-[The inestimable Kyle Orland was kind enough to attend the Games For Health conference in Baltimore late last week for Gamasutra & friends, and took a lot of fascinating lecture notes we're writing up - here's our buddy Neils Clark discussing game addiction, for starters.]

Following his latest Gamasutra feature on the subject, writer and researcher Neils Clark spoke at the ongoing Games for Health conference in Baltimore on game addiction.

In his talk at the conference, he covered the perceived problems, a run-down on why people might get addicted, and some proactive measures that developers can use to combat addictive behavior in the future.

"You could say that game addiction is all a joke... or at least based on one," said Clark. In 1995, he explained, internet addiction disorder (IAD) became "official," and that eight item criteria written 13 years ago is now the standard for online game addiction understanding.

The Problem

Clark pointed out that there's no differentiation in many studies between adults and children, though pathologies differ between children and adults, saying that studies in the future need to realize this.

Games aren't without problems, he admitted, adding that most in the audience probably knows someone who has 'problems' with World of Warcraft now and again, but says the way we understand those problems currently is really 'interim.'

That's a good word for the situation, said Clark, one that can be used with medical people to explain that the debate on the subject between what happens in a game and whether the IAD criteria really measure it hasn't been settled, and keeps the conversation dynamic.

The Elements

Clark broke down three key elements to help understand what exactly makes up game addiction. The first of these was 'immersion' - "the way the brain handles taking in the experience of the game itself."

"When I put my mom and her brain in front of a game like [BioWare's Star Wars RPG Knights of the Old Republic], her brain has no idea how to process that. Her brain shuts down," he said. But, put her in front of Solitaire, Clark continued, and the immersion is much more slick.

The second of Clark's elements was 'culture,' or how the world works, as he referenced Tolkien on the brain's ability to get sucked into literature, on how amazing stories create texture that hold us in worlds that exist only in our minds.

These secondary worlds have different structures and a culture all their own, and, he said, researchers need to look at how these two worlds relate when they study addiction. For instance, in Korea there's a real-world concept known as Wang-tta -- which roughly translates to the concept of the 'low man on gaming totem pole' -- which might explain play habits, pulling Korean gamers in more deftly than elsewhere.

Finally, Clark said his third element was "simply how people interact with games" -- is gaming pathological, he wondered, and really causing a problem, or are players just having fun?

Does immersion actually cause time loss, he asked, or just part of getting locked into the world because of friendships, culture, and various other things people get out of playing the game?

People don't go into [virtual world] Whyville for nefarious reasons, said Clark - instead they have friends, agency, validation, and in-game rewards. When people study that interaction, they get a clearer idea of why a player goes into any given game. Researchers, he said, should create a model for how a patient is interacting with a game.

The Real World Relationship

Pathologies tend to affect both the primary and in-game worlds, continued Clark. For instance, insomnia in the real world could be correlated with obsessive level grinding in World of Warcraft. Play that meets the definition of 'internet addiction disorder' isn't necessarily pathological excess, as the IAD-type definition conflates healthy with therapeutic or harmless uses.

A preoccupation with a game like World of Warcraft isn't necessarily bad, said Clark. People have in-game friendships and real-world pressures, and taking away games might take away the good things that go with it. Researchers, he suggested, "need a more robust way of looking at the problem."

The Solutions

So what can developers do to combat the problem? Clark said they should be more pro-active, by providing functional tools that help people monitor their own play, send timed messages to remind players to 'go do real world stuff,' or employ voluntary lock-out systems.

In the long term, the industry needs a critical design discussion to talk about how immersion, culture, and interactions come together to cause this perceived addiction, Clark suggested. The Sims developers have been talking about immersion in their game for years, for instance, and the desire to make sure it's not harmful.

At the same time, Clark concluded, researchers need to connect with each other and work together to ensure they're up on the latest research, and "move outside the internet addiction criteria to get a handle on what's actually happening." The current criteria are attractive, with a simple checklist to figure out an addiction "percentage," but the real problem, said Clark, is much harder.