Totally wired: why are so many young people addicted to video games?
Tim Lewis, The Observer, Games

Henrietta was interviewed by The Observer about setting up the first ever NHS clinic to treat Gaming Disorders. She speaks to journalist Tim Lewis and describes both the disorder and the process of setting up the clinic.

“Locked in their bedrooms, playing video games into the small hours, children as young as 10 years old are now addicted to their consoles. Tim Lewis hears how the compulsive games can be impossible to resist – and meets the experts tackling the issue.”

It was only when the doorbell rang at 2am that Dee realised how serious a problem her son had. She had been asleep, so she was especially disoriented to open the door and find two paramedics, an ambulance blinking behind them in the dark. The lead medic asked if Jake was home. She directed him to the bedroom of her son, who was 16 at the time. Five years later, the shock and distress still causes Dee’s eyes to fill with tears. “I didn’t know what was happening,” she recalls. “It’s the worst nightmare a mother could ever think of.”

Owing to patient confidentiality, it was not immediately clear who had called the paramedics or why. Dee, who lives in the West Midlands, had to piece it together over the subsequent days. But eventually she worked out that the chain of events had started the night before when she had come home late from her job as an NHS nurse practitioner. Her shift finished at 10pm and she had asked Jake to fix her some rice to eat when she got back. He hadn’t done it: as usual, he was holed up in his room playing video games. Dee lost her temper and confiscated his laptop. The following day, Jake stayed in his room and sent increasingly fraught and extreme messages to his girlfriend. On the instant-messaging platform Discord, he complained about his mother to his gaming-community friends. At some point, he went to the kitchen and took a knife back to his room. His thought processes spiralled darkly, to the extent that his girlfriend feared he was suicidal and called the ambulance.

“Jake did not tell his girlfriend why he wanted to kill himself,” says Dee, who later accessed her son’s phone and laptop. “But his messages are just heartbreaking to read: he’s saying he feels useless, he is nothing… It did not sound like my son. How on earth does he feel this? He is a really loved child, a favourite grandson, the only grandson. He’s my everything.”

At the root of it all, though, was Jake’s compulsive gaming. Dee is from the Philippines and moved to the UK to work when Jake was five, leaving him in the care of her mother and sister back home. He was given a handheld Game Boy Advance not long after and a laptop so he could speak to Dee more easily, then he moved on to an Xbox and more sophisticated consoles. Jake particularly liked the Final Fantasy and Soulcalibur series: “Anything with killing,” says Dee, wincing.

Another level: research suggests that 88% of young people aged 16 to 24 in the UK play video games.

Jake was a quiet, introverted child, but his behaviour was deteriorating: he got into trouble at school for pinning down one of his female friends. Dee decided to move him to live with her in the UK, but still, every spare moment was spent gaming. He would pretend to go to bed and stay up until 5 or 6am. “Then he’d get up, go to school and repeat again,” says Dee. He would eat meals in “a blink of an eye, 90mph” so he could retreat to his room. “And he smells,” she says. “If I didn’t prompt him to have a shower, he’s not going to have a shower for a week or a month or whatever. He was so dirty, he didn’t brush his teeth.”

But the 2am visit from the paramedics was the real wakeup call. Dee had read a newspaper article about a new NHS National Centre for Gaming Disorders that was being set up; she made contact, but the service wasn’t taking on patients yet. So, instead, she sent Jake for private counselling and engaged a tutor to arrest his school grades, which were in freefall. Neither worked especially well and Dee, who had now been diagnosed with cancer herself, was losing hope. “I said to Jake, ‘You really need some help. If I need to take you to rehabilitation, I’ll do it,’” she says. “I’d been looking, searching anywhere, everywhere. It had to be done sooner rather than later before my son was totally broken.”

Then, two years after her first contact, Dee reached out to the National Centre for Gaming Disorders again. When one of the team, Alison Smith, a family psychotherapist, rang her back to say they could treat Jake, Dee cried. “It was everything,” she says. “At that time my son’s wellbeing was far more important than my cancer. I don’t care about that. When I got that call from Alison, I was in pieces. I said, ‘My son needs help. Help him!’”

