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Michelle Colder Carras Department of International Health, Johns Hopkins Bloomberg School of Public Health, & Johns Hopkins University Global Digital Health Initiative, Baltimore, MD, USA

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Vasileios Stavropoulos Institute for Health and Sport, Victoria University, Melbourne, Australia
Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece

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Frosso Motti-Stefanidi Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece

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Alain Labrique Department of International Health, Johns Hopkins Bloomberg School of Public Health, & Johns Hopkins University Global Digital Health Initiative, Baltimore, MD, USA

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Mark D. Griffiths International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK

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Abstract

In August of 2021, China imposed severe restrictions on children’s online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Abstract

In August of 2021, China imposed severe restrictions on children’s online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Draconian policy measures are unlikely to prevent disordered gaming

In 2019, the Chinese government imposed significant restrictions on minors’ online videogame play out of concerns regarding gaming addiction (State Council Information Office of the People’s Republic of China, 2019). These new regulations limited underage gamers to 90 minutes of gaming on weekdays and three hours on weekends and holidays, with a complete ban on gaming between 10pm and 8am. Citing continuing concerns by parents that these restrictions were not sufficient to reduce problems related to online gaming (Shin, 2021), the government reduced time even further in August 2021 to a limit of one hour of play only on Friday, Saturday and Sunday, with the frequency and intensity of government inspections of online gaming companies increased to ensure compliance (Goh, 2021). Such policies reflect a perspective that gaming is intrinsically negative without taking into the role of gaming in normal development and how differences between gamers in their unique gaming contexts may account for the diverse impact of gaming experiences over time (Stavropoulos, Gomez, & Griffiths, 2021; Stavropoulos, Kuss, Griffiths, Wilson, & Motti-Stefanidi, 2017). Such policies seem to deny evidence for the many benefits that moderate gaming involvement can bring from educational, health, cognitive, and therapeutic perspectives (Colder Carras, Van Rooij, et al., 2018; Griffiths, 2019; Nuyens, Kuss, Lopez-Fernandez, & Griffiths, 2019) and also fail to address the need to consider disordered gaming as a maladaptive solution to another problem (Brown, Stavropoulos, Christidi, Papastefanou, & Matsa, 2021; Kardefelt Winther, 2014).

Both changes in technology and advances in gaming disorder research point to the need for prevention and policy that take a nuanced approach. Cutting-edge advancements in internet gaming such as increased possibilities for interactions between gamers and game worlds and the use of algorithms that tailor one’s gaming experience to their user profile have led to a boom in internet gaming (Stavropoulos, Motti-Stefanidi, & Griffiths, 2021). This expansion in popularity of internet gaming has precipitated an impassioned dialogue regarding the possible benefits of gaming in relation to its likely deleterious impact (Raith et al., 2021; Richard, Temcheff, & Derevensky, 2020). While older public health approaches mostly segregated gaming as either being inherently “good” and/or “bad” for gamers, newer research findings point to the necessity of determining how differences between gamers, including individual factors, in-game experiences, and out-of-game context, and their interactions over time, may generate diverse outcomes (Stavropoulos, Motti-Stefanidi, & Griffiths, 2021).

Most gamers benefit through online gaming. It may promote their socialization, cognitive skills, and the development of dexterity (Colder Carras, Van Rooij, et al., 2018; Raith et al., 2021). In contrast, a relative few may lose control over their gaming, which may have detrimental consequences for their mental health and functioning (Richard et al., 2020; Stavropoulos, Motti-Stefanidi, & Griffiths, 2021). For these individuals, excessive gaming may be a way to cope with existing problems such as low social competence, depression, anxiety, and dysfunctional family relationships or to stave off severe symptoms such as suicidal thoughts or substance cravings (Colder Carras, Kalbarczyk, et al., 2018; Hygen, Belsky, et al., 2020; Hygen, Skalická, et al., 2020; Li, Garland, & Howard, 2014).

