Problematic gambling, problematic gaming, and behavioural addictions

In recent years there has been a growing focus on problematic gaming. In the DSM 5-TR which is the most recent version of the diagnostic manual for mental health disorders, Internet Gaming is listed as a condition for further research and study, which generally means there has been a noteworthy increase in reported occurrences, impact to people's lives, as well as increased research evidence to indicate 'hang on, this may be a problem'. 

Based on accounts from many parents I am well aware this can be a real issue. I work with young people, as well as adults, who may spend up to 15-18 hours daily engaged in gaming. The gaming becomes front and centre focus, often at the detriment of other life activities. 

I believe I can relate well to gamers, and I am happy to report I am an avid GTA 5 Online player (nearing level 300 with an excess of $100mill in the bank - if you don't know what this means I can assure you this takes time). I am the proud owner of my Roblox account as well as an active Playstation subscription. 

Gaming can be fun, entertaining, exciting, educational, social, and a great addition to life. However, it can equally be the source of problems (endless grinding, 'griefers', conflict with parents and partners). 

I would like to help to achieve a better balance in life, and to restore the gaming experience back to fun again.   

Problematic gambling can be the source of great life pain and interpersonal problems. Often the addiction cause havoc with those affected in destroying relationships, and shattering dreams of such as house ownership and financial security. 

Those affected by gambling addiction report being on a roller coaster, swinging from the lowest of the low after bad losses to excitement and highs when winning. After some time, the roller coaster ride speeds up - no longer determined by winning or losing but now entirely stressful, causing embarrassment, guilt, shame, and sadness. In trying to escape these difficult emotions, the person may resort to even more gambling, creating a vicious cycle without an exit strategy. 

Gambling addiction is recognised in the DSM 5 - TR as a real mental health disorder. There is no doubt in the scientific community that this is a real disorder of the mind causing significant impact in the lives of those affected. 

Waking up with regrets and anxiety over the loss, making oaths to self and others never to gamble again. By midday the feelings have perhaps slightly subsided, and sneaky thoughts such as 'hm, I guess I could just....' and 'if I only X, then maybe Y' or some other ambivalent thought in disguise. By 6pm the person is yet again feeling a rising thrill of excitement as they drive home from work on the normal route, almost detached from self as they enter the gaming venue they swore to never again visit. 

Any substance or behaviour that feels good (which means at a neuro-chemical level in our brain  it releases dopamine and/ or serotonin) can become habitual, including problematic gaming and problematic gambling but also activities we generally consider healthy such as exercise, having sex, shopping, using the internet. However, anything we do excessively and at the expense of other important activities can equally become problematic. 

With dopamine in particular, there is a well known relationship between pleasure and pain, often referred to as the 'process opponent theory' - two sides of the same coin, but with a negative correlation: one goes up which means the other goes down. 

Any activity that provides pleasure follows a pattern: after too much exposure the pleasure experience reduces, and we lose the ability to feel pleasure from the activity (anhedonia). Beyond this point if the activity is continued it will cause pain, such as regret, anger, shame, embarrassment, etc.