‘My son needs help. Help him!’

The NHS treats around 3,000 game addicts a year in 15 centres across the UK.

The story of Dee – and Jake, who agreed to be featured in this article, but preferred not to be interviewed – is depressingly familiar to Professor Henrietta Bowden-Jones OBE, the founder and director of the National Centre for Gaming Disorders. “I remember a boy who was primary-school age who walked two miles in the middle of the night to his grandmother’s house to sit on her doorstep so he could use her wifi,” she says. “He wasn’t, but he could have been run over.

‘The force with which gaming disorder has presented itself has been quite overwhelming and unexpected’:

Henrietta Bowden-Jones

“Another child,” Bowden-Jones goes on, “unscrewed the downstairs windows of his house at night, so he could get into the locked room where the devices were. Then one day a window fell out, because he hadn’t put it back properly. And the mother was astounded: can you imagine the planning, the organisation and also the determination of some of these children? Or grabbing a knife, wanting to harm yourself, threatening to harm yourself. The impulse-control issue is very interesting.”

Bowden-Jones, 60, is something of a legend in the study and treatment of addictions. Born in Turin to Anglo-Italian parents, she studied medicine at the University of Pavia before specialising in psychiatry. She then earned a doctorate in neuroscience from Imperial College London and worked for years in the field of alcohol and drug dependency. It is in the field of gambling addiction, though, that Bowden-Jones is probably best known. In 2008, she founded the first National Problem Gambling clinic: the NHS now has the capacity to treat up to 3,000 patients a year in 15 centres across the UK based on Bowden-Jones’s methodology.

“It took years for people to take pathological gambling seriously,” she says. “When I started talking about setting up a clinic, people were literally just looking at me blankly going, ‘Why? What are you talking about?’ It’s only been in the last five or six years that gambling disorder has had a significant recognition as a life-destroying disastrous illness. It is a proper addiction with genetic heritability.”

I first met Bowden-Jones in March 2020 to discuss her latest venture on gaming disorders. The new centre had been allocated NHS funding in 2019 and now referrals from schools, GPs and parents were trickling in. At that time they had received 23 referrals, including two children aged 12, and 49 expressions of interest. We sat in a grand, high-ceilinged room in Earl’s Court, which is also the current base for the gambling clinic, and discussed what form an article might take. Bowden-Jones explained that the National Centre for Gaming Disorders was expecting to treat no more than 50 patients a year and had been funded accordingly.

‘It’s only been in the last few years that the disorder has had a significant recognition as a life-destroying illness

Did Bowden-Jones have any concern that gaming could be as destructive as gambling? “Are we facing a similar situation?” she replied in 2020. “I sincerely hope not, because it would mean that there would be many, many young people in terrible trouble. So my hope is that this isn’t going to be as prevalent or as harmful. But we’re here to deal with it and see what happens.”

Then the pandemic landed and our plan for a fly-on-the-wall report of the new gaming centre had to be shelved. More pressingly, as a nation, we were suddenly confined to our homes. If ever you wanted to create conditions for addictive behaviours to flourish, it was the national lockdowns of 2020 and 2021. “You could not have dreamed up a situation where people would be able to drink more and game more,” agrees Bowden-Jones now. The centre, which had been set up with a plan to see all patients face-to-face in London, pivoted swiftly to video calls, which remains the format its therapy sessions still take. “We responded immediately: gambling and gaming,” she says. “I thought, ‘There’s no way on earth I’m shutting this down. There’s going to be even more of a need.’”

Whether it was exacerbated by the pandemic or the existing problem had been underestimated, the National Centre for Gaming Disorders has been overrun since day one. Instead of 50 patients a year, Bowden-Jones and her team had to manage around 700 referrals in the first three years (as of June 2024, they had received 1,050 referrals). Bowden-Jones has been pushing for urgent extra funding and the clinic has taken the difficult decision to pause family work: this has brought the assessment waiting time down from over a year to three months. Most patients are young and male. Most patients are young and male, and the average age is 17; the youngest it has treated is 13 and the oldest gamer was a woman in her 70s.

