A version of this story was originally published in 2018 and has been updated.
They are popular. They are controversial. And now, video games have just become an internationally recognized addiction.
On May 25, the World Health Organization officially voted to adopt the latest edition of its International Classification of Diseases, or ICD, to include an entry on "gaming disorder" as a behavioral addiction.
This is a move that could alarm parents all over the country. According to Pew, 97 percent of teen boys and 83 percent of girls play games on some kind of device.
But in order to be classified as having a disease, being a video game fan isn't enough. According to WHO, the criteria doesn't include a certain amount of hours spent playing. Instead, the description is of someone with an inability to stop playing even though it interferes with other areas of one's life, such as family relationships, school, work, and sleep. And, these problems would typically continue for at least one year.
And although WHO's voice is powerful, it's not the last word in the world of science.
"There is a fairly even split in the scientific community about whether 'tech addiction' is a real thing," says Dr. Michael Bishop, who runs Summerland, which he calls "a summer camp for screen overuse" for teens.
"Technology addiction" doesn't appear in the latest Diagnostic and Statistical Manual, the DSM-V, published in 2013. That's the bible of the psychiatric profession in the United States. The closest it comes is something called "Internet Gaming Disorder," and that is listed as a condition for further study, not an official diagnosis.
This omission is important not only because it shapes therapists' and doctors' understanding of their patients but because without an official DSM code, it is harder to bill insurers for treatment of a specific issue.
Dr. Nicholas Kardaras is the author of the 2016 book Glow Kids: How Screen Addiction Is Hijacking Our Kids. There are brain-imaging studies of the effects of screen time, he says. And he also has treated many teens who are so wrapped up in video games that they don't even get up to use the bathroom.
He says the evidence is clear, but we're not ready to face it.
"We have, as a society, gone all-in on tech," he says. "So we don't want some buzz-killing truth sayers telling us that the emperor has no clothes and that the devices that we've all so fallen in love with can be a problem" — especially for kids and their developing brains, he adds.
Addiction may not be an official term in the U.S., at least not yet. But researchers and clinicians like Bishop, who avoid using it, are still concerned about some of the patterns of behavior they see.
"I came to this issue out of a place of deep skepticism: addicted to video games? That can't be right," said Dr. Douglas Gentile at Iowa State University, who has been researching the effects of media on children for decades.
But "I've been forced by data to accept that it's a problem," he told me when I interviewed him for my book The Art of Screen Time. "Addiction to video games and Internet use, defined as 'serious dysfunction in multiple aspects of your life that achieves clinical significance,' does seem to exist."
Measuring problematic use
Gentile's definition doesn't address the questions of whether media can cause changes in your brain or create a true physical dependency.
It also doesn't address the question, raised by some of the clinicians I've spoken with, of whether media overuse is best thought of as a symptom of something else, such as depression, anxiety or ADHD. Gentile's definition simply asks whether someone's relationship to media is causing problems to the extent that the person would benefit from getting some help.
Gentile was one of the co-authors of a study published in November that tried to shed more light on that question. The study has the subtitle "A Parent Report Measure of Screen Media 'Addiction' in Children." Note that the term addiction is in quotes here. In the study, researchers asked parents of school-age children to complete a questionnaire based on the criteria for "Internet Gaming Disorder."
For example, it asked: Is their preferred media activity the only thing that puts them in a good mood? Are they angry or otherwise unhappy when forced to unplug? Is their use increasing over time? Do they sneak around to use screens? Does it interfere with family activities, friendships or school?
The experts I've talked to say the question of whether an adult, or a child, has a problem with technology can't be answered simply by measuring screen time. What matters most, this study suggests, is your relationship to it, and that requires looking at the full context of life.
Sarah Domoff, the lead author on that study, runs the Problematic Media Assessment and Treatment clinic at the Center for Children, Families, and Communities at Central Michigan University. She works with young people directly, and also trains pediatricians to spot problems with screens and to offer help to families. She says that problems with video games often are found in children who also have a diagnosis such as ADHD or autism spectrum, while young people who have problems with social media are more likely to have a diagnosis such as depression or anxiety.
Rather than go "cold turkey" on technology, she focuses on helping families with "harm reduction" such as keeping devices out of the bedroom and making sure that young people go to school, spend time with friends and play outdoors. Addiction, she says, may be "in the single digits" --that is, less than 10 percent of all those who use media--but we need more research to know for sure.
Though tech addiction isn't officially recognized yet in the United States, there are in-patient treatment facilities for teens that try to address the problem.
For my book, I interviewed a teenage boy who attended a wilderness therapy program in Utah called Outback.
"I started playing [video games] when I was around 9 years old," said Griffin, whose last name I didn't use to protect his privacy. He chose email over a phone interview. "I played because I found it fun, but after a while I played mostly because I preferred it over socializing and confronting my problems."
After he spent weeks hiking through the wilderness, his mother saw a lot of improvement in his demeanor and focus. However, Griffin came home to a reality where he still needed a laptop for high school and still used a smartphone to connect with friends.
Bishop, who runs therapeutic Summerland camps in California and North Carolina, says the teens who come to him fall into two broad categories. There are the ones, overwhelmingly boys, who spend so much time playing video games that, in his words, they "fall behind in their social skills." Often they are battling depression or anxiety, or they may be on the autism spectrum.
Then there is a group of mostly girls who misuse and overuse social media. They may be obsessed with taking selfies — Bishop calls them "selfists" — or they may have sent inappropriate pictures of themselves or bullied others online.
Regardless of the problem, "We feel the issue is best conceptualized as a 'habit' over an 'addiction,' " Bishop says. "When teens think about their behavior as a habit, they are more empowered to change."
Labeling someone an addict, essentially saying he or she has a chronic disease, is a powerful move. And it may be especially dangerous for teens, who are in the process of forming their identities, says Maia Szalavitz.
Szalavitz is an addiction expert and the author of Unbroken Brain: A Revolutionary New Way Of Understanding Addiction. Based on her experience with drug and alcohol addiction, she thinks grouping kids together who have problems with screens can be counterproductive. Young people with milder problems may learn from their more "deviant peers," she says. For that reason, she would encourage families to start with individual or family counseling.
Different habits demand different approaches to treatment. People who have problematic relationships with alcohol, drugs or gambling can choose abstinence, though it's far from easy. Those who are binge eaters, however, cannot. They must rebuild their relationships with food while continuing to eat every day.
In today's world, technology may be more like food than it is like alcohol. Video games or social media may be avoidable, but most students need to use computers for school assignments, build tech skills for the workplace, and learn to combat distraction and procrastination as part of growing up.
The word "addiction" may currently be attracting controversy, but you don't need a doctor's official pronouncement to work on putting the devices down more often — or to encourage your kids to do so as well.