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Identifying and Intervening with Students Exhibiting Signs of Gaming

Addiction

and Other Addictive Behaviors: Implications for Professional School Counselors

by W. Bryce Hagedorn , Tabitha Young

Many professional school counselors who read the title and abstract of this article

may be quick to ask why this content is important to the jobs they do, especially

given their multiple other responsibilities. School counselors typically do not conduct

the level of psychotherapeutic interventions necessary to address students' addictive

disorders. However, we assert that most school counselors would be quick to recognize

that, as the front line clinicians, they witness the impacts of these disorders on

students like no other helper would (Burrow- Sanchez, Lopez, & Slagle, 2008). Whether

affecting academic, emotional/behavioral, or familial situations, addictive disorders

are tied into the world of children and adolescents more today than at any other

time

in

history (Dickson & Derevensky, 2006; Medina-Mora & Real, 2008). Unfortunately, the

vast majority of school counselors feel ill-equipped to address these concerns

in

their students (Burrow- Sanchez et al., 2008; Pérusse & Goodnough, 2005).

Recognizing that most professional school counselors may not have had addiction-related

content as a part of their graduate work in school

counseling

(Click, 2008; Hagedorn, 2006; Ritter, 2002), much less any graduate-level coursework

related to the impacts of addictive behaviors (e.g., sex, food, gambling; Hagedorn,

2003, 2009; Hagedorn & Juhnke, 2005), we believe that the content of this article

can serve the needs of school counselors for several reasons. First, a well-established

connection exists between academic performance/problems and addictive disorders (e.g.,

Atwood, 2006; Bardick, Bernes, & McCulloch, 2004; Crosnoe, 2007; Dickson & Derevensky,

2006; Goble, 2008; Fergusson & Boden, 2008; Lambie & Sias, 2005; Petry, 2005). Similarly,

studies have shown clear connections between substance use disorders (alcohol and

other drugs) and behavioral addictions (e.g., sex, food, gambling; Merta, 2001; Ledgerwood

& Downey, 2002; Potenza, 2002; Young, Pistner, O'Mara, & Buchanan, 1999), and between

addictive and psychiatric disorders (e.g., depression, attention deficit/hyperactivity

disorder, and anxiety; Manley & Koehler, 2001; Ohlmeier et al., 2008; Ragan & Martin,

2000). Given these links, school counselors need tools to determine whether their

students' academic or personal concerns are the result of an underlying addictive

disorder. Otherwise, counselors may aim remedial efforts at enhancing a student's

study skills when the actual problem may be much more profound.

In

addition to the aforementioned connections between addictive behaviors and other

student concerns, both the ASCA National Model (American School Counselor Association

[ASCA], 2005) and the School

Counseling

Competencies (ASCA, 2007) call for professional school counselors to respond to

their students' crises and immediate needs. Addictive disorders and their accompanying

complications would fall into these categories. Finally, the recently updated and

implemented counselor education accreditation standards by the Council for Accreditation

of

Counseling

and Related Educational Programs (CACREP, 2008) mandated that all accredited counselor

education programs provide their students, regardless of specialty area, with the

content necessary for them to adequately prevent, intervene, and treat addicted clients

and students. Thus, the purpose of this article is to provide the practicing school

counselor with a list of warning signs, questions for assessment, and methods for

intervening with addicted students. Given the research already available to assist

professional school counselors with those issues related to their students' alcohol

and drug-related concerns (see Coker, 2001; Froeschle, Smith, & Ricard, 2007; Halverson,

1999; Lambie & Rokutani, 2002; Lambie & Sias, 2005; Post & Robinson, 1998; Watkins,

Ellickson, & Vaiana, 2006), this article focuses exclusively on the most common and

problematic addictive behaviors that affect children and adolescents (Black, 2007;

Chak & Leung, 2004; Fisher et al., 1995; McCabe & Ricciardelli, 2004; Park, Kim,

& Cho, 2008), with a special emphasis on gaming

addiction.

