From online communities to boot camps, people are seeking help for problem gaming — but what do we know about the best way to treat it?

Key points: WHO defines gaming as online or offline "digital gaming" or "video gaming"

WHO defines gaming as online or offline "digital gaming" or "video gaming" Only a very small proportion of gamers would be diagnosed as being addicted

Only a very small proportion of gamers would be diagnosed as being addicted It's early days when it comes to testing treatments for problem gaming, but underlying mental health issues can still be treated

Whether or not gaming addiction is a diagnosable mental illness is still a hot topic of debate — some experts argue, for example, problem gaming is merely a symptom of other conditions.

In June, the World Health Organisation (WHO) included gaming addiction on a list of diagnosable conditions.

But still — the controversy persists.

No matter the debate, the WHO decision appears to have led to a rise in people seeking help and in new treatment programs.

So what do we know about how to treat problem gaming?

Last week we heard about a new residential "detox" program in Thailand designed to help young adult male gaming addicts.

It's promoted by Canadian "reformed game addict" turned entrepreneur Cam Adair, whose organisation Game Quitters is "dedicated to helping game addicts the world over" and purportedly has over 50,000 members.

Child and adolescent psychiatrist Huu Kim Le, who helps advise Game Quitters, sees patients for gaming disorder at a public hospital in Adelaide.

He's seen an increase in visits from parents concerned about their child's gaming behaviour since the WHO decision.

"The number of referrals I have had has increased from one a month to one or two a week," Dr Le said.

But what does an online gaming problem look like?

Loading...

The WHO defines "gaming disorder" as a condition involving addictive behaviours, where someone loses control over their gaming, to the extent that it takes over other parts of their life, with negative consequences.

But only a very small proportion of gamers would be affected in this way, according to the WHO.

Only a "handful" of those referred to Dr Le meet the WHO criteria for gaming addiction, he said.

But former gamer Mr Adair said given the billions of people who play games worldwide, the total number affected could be significant.

And gaming can still be a problem in less extreme cases that don't meet the WHO criteria for addiction, according to other experts contacted by the ABC.

So where are people seeking help?

Where's the evidence?

As far back as 2002, the gaming community organised OLG-Anon (On-Line Gamers Anonymous) — an online community that promotes a 12-steps approach to help "excessive gamers".

Mr Adair supports OLG-Anon but suggests its approach may not appeal to the gamers he is targeting with Game Quitters.

"The second you mention 12-steps, they shut down and are not super receptive to it, even if the advice itself is exactly what they need," he said.

Mr Adair has teamed up with an addiction treatment centre called The Edge in Thailand, which provides a residential program.

He said the program aims to "reset the relationship with gaming" and involves a period of abstinence — "taking the crutch away" — to help gain insight into the reason for the addiction.

"Most gamers now start gaming when they're two or three or four or five years old. They've never actually lived their life without gaming," Mr Adair said.

A similar program in Seattle called reSTART urges people to "connect with life, not your device".

According to Dr Le, some psychologists and family therapists are taking a special interest in the area of gaming addiction, and detox retreats are also available in Australia.

"I also have heard of desperate families who seek paramilitary boot camps that cost $5,000-plus in Queensland," he said.

Programs at The Edge in Thailand and reSTART in Seattle are considerably more expensive than this.

Popular games like Fortnite involve multiple competitors fighting for survival by gathering resources, building defence structures and wiping out opponents. ( Supplied: BagoGames )

There are also retreats in the US and the Netherlands and camps in South Korea and Japan dedicated to helping gaming disorder, University of Adelaide clinical psychologist Daniel King said.

But while such retreats may be based on sound psychological and social principles, the question is whether they work — especially in the long term.

The Edge, for example, said it could not provide any success rates at this stage.

Dr King was involved in the WHO decision on gaming disorder, and has reviewed the available evidence on treatment.

He said it's still early days for research on treatment for problem gaming, but there was some support for the use of Cognitive Behaviour Therapy (CBT).

This article contains content that is not yet available here.

"We can take lessons from what we know in CBT for gambling or alcohol," he said.

"It's not perfect, but that's the best we can do.

"It's about identifying the underlying thinking processes behind a gaming behaviour."

CBT is about helping people identify patterns of unhelpful thinking and developing more helpful beliefs.

