The American Journal of Drug and Alcohol Abuse, 36:268–276, 2010 Copyright © Informa Healthcare USA, Inc. ISSN: 0095-2990 print / 1097-9891 online DOI: 10.3109/00952990.2010.491879 Computer and Video Game Addiction—A Comparison between Game Users and Non-Game Users Aviv Malkiel Weinstein, Ph.D. Department of Medical Biophysics and Nuclear Medicine, Hadassah Hospital, Ein Kerem, Jerusalem, Israel,and Department of Nuclear Medicine, Sourasky Medical Center, Tel Aviv, Israel Background: Computer game addiction is excessive or com- pulsive use of computer and video games that may interfere with daily life. It is not clear whether video game playing meets di- agnostic criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Objectives: First objective is to review the literature on computer and video game addiction over the topics of diagnosis, phenomenology, epidemiology, and treatment. Second objective is to describe a brain imaging study measuring dopamine release during computer game playing. Meth- ods: Article search of 15 published articles between 2000 and 2009 in Medline and PubMed on computer and video game addiction. Nine abstinent “ecstasy” users and 8 control subjects were scanned at baseline and after performing on a motorbike riding computer game while imaging dopamine release in vivo with [123I] IBZM and single photon emission computed tomography (SPECT). Results: Psycho-physiological mechanisms underlying computer game ad- diction are mainly stress coping mechanisms, emotional reactions, sensitization, and reward. Computer game playing may lead to long-term changes in the reward circuitry that resemble the effects of substance dependence. The brain imaging study showed that healthy control subjects had reduced dopamine D2 receptor occu- pancy of 10.5% in the caudate after playing a motorbike riding computer game compared with baseline levels of binding consis- tent with increased release and binding to its receptors. Ex-chronic “ecstasy” users showed no change in levels of dopamine D2 recep- tor occupancy after playing this game. Conclusion: This evidence supports the notion that psycho-stimulant users have decreased sensitivity to natural reward. Significance: Computer game ad- dicts or gamblers may show reduced dopamine response to stimuli associated with their addiction presumably due to sensitization. Keywords addictionx, brain imaging, computer game playing, dopamine, reward, video game playing INTRODUCTION Problem Definition Computer or video game addiction is excessive or compulsive use of computer and video games that interferes with daily life. Address correspondence to Aviv M. Weinstein,, Ph.D., Department of Medical Biophysics and Nuclear Medicine, Hadassah Hospital, Ein Kerem, Jerusalem, Israel. E-mail: avivweinstein@yahoo.com Users may play compulsively, isolating themselves from other forms of social contact, and focus almost entirely on in-game achievements rather than broader life events. Griffiths (1) has operationally defined addictive behavior as any behavior that features what he believes are the six core components of addiction (i.e., salience, mood modification, tol- erance, withdrawal symptoms, conflict, and relapse). He further argued that video game addiction fulfils the criterion of addic- tion by virtue of meeting these criteria. In his view, since many video game users are excessive users and not addicts, video game addiction may be a medium for satisfaction of arousal and reward (see section on mechanisms of reward). In addition to the neurochemical basis for addiction, there are accompa- nied behavioral markers of dependence in adolescents such as stealing, truancy, not doing homework, irritability if unable to play, etc. Finally, single case studies have shown the video game addiction was used in order to compensate for deficiencies in one’s life in areas such as interpersonal relationships, physical appearance, disability, coping, etc. Griffith (2) argued that al- though there are educational, social, and therapeutic benefits to video games play, taken in excess they could lead to addiction, playing 24 hours a day 7 days a week and in some cases to a gambling problem. Finally, Griffiths (3) concluded that adverse effects of video game addiction are relatively minor and tempo- rary resolving spontaneously with decreased frequency of play or to affect a small group of players. There is no evidence for genetic factors influencing video or computer game addiction. Most studies describe a behavior that is independent of other psychiatric disorders (e.g., not just secondary to another condition such as attention deficit hyper- activity disorder [ADHD] or mania). There is a single study suggesting co-morbidity with depression (4) and for comorbid- ity with ADHD (5) but there is no evidence for co-morbidity with substance use disorder. On the spectrum of impulsivity and obsessive-compulsive behavior, there is some evidence for impulsivity on the Barrat Impulsiveness scale (4), and exces- sive computer and video game playing supports the notion of obsessive-compulsive behavior although formal assessment of obsessive-compulsive behavior in these individuals has not been 268 Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Simon Fraser University on 04/04/11 For personal use only.