Although guidelines exist that address screen time in general and focus on balancing screen and other activities (e.g., Chassiakos et al., 2016), there is no consensus on the acceptable amount of videogame play for children and adolescents. One study of European adolescents suggested that those who played for two or more hours a day had twice the odds of having dysfunctional internet behavior, but the same levels of social networking use were associated with three times the odds (Tsitsika et al., 2014). A large representative sample of children in the United Kingdom found that those who played videogames between one and three hours a day had similar levels of wellbeing as those who did not play games at all (Przybylski, 2014). Although those seeking treatment for internet addiction played for six to seven hours a day in one sample (Müller, Beutel, & Wölfling, 2014), a case series demonstrates that even gaming for fourteen hours a day is not necessarily indicative of addiction, e.g., if temporary and the gamer is able to cut back when competing demands arise (Griffiths, 2010). These considerations point to the vital need to adopt a multifaceted and individualized view when designing and implementing prevention and intervention policies. Such policies must not focus only on gaming time, but also address risk factors of disordered gaming and capitalize on the range of benefits for all types of gamers (Király, Tóth, Urbán, Demetrovics, & Maraz, 2017).

Thus, draconian policy measures to reduce time spent gaming may seem useful on the surface, but don’t reflect current theory and knowledge about prevention of problematic or disordered digital media use (Stavropoulos, Motti-Stefanidi, & Griffiths, 2021) and often fail to work at all (Koh, 2015). According to one systematic review, the idea that simply reducing time spent playing games will reduce problematic gaming is "deeply misleading" (Király et al., 2018). Such strict regulations that limit personal freedoms will be difficult to enforce, and recent news articles indicate that even measures such as facial recognition systems are already being fooled (Borak, 2020; Lee, Kim, & Lee, 2019; Shen, 2021). A similar approach in preventing youth gambling is age restrictions, which have little empirical support for their effectiveness and have been shown to be difficult to enforce (Shi, Colder Carras, Potenza, & Turner, 2021). Policies that address only the time spent playing also fail to consider the role of online gaming in the normative development of children and may provoke reactance and excessive gaming in adulthood (Hygen, Skalická, et al., 2020). Most importantly, policies such as these may fail to address the other contributing factors that may lead individuals to use gaming as a coping mechanism, which runs the risk of driving youth to other maladaptive coping methods such as substance use (Hsu & Marlatt, 2012).

Concerns about the extent to which cultural differences drive gaming-related research and policy have been expressed in the gaming disorder literature (Király et al., 2018; Stavropoulos et al., 2020). For instance, in South East Asia, parents tend to pathologize any online leisure activities that take time away from family and/or educational activities (Griffiths, Kuss, Billieux, & Pontes, 2016). In China specifically, internet addiction has been associated with family-level risk factors such as psychological and physical abuse, which suggests that Chinese adolescents may use the internet to cope with difficult and uncontrollable life situations (Li et al., 2014).

As Solon in 594 BCE had to revise the Draconian constitution to allow ancient Athens to flourish socially, politically and financially (Lape, 2002), draconian gaming measures implemented in China may need to be revised to enhance the wellbeing of children and adolescents. Indeed, Draco’s laws in ancient Athens, as the currently introduced Chinese policies, tended to rigidly and horizontally impose the same severe punishment (in Draco’s case the death penalty) across a series of minor and major offences whilst ignoring their substantial differences and providing no right of appeal. Acknowledging the lack of a differential and case-by-case approach, Solon varied the sentences imposed and provided the right to appeal for those who felt that their circumstances deserved alternative treatment (Rhodes, 2006).

The success of policy measures can be increased through collaborative approaches that are both culturally aware and sensitive (Hudson, Hunter, & Peckham, 2019; O’Farrell, Baynes, Pontes, Griffiths, & Stavropoulos, 2020). More specifically, stakeholder-engaged and community-based research may improve the outcomes of applied empirical findings and promote their successful adoption in public health interventions and population health (Freudenberg & Tsui, 2014; Katapally, 2019). Previous research with gamer stakeholders demonstrates their willingness to discuss problems such as gaming disorder and to provide their own recommendations for interventions. For example, small studies with gamer stakeholders (i.e., gamers who attended gaming fan conventions) identified a specific game feature that promoted excessive play (i.e., appointment mechanics, a game feature that requires players to log in at a specific time to receive some award or be able to take a specific action, Kim, 2015) as well as a novel target for a preventive intervention (peer support for recognizing and preventing prolonged play periods; Colder Carras, Carras, & Labrique, 2020; Colder Carras, Porter, et al., 2018). This suggests that involvement of voices from the ground up can help inform interventions that would be acceptable and effective in the population for which they are designed.

