In Addition to the Substances, He’s Gaming All Night…

saddeneddeeply updated us on Thanksgiving break with his son and tries to sort out the drug & alcohol use from the obsessive gaming all night…

"So my son came back for thanksgiving. Using your technique for communication, the time was reasonably peaceful. We did not notice any marijuana or alcohol or nicotine use in the house but we suspect he was using during gatherings w his fellow high school students. I was a bit distraught and had an car accident a few days after I learned he was using initially. The car was totaled. We took the car we bought for him after he was admitted by Cornell. We did not add his name to the insurance so he couldn’t drive it. He has to get ride from his fellow users or take Uber which seemingly made him miss some gatherings because his rides did not show up occasionally (surprise surprise his clear minded reliable friends). However he plays video game from 11pm to 6 am then sleep till 2pm. We go in to his game room at 1am to gently tell him not to stay too late. We give him breakfast at 2 pm. We are a bit not sure when we should consider he is using video games and give cold shoulders and when we should consider he is not using video games and give warm treatment. His school work is in completely shambles. He has to quit school this semester and next for a leave. Thank you.
 

I am glad to hear that communications with your son over Thanksgiving were slightly improved as a result of the suggestions on this site. It sounds like you were able to put down boundaries that he respected with regards to alcohol, marijuana, cigarettes, and the use of the car. Bravo!
 

Should you treat the gaming like the substance use?

What you observed while your son was home was the excessive use of video games, to the point he would stay up late into the night and sleep until early afternoon. You want to know how to address this behavior.

The combination of the alcohol, pot, and gaming has ruined his first semester at college to the point that he is now forced to take a leave from school. It’s a huge consequence. It also brings up a whole set of questions about how you address this change in plans. Where does he go now? If he does come home, how do you manage this growing cluster of addictive behaviors?

I’d like to address you son’s gaming in this post. The alcohol, pot, and cigarettes are clearly risky and clearly chemicals that can be abused. The question of gaming though as a possible addiction is less clear-cut. Is it an obsession or an addiction? Even within research and clinical circles there is less consensus that gaming or shopping or iphones for that matter can become an addiction as defined by its key hallmarks.
 

Can Gaming Truly Be Considered an Addiction?

Here is the American Psychological Association's description of addiction as it relates to drugs:
 

• Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use;
• Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use;
• Risky use: substance is used in risky settings; continued use despite known problems;
• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance);

It is easy to see from this description how it can be applied to gambling or gaming or shopping.
 

What's actually happening during an 'Addictive Event'?

Next, it may be helpful as a family member to enter the internal world of someone addicted to learn what the individual cycle of an addictive event feels like:
 

• Feelings get increasingly difficult to handle. The need to escape normal life events gets more attractive. Like a steady drum beat, the need to feel better or comfortable recurs over and over in the mind. The body experiences subtle or less-subtle feelings of withdrawal from the prior use and pulls the biology towards wanting to use. An assault of cravings is now real and constant.
   
• The user starts to fantasize about the drug or the behavior but resists initially knowing it is harmful or breaks a promise made to oneself or others. The thinking is now obsessive, perhaps ambivalent or tortured. Anxiety increases.
   
• The internal fight is lost and the user consumes or acts out in the problem behavior.
   
• Initially there is tremendous relief. The loud drum ceases. The pleasure from the drug or behavior is instantaneous, even though it probably doesn’t equal the highs first experienced in those early days. In some instances, like with opiates, using gets the person back only to a relatively normal state, now able to function and get things done.
   
• It gets harder and harder to stop the binge. Whereas, before less of the drug or shorter forays into the behavior were sufficient to feel satisfied, now it takes more or longer as the tolerance increases, both psychologically and physically.
   
• The drug runs out or the body wears out, and the lack of drug and/or exhaustion forces the person to stop.
   
• The withdrawal can be limited to guilt or shame, promises to oneself to never do that again, insomnia or sleep, and/or the more devastating physical withdrawals experienced from drugs like alcohol or opioids.
   
• The emotions are negative and very unpleasant. The physical withdrawals can stop all ability to function. The feelings get increasingly difficult to handle, the thought occurs that a little bit of drug or problem behavior would improve things greatly. The fantasy begins……

And the cycle starts all over again. Tolerance builds with each using event, the cycle gets more serious, and periods of use are longer. It gets increasingly harder to pull out for good.

I think we can all relate to this cycle whether or not we’ve ever been “addicted” to something. It suggests the need for great empathy from us for those we love who struggle.

Some addiction theory that can help us sort this out

I want to throw out one more piece of theory about addiction, which I think addresses the issue of gaming.

Howard Schaffer is a psychiatrist from Harvard who writes about an addiction syndrome, whereby the object of addiction can be many things (heroin or gambling), any of which stimulate the same neurological circuits in the brain (http://www.expressionsofaddiction.com/docs/shafferetalsyndrome.pdf). It’s not an easy read but I’m going to reprint a few key sentences.

When (1) individuals engage in repeated interactions with a specific object or objects of addiction, and (2) the neurobiological or social consequences of these interactions produce a desirable (i.e., sought-after) subjective shift that is reliable and robust…

Research suggests that addiction is not necessarily inextricably linked to a particular substance or behavior. For example, circumstantial opportunity plays a more influential role in the development of addictive behavior than individuals’ preferences for certain drugs. Further, with or without treatment, it is very common for people recovering from one addiction (e.g., opioids) to “hop” to another (e.g., cocaine, alcohol, gambling, or exercise) before successfully recovering from “all” addictions. Hser and colleagues examined longitudinal patterns of alcohol and narcotic use, and observed a decrease in alcohol consumption at the time that narcotic addiction began; likewise, during periods of decreased narcotics use, alcohol consumption rose.

This “hopping” between addiction objects has been demonstrated for illicit drugs and nicotine, for alcohol abuse and bulimia, and for substance abuse and pathological gambling.

Howard argues that one syndrome encompasses all drugs and all problematic behaviors. With abuse comes choice, based on what’s available in the environment and personal preference. If one choice disappears, the person gravitates to another, which keeps the cycle of addiction alive.

The object of addiction can be almost anything, Schaffer would say. Gabor Mate talks about his addiction to classical music CDs. A doctor, Mate once left a woman in labor to spend $8,000 on CDs in a store.
 

If you treat the gaming like SUD, what needs to happen?

So yes, I would argue that your son is showing signs of a burgeoning addiction to gaming. If this is the case, you will want to treat this behavior like the alcohol and pot. Do you allow it in your house? Do you remove yourself when he plays or is withdrawing from playing? Would you remove breakfast at 2 in the afternoon when he rises from a night of playing?

If your son tries to stop drinking or smoking marijuana, will the gaming episodes worsen? Probably.

You’ve made a good start over Thanksgiving with your son, improving your communication and setting boundaries (Learning Module 4). You are more aware of your son’s daily use habits as related to these behaviors (Learning Module 2). Our suggestion is to continue what you are learning from this site to address your son’s alcohol, pot use, and gaming. Ignore the cigarettes for now. Leave the bucket for his butts out back, ideally in a place without shelter from wind, snow, and rain. Concentrate on the more short-term devastating problems.

You have made a huge start by working the program on this site. We are here for you.