[humanser] Identifying and Intervening with Students Exhibiting Signs of Gaming

[Mary Ann Robinson]

Identifyi


ng 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; P
érusse & 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
Number: 250+. © 2011 American Counseling Association. Provided by ProQuest LLC. All
Rights Reserved.