As we have shown here, evidence consistently suggests that identifying all contextual factors in an appropriate cultural context, rather than focusing exclusively on reducing access to the “pull factors” of digital and gaming media itself, stands a much better chance of reducing disordered gaming risk (Stavropoulos, Motti-Stefanidi, & Griffiths, 2021). Many empirical evaluations of policy and programmatic interventions to prevent problematic gaming exist (King et al., 2018; Király et al., 2018, 2020; Throuvala, Griffiths, Rennoldson, & Kuss, 2019), and these evidence-based reviews, when combined with appropriate stakeholder and community-engaged research, are most likely to promote the development and implementation of successful prevention interventions and policy.

Funding sources

VS: Australian Research Council, Discovery Early Career Researcher Aw, Grant/Award Number: DE210101107. No other financial support was received for this article.

Authors’ contributions

MCC wrote the first draft of the paper and worked with the other co-authors on subsequent drafts. All authors contributed to the editorial process and have approved the final submitted version of the manuscript.

Conflict of interest

MCC consults with various companies around videogames and wellbeing and is the CEO and founder of Gaming and Wellness Association, Inc., a nonprofit organization dedicated to research and education about healthy videogame play. MDG’s university currently receives funding from Norsk Tipping (the gambling operator owned by the Norwegian Government) for research evaluating responsible gambling tools in Norway. MDG has received funding for a number of research projects in the area of gambling education for young people, social responsibility in gambling and gambling treatment from Gamble Aware (formerly the Responsibility in Gambling Trust), a charitable body which funds its research program based on donations from the gambling industry. MDG also undertakes consultancy for various gaming companies in the area of social responsibility in gambling. AL, FMS, and VS declare no conflict of interest.

Ethics

This commentary article does not involve human participants.

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Dr. Zsolt Demetrovics
Institute of Psychology, ELTE Eötvös Loránd University
Address: Izabella u. 46. H-1064 Budapest, Hungary
Phone: +36-1-461-2681
E-mail: jba@ppk.elte.hu

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2023  
Web of Science  
Journal Impact Factor 6.6
Rank by Impact Factor Q1 (Psychiatry)
Journal Citation Indicator 1.59
Scopus  
CiteScore 12.3
CiteScore rank Q1 (Clinical Psychology)
SNIP 1.604
Scimago  
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SJR Q rank Q1

Journal of Behavioral Addictions
Publication Model Gold Open Access
Submission Fee none
Article Processing Charge 990 EUR/article
Effective from  1st Feb 2025:
1400 EUR/article
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%.
Subscription Information Gold Open Access

Journal of Behavioral Addictions
Language English
Size A4
Year of
Foundation
2011
Volumes
per Year
1
Issues
per Year
4
Founder Eötvös Loránd Tudományegyetem
Founder's
Address
H-1053 Budapest, Hungary Egyetem tér 1-3.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2062-5871 (Print)
ISSN 2063-5303 (Online)

Senior editors

Editor(s)-in-Chief: Zsolt DEMETROVICS

Assistant Editor(s): 

Csilla ÁGOSTON

Dana KATZ

Associate Editors

  • Stephanie ANTONS (Universitat Duisburg-Essen, Germany)
  • Joel BILLIEUX (University of Lausanne, Switzerland)
  • Beáta BŐTHE (University of Montreal, Canada)
  • Matthias BRAND (University of Duisburg-Essen, Germany)
  • Daniel KING (Flinders University, Australia)
  • Gyöngyi KÖKÖNYEI (ELTE Eötvös Loránd University, Hungary)
  • Ludwig KRAUS (IFT Institute for Therapy Research, Germany)
  • Marc N. POTENZA (Yale University, USA)
  • Hans-Jurgen RUMPF (University of Lübeck, Germany)
  • Ruth J. VAN HOLST (Amsterdam UMC, The Netherlands)

