In recent years, there has been a move to include more gaming or skill-based elements into gambling and more gambling elements into online gaming. These new, affordable, and accessible forms of gambling have been created to engage younger consumers, who are not attracted to more traditional approaches (e.g., slots or horseracing), and to bring in more revenue.1,2
This development is what some call the “gamification of gambling.” The blending of gaming and gambling features includes, but is not limited to, gambling elements in games on social media as well as social gaming features on online gambling sites.1,2
These changes are a cause for concern in some quarters related to the blurred lines between gaming and gambling, which has already started to occur, as demonstrated by the increasing use of the term “gaming” when referring to the use of electronic gambling machines.2
In the last few decades, Internet use has increased exponentially, but research on problem Internet use has not kept up. This gap has sparked questions about the potential negative effects of Internet use. More troubling is the ambiguity between Internet use and problem Internet use.3 Since online gambling and gaming are becoming increasingly popular, there is a need to understand its connection to problem technology use.
“Problem technology use” is an umbrella term often used to describe high-risk behaviours related to a variety of activities, including:4
- playing video games
- watching YouTube videos
- streaming movies and sports
- accessing social networks
- using cybersex and online porn
- visiting gambling websites
- visiting eBay and other online auction or shopping websites
- using social media
- engaging in texting
- using smartphones.
Adding to the ambiguity surrounding this topic, the terminology used in the literature is inconsistent, largely because problem technology use is not a formally recognized mental health disorder. Some of the terms used include:
- problem technology use
- problem Internet use
- video game addiction
- gaming disorder.
While there are some distinctions between these different types of problems, researchers often use these terms interchangeably and inconsistently. Therefore, this EIP section will use a variety of terms when referring to problem technology use.
What does the evidence say?
Researchers typically group problematic use of electronic devices and the Internet together, making it difficult to discern between the two. Also, problem technology/Internet use is not formally recognized as a disorder in the
Diagnostic and Statistical Manual of Mental Disorders (5th ed.;
International Classification of Diseases 11th Revision (ICD-11).5,6 However, the
ICD-11 has recognized gaming disorder (see below).
A 2016 study of Ontario adults showed that about 40 per cent met the criteria for any problematic use of technology/electronic devices, and about eight per cent met the criteria for moderate to severe problematic use. In addition, almost 30 per cent tried to cut back on their use of electronic devices, suggesting a need for intervention and support.7
A study of Ontario high school students also showed increasing use of technology and social media increased. About 30 per cent report spending five or more hours per day on the use of electronic devices (smartphones, tablets, laptops, computers, gaming consoles, etc.). In addition, 20 per cent of students spend at least five hours per day using social media, a four per cent increase from 2015 and a nine per cent increase over 2013.8
Lastly, five per cent of Ontario high school students have symptoms that are consistent with a serious technology use problem, such as a preoccupation with technology, loss of control, withdrawal symptoms, and problems with family and friends.6 This is a concern because there is evidence of a possible link between problem technology use and mental health problems.9
Problem technology use has been linked to the a variety of mental health problems in adults, for example:9,10
- mood disorders, particularly depression
- anxiety disorders, including generalized anxiety disorder and social phobia
- attention-deficit hyperactivity disorder (ADHD)
- obsessive-compulsive disorder.
Similarly, the following mental health problems have been linked with problem technology use in youth and young adults:10,12,13,14
- mood disorders, particularly depression10,12,13,14
- anxiety disorders, including generalized anxiety disorder and social phobia14
- personality disorders14
- substance use, particularly cannabis12 and alcohol.10
Results from a 2013 systematic review suggest that depression and ADHD are the most significantly and consistently reported disorders among people with Internet use problems. Also, the research has consistently found that males have a higher prevalence of problem Internet use than females. That review, however, did not distinguish between adults and adolescents.15
While the term “problem technology use” includes problem gaming, researchers often view it as a separate disorder. And while the
DSM-5 does not formally recognize gaming disorder as a mental disorder, it lists Internet gaming disorder as a condition that warrants further study.5
On the other hand, the
ICD-11 classifies gaming disorder under “disorders due to addictive behaviours,” and identifies the following diagnostic criteria:6
- preoccupation with gaming (either online or offline)
- inability to limit or control gaming
- repeated unsuccessful attempts to reduce gaming despite negative consequences.
