Major Depression, Internet and Gaming Addiction: Healing Through Dual-Diagnosis Treatment

As with most process addictions, the concept of video game addiction is often misunderstood, minimized, or rejected altogether. After all, video games ostensibly don’t involve a drug as we typically understand it. However, video games are increasingly recognized for their potential to act like a drug due to their neurological impact. “Video game play, a completely unnatural behavior divorced from intrinsic reward, activate[s] the pleasure circuit,” explains Dr. David J Linden, professor of neuroscience at Johns Hopkins University School of Medicine. This pleasure circuit is also the site of impact of recreational drugs and repeatedly activation of the circuit by any means is known to produce cravings, anticipation of reward, tolerance, and withdrawal due to changes in dopamine receptors and neural pathways. Indeed, in 1998 video games were shown to increase dopamine levels by 100% (an effect many believe has become even more pronounced as games have evolved), which can have long-term implications for dopamine receptor sites.

At the same time, research reveals that video games can induce “measurable changes in the parts of the brain linked to cognitive function and emotional control,” potentially diminishing the player’s ability to comprehend and regulate their thoughts, feelings, and behavior. As our knowledge of these phenomena continues to grow, the medical community is increasingly recognizing video game addiction as a legitimate condition. In 2017, for example, the World Health Organization (WHO) officially recognized “gaming disorder” in its 2018 International Classification of Diseases.

Video game designers employ psychological consultants specifically to create games that will encourage prolonged and repeated play; compulsive playing is perpetuated by the games themselves. As such, video game addiction can develop in people without pre-existing mental health disorders. However, people struggling with mental illness like major depression are particularly vulnerable to such addiction. “Excessively engaging in gaming may function as an escape mechanism for, or coping with, underlying psychiatric disorders in an attempt to alleviate unpleasant feelings,” says Dr. Cecilie Shou Andreassen, a clinical psychologist at the University of Bergen whose research has revealed strong connections between depression and video game addiction.

While escapism and distraction may be part of what allows gaming to be used as a coping mechanism, the pleasure circuit itself is believed to play a significant role. When people are depressed, they typically struggle to experience pleasure through ordinary means. As a result, they may both crave dopamine-induced pleasure more than non-depressed people and require higher levels of dopamine to experience pleasure; in other words, video games may be one of the few accessible things that create neurological rewards and as tolerance builds, your adult child may need larger “doses” of gaming in order to achieve their desired effect. However, the relationship between depression and video game addiction is not a one-way street. Rather, the two can work together to create a cycle of use and suffering much like that experienced by substance users. This may, in part, be driven by the neurological highs and crashes of the gaming experience.

Another factor may be the way video game addiction removes your loved one from healthy situations and behaviors that support mental wellness; as gaming comes to take on an ever-increasing role in their life, other vital pieces may fall away, including in-person social relationships, educational or professional pursuits, healthy sleep and dietary habits, and physical activity. As a result, their mental health is further compromised and depression deepens, potentially strengthening the impetus to find relief in gaming.

For many gamers, the Internet plays a critical role in their gaming activities. From online games to participation in gaming culture, the Internet often acts as a critical space for the development and experience of video game addiction. But Internet addiction is, of course, not only experienced by gamers, nor is Internet addiction necessarily directly related to gaming even for those struggling with video game addiction. Rather, Internet addiction may exist independently from or intertwine with gaming addiction in complex ways. Regardless of the exact relationship, the issues that arise from addiction are largely the same.

Internet use can act on the brain in the same way video games do, activating the reward circuit and altering neural pathways over time, resulting in addiction. As Internet use has become increasingly prevalent and spurred a growing number of people toward addiction, researchers have come to acknowledge not only the existence of the condition, but regard Internet use as a public health issue due to its addictive potential. According to a 2014 report from the WHO, Internet addiction poses significant risks to both physical and psychosocial health, with social development, sleep deprivation, aggressive behaviors, and exposure to cyber-bullying being of particular concern. Excessive Internet use can also “be associated with a range of social and psychological problems such as poor psychological well-being, poor self-confidence, family problems, marital breakdown, [and] reduced work and academic performance.” The causes of many of these issues may lie in the fact that although Internet use may seem—and, at times, be—a positive social experience, it does not offer the same positive psychological effects as in-person contact. As such, replacing “real life” social interactions with Internet-based socialization can be deeply damaging and, despite your child’s perception, increase isolation. The report also identifies depression as both a known risk factor for and a risk of Internet addiction.

The WHO is not the first to suggest a link between major depression and Internet addiction; there is a rapidly growing body of evidence showing that the two are often intimately connected. The reasons for this are much the same as those that underpin the relationship between major depression and Internet addiction in terms of coping and reward. However, depression and Internet addiction are more well-researched in terms of causality, with strong evidence for dual causal relationships. A 2014 study, for example, found that depression and self-esteem are significant predictors of Internet addiction. Meanwhile, a 2011 study found that “those who used the Internet excessively were more than twice as likely as others to be depressed nine months later,” suggesting that excessive Internet use is predictive of depression. As with video game addiction, this co-occurrence can be self-perpetuating, as each condition sets the stage for the other to flourish.

When a person has a mental health disorder and co-occurring addiction, dual diagnosis treatment is considered the best option for recovery, as leaving one part of the equation unaddressed means continued suffering and heightened risk of relapse. This includes cases where the co-occurring addiction is a process addiction rather than a substance use disorder. In a dual diagnosis treatment program, your adult child will have the opportunity to explore both of their conditions simultaneously as well as the connections between them in order to create durable healing.

Unfortunately, when your child is struggling with major depression and Internet or video game addiction, finding help can be a struggle. Due to the relatively recent recognition of these process disorders, many clinicians are not well equipped to deliver the kind and quality of care necessary for recovery. However, there are a growing number of mental health professionals with the experience and training necessary to correctly diagnose and treat these complex conditions and guiding your loved one toward their care can lead to true transformation. If your adult child’s condition is severe or if they have serious functional struggles, seeking the help of a long-term dual diagnosis treatment program may be the best option. While long-term treatment has long been known to improve outcomes for severe depression as well as co-occurring substance use disorders, it is now becoming clear that it also provides significant opportunities for people struggling with process addictions as well.

Within a structured residential environment, your loved one will be able to deeply investigate their conditions while getting the support they need at each stage of recovery. Removed from the stressors of everyday life, they can break free from their addictive behaviors and develop the insight and skills necessary to cope with triggers, withdrawal, and cravings in a safe, monitored environment. At the same time, they can find healthy strategies to cope with symptoms of depression and learn to re-connect with the world around them—and to themselves. As they go through the recovery process, they will gradually shift their focus on long-term functionality and self-care. In doing so, they can gain a newfound sense of confidence, self-esteem, and purpose and experience profound empowerment that will propel their healing and create a strong foundation for ongoing growth.