GAMING AND OTHER ADDICTIVE DISORDERS: DEFINITIONS, IMPACTS, AND WARNING SIGNS

Professional school counselors may be somewhat familiar with addictions to such things

as alcohol, marijuana, and nicotine, but the idea of addictive behaviors is relatively

new. These behaviors, often called "process addictions," include addictions to such

things as sexuality, Internet use, gaming, and gambling. This article will use the

term "addictive behaviors" or "addictive disorders." Addressing the justifications

for the legitimacy of designating these disorders as addictive is beyond the scope

of this article (for such discussions, see Hagedorn, 2009), but research has demonstrated

that these behaviors cause similar physiological effects

in

the brain as those of drugs and alcohol: epinephrine, dopamine, and serotonin levels

are all impacted (Bostwick & Bucci, 2008; Guay, 2009; Westphal, Jackson, Thomas,

& Blaszczynski, 2008). One way to distinguish between "normal" and addictive behaviors

is to use the definition developed by Goodman (2001), who suggested that a behavior

moves from normal to addictive when it (a) both produces pleasure and reduces negative

moods and (b) includes two key features: (1) the individual is unable to control,

cut back, or stop the behavior, and (2) the individual continues to use the behavior

despite substantial negative consequences. When seen

in

this light, one can more easily recognize, for example, the difference between an

adolescent's addictive use of Internet gaming as a means of avoiding the negative

feelings associated with his parents' divorce (e.g., spending six hours on-line and

thus not fulfilling such responsibilities as homework and household chores) and an

adolescent's use of gaming as a hobby after finishing his school assignments. For

a complete list of diagnostic criteria, see Hagedorn (2009).

The most common and problematic addictive behaviors found among children and adolescents

include (a) food, (b) gambling, (c) exercise, (d) sex, (e) spending, (f) the Internet,

and (g) video/computer games. Much research has already studied how adolescents experience

challenges with eating (see Boes, Ng, & Daviston, 2004; Crosnoe, 2007; Goble, 2008),

gambling (see Dickson & Derevensky, 2006; Fong, 2006), exercise (see Aidman & Woollard,

2003; McCabe & Ricciardelli, 2004; Zmijewski & Howard, 2003), sex (see Atwood, 2006;

Rimington & Gast, 2007; Sussman, 2007), spending (see Black, 2007; Miller, 2007),

and the Internet (see Kaltiala-Heino, Lintonen, & Rimpela, 2004; Nalwa & Anand, 2003).

Given the applied nature of this article and its objective to equip readers with

the necessary tools to intercede with their troubled students, a list of warning

signs for each of these disorders is provided

in

the Appendices. Using these lists, school counselors can quickly determine if further

intervention is warranted. The remainder of this article is focused on gaming

addiction

, the disorder that has received less attention yet is causing increased concerns.

The article concludes with suggested screening and intervention strategies that professional

school counselors can use

in the school setting to determine the proper course of action for their troubled

students.

GAMING ADDICTION AND STUDENTS

The notion of gaming addiction was first identified in

the early 1990s (Griffiths & Hunt, 1995) and popular media and research recently

have paid it a great deal of attention, particularly the gaming that occurs on the

Internet. While some of this increased attention has been focused on the connection

between gaming and aggressive behaviors (Grusser, Thalemann, & Griffiths, 2007; Khan,

2007), much of it has been directed at the extreme impacts that Internet gaming has

had on adolescents (Smahel, Blinka, & Ledabyl, 2008). These influences range from

isolation from friends and

family

, to nutritional deficiencies and poor hygiene, to negative influences on school

performance and interpersonal relationships, to suicidal and homicidal behaviors

(Hart et al., 2009; Tanner, 2007). Similar to other addictive disorders, gaming

addiction

has components of cravings, mood alteration, withdrawal symptoms (anxiety, anger,

irritation, and depression), problems with impulse control, increased use despite

negative consequences, and loss

in

other life domains (work, school, recreation, interpersonal relationships, spirituality,

etc.) (Grusser et al., 2007). Upwards of 90% of American youth play video and/or

online games, with approximately 10-15% meeting criteria for

addiction, the majority of whom are male (Chak & Leung, 2004; Griffiths & Hunt; Grusser,

et al.; Khan).

Children and adolescents make up the majority of those who struggle with gaming addiction

, and many experience consequences common to other addictive disorders. The biggest

source of recent concern

in gaming addiction among adolescents is in

the massively multiplayer online role-playing games (MMORPGs), otherwise known as

MMOs (Chappell, Eatough, Davies, & Griffiths, 2006). These games are played competitively

with others online by using various input devices (e.g., instant messaging, email,

on-line video, telephones, and/or software like Skype®; Khan, 2007). Hundreds of

people can play these games at the same time and the games occur

in

real time. Smahel et al. (2008) noted that many gamers average upwards of 23 hours

per week playing MMOs, with almost 9% reporting having spent 40 hours per week. Three

common examples of MMOs are World of Warcraft®, Call of Duty®, and Everquest®, each

of which can offer players enjoyable recreation, but when these games are overused,

consequences such as those previously mentioned become all too common.

