Not every gamer will become an addict, but regulation is necessary

Gamers8, a major esports and gaming festival, kicks off in Riyadh this week, on July 14th. The event will run until Sept 8th, when the world’s best-known and most successful Esports teams slog it out for a slice of the $15 million prize pool. The event also boasts a Formula One-style concert line-up, with performances by the Black Eyed Peas, Marshmallow, Nancy Ajram and more. Esports and gaming are undeniably mainstream. Their popularity has risen to the extent that gaming threatens many physical sports in terms of active participation numbers and viewership. For example, a report by Greenman Gaming suggests that E-sports attracted a global viewership of 443 million in 2019, much of it located in Asia. By comparison, American football and rugby combined attracted around 410 million viewers. The future of sports, in general, is closely connected to Esports, and gaming will only grow in popularity with the emergence of the Metaverse and increasingly sophisticated and gamified uses of virtual and augmented reality. No activity becomes extremely popular, though, without at least a few psychiatrists and psychologists suspecting it might be pathological when taken to extremes. Shopping, social media use, physical exercise and gaming have all been discussed, at one time or another, as possible behavioural addictions. In May 2019, however, the gaming discussion ended, and the World Health Organisation formally agreed to recognise gaming disorder as an official diagnostic entity. The diagnosis might be made, for example, when a person routinely puts gaming ahead of other priorities, whether social (eg, family) or occupational (eg, work assignments). A diagnosis is even more likely if such behaviour repeatedly has adverse consequences, such as irreparably damaged relationships, deteriorating workplace performance and job losses. Not all clinicians and researchers agree on this conceptualisation of gaming disorder. For example, some argue that problematic gaming is a maladaptive way of coping with underlying depression. Such debates aside, nobody contests the idea that excessive gaming can give rise to real-world problems for some people. Issues that some individuals might like help overcoming. Including gaming disorder within the WHO’s international disease classification system has important implications. As a recognised medical condition – a behavioural addiction – it can now be covered by medical insurance. This move also means that healthcare systems need to provide services for those who may be experiencing problem-gaming. The UAE quickly responded to this, establishing a gaming disorder clinic at the National Rehabilitation Centre in Abu Dhabi in 2020. It may be obvious but it is necessary to point out that gaming and gaming disorder are not the same. A person can have a very healthy and positive relationship with gaming. Gaming can help a person unwind; overcoming in-game challenges may also give them a sense of achievement. In many cases, games are social and can give players a healthy sense of belonging to a valued group. Several studies have even found that among male gamers, longer hours of internet gaming are associated with a reduced consumption of alcohol. In some cases, gaming is the lesser of two ills. Gaming has benefits, but it can be problematic too. I think of it like this: not every cyclist will fracture their skull. Not every gamer will develop a behavioural addiction. However, the fact that some will experience adverse outcomes means we should be vigilant and attempt to minimise risks. Just as we advise or make it mandatory for cyclists to wear helmets, we also need regulations and public health initiatives to prevent the onset of gaming disorder. Such action is needed more than ever as gaming grows increasingly popular. More gamers equal more cases of gaming disorder. Studies that have tried to determine the global prevalence of gaming disorder tend to suggest that around 3-4 per cent of gamers develop problems, with a gender ratio of about three males to each female. However, digging deeper, you find international and regional variations in those numbers. For example, the prevalence of gaming disorder appears to be much higher in Southeast Asian nations, with numerous studies reporting rates upward of 10 per cent. Much of this prevalence research was done before the Covid-19 Pandemic. Lockdown was a great time to pick up the joystick, and many of us did. An article published in Frontiers in Public Health in February suggests an overall increase in screen time among young people, with gaming reaching an all-time high. Beyond being inherently problematic, gaming disorder is also associated with several additional physical and mental health issues. For example, an article published in the Journal of Addiction Medicine and Therapeutic Sciences suggests it has links with anxiety, depression, sleeping disorders, musculoskeletal problems, vision issues and obesity. Gaming is growing in popularity globally. This growth has heightened the need to assess the issue of gaming disorder, raise awareness about it and develop strategies to help prevent healthy gaming from morphing into a behavioural addiction. Events such as Gamers8, the Yas Gaming Festival 2022, and Middle East Games Con 2023 can help play a role here. Such events are an excellent opportunity for targeted public health outreach, where we can promote digital wellbeing and help prevent problematic technology use.