Ricardo Quintero punched his sister when he was 14 after she tried to tell him how to play a video game. “How could I have done that?” he asks. He had lost control. His addiction to video games saw him lose friendships, break commitments and damage his academic performance.

The biggest challenge with video game addiction is that these kids have very little awareness of the illness Susana Jiménez

International studies report that 9% of people who play video games are addicts. In Asian countries it is even considered a public health problem. In China, the internet giant Tencent has set daily limits on the time users can spend on its video game King of Glory to prevent more young people from falling into addiction. This year, the World Health Organization (WHO) included video game addiction as a mental illness in the draft of its upcoming revised International Classification of Diseases. ESA, an association based in the United States which represent video game products and distributors, has called on the WHO to reconsider its decision. The Spanish Association of Video Games has not commented, given it is just “a draft.”

Video game addiction is characterized by a “continuous or recurrent” pattern of playing. According to the WHO, an addict prioritizes playing games over daily activities and their basic needs. They also lose control over how long and how frequently they play.

Quintero, 29, used to work as a publicist and at times did not finish his work because he was playing a video game. He would lie to his clients. “I would say five minutes and this became four hours,” he says. His addiction also affected his personal life. Quintero remembers that he almost lost his now-pregnant girlfriend when he was 22 because “I preferred playing to being with her.”

It is easy to become an addict because video games demand a huge amount of time but don’t have any specific end

Most video game addicts are on average 20 years old, struggle with social relationships and have difficulty achieving their goals, according to Susana Jiménez, clinical psychologist and coordinator of the unit for pathological gambling and other behavioral addictions at Bellvitge hospital in Barcelona. In her unit, medical appointments for video game addiction have risen by 2% since 2004. Of the 3,500 cases of patients with behavioral addictions, 5% are addicted to video games – in particular online games, role games and multiplayer games like World of Warcraft and League of Legends (LOL).

Isaac Flores began playing the latter when he was 17. Each week he spent at least two days without sleeping “to improve” his performance in the game. Jiménez explains that it is easy to become an addict because video games demand a huge amount of time but don’t have any specific end. While Flores first started playing with his friends, he ended up distancing himself from them. “If you want to get better, you end up leaving behind people who are not at your level,” he explains.

But what began as an addiction turned into a job for him. Two years later Pepiinero, as he is known in this world, became one of Spain’s best LOL players, made up to €3,500 a month and was sought after by various teams. But he was playing more than 10 hours a day: “You stop living for yourself and end up living for the video game”. Now at age 23, he has lost his passion for LOL and is more interested in books. The last one he read was A column of fire by Ken Follet. “For me it’s been productive because I have gotten something in return, but there are people who invest the same or even more time but don’t get anywhere. Most of the time, they do it to make themselves feel like they are good enough,” he says.

You stop living for yourself and end up living for the video game Pepiinero

Gabriel Rubio, head of psychiatric services at the 12 de Octubre Hospital in Madrid, agrees that video games can help players improve their self-esteem. His unit mainly treats gambling addicts. According to the doctor, one in three patients were former gamers but swapped video games for betting games. Jiménez says it is easier to treat someone with a compulsive gambling disorder because they are aware they have a problem. “The biggest challenge with video game addiction is that these kids have very little awareness of the illness,” he explains. Treating addiction occurs in two phases: intensive weekly sessions for the first four months followed by follow-ups for two years.

Family plays a very important role, especially in prevention. “There is absolutely nothing bad about playing video games but you have to limit the time spent on them and give children a diverse range of entertainment,” says Andrés Quinteros, director of the psychology center Cepsim. It’s recommended that children play no more than two hours a day and keep the light on. Children should not get too close to the screen and avoid turning the screen on full brightness. During treatment, the objective is not to convince addicts that video games are bad but rather to make them see what they are missing out on as a result of playing more than eight hours a day.

Quintero did not receive any treatment to put an end to his addiction. But he has found more productive ways to spend his time: he focuses on work, plays the drums and hangs out with his girlfriend. Now he spends four hours a week playing the video games FIFA and Destiny 2 on his PlayStation 4. But what used to be “everything” to him is now just escapism. Quintero is aware that many people lose everything to their addiction – family, friends, work – but he has a hopeful message: “The good thing about reaching rock bottom is that your only option is to go up.”