Following is an explanation and overview of the components common to MMOs. Some MMOs

operate on software that can be downloaded from the Internet free of charge, whereas

others must be purchased and paid for monthly. Players create a game persona, often

called an avatar, each of whom has a role to play as a part of a mission that is

accomplished

in

teams (often called "guilds," "clans," or "squads"). One avatar may serve the role

of defender, another as a leader, and still another as a strategist, with the structure

of the clan designed

in

such a way as to successfully complete each mission. As gamers interact during play,

they often will "hot seat," or use the language, vocal tones, and characteristics

of their avatar. Raids or missions can last anywhere from several hours to several

days; the game itself never ends.

In

fact, the start and end times of each mission are dictated by the guild leader.

For example, a guild leader may live in

Tokyo and decide to begin a six-hour game beginning at 12 p.m. on a Wednesday. Given

that members can reside anywhere

in

the world, players who live on the east coast of the United States who choose to

join the mission must begin when the mission begins, which would equate to a start

time of 11 p.m. and an end time of 5 a.m. on Tuesday. This would have obvious impacts

on sleep and school performance. The point is that membership on these teams becomes

very important as each individual becomes dependent upon others to successfully play

their role

in

order to accomplish the mission's goals.

Online relationships often become more important for gamers than real-life relationships

(Peters & Malesky, 2008). As an example of the interdependency experienced by gamers,

say an adolescent is being called by his mother to come join the

family

to eat dinner. He then communicates his need to drop out of the mission to the other

guild members. Guild members, not wanting to lose what his character provides (e.g.,

magic spells, defense, leadership, etc.) then respond negatively, and one can easily

imagine how adolescent males would respond

in

this manner (particularly if they are hot-seating). The adolescent then decides

that his participation and the social support afforded by the game are more important

than being with

family and/or eating a meal.

One final practice worth mentioning that is unique to on-line gaming is "gold farming"

(Brookey, 2009). Gamers spend time acquiring (i.e., "farming") items of value (i.e.,

"gold")

in

the game environment (e.g., strength points, weapons, spells, etc.) and/or build

up their avatar to extremely high levels of power or ability. Gamers then have been

known to sell these items/advanced players to others via on-line auctions and their

own Web sites, often for large profits. The senior author once had a client who made

a comfortable living with gold farming, but at the expense of time spent with his

family

. This practice has not been mentioned much outside of the popular media, but one

can imagine the possible interactions with other problematic behaviors (e.g., Internet

addiction, addictive gambling).

In

addition to MMOs, other games can have negative impacts. These include online multiplayer

games (OMGs) and single player role playing games (RPGs; e.g., Second Life®), console

games (e.g., Xbox ®, PlayStation®, Wii®), and other computer and cellular phone-based

games (e.g., card games, memory games, puzzles, etc.). Fewer reports of negative

consequences have been linked to these games when compared with those attributed

to MMOs, but these games may serve as a gateway to more serious game playing. Given

their availability, these games, particularly those found on most cellular telephones,

may also hook those who had pulled away from the addictive gaming scene. Rallying

school counselors, administrators, and parents to forbid adolescents from playing

these games is not the purpose of this article. Rather, it is to provide the needed

information to help inform adults and assist them

in setting appropriate limits for their adolescents in

order to ensure pleasurable experiences and limit the consequences of

addiction.

The list of addictive disorders affecting students that this article provides is

by no means exhaustive. Research has indicated that individuals can develop addictions

to such things as religion, television, spending, work, and relationships (Black,

2007; Fontanella, 2006; Griffin-Shelley, 1995; Harpaz & Snir, 2003; Taylor, 2002).

Most important is that school counselors be aware of the activities

in

which their students are engaging and be ready to intervene when necessary with

a set of research-based screening questions (which can be derived from those found

in the Appendices) and assessment strategies.

ADDITIONAL SCREENING TOOLS FOR ADDRESSING ADDICTIVE BEHAVIORS

Although professional school counselors are rarely called upon to perform addiction

-related psychotherapeutic interventions with their students, the authors believe

school counselors can and should serve as facilitators to support their students'

change efforts. This begins by acknowledging that school counselors are the professionals

who are often best situated to identify these maladaptive behaviors

in

the students with whom they work. Using the lists of warning signs offered

in

the appendices, school counselors can determine if a more direct intervention (

in the form of screening/assessment and/or referral) is warranted.

