Current and Future Directions in Gaming Disorder Research

The global video gaming market has surged in recent years. Valued at more than $200 billion CAD and continuing to expand, gaming now constitutes the largest entertainment industry.1 Indeed, a growing global population of more than 3 billion adults now report playing video games.2 Although an innocuous pastime for most, for a subpopulation of gamers, gaming may become excessive. Excessive gaming contributes to a variety of adverse outcomes, including impaired academic and social functioning, increased aggressive and oppositional behaviours, reduced sleep quality, and poorer overall physical and mental health.3,4 Consequently, an understanding of its risk factors is critical. Acknowledging the potential for gaming to become problematic, gaming disorder is now recognized as an addictive disorder in the International Classification of Diseases 11 and is characterized by impaired control over gaming, continuation of gaming despite negative consequences, and the prioritization of gaming over other life interests.5 The Diagnostic and Statistical Manual of Mental Disorders similarly highlights internet gaming disorder as a recommended condition for further study, with its diagnostic criteria mirroring those of other addictive disorders.6 Recent data suggest that approximately three percent of adolescents and adults globally meet the criteria for gaming disorder––comparable to the prevalence of some substance use disorders and exceeding that of gambling disorder.7,8 Together, these formal recognitions and high prevalence estimates have precipitated a burgeoning field of research seeking to understand the biological, psychological, and social factors subserving risk for and protection against gaming disorder,9–11 and its convergence with other addictive disorders.12 Still, with the continuing expansion of the global gaming market and the concomitant broadening of the gaming population, new empirical data incorporating multidisciplinary and cross-cultural perspectives are needed to understand for whom and in what contexts the risk for gaming disorder may be heightened. To this end, we are pleased to introduce this special issue in the Canadian Journal of Addiction, featuring 5 papers describing recent advances in gaming disorder research. NEUROBIOLOGICAL AND PSYCHOLOGICAL CORRELATES OF GAMING DISORDER Mounting evidence suggests that gaming disorder, though a behavioural addiction, may have important neurobiological underpinnings. Mestre-Bach and Potenza13 consolidate this evidence, providing a narrative review of studies investigating the neural correlates of gaming disorder and its treatment. Neural correlates of gaming disorder identified were both structural and functional. Structurally, Mestre-Bach and Potenza present evidence for differences in grey matter volume and white matter integrity in several brain regions, including those implicated in cognitive control, attention, and emotion regulation––functions that, they argue, may contribute to the presentation of hallmark characteristics of addiction, including impulsivity, reward sensitivity, and self-medication. Functionally, the authors present findings from both resting state and task-based fMRI studies that support differences in activity and functional connectivity in brain regions and networks associated with functions such as response inhibition, decision-making, and cue reactivity. Mestre-Bach and Potenza also summarize the extant literature on neural correlates of gaming disorder treatment, propounding evidence that structural and functional changes in frontostriatal and subcortical regions and networks may be associated with gaming disorder recovery following both pharmacological and psychological interventions. This review underscores the importance of further study of the neurobiological underpinnings of gaming disorder to inform its prevention, maintenance, and treatment. CONTEXTUAL CORRELATES OF GAMING DISORDER Critical to a fulsome understanding of gaming disorder is consideration of the cultural context in which it is studied. de Andrade et al14 outline the theoretical and pragmatic challenges in the study and treatment of gaming disorder in Brazil, which houses the largest gaming market in South America. The authors note that cross-culturally, the very concept of gaming disorder is poorly defined, attributable to considerable variability in the activities that are considered “games” and degrees of impairment that constitute a “disorder.” They caution that this obscurity in the conceptualization of gaming disorder may lead to the overpathologization of benign gaming. The authors also describe pragmatic limitations to gaming disorder research and treatment in Brazil, including inadequate resources, regional inequality in research productivity, and a dearth of gaming-specific treatment programs. de Andrade et al conclude with proposed solutions to these challenges for researchers, clinicians, and policymakers. The early months of the COVID-19 pandemic also represented an important context in which gaming patterns were of particular interest. In a longitudinal study of 332 Canadian adults, Ritchie et al15 examined changes in time spent gaming across the first 9 months of the COVID-19 pandemic. Latent growth curve modelling revealed high levels of gaming at the start of the pandemic, which declined overtime. For older participants, time spent gaming decreased at a more accelerated rate. Findings suggest that for the average community-based Canadian adult, gaming trajectories were not problematic during the initial waves of the COVID-19 pandemic, though further research examining subsequent pandemic waves is needed. GAMING-GAMBLING CONVERGENCE AND GAMING DISORDER An emerging concern among gaming disorder researchers and policymakers is the gamblification of video games; that is, the incorporation of (often) paid, gambling-like features in video games, as well as gambling activities in which bets are wagered on the outcomes of video games. This phenomenon, known as convergence, has important implications for gaming disorder, which Mills et al16 articulate in a narrative review. The authors discuss gaming-gambling convergence in terms of social casino gaming, loot boxes, skin betting, esports betting, and play-to-earn video gaming. Their review suggests that these areas of convergence confer modest to strong increases in risk for gaming disorder and related harms, as well as migration to gambling and problem gambling. Mills and colleagues highlight important directions for future research on gaming-gambling convergence, including extending existing research using longitudinal study designs, as well as investigating the gaming- and gambling-related outcomes of watching other players engage in gambling-like gaming activities (eg, opening loot boxes). Loot boxes describe paid virtual containers within video games that contain randomized items of varying values. In requiring players to wager money on a chance-based outcome of uncertain value, loot boxes are perhaps the clearest depiction of gaming-gambling convergence and have amassed considerable concern as a potentially addictive element of video games. In a sample of 608 crowdsourced gamers, Slattery and Yakovenko17 investigated gaming-related and gambling-related traits and motivations as potential predictors of increased loot box purchasing. The authors found that when controlling for impulsivity, completionism (the need to collect in-game items) and perceived social pressure were associated with greater spending on loot boxes, underscoring the importance of social and contextual factors in shaping gamers’ engagement with gambling-like features in video games. CONCLUSION AND FUTURE DIRECTIONS The articles featured in this special issue provide novel insight into the individual and contextual correlates of gaming disorder, and point to several important directions for future research. First, review articles included in this issue note the lack of longitudinal studies in the gaming disorder research literature. Such study designs are needed to elucidate the neurobiological and psychosocial antecedents of gaming disorder, as well as its long-term individual-level and population-level consequences. Second, as the gaming market continues to expand, gamers will likely become an increasingly heterogeneous group. Person-centered analytic techniques, such as latent variable mixture and growth mixture modelling, would be beneficial in characterizing this heterogeneity to reveal distinct subgroups and gaming trajectories among gamers and people with gaming disorder. Third, further research is needed to clarify the very construct of gaming disorder. This research should focus on theory building using bottom-up, person-centered approaches that incorporate perspectives from both experts and people with lived experience. Moreover, an improved conceptualization of gaming disorder should consider cross-cultural variation in gaming and problem gaming. Collectively, these future research directions will advance the understanding of gaming disorder and inform its prevention and intervention.