate between reality and their game play. 

Connect me with something more pleasurable then gaming and I'll quit. Finding suitable replacement behaviors is difficult for the over using video game player. As tolerance increases, users seek greater engagement, and higher intensity games to keep the reward/response system at a level which doses out pleasure. Simply unplugging game players has not been met with success. 

Don't call me an addict, you're using too! Video game players spend quite a bit of time "thinkering."  Using their keen observation skills, they notice their friends are using, their parents may or may not be modeling healthy digital behaviors, and they reflect on the hypocrisy of calling them addicts. 

I'll quit this quarter, or this week, or tomorrow. In reality, it's quite difficult to quit on your own if your level of use rises to the level of addiction. A digital detox may be required to uncover underlying issues preventing long term change.

These are but a few examples of the repetitive themes uncovered in working with problematic users over the past decade. Lumping people together in the name of "addiction" misses critical concerns unique to the Internet or video game user. When clinicians, providers, or treatment programs miss these nuanced concerns by lumping all types of addictions together, the likelihood of misunderstanding, and thus, inhibiting therapeutic rapport (which according to research is the most critical ingredient responsible for creating lasting change) desired outcomes are adversely impacted. It is for these, and other reasons that seeking care from providers who specialize in process addictions and recovery is paramount. 

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