Myth world: A brief look at some myths about Gaming Disorder
Earlier this year, the World Health Organisation announced that ‘Gaming Disorder’ (GD) was to be officially been included in the latest (eleventh) edition of the International Classification of Diseases (ICD-11). The announcement received worldwide media coverage alongside many debates as to whether its inclusion was justified based on the scientific evidence. The extensive media coverage raised many questions but also appeared to give rise to a number of myths. In this blog, I address these myths in the British context but some of these myths also have resonance outside the UK.
Myth 1 – Gaming Disorder equates to gaming addiction. Almost all of the worldwide press coverage for GD in June 2018 was equated with gaming addiction. However, the World Health Organization (WHO) does not describe GD as an addiction and the WHO criteria for GD do not include criteria that I believe are core to being genuine addictions (such as tolerance and withdrawal symptoms). Confusingly, the criteria for Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic Manual of Mental Disorders (DSM-5) does include all my core criteria of addiction. However, to be diagnosed with IGD, an individual does not necessarily have to endorse all the core addiction criteria. In short, all genuine gaming addicts are likely to be diagnosed as having GD and/or IGD but not all those with GD and/or IGD are necessarily gaming addicts.
Myth 2 – Gaming has many benefits so should not be classed as a disorder as it will create a ‘moral panic’: Predictably, the videogame industry has not welcomed the WHO’s decision to include GD in the ICD-11 and issued a statement to say gaming has many personal benefits and that GD will create moral panic and ‘abuse of diagnosis’. None of us in the field dispute the fact that gaming has many benefits but many other activities such as work, sex, and exercise can be disordered and addictive for a small minority, and is not a good basis for denying the existence of GD. The videogame industry also claims the empirical basis for GD is highly contested but then ironically uses non-empirical claims (i.e., that the introduction of GD will cause a moral panic and lead to diagnostic abuse by practitioners) as a core argument for why GD should not exist.
Myth 3 – Gaming Disorder is associated with other comorbidities so is not a separate disorder. In coverage concerning GD, those denying the existence of GD sometimes resort to the argument that problematic gaming is typically comorbid with other mental health conditions (e.g., depression, anxiety disorders, etc.) and therefore should not be classed as a separate disorder. However, such an argument is not applied (for instance) to those with alcohol use disorder or gambling disorder which are known to be associated with other comorbidities. In fact, we recently published some case studies in the International Journal of Mental Health and Addiction highlighting those attending treatment for GD included individuals both with and without underlying comorbidities. Consequently, diagnosis of disorders should be based on the external symptomatic behavior and consequences, not on the underlying causes and etiology.
Myth 4 – Gaming Disorder can now be treated for free by the National Health Service: Unlike many other countries, the UK has a National Health Service (NHS) whose treatment services can be accessed free of charge. A number of British newspapers reported that inclusion of GD in the ICD-11 meant that those with GD can now get free treatment. However, this claim is untenable and is unlikely to happen. All health trusts in the UK have a finite budget and allocate resources to those conditions considered a priority. Treating individuals with GD will rarely (if ever) be given priority over treatment for cancer, heart disease, schizophrenia, depression, etc. In countries where private health insurance is the norm, GD is likely to be a condition excluded for treatment on such policies even though it is now in the ICD-11.
Myth 5 – The inclusion of Gaming Disorder as a mental disorder will lead to ‘millions’ of children being stigmatized for their videogame playing: This myth has been propagated by a group of scholars (mainly researchers working in the media studies field) but is completely unsubstantiated. The number of children who would ever be officially be diagnosed as having GD is extremely low and – as noted above – millions of children play videogames for enjoyment without any problems or stigma.
(Please note: This article is based on an editorial that I first published earlier this year: Griffiths, M.D. (2018). Five myths about gaming disorder. Social Health and Behavior Journal, 1, 2-3)
Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Aarseth, E., Bean, A. M., Boonen, H., Colder Carras, M., Coulson, M., Das, D., … & Haagsma, M. C. (2017). Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. Journal of Behavioral Addictions, 6(3), 267-270.
Gentile, D.A., Bailey, K., Bavelier, D., Funk Brockmeyer, J., … & Young, K. (2017). The state of the science about Internet Gaming Disorder as defined by DSM-5: Implications and perspectives, Pediatrics, 140, S81-S85. doi: 10.1542/peds.2016-1758H
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2017). Behavioural addiction and substance addiction should be defined by their similarities not their dissimilarities. Addiction, 112, 1718-1720.
Griffiths, M.D. (2018). Conceptual issues concerning internet addiction and internet gaming disorder. International Journal of Mental Health and Addiction, 16, 233-239.
Griffiths, M.D., Kuss, D.J., Lopez-Fernandez, O., & Pontes, H.M. (2017). Problematic gaming exists and is an example of disordered gaming. Journal of Behavioral Addictions, 6, 296-301.
European Games Developer Foundation. Statement on WHO ICD-11 list and the inclusion of gaming. 2018 June 15. Available from: http://www.egdf.eu/wp-content/uploads/2018/06/Industry-Statement-on-18-June-WHO-ICD-11.pdf
Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.
