# Video game addiction in China

Video game addiction is considered an impulse control disorder, analogous to pathological gambling that does not include using intoxicating drugs. In China, as well as other parts of the world, the disorder is considered a problem. In June 2018, the World Health Organization listed "gaming disorder" in the 11th Revision of its International Classification of Diseases. According to its definition, it is characterized by impaired control, prioritizing gaming by giving excessive time to games rather than other activities, lack of other interests in daily activities, and the continuation of gaming despite the negative consequences. China has in place multiple laws attempting to combat video game addiction in minors.

## Possible addictive elements in video games

Many video games have no pre-defined endgame. The inclusion of downloadable content (DLC) means the game continues to expand over time. DLC enables developers to expand their games and attract others for a player to play against. There is always another game.
Video games satisfy the need of social connections and activities. Today's games encourage players to interact with each other, supporting the societal demand for interpersonal connections. Massively multiplayer online role-playing games are an example of this.
Level reward systems are addictive, and provide incentives to the player to level up. In the introductory period of a game, players begin with basic characteristics with regards to attributes and skills. At low levels, it takes little effort to level up and progress. Each new level requires progressively more work to reach.
Multiplayer games do not end; this kind of game often encourages players to connect and collaborate with gamers around the world. Massively multiplayer online role-playing games let players connect with each other. Examples include League of Legends and PUBG.
Video games often have digital currencies. The more time players spend in a game, the more "wealth" they acquire. Players use this virtual wealth to "purchase" new aspects of the game. Rewards are set on different time schedules in video games. Players may be rewarded for finishing tasks within a certain time frame, or might be given bonuses for playing during a pre-determined period.
The virtual gaming world continues to evolve, even when players are not online. Even when players are not playing, the game's world may continue to develop. This creates an incentive to keep playing the game due to the fear of falling behind.
Top players or teams can receive rewards in real life, as some tournaments offer cash prizes. Video games do not reward short and unscheduled periods of player time. Achieving competency in games requires a large time investment. Casual players will often be unable to catch up to more dedicated players due to their lack of skills or in-game items.
Video games can generate strong emotions in players. Addictive games offer unique methods to create emotional connections with players. It is an unconscious decision for people addicted to computer games to spend more time playing when they are emotionally invested in a game.
Modern video games are enormous and dense. Many modern games focus on delivering large amounts of content through open-world levels or compulsion loops, allowing the player to delve deeply into a world for long periods of time.
Apart from the common factors contributing to video game addiction, certain specific phenomena prevalent in China exacerbate this issue. The nation's high-pressure educational environment significantly correlates with addiction, particularly among individuals aged 12 to 18. Research by Rui Zhou (2023) revealed that the prevalence of Video Game Addiction (VGA) in adolescent psychiatric patients was 40.9%, with a comparable rate of 41.8% for Social Media Addiction (SMA). Notably, both VGA and SMA exhibited a co-occurrence rate of 23.6% (see Figure 2). The mean age of those affected was 14.9 years (SD = 1.8 years; range 12–18 years), with an average of 9.0 years of education (SD = 1.7 years; range 5–13 years). Furthermore, there exists a negative correlation between academic performance and video game addiction, indicating that academic pressure is linked to teenagers' addiction. However, the study concludes that individualistic personality and childhood trauma are more significant risk factors.
During the COVID-19 pandemic, the situation appeared to worsen due to China's strict lockdown policies. As a result, internet-based entertainment saw significant development, emerging as the most convenient means for people to relax. This shift has led to a notable increase in addiction among the population. According to Yang-Yang Li (2021), during the pandemic, the overall prevalence of Internet addiction among the general population was recorded at 36.7%, with severe Internet addiction affecting 2.8% of individuals, as indicated by scores on the Internet Addiction Test (IAT). Recreational Internet usage notably increased during this period, with nearly half of the participants reporting heightened severity of Internet addiction. Negative emotions play a significant role in exacerbating the issue as well. People are eager to find activities that can help soothe their minds amid challenging circumstances.

## Treatment

Treatments may include in-patient intervention programs with a team of mental health professionals who are specialized in combating computer game addiction. Wilderness therapy, which is similar to in-patient treatment, provides treatment in an outdoor setting devoid of any technology or electronic devices. One-on-one counselling with a psychologist or mental health professional, experienced in working with computer game addictions, may be useful. Family therapy entails a therapist looking at the family system and how it interacts with family activities. Computer game addiction books are available that allow an individual to self-treat their issues.
The Chinese government operates several clinics to treat those who overuse online games, chatting and web surfing. Treatment for the patients, most of whom have been forced to attend by parents or government officials, includes various forms of pain including shock therapy. In August 2009, Deng Sanshan was reportedly beaten to death in a correctional facility for video game and Web addiction. Most of the addiction "boot camps" in China are actually extralegal militaristically managed centers, but have remained popular despite growing controversy over their practices.

## Anti-addiction measures

In August 2021, China’s strict limits on how long minors can play online video games got stricter. Chinese children and teenagers are barred from online gaming on school days, and limited to one hour a day on weekend and holiday evenings.
A new law passed in November 2019 limits children under 18 to less than 90 minutes of playing video games on weekdays and three hours on weekends, with no video game playing allowed between 10 p.m. to 8 a.m. These are set by requiring game publishers to enforce these limits based on user logins. In September 2020, the government implemented its own name-based authentication system to be made available to all companies to uphold these laws.

## Discourse

Significant media coverage and public discourse developed in 2017 in relation to the Tencent game, Honor of Kings.$^{:237}$ China Youth Daily described the game as "digital opium" and noted several game addiction cases involving Honor of Kings.$^{:238}$ In Hangzhou, a middle school teacher wrote a widely-disseminated article calling for the game to be banned, attributing to it negative effects on teenagers' mental health.$^{:238}$ Shortly thereafter, a thirteen year-old in Hangzhou jumped off a building because his father prevented him from playing Honor of Kings and the Qianjiang Evening News called for a ban on the game.$^{:238}$ Southern Metropolis Daily reported that Honor of Kings had not implemented the national system that aimed to protect adolescents from video game addiction.$^{:239–239}$
On 3 July and 4 July, People's Daily published a pair of critical articles, after which Tencent share price dropped significantly.$^{:239}$ On 4 July, Honor of Kings implemented measures to reduce teenager's time playing the game.$^{:239}$ Honor of Kings started limiting children under the age of 12 to one hour of play time per day, with an additional restriction from playing after 9pm. Children aged from 12 to 17 were limited to two hours per day. It is believed that rising concerns over excessive gaming habits in children led Tencent to self-impose these restrictions. After these changes in Honor of Kings, public and media debate about game addiction shifted towards debate about the role of family, school, education, and other factors.$^{:239}$ The value of Tencent stock increased shortly thereafter.$^{:239}$
On 31 October 2021, Honor of Kings updated its juvenile addiction prevention system following the requirement from National Press and Publication Administration. Under the new changes, juveniles only can log in to the game from 20:00 to 21:00 on Friday, Saturday, Sunday, and legal holidays.