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Mitigating the pitfalls of online gaming addiction

At the launch of National Addiction Awareness Day 2021 by the National Addictions Management Service in August, Senior Minister of State for Health Janil Puthucheary noted that the rates of addiction to online gaming are expected to rise over the years.

Covid-19 has led to a surge in internet use and also online gaming worldwide.

Covid-19 has led to a surge in internet use and also online gaming worldwide.

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At the launch of National Addiction Awareness Day 2021 by the National Addictions Management Service in August, Senior Minister of State of Health Dr Janil Puthucheary noted that the rates of addiction to online gaming are expected to rise over the years.

He added that it is important for the Institute of Mental Health’s National Addiction Management Services to keep up with addiction trends and tailor its services for at-risk groups.

Indeed, Covid-19 has led to a surge in internet use and also online gaming worldwide.

This is partly due to a series of lockdowns and work-from-home measures that have led to heavier use and access to technology and the internet.

Unbeknownst to some, online gaming done in moderation is known to offer benefits such as keeping in touch with others and maintaining a sense of connection to the outside world. This is particularly important for reducing loneliness during the pandemic.

Empirical evidence also demonstrates positive outcomes of online gaming in youth undergoing chemotherapy, and those receiving psychotherapy for anxiety or depression that can perhaps be extrapolated to persons facing difficulties during the pandemic.

Yet, worries that online gaming also presents an easy opportunity for one to unknowingly become addicted are not unfounded.

Increasingly, studies have been emerging from Asia to point to an increase in addiction to online gaming during the pandemic. For instance, a study led by Dr Susumu Higuchi in Japan last year found prolonged use of gaming amongst treatment seekers with gaming disorder arising out of Covid-19 social restrictions.


Addiction to online gaming is a condition that is undergoing rapid acceptance as a psychiatric diagnosis.

The World Health Organization has formally recognised “gaming disorder” as a disease in the updated International Classification of Diseases from 2018, after a unanimous vote amongst representatives of the 72nd World Health Assembly in Geneva, Switzerland.

This recognises gaming disorder as dysfunctional behaviour, marked by impaired control of gaming behaviour, prioritisation of gaming over other activities and persistent or exacerbated gaming behaviour despite negative life consequences.

Several individuals are at higher risk of gaming disorder.

Mounting data suggests that younger people as well as those with reduced face-to-face and online family time have higher risk of developing these addictions.

Patients with psychiatric conditions such as attention deficit hyperactivity disorder, social anxiety disorder, depressive disorder and alcohol abuse also have increased chances of suffering from gaming disorder at some point.

Unfortunately, precious time and energy can be wasted on online games if one becomes addicted to them.

Other more debilitating consequences may ensue.

A study published in BMC Psychiatry suggests that additional problems of gaming disorder include insomnia, which can contribute to depression and suicide ideation.


Several strategies may be helpful to curb the development of gaming disorder.

First, consider health warning messages in online games.

Some game users, especially new users, may not be aware of the high potential for addiction in online games.

A potential solution is the provision of health warning messages cautioning the possibility of addiction before the start of online games, similar to health warnings on cigarette packages.

Similar approaches have been adopted in other countries.

According to Journal of Behavioral Addictions, China implemented a regulation where online game providers had to monitor users’ duration of gaming and, after five hours, display a message every 15 minutes to warn players of their unhealthy game time and that they should stop promptly.

Secondly, ensure higher vigilance on gaming behaviour for individuals with conditions associated with gaming disorder.

For instance, family and loved ones of patients with attention deficit hyperactivity disorder or social anxiety disorder should monitor them for excessive gaming behaviours, and promptly refer them to healthcare providers if gaming disorder is suspected.

A 2020 study partially funded by Kaohsiung Municipal Siaogang Hospital added that parents and educators of patients with social anxiety disorder must provide alternative avenues for social interaction to mitigate gaming disorder besides regulating time spent gaming.

Thirdly, explore innovative treatment for persons with gaming disorder.

A form of innovative treatment is therapeutic residential camps which were first developed in South Korea, which expose participants to various therapies such as psychotherapy, psychoeducational therapy and cognitive behavioural therapy. Such camps run for periods of up to three to four weeks.

This concept has since been adopted in countries like Japan, where it was implemented as a Self-Discovery Camp lasting nine days and eight nights at the National Hospital Organization Kurihama Medical and Addiction Center.

The camp was found to be highly effective in reducing gaming time of participants as well as in promoting self-efficacy.

At present, Singapore’s National Addictions Management Service (NAMS) runs a dedicated service for adolescents with gaming disorders called ReLive.

This service is provided for by a multidisciplinary team of professionals, including psychiatrists, social workers, psychologists and counsellors who work with individual patients on behavioural modification, finding of role models, goal-setting, activity scheduling, communication with family and finding alternatives to punitive strategies.

Also, community-based services like We Care in Singapore, functions as a recovery centre for addiction problems including gaming disorder. It provides a structured therapy programme and counselling sessions for individuals with gaming disorder as well as optional family sessions.

In the future, it is paramount for addiction centres to study the efficacy of innovative treatment, and adopt and tailor such services for individuals diagnosed with gaming disorder by collaborating with community based services for implementation.

As healthcare providers, it is our hope that all persons who suspect or are already known to have gaming disorder seek help early and receive appropriate treatment.



Associate Professor Lee Cheng is a senior consultant and clinical director of the Office for Population Health and Programme Director of the National Addictions Management Service at the Institute of Mental Health. Dr Alvona Loh Zi Hui is a medical officer working in Singapore.

Related topics

gaming addiction National Addiction Awareness Day online gaming Covid-19

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