But Dr King said therapists using CBT need to understand how to tailor it to someone with gaming problems.

When it comes to retreats, he said, removing people from a problem gaming environment may help, but the effect will be only short term unless there is continued follow-up and support.

Dr King suggested people ask themselves if the money spent on retreats would be better spent on seeing a local qualified psychiatrist or clinical psychologist.

"I'm sure some people do really well at these retreats but it's not going to be feasible for everybody," he said.

A mix of mental health issues involved

Problem gaming often occurs alongside other mental health conditions like anxiety and depression, and some experts argue it is a symptom of these, rather than a unique condition in its own right.

Others take issue with the idea that you can have an addiction to gaming, in the same way you can be addicted to drugs.

The American Psychiatric Association is yet to fully accept the condition in their disease manual, calling for more research to be done.

Meanwhile, a 2017 survey of psychiatrists in Australia and New Zealand found that nearly 60 per cent had already accepted gaming disorder as a distinct mental health condition — although only 16.3 per cent said they felt confident in managing it.

But psychologist Wayne Warburton of Macquarie University, who studies the impact of screen technologies, argues treatment doesn't have to wait for the current scientific arguments to settle, or indeed even for a clear diagnosis.

"If someone comes to you and their son hasn't been out of their room for eight years, or has not been to school for two years, or is beating up his mother when she asks him to stop being on the screen — then you don't wait for a diagnosis," Dr Warburton said.

"You look for the underlying issues and deal with those.

"For the people who become addicted to gaming, there is generally something else going on. It's meeting some other need in their life that hasn't been met in other ways or there's some underlying trauma."

Dr King talks about the "additional benefits" of treating gaming disorder. He gives the example of depression, which he said can be "fused with gaming disorder".

If someone feels out of control with their gaming, and therefore helpless about the future and worthless as an individual, gaining more control over gaming could help them feel more capable and challenge their feelings of worthlessness, he said.

Self-confessed "reformed game addict" Cam Adair has set up online and residential help programs. ( Supplied: Derek Heisler/derekheisler.com )

Family matters

Dr Le agrees most available evidence supports the use of CBT to treat gaming problems, but describes his approach as a "bio-psycho-social" one.

"When I work with a family, I'm trying to find out what's actually going on in that family," he said.

"Essentially with kids you're relying on the parents to set some limits and there could be different reasons they are unable to set limits.

"Usually it's because the child has the power in the family or someone is enabling that behaviour. Often it's about parents having lost their sense of authority in the family."

In cases where a child thinks they are only able to socialise via online games, he said a period of abstinence is probably necessary to help them discover there are other ways they can socialise.

The new normal in screen time

It goes without saying that in a digital world, increasing screen time is the new normal.

Dr King said in 2007, a typical adolescent would spend 20 minutes a day gaming, however now it's more like 80-150 minutes a day.

But increasing time spent gaming isn't necessarily causing harm, he cautioned.

"Many millions engage in gaming in a healthy way," Dr King said.

"And the young people who say 'Get off my back, I'm just playing with my friends' — probably many of them are healthy gamers too.

"It's the young people you can't talk to, that are at home not going to school any more, playing games from the hours of midnight to 10am and then sleeping all day and they're depressed and not eating. This is the invisible population not getting help."

Those who don't quite meet the WHO criteria for addiction, yet still have problems, may still benefit from treatment, according to Dr King.

"There's a continuum," he said.

Involvement in offline socialising may take some encouragement. ( Getty Images: J and J Productions )

Moral panic?

Some psychologists have claimed that the WHO's likening of gaming to substance abuse is a response to "moral panic".

Mr Adair argues this is "mocking" people who need real help, and Dr Warburton believes the "moral panic" argument does not reflect the majority view of experts.

Whatever the case, it's clear despite the WHO decision, problem gaming continues to be a hot-button issue.

"There are very strong feelings on both sides," Dr Warburton said.

"There's a lot of money at stake and there's been some quite harsh and hostile interchange over this issue."

He believes it's only a matter of time before things settle.

"Twenty years ago I talked about gambling as an addiction and people laughed at me and said it was just 'bad behaviour'," he said.

"Now it's widely accepted as an addiction — but it's taken decades to reach that point."