Király, O., Griffiths, M.D., King, D., Lee, H-K., Lee, S-Y., Bányai, F., Zsila, A. Demetrovics, Z. (2018). An overview of policy responses to problematic videogame use. Journal of Behavioral Addictions, 7, 503-517.
Kuss, D.J., Griffiths, M.D. & Pontes, H.M. (2017). Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field. Journal of Behavioral Addictions, 6, 103-109.
Kuss, D.J., Pontes, H.M. & Griffiths, M.D. (2018). Neurobiological correlates in Internet Gaming Disorder: A systematic review. Frontiers in Psychiatry, 9, 166. doi: 10.3389/fpsyt.2018.00166
Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.
Rumpf, H. J., Achab, S., Billieux, J., Bowden-Jones, H., Carragher, N., Demetrovics, Z., … & Saunders, J. B. (2018). Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective: Commentary on: A weak scientific basis for gaming disorder: Let us err on the side of caution (van Rooij et al., 2018). Journal of Behavioral Addictions, 7(3), 556-561.
Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. Farriols-Hernando, N. & Torres-Jimenez, E. (2018). Internet gaming disorder treatment: A case study evaluation of four adolescent problematic gamers. International Journal of Mental Health and Addiction, https://doi.org/10.1007/s11469-017-9845-9.
Campaign killer? Gambling with people’s reputations (revisited)
On Twitter last week, Adrian Parkinson of the Campaign for Fairer Gambling (and the associated Stop The FOBTs campaign) posted a number of tweets about me (and my research). In the tweets, Parkinson said that (a) I am a “supposed academic”, (b) I am the “industry ‘funded’ defender of FOBTs” (fixed odds betting terminals), (c) I am “doing more dirty work” for the Association of British Bookmakers, and (d) I do “what the industry tells [me] to do”.
All of these assertions are untrue and potentially libellous. According to legal dictionaries, the official definition of libel is “to publish in print (including pictures), writing or broadcast through radio, television or film, an untruth about another which will do harm to that person or his/her reputation, by tending to bring the target into ridicule, hatred, scorn or contempt of others”. Based on this defintion, Parkinson’s tweets are potentially libellous and are definitely an attack on my professional integrity. This cannot go unchallenged so here are the facts of the matter in relation to the claims made.
- “Supposed academic”: Obviously the assertion by Parkinson that I am a “supposed academic” is both false and deliberately malicious. An academic by most dictionary definitions is “a teacher or scholar in a university or other institute of higher education”. As a professor employed at an English university, there is nothing “supposed” about my occupation or status. To add to this, I would point out that on the basis of my academic research and reputation I became of one of the UK’s youngest ever professors (aged 34 years). So far in my career, I have been awarded 14 national and/or international awards and prizes for my gambling research and research dissemination including three Fellowship awards (British Psychological Society, Royal Society of Arts, and the Academy of Social Sciences) and two Lifetime Achievement awards. I am also one of the most highly cited psychologists in the world (currently 17,500 citations on Google Scholar that you can check here).
- “Industry funded’ defender of FOBTs”: Parkinson claimed that I am “funded defender” of FOBTs and the gambling industry. In my career to date, I have published approximately 460 academic peer reviewed journal papers (which most academics would describe as ‘prolific’ – and not bad for a “supposed academic”) and another 1000+ academic articles (in professional/practitioner journals, gambling trade press, newspapers, magazines, etc.). Of these 1500 or so papers and articles, none were funded by a research grant from the gaming industry. Two of the papers I have published – both concerning social responsibility in gambling initiatives – did arise out of gaming industry consultancy (one study was about gamblers’ attitudes toward the social responsibility tool PlayScan funded by Svenska Spel, and the other was the development of a new social responsibility tool for the gaming industry to use to protect vulnerable player funded by the Nova Scotia Gaming Corporation). Also, none of my published academic papers has ever been specifically about FOBTS. I have published a handful academic journal papers that have mentioned FOBTs in passing but all of those were papers based on data collected in the British Gambling Prevalence Surveys (of which I was one of the co-authors) and were funded by the Gambling Commission not the gambling industry. In 2008, I also wrote a report for the Department of Culture, Media and Sport (again funded by the Gambling Commission) on high stake-high prize machines that included references to FOBTs. However, the only article I have ever published specifically on FOBTs was one of my previous blogs (which looked at FOBTS in relation to the BGPS findings). In short, the assertion that I am an “industry ‘funded’ defender of FOBTs” simply has no basis in truth whatsoever.