Editorial Board

  • Sophia ACHAB (Faculty of Medicine, University of Geneva, Switzerland)
  • Alex BALDACCHINO (St Andrews University, United Kingdom)
  • Judit BALÁZS (ELTE Eötvös Loránd University, Hungary)
  • Maria BELLRINGER (Auckland University of Technology, Auckland, New Zealand)
  • Henrietta BOWDEN-JONES (Imperial College, United Kingdom)
  • Damien BREVERS (University of Luxembourg, Luxembourg)
  • Julius BURKAUSKAS (Lithuanian University of Health Sciences, Lithuania)
  • Gerhard BÜHRINGER (Technische Universität Dresden, Germany)
  • Silvia CASALE (University of Florence, Florence, Italy)
  • Luke CLARK (University of British Columbia, Vancouver, B.C., Canada)
  • Jeffrey L. DEREVENSKY (McGill University, Canada)
  • Geert DOM (University of Antwerp, Belgium)
  • Nicki DOWLING (Deakin University, Geelong, Australia)
  • Hamed EKHTIARI (University of Minnesota, United States)
  • Jon ELHAI (University of Toledo, Toledo, Ohio, USA)
  • Ana ESTEVEZ (University of Deusto, Spain)
  • Fernando FERNANDEZ-ARANDA (Bellvitge University Hospital, Barcelona, Spain)
  • Naomi FINEBERG (University of Hertfordshire, United Kingdom)
  • Sally GAINSBURY (The University of Sydney, Camperdown, NSW, Australia)
  • Belle GAVRIEL-FRIED (The Bob Shapell School of Social Work, Tel Aviv University, Israel)
  • Biljana GJONESKA (Macedonian Academy of Sciences and Arts, Republic of North Macedonia)
  • Marie GRALL-BRONNEC (University Hospital of Nantes, France)
  • Jon E. GRANT (University of Minnesota, USA)
  • Mark GRIFFITHS (Nottingham Trent University, United Kingdom)
  • Joshua GRUBBS (University of New Mexico, Albuquerque, NM, USA)
  • Anneke GOUDRIAAN (University of Amsterdam, The Netherlands)
  • Susumu HIGUCHI (National Hospital Organization Kurihama Medical and Addiction Center, Japan)
  • David HODGINS (University of Calgary, Canada)
  • Eric HOLLANDER (Albert Einstein College of Medicine, USA)
  • Zsolt HORVÁTH (Eötvös Loránd University, Hungary)
  • Susana JIMÉNEZ-MURCIA (Clinical Psychology Unit, Bellvitge University Hospital, Barcelona, Spain)
  • Yasser KHAZAAL (Geneva University Hospital, Switzerland)
  • Orsolya KIRÁLY (Eötvös Loránd University, Hungary)
  • Chih-Hung KO (Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan)
  • Shane KRAUS (University of Nevada, Las Vegas, NV, USA)
  • Hae Kook LEE (The Catholic University of Korea, Republic of Korea)
  • Bernadette KUN (Eötvös Loránd University, Hungary)
  • Katerina LUKAVSKA (Charles University, Prague, Czech Republic)
  • Giovanni MARTINOTTI (‘Gabriele d’Annunzio’ University of Chieti-Pescara, Italy)
  • Gemma MESTRE-BACH (Universidad Internacional de la Rioja, La Rioja, Spain)
  • Astrid MÜLLER (Hannover Medical School, Germany)
  • Daniel Thor OLASON (University of Iceland, Iceland)
  • Ståle PALLESEN (University of Bergen, Norway)
  • Afarin RAHIMI-MOVAGHAR (Teheran University of Medical Sciences, Iran)
  • József RÁCZ (Hungarian Academy of Sciences, Hungary)
  • Michael SCHAUB (University of Zurich, Switzerland)
  • Marcantanio M. SPADA (London South Bank University, United Kingdom)
  • Daniel SPRITZER (Study Group on Technological Addictions, Brazil)
  • Dan J. STEIN (University of Cape Town, South Africa)
  • Sherry H. STEWART (Dalhousie University, Canada)
  • Attila SZABÓ (Eötvös Loránd University, Hungary)
  • Hermano TAVARES (Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil)
  • Wim VAN DEN BRINK (University of Amsterdam, The Netherlands)
  • Alexander E. VOISKOUNSKY (Moscow State University, Russia)
  • Aviv M. WEINSTEIN (Ariel University, Israel)
  • Anise WU (University of Macau, Macao, China)
  • Ágnes ZSILA (ELTE Eötvös Loránd University, Hungary)

 

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