“Erzi, could you please help me carry in the groceries?” my mom asked my little brother, a typical teenage avid internet user and video game player. He did not even hear our mother as he sat intently hunched over his computer screen with his headphones on and continued to click away furiously.
According to a 2018 Pew Research Center survey, 97% of teen boys play video games, compared to 83% of girls.
A 2008 Iowa State University study found that United States youth spent an average of 13 hours per week playing video games, and boys averaged 16 to 18 hours per week.
Of those millions of gaming youth, a 2009 national Harris Poll survey found that 8.5% of computer game users were pathological players, according to standards established for an addiction to pathological gambling.
There are stories of students who have dropped out of college, had seizures, or have died as a result from internet and video game addictions, according to the Wall Street Journal, American Addiction Centers, and MIT Technology Review.
But there are still skeptics who call such stories mere anecdotes and decry warnings about excessive internet and video game playing as alarmist.
The traditional psychological literature has many studies correlating internet and video game addiction, also known as IVGA, with adverse outcomes including poor sleep, poor grades in school and aggression, according to 2017 Iowa State University research.
In the past 10 years, research from the field of neurobiology has added startling new insights into the effects of IVGA on the brain, adding fuel to the argument that IVGA is indeed harmful, not only to the psyche, but to the hardware of the brain itself.
So, what is known about the neurobiology of addiction in general?
Addictive substances like cocaine and heroin cause the neurotransmitter dopamine to flood the brain, creating a feeling of intense pleasure, according to Harvard Health.
The problem is that the brain adapts to this flooding by down-regulating the number of dopamine receptors and their sensitivity to dopamine. For ordinary rewarding stimuli like reading a good book or eating a tasty meal, the dopamine released finds fewer and less sensitive receptors to fill, and a smaller pleasure signal is registered in the nucleus accumbens and other pleasure centers located in a deeper part of the brain called the striatum, according to the U.S. National Library of Medicine.
The baseline state of the addict becomes dysthymic — irritable or unhappy, and anhedonic — less able to experience pleasure, according to the U.S. National Library of Medicine. The addict needs to keep using to release enough dopamine just to feel neutral.
When an addict stops their addictive behavior, they feel dysphoric — anxious, uneasy, miserable, which is the phenomenon of withdrawal. Because the receptors keep down-regulating, the addict has to use more and more to try to feel better in a vicious negative cycle, which is the phenomenon of tolerance. Addiction thereby desensitizes the brain to pleasure, according to the U.S. National Library of Medicine.
Neurobiological studies have unfortunately confirmed that this same addictive process occurs in the brains of IVG addicts.
According to the American Journal on Addictions, positron emission tomography scans reveal the same down-regulation in dopamine receptors that occurs in drug abusers, as the immediacy and frequency of how technology serves up rewards in game playing causes dopamine flooding similar in magnitude to substance abuse.
MRI studies have revealed that IVG addicts even suffered structural damage of their reward structures over time with shrinkage of the nucleus accumbens, according to a 2008 Wake Forest University School journal in the U.S. National Library of Medicine.
Sadly, similar damage occurs to the inhibitory upper brain cortico-striatal pathways between the cortex (seat of judgment and reason) and the striatum (area of pleasure registration) responsible for self-control.
Addicts undergoing neuropsychiatric testing performed poorly compared to non-addicts on tests of inhibition and monitoring with functional MRI studies confirming less efficient functioning of their executive function pathways (Drs. Weinstein and Univ. of Diderot’s Dr. Michael Lejoyeaux, 2013).
The 2017 MRI studies by Choi and 2013 studies by Dr.C.B. Weng of Anhui Medical University revealed significant gray matter atrophy of the prefrontal and orbitofrontal cortices, areas of cortex involved in executive function, that correlated with how addicted players scored on the Young’s Internet Addiction Scale.
Naysayers may argue that rather than IVG overuse causing this damage in the rewards and executive function pathways, people with deficient circuits are the ones who turn to IVG overuse to cope with their deficiencies.
But in 2010, Dr. D. Han of Chung Ang University in Seoul found that non-addicted college students who were made to play over an hour of internet games daily for six weeks actually developed changes by functional MRI that resembled the early changes of addiction in drug abusers.
In a 2011 study by Han, IVG addicts given bupropion, a medication used to help smokers quit, to successfully treat their IVGA addiction showed some reversal of these changes on their fMRIs.
Furthermore, in 2011, Dr. Gentile did a longitudinal study on 3034 youth in Singapore. He found that IVGA predicted the development of depression and anxiety over the next two years, as well as the development of social phobias, decreased grades, and increased aggressive tendencies.
In addition, the 16.4% of youth who recovered from the IVG addiction demonstrated lower rates of depression, anxiety, and social phobia, and higher grades. Neurobiological studies confirm brain changes in the reward and executive function pathways that could mechanistically explain these results. Put together, neurobiological and psychological research powerfully suggest that IVGA causes mental disorders in developing minds.
What do we do with this information? Greater efforts at education must be made before society ends up with a generation of addicts with a new normal of requiring constant stimulation and instant gratification.
Technology is reshaping our brains fast. Before it is too late, federal public health authorities should spearhead a nationwide campaign to educate the public about the potential harms of excessive internet and video game playing.
Perhaps the Surgeon General could issue a warning on each Internet and video game label with educational links, such as to the American Academy of Pediatrics’ recommendation to limit total screen time to less than one to two hours a day.
In addition to more education of the public to limit IVG playing in order to prevent the malformation of developing minds from IVGA, we need to do more research on the effect of IVG playing on so-called “nonaddicted” brains. Neurologists have a saying, “What fires together, wires together,” according to 1992 research by neurobiologist Carla Shatz.
The brain changes of IVGA are not instantaneous but develop with practice. It makes sense that game users are slowly changing their brains with every repetitive click of the mouse. More research needs to be done longitudinally over time on what is happening inside my brother’s head and millions of teenagers like him. In the meantime, I hope my brother takes charge of his game playing while he still can, before it takes charge of him.