Gaming is a key part of life for most young people: research from 2022 suggested that 88% of those aged 16 to 24 in the UK play video games. Analysis from Ofcom in 2021 found that (for those aged between 13 and 64) the average time spent on gaming was 7.5 hours a week, but some play for much longer: around 5% gamed for 20 or more hours per week. There’s no simple figure at which someone would be described as being addicted. Instead, health professionals are looking for, according to guidelines from the World Health Organization, “marked impairment in personal, family, social, educational, occupational or other important areas of functioning”.

Bowden-Jones admits she was not fully prepared for the scale of gaming addiction in the UK, and especially the young age at which it can become problematic. “It is shockingly early,” she says. “There are people we are turning away because they are nine or 10 and we are only commissioned to see people who are older. But the force with which gaming disorder has presented itself, via our patients, our young patients, was quite overwhelming at times. And unexpected.”

“There’s no simple figure at which someone would be described as being addicted

For those patients who have come through the clinic, Bowden-Jones has been pleased with the results. Treatment typically takes the form of 12 weekly sessions, based around cognitive behavioural therapy (CBT) principles. Where the patient is young, sessions with parents or carers are also recommended.

The treatment plans lean heavily on Bowden-Jones’s previous experience of addiction, but there are some key ways in which gaming is distinct from other disorders. The main one is that the goal of therapy is not to make a patient give up the activity, but instead to manage and control it. “You can’t remove the gaming completely,” Bowden-Jones advises. “We’ve really learned that, unlike all the other addictions that need to stop, with gaming, because so many young people are gaming, they are finding solace and are finding company in gaming with others. Removing it meant that they really had lost everything.”

Jake was initially resistant to treatment at the National Centre for Gaming Disorders. He would tell Dee that he had been logging into therapy sessions, but would secretly skip them. “I even asked him” ‘So how’s your session, Jake?’” she says. “He said, ‘OK. Very good.’” Cleaning his room one day, she found a knife under his bed again.

The clinic has a rule that if you miss three consecutive sessions, it suspends treatment, but Dee caught Jake’s lies just in time. They attended sessions together, and also with Dee’s new partner, Peter. They dug deeper into their problems: Jake admitted he still felt confused about why he had not travelled with his mother from the Philippines when he was a child. “One of the reasons for him diving into gaming is he wants to understand why I moved here to England, why I left him when he was only five,” she says.

“Many of them hate their daily reality, many of them cannot wait to grow up

Bowden-Jones notes that it is common for addiction to stem from multiple underlying factors. “I am seeing sometimes a drive and compulsion to use gaming as a saviour,” she says. “Many of them hate their daily reality, many of them cannot wait to grow up. Many of them are very anxious about the marriage or mental health of their parents. It just shows you how multifactorial addiction is, and how gaming disorder is just one more manifestation of things going wrong.”

When Jake did attend sessions regularly, he seemed to turn a corner. He began to help with cooking at home and his grades at school improved. Now 21, he is studying game design and programming at university. As part of his admission statement, Jake wrote that he wanted to create video games that had a positive impact on mental health. He received three offers of places. “Just reading that statement, I said, ‘You can’t just write that. You have to stand by it,’” says Dee. “So I keep reminding him of that and I know it’s going to be a long journey. We’ve still got battles to fight.”

Dee credits the gaming disorders clinic with making the breakthrough with Jake. Does she have any advice for other parents who are worried about their child’s gaming? “I’d say to all parents, please don’t ever give up. It’s worth fighting for. And it does work,” she says, “We’re the living proof that it can work.”

For more information, visit cnwl.nhs.uk/national- centre-gaming-disorders.

As appeared in The Observer, Sunday 7th July 2024 >>

Image Credits:

Cover illustration by @smlxl.company
‘My Son Needs Help’ Illustration: Guillem Casasus/The Observer
Henrietta Bowden-Jones Photograph: Roo Lewis/The Observer