To aid in

the process of a more formal screening and assessment interview, several research-based

tools are available to the school counselor. For example, to screen/assess for disordered

eating/food

addiction

, the SCOFF questionnaire was developed by Morgan, Reid, and Lacey (1999) and adapted

to the American language by Johnston, Fornai, Cabrini, and Kendrick (2007). It involves

five questions that have garnered strong empirical support (Hautala et al., 2008;

Rueda Jaimes, Diaz Martinez, Ortiz Barajas, Pinzon Plata, Rodriguez Martinez, & Cadena

Afanador, 2005). The five questions from the SCOFF consist of:

1. Do you make yourself Sick because you feel uncomfortably full?

2. Do you worry you have lost Control over how much you eat?

3. Do you believe yourself to be fat when Others say you are too thin?

4. Have you recently lost more than Fourteen pounds in a 3-month period?

5. Would you say that Food dominates your life?

A students affirmative answer to two or more of these questions would signify a strong

case for anorexia or bulimia and therefore warrant a referral to a qualified clinician.

If addictive gambling is suspected, the school counselor can turn to the brief screening

instrument developed by the Florida Council on Compulsive Gambling (2008), which

involves two brief questions. Gambling may be a problem for the adolescent answering

yes to one or both of the following questions: (1) Have you felt the need to bet

more and more money? and (2) Have you lied or argued with people important

in

your life about gambling? A more thorough instrument, the South Oaks Gambling Screen:

Revised for Adolescents (SOGSRA), developed by Winters, Stinchfield, and Fulkerson

(1993), is a 12-item, research-supported screening instrument for adolescent gambling

(Boudreau & Poulin, 2007; Parker, Taylor, Eastabrook, Schell, & Wood, 2008). A student

acknowledging four of the items on this instrument would warrant a referral to a

counselor trained

in treating addictive gambling.

In terms of addictive exercise, the Exercise Addiction

Inventory (EAI; Terry, Szabo, & Griffiths, 2004) is an empirically-based, six-item

screening tool that uses a five point Likert scale (ranging from 1 = Strongly Disagree

to 5 = Strongly Agree). If a school counselor tallies a student's responses to the

following six questions and attains a score of 24 or greater, a referral is

in order:

1. Exercise is the most important thing in my life.

2. Conflicts have arisen between me and my family and/or my partner about the amount

of exercise I do.

3. I use exercise as a way of changing my mood.

4. Over time I have increased the amount of exercise I do in a day.

5. If I have to miss an exercise session I feel moody and irritable.

6. If I cut down the amount of exercise I do, and then start again, I always end

up exercising as often as I did before. (Terry, et al., p. 493).

Additional empirically supported screening instruments include Young's Diagnostic

Questionnaire (YDQ: Young, 1998) for students exhibiting problematic Internet use.

This eight-item yes/no screening tool offers a cut-off score of 3 or greater, which

indicates that a problem exists (Dowling & Quirk, 2009) and that a follow-up by a

trained counselor is

in

order. At the time of the writing of this article, the authors found no empirically

validated screening instruments for addictive gaming. The list of questions on the

On-Line Gamers Anonymous Web site (www.olganon.org) may be a useful tool for school

counselors suspecting problematic gaming among their students. Finally, one instrument,

the Shorter PROMIS Questionnaire (SPQ: Cristo, Jones, Haylett, Stephenson, & Lefever,

2003) has shown initial promise (no pun intended) for assessing, rather than screening,

for the presence of multiple addictive behaviors at the same time. The SPQ is a 16-scale,

self-report instrument assessing the use of nicotine, recreational drugs, prescription

drugs, gambling, sex, caffeine, food, exercise, shopping, work, relationships, and

compulsive helping. More recently, three additional scales assessing the addictive

use of video games, the Internet, and mobile phones were added (Couyoumdjian, Baiocco,

& Del Miglio, 2006). Research has shown the utility of this assessment instrument

across various populations, including adolescents (Pallanti, Bernardi, & Quercioli,

2006; Tafà & Baiocco, 2009).

The WASTE-Time structured interview (Hagedorn & Juhnke, 2005) is one clinically-based

screening tool (see Appendices) the authors have successfully used with addicted

clients. Developed by the first author

in

response to the lack of such instruments to screen for multiple process addictions,

each letter of the acronym WASTE-Time corresponds to one or more of the diagnostic

criteria for addictive behaviors (as noted by Goodman, 2001). Questions that emanate

from the interview can be tailored to circumvent student denial and resistance and

may be adapted to fit the school setting.

