Opinion: Video gaming occupies two contrasting public perceptions. It is widely embraced as a beloved hobby, yet also seen as a source of harm.

As games become more sophisticated, encouraging longer and more frequent play, a growing number of individuals are swept up to the point of losing control.

After decades of excessive gaming often being dismissed as a mere obsession rather than a health concern, the World Health Organization officially acknowledged ‘gaming disorder’ as a mental health condition in 2019.

Gaming disorder is characterised as an addiction to video games and is estimated to affect about 3 percent of the global population. People with gaming disorder may find themselves immersed in virtual worlds for more than 85 hours a week – a figure that not only encompasses playing games but also the consumption of related content, such as watching streamers (ie, people who livestream their gaming sessions).

According to the WHO definition, gaming disorder is a loss of control over gaming, where the prioritisation of gaming over other activities and responsibilities has a detrimental impact on a person’s life for at least 12 months. Negative consequences manifest as absence from or poor performance at school or work, a decreased ability to care for one’s children, social isolation, sleep problems, eating irregularities, depressed mood, and so on.

These negative consequences are what can generally differentiate an avid gamer from one who has a gaming disorder. The latter continues or escalates play despite the player experiencing significant impairments to their functioning.

Global efforts to curb gaming disorder have seen varied approaches since the early 2000s, from South Korea’s now-defunct ‘Cinderella Law’ which prohibited children under 16 from gaming between midnight and 6am, to Thailand’s shutdown system that required game providers to block access to their online games during certain hours. These structural interventions were met with resistance. The pushback from the gaming community highlighted a critical need for alternative interventions that respect gamers’ autonomy while offering effective support for those who seek it.

This brings us to the crux of the matter: treatment. How are health systems responding to those seeking help?

The US, South Korea, Switzerland and Australia have already implemented and rolled out specialised treatment services.

It’s a different story in New Zealand. We have no government-funded specialised services nor gaming-specific treatment available in community mental health services. Those seeking help turn to mental health services that are willing to help but typically lack gaming-specific tools or training to do so.

Where treatments have been offered overseas, they have predominantly targeted severe cases and are often intensive, costly, and in-person. Though having access to treatment is important, it is crucial to note these treatments may not be suitable for those with low to moderately severe gaming problems in terms of approachability, appropriateness, and affordability.

People with less severe gaming problems are seeking treatment to cut down or quit too, but little is out there that suits their preferences. There is evidence that gamers would prefer online treatment, if available, that can be self-managed or accessed in combination with in-person care. It is time we address the needs of this group, as early and brief interventions can help stop their problems from escalating.

Introducing brief online treatment would be a promising way to get ahead of the game and expand treatment options that can accommodate different levels of gaming disorder severity. The beauty of this type of treatment lies in its online nature – it can be accessed anywhere, at any time, and usually for free. The online environment may also be more comfortable for gamers, especially those who are introverted or seek anonymity.

As part of my PhD, a brief website-based treatment called ‘Gaming Habit Hacker’ was developed and tested with a randomised controlled trial involving more than 200 New Zealanders and Australians. It offered a 28-day programme that guided participants to create personalised plans using gaming reduction strategies, derived from the lived experience of other gamers who have successfully cut down. Throughout the programme, participants were supported by an online coach who provided feedback on plans and weekly check-ins to help track gaming time.

The trial found that Gaming Habit Hacker was not only effective in reducing gaming time, from an average of 28 hours a week to 13 hours a week, but also improved participants’ wellbeing, sleep, and relationships.

In practice, online treatment can be delivered as a stand-alone intervention or combined with in-person care to provide ‘blended treatment’. Interventions like this can be made available to equip pre-existing health services for blended treatment. However, there is a need to simultaneously train the mental health workforce, which would require funding and further research.

It is one thing to provide physically accessible services, but it is another to provide fully accessible services that are low-cost, gaming-specific, time-efficient, and accommodate varying levels of gaming disorder severity.

In an ideal – or at least better – world, the rising popularity and harm associated with video games would be met by expanding treatment options and facilitating capacity-building across the mental health sector.

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