- “Dirty work” for the Association of British Association of Bookmakers: Parkinson claimed I carry out “dirty work” for the ABB. In my academic career I have been a consultant in the area of responsible gambling for approximately 15 years and have written in the region of 150 consultancy reports. Of these reports, three have been for the Association of British Bookmakers. The first report (in June 2013) was evaluation and input into the new code of conduct concerning responsible gambling and player protection (and which I wrote about in a previous blog). I was invited to carry out this piece of work by Neil Goulden (Chairman of the UK’s Responsible Gambling Trust) specifically because of my reputation of being both totally independent and as someone that has been critical of the gambling industry on previous occasions in relation to social responsibility and player protection. More recently (July 2014), I was commissioned to carry out two further pieces of consultancy for the ABB. The first was a review of problem gambling in Great Britain and the second was a preliminary evaluation of the responsible gambling initiatives relating to the introduction of the ABB’s new Code of Conduct (both of which are being published today). All three pieces of consultancy that I have carried out for the ABB concerned player protection and responsible gambling. Far from being “dirty work” they are the very areas areas that are at the heart of almost all the research that I carry out into problem gambling.
- “Doing what the industry tells me to do”: Of all the potentially libellous claims made about me by Parkinson, this is the one that is the most ludicrous. The main reason I was asked for my expertise in the first place by the ABB was because I have never been afraid to criticize the gaming industry when they have done something I believe to be wrong and/or socially irresponsible. Anyone who actually knows me and has followed my research career over the last three decades will tell you that the one common denominator is my absolute independence in anything that I do. For the best part of 15 years I was vilified and criticized by some members of the gaming industry because of my belief that vulnerable and susceptible people should be protected from the potential harms of gambling. When ‘social responsibility’ and ‘responsible gambling’ became important issues in gaining operating licenses, gaming companies soon started approaching me to help them develop their codes of conduct and player protection programs. In short, I have spent years telling the gambling industry what I think they should do to minimize problem gambling (not the other way around).
There are of course bigger issues here concerning research funding, and this is an issue on which I have published my own views (see ‘Further reading’ below). Parkinson’s incorrect and misguided comments about me appear to be based on the view that academics shouldn’t have any association whatsoever with the gambling industry. Unfortunately, this (in my opinion) is a blinkered view that will not help those that need it (i.e., vulnerable populations). Almost all of the ‘big name’ researchers in the gambling studies field have carried out research and/or consultancy funded by the gambling industry. When this happens it may call into question academic ‘independence’. However, industry funded research appears to be an increasing economic reality in many countries across the world. In the UK, the governmental philosophy of research funding relating to gambling is now ‘polluter pays’ (i.e., the UK government has said it will not fund research on gambling and that the industry will have to pay for such work itself). Although my own research is not industry funded, the current funding model is pushing researchers in the gambling field down such a route.
One researcher that I have published with (now retired from day-to-day university life) refuses to carry out research or consultancy if it is sponsored or funded by the gambling industry (even indirectly via the Responsible Gambling Trust because the money is accrued from voluntary donations by the gambling industry). Furthermore, he will not attend conferences that have gaming industry sponsorship and declines invitations to speak if they are held on gaming premises. Although laudable and highly principled, researchers who now want to pursue a research career in the gambling studies field will are likely to find that taking such principled actions will become a barrier to career enhancement.
Having been in the gambling studies field for nearly 30 years now, I feel very proud that over the last decade, some sectors of the gaming industry have now started to take the issue of social responsibility in gambling seriously. All the personal vitriol that I received for years from certain individuals working in the gaming industry appears (in retrospect) to have been worth it. My own view is that if those in the gambling industry are really serious about social responsibility, they need to sometimes work in partnership with researchers in the gambling studies field if the end goal is the same (i.e., protection of vulnerable individuals and minimization of problem gambling).
From my research, I have gotten to know people that have had gambling problems and that would like to ban slot machines (including FOBTs). This is highly unlikely to reduce gambling problems. We know that banning alcohol does not cure alcoholism. Similarly, banning gambling products will not solve the issue of problem gambling. It would only drive the activity underground. Most people that gamble (including myself) do not have a problem. The underlying principle of social responsibility is to maximize fun for those that enjoy gambling and minimize harm for those that may be vulnerable. Mr. Parkinson and his campaign have every right to express their views but what they say should have a basis in fact (rather than prejudice) and they definitely shouldn’t resort to questioning my reputation or research in the absence of the full facts.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham
Adams P. J., Raeburn J., De Silva K. (2009). A question of balance: prioritizing public health responses to harm from gambling. Addiction, 104: 688–91.
Griffiths, M.D. (2009). Minimising harm from gambling: What is the gambling industry’s role? Addiction, 104, 696-697.
Griffiths, M.D. (2008). Impact of high stake, high prize gaming machines on problem gaming. Birmingham: Gambling Commission.
Griffiths, M.D. (2009). Gambling research and the search for a sustainable funding infrastructure. Gambling Research, 21(1), 28-32.
Griffiths, M.D., Wood, R.T.A. & Parke, J. (2009). Social responsibility tools in online gambling: A survey of attitudes and behaviour among Internet gamblers. CyberPsychology and Behavior, 12, 413-421.
Morrison, P. (2009). A new national framework for Australian gambling research: A discussion paper on the potential challenges and processes involved. Gambling Research, 21(1), 8-24.
Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.