A study of Ontario high school students found that about 23 per cent play video games daily or almost daily, and nine per cent play video games five hours or more per day. Also, about 12 per cent report symptoms of a video gaming problem, including preoccupation, tolerance, loss of control, withdrawal, and negative consequences.8
Similar prevalence rates have been found among Ontario adults, with about 18 per cent reporting up to one hour per week of video or computer game playing, and about eight per cent meeting criteria for moderate-to-severe problematic use.7
Researchers appear to blur the definitions of gaming, internet use, and technology-related disorders, which makes it difficult to obtain accurate prevalence and comorbidity rates. However, a recent review outlined the following co-occurring problems in people with online gaming problems:16
- social anxiety
Putting the evidence into practice
The Canadian Paediatric Society (CPS) recommends imposing limits on screen time in children. It discourages technology-based activities for children less than two years old and recommends limiting recreational technology use to less than one hour per day for children two to five years old.
Although these limits may be difficult for parents to enforce, the
CPS recommendations state that it is parents should focus on monitoring how and when children use technology rather than the amount of time they spend using technology.17
Who is impacted by problem technology use?
When assessing the risks and impacts of problem technology use, there are several risk factors to consider as well as biological, psychological, social, and cultural factors. These factors include:
- younger developmental stage4
- low self-esteem18,19
- family conflict11,19
- access to technology21
- perfectionism (neuroticism)22,23
- poor social adjustment21,24,25
- lack of resilience26
- learning difficulties or exceptionalities, such as high IQ.24
How to Screen for Technology Use Problems
Screening for problem technology use can be informal or formal. In an informal screen, ask the client a few initial questions to open the discussion and probe for any potential signs of problem technology use.27
Ask one or two direct questions, such as:
- How often do you find yourself using technology on a typical day?
- Has a friend or family member suggested you cut down on your use of technology?
Several research-validated screening tools are available to identify problem technology use. One example is the
Problematic Internet Use Questionnaire. This open-access, self-administered tool includes criteria such as preoccupation with online use, neglect of non-online activities, and inability to refrain from using the Internet.28
Given the high rate of co-occurring mental health problems associated with problem technology use,8,10,12,29 it can be helpful to screen for mental health problems and other functional difficulties.21 A useful tools for this purpose is the Global Appraisal of Individual Needs – Short Screener (GAIN–SS). The
Staged Screening and Assessment for Addictions guide outlines how to use and interpret the GAIN–SS.
How to treat technology use problems
There is limited research on the treatment of problem technology use, which makes it difficult to form definitive conclusions surrounding best practices for treatment of this problem. A recent meta-analysis found the following approaches to be effective:3
- cognitive behavioural therapy (CBT; group or individual)
- motivational interviewing
- family therapy
- medications (i.e., selective serotonin reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, benzodiazepines, antipsychotic medication, and methylphenidate)
- a combination of different approaches.
However, psychological therapies (such as CBT, motivational interviewing, and family counselling), yielded varying results across the studies includes in this meta-analysis, which made it difficult for the authors to draw definitive conclusions.3
In the five studies that examined the use of medications to treat co-occurring issues (i.e., selective serotonin reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, antipsychotic medications, benzodiazepines, and methylphenidate) the results show that medications reduced both the symptoms and the time spent online. It is important to note, however, that these studies had small sample sizes, so no definitive conclusions cannot be drawn at this time.3
Clinical simulation video
Download video transcript
This video clip shows a fictitious therapist and client session for teaching purposes.
The scenario shows a typical cognitive-behavioural therapy session with a client (Bart) who is trying to maintain his changes related to problem gaming. The client and his therapist are discussing a recent lapse. The therapist works collaboratively with him to complete the
Learning from Slips and Relapses handout and find alternate activities and coping strategies for triggers that may lead to excessive video gaming.