On Second Life and addiction

I wasn’t going to say anything on the sad story of the Korean couple who allegedly left their baby to starve while they spent time in the virtual world Prius Online, because, you know, it seemed a bit exploitative, but I noticed that a few other blogs had referred to the issue directly or indirectly, and of course I couldn’t resist putting my two cents worth into the comments, (though it turns out that last post wasn’t inspired by the Korean incident after all), so I thought I might as well draw a few thoughts together and post them here.

Actually I’m not going to address the Korean story directly, since all I know about it is what I’ve read in the papers, and in cases like these one really needs to have all the facts before formulating any opinions. Instead I’ll say something more general about the concept of internet addiction – whether it exists at all, and, if so, what can be done to help those suffering from the problem.

My personal opinion is that problematic use of the internet should be regarded as a pathological behaviour, and that it is best thought of as an impulse-control disorder. I first became interested in the topic after reading Caught in The Net, by Kimberly Young, who did a lot of the early work in this area, and who runs the Center for Internet Addiction. Her book is aimed at a lay audience – she does tend to throw around terms like “obsession”, “compulsion” and “addiction” a bit freely – but her conceptualisation of dysfunctional online activity, drawing on the model of pathological gambling, is basically sound.

The existence and nature of internet addiction is still the subject of academic debate though. I thought Jerald Block made a good case a couple of years ago in an editorial in the AJP, Issues for DSM-V: Internet Addiction, but the draft DSM V, out last month, fails to include it. Interestingly the draft also proposes to move pathological gambling out of “Impulse-Control Disorders Not Elsewhere Classified” and into “Addiction and Related Disorders”, a move that has been labelled one of the “The 19 Worst Suggestions For DSM5“.

This argument about classification may seem a bit arcane, but it reflects a division of opinion that was also evident in the discussion of the Korean case; to what extent does labelling a particular behaviour an “addiction” absolve the person concerned of responsibility for their actions?

When it comes to MMORPGs (which for the sake of this argument we’ll take as including Second Life) there is a tendency among pro-game writers to deny that virtual worlds have any addictive properties at all, and to focus instead on the personal characteristics of the “addicts”, and especially their “personal responsibility” or lack thereof, when seeking to explain the problem. This is evident in the posts I linked to above, and more so in the comments, and is understandable when one considers that politicians and the media are quick to stir up moral panics about the supposed corrupting influence of games on society.

It’s true that impulse-control disorders are rooted in individual psychopathology, which in turn develops from the complex interaction of neurobiology, psychodynamics, cognition, social factors and environment. However I think it has to be acknowledged that games, and especially MMORPGS, have features which may promote problematic use in vulnerable people.

What are these elements? The ability to produce feelings of mastery, to increase confidence in social interaction and to explore hidden aspects of personality, which can combine to boost self-esteem. (These are of course the same things that make the worlds attractive in the first place.) Add in the variable reward schedules that are designed into the games to a greater or lesser degree, and you have the potential to set up cycles of dysfunctional behaviour.

This doesn’t mean that games are inherently dangerous, since clearly the vast majority of players manage to use them without coming to any harm. It does suggest though that there is a particular subset of players for whom over-use of games might become a problem, and raises the question of whether game developers like Linden Lab should be responsible for raising awareness of the possible hazards among residents of their worlds. I would argue that there should be some material about recognising the signs of internet addiction included in the orientation process, and perhaps a timer built into the viewer that that pops up after, say, two hours on the grid and suggests that it might be time to take a break. I can’t see this happening though, since steps like these could be construed as an admission by the Lab that they are aware of the potentially harmful nature of their product, which would presumably expose them to some sort of liability.

What of treatment? In general terms, my experience of treating this sort of problem has convinced me of the importance of taking a non-judgemental approach. Although therapy for impulse-control disorder does focus on the choices that the client makes in certain situations, with the aim of helping them regain a feeling of control, over-emphasising “personal responsibility” is usually not helpful. These clients start with low-self esteem, and the condition further erodes their confidence in their ability to take charge of their lives, so reminding them that they could have avoided the mess by making different choices tends not to make them feel any better. Instead it’s more useful to focus on the positives, the areas of their lives that they feel they can manage sucessfully, and try to build on these.

It’s interesting that discussion of addictions, and particularly process addictions (which, as mentioned above, I prefer to conceptualise as impulse-control disorders, though plenty of people would disagree with me), often takes on a rather moralistic tone, with implicit, or sometimes explicit, condemnation of addicts for failing to take “responsibility” for what they do. I tend to think that this position represents a defence against acknowledging the extent to which everyone is a potential “addict”, a projection of intolerable unconscious “irresponsibility”. I think it’s healthier to recognise that we are all fallible humans, and we can all make bad choices, and remember that when we do mess up it’s nicer if people treat us with sympathy and compassion, rather than going on and on about “personal responsibility”.

In internet addiction specifically the treatment with the best evidence base is CBT – Young published a paper on treatment outcomes in 2007. There was also an interesting paper last year from the International Gaming Research Unit at Nottingham Trent University last year looking at various treatment approaches to videogame addiction, including 12-step, CBT and Motivational Interviewing. 12-step programmes for internet addiction are widely available – at On-Line Gamers Anonymous for example – but I’m not aware that these have been rigorously evaluated. I’m not as familiar as I would like to be with the published work coming out of South Korea and China, where they take this problem very seriously, but what I have read suggests that behavioural and family therapy approaches are useful, in younger populations especially. I expect there will be a lot more research into treatment of internet addiction published in the West over the next few years, and the best therapeutic options should become more evident.