Validation is ongoing of the WASTE-Time structured interview as a screening tool

in

and of itself, but given that it is based directly on the diagnostic criteria developed

and validated by such researchers as Carnes (2001), Good man (2001), Schneider and

Irons (1996), and Young (1998), the authors have found it to provide useful information

about the addictive patterns of their clients. They provide it here as an adjunct

to other screening and assessment measures and note that diagnoses and clinical decisions

should always be made using a multimodal and multi-method process.

Professional school counselors can review the results of the WASTE-Time structured

interview with parents to help connect students with the most appropriate level of

care. For example, an affirmative answer to one question may suggest a strong possibility

of the presence of an addictive behavior. Given these results, parents could be encouraged

to see a community-based mental health counselor for follow- up and further assessment.

Clients who have answered three or more answers affirmatively often meet criteria

for an addictive disorder,

in

which case immediate intervention by a community-based mental health counselor would

be warranted. At this level, students may need transitions into such settings as

inpatient hospitalization, intensive outpatient

counseling, or at the minimum, self-help support group attendance.

Given that the aforementioned levels of care are not typically within the professional

school counselor's treatment milieu, counselors are encouraged to set up meetings

with the student and his or her

family

to discuss possible options once a problem has been identified. By focusing on the

connection between the student's inability to regulate tension (e.g., stress, anger,

or emotional pain) and his or her pattern of discharging tension through less-thandesirable

behaviors (e.g., addictive gambling or Internet

addiction

), professional school counselors can help destigmatize some of the possible shame

experienced by the student. If a few students

in

the school are reporting similar experiences, the counselor might consider bringing

these students together with a small group experience that addresses stress management

skills, study skills, and/or communication skills. This

in

itself may help propel students and their families to follow through on more formal

recommendations.

For those students who answer three of the WASTE-Time questions affirmatively (or

who exhibit several of the warning signs for any disorder as indicated

in

the Appendices), the professional school counselor could recommend the need for

further assessment of the student by a mental health counselor with expertise

in that specific addiction

. These recommendations could evolve from up-todate referral lists of community resources

that work with process addicted children and adolescents. National referral lists

can be found on the Internet; for example, www.edreferral.com is a resource for finding

treatment providers to work with those addicted to eating; www.netaddiction.com for

those addicted to the Internet; www.iitap.com for those addicted to sexuality; and

www.ncpgambling.org for those addicted to gambling. Ideally,

family counseling (since the student's concerns are likely impacting the family system),

group counseling

(for reality testing and universality), and individual

counseling (to develop new coping skills) should be included whenever possible.

Finally, with support groups available for both addicted students and those in relationships

with them (e.g., friends and family

), school counselors can encourage students and their families to attend meetings

of such groups. For the student, groups include Overeaters Anonymous, On-Line Gamers

Anonymous, Celebrate Recovery, and Rational Recovery (among many others).

Family

members can attend their own support group meetings, such as Gam-Anon (

family members of addicted gamblers), OLG-Anon (family

and friends of those addicted to on-line gaming), and Co-Dependents Anonymous (for

those who have lost their own identity as a result of being consumed with the addict's

behaviors). For those living

in

regions without access to some of these more specialized support groups, online

groups can be found, or, at a minimum, students and

family

members can be encouraged to attend Alcoholics Anonymous and Al-Anon. Granted, these

groups are for those addicted to alcohol and for the

family

and friends of alcoholics, but without the availability of the most appropriate

support groups, individuals can always introduce themselves

in

the meeting as, "I'm Jim and I am a struggling addict," rather than, "I'm Jim and

I'm an alcoholic." Overall, support groups like those mentioned above are available

in

most cities, offer participants the type of accountability and structure they will

need to maintain a sober lifestyle, and provide the support and acceptance that other

individuals cannot.

This article only scratches the surface of the literature available to professional

school counselors that can aid them in

helping students who struggle with addictive behaviors. However, given the increased

demands placed on counselors, making an exhaustive search to determine the best course

of action when faced with a crisis is often challenging. This article's objective

is provide the practicing counselor with the most timely research conclusions, a

list of warning signs and screening questions, and some steps toward connecting the

hurting adolescents with the resources they need to thrive.

-1-

Questia, a part of Gale, Cengage Learning. www.questia.com

Publication Information:

Article Title: Identifying and Intervening with Students Exhibiting Signs of Gaming

Addiction and Other Addictive Behaviors: Implications for Professional School Counselors.

Contributors: W. Bryce Hagedorn - author, Tabitha Young - author. Journal Title:

Professional School Counseling. Volume: 14. Issue: 4. Publication Year: 2011. Page

Rights Reserved.

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