Why do adults seek treatment for gaming (disorder)? A qualitative study

Despite the inclusion of "gaming disorder" in the ICD-11, research on why adults seek treatment for gaming is limited. Existing literature primarily focuses on children and adolescents, leaving a significant gap in understanding adult treatment-seekers' motivations. This preregistered qualitative study addresses this gap by analyzing data from 110 adults who sought help for their videogame play through a Finnish treatment program called "Restart." The study aims to understand the diverse reasons behind adults seeking treatment for their gaming habits, investigating whether these reasons align with the criteria outlined in the ICD-11 diagnosis for gaming disorder. Understanding these motivations is crucial for developing effective treatment strategies and interventions tailored to the specific needs of adult gamers.

Previous research on gaming addiction has employed various methods, including cluster analysis, latent class analysis, and theory-driven approaches, to identify different player typologies. However, most studies lack treatment-seeking data, particularly from adults, and have not used official gaming disorder diagnoses (ICD-11). Existing qualitative studies often involve young men whose parents sought treatment on their behalf, neglecting the subjective perspectives and internal motivations of adult treatment-seekers. While some large-scale studies have included adult participants, they lack explicit exploration of treatment-seeking reasons. This study uniquely focuses on the perspectives of adults who actively sought treatment for their gaming problems, filling a critical gap in the existing literature. This study aims to provide a detailed qualitative analysis of the reasons adults seek help specifically for gaming-related issues in contrast to studies focusing on adolescent populations where parental influence may be stronger.

The data for this study came from adult participants (N=110) who sought treatment for gaming problems in Finland between 2020 and 2022 through the "Restart" program. Data was accessed with written permission, and ethical considerations were addressed according to Finnish Research Integrity guidelines. The participants completed an entrance survey with three open-ended questions about their reasons for seeking treatment, expectations, and support needs. Template analysis was used to analyze the open-ended data. The Internet Gaming Disorder Test (IGDT-10) scores were also collected from 89 participants for descriptive reporting, along with information on the types and duration of gaming problems and the games that caused difficulties. A pre-registered research question regarding the differences between those committing to treatment and those who do not was not pursued due to insufficient data. Two coders independently coded the data, with one using Finnish and the other English, to capture potential conceptual nuances. A three-tier template was developed through iterative coding and team negotiation. A secondary, para-exploratory analysis compared thematic distribution between those meeting and not meeting the IGDT-10 cutoff for internet gaming disorder.

Template analysis identified five main themes reflecting the reasons for seeking treatment: 1. **Social Reasons:** This theme comprised two subcategories: complying with social pressure (often from a spouse) and seeking improvement in social life (e.g., becoming a better partner or parent). 2. **Existential Reasons:** Participants in this theme sought to address a loss of meaning in both their gaming and their broader lives, including searching for new interests and self-reflection. 3. **Practical Reasons:** This encompassed problems related to performance (educational, occupational, or routine duties), health (anxiety, sleep problems, mental health comorbidities), and finances (excessive spending on gaming). 4. **Self-Perceived Addiction:** This theme included two subcategories: the desire to control or break the addictive process and acknowledging problems like excessive time use and relapse. 5. **Wish for Support:** This theme highlighted the need for guidance, practical tips, and peer support, with many participants feeling lost or perplexed and needing help they could not find independently. The average IGDT-10 score was 3.86 (SD = 2.55), with 37 (42%) of participants meeting the cutoff for internet gaming disorder. A wide variety of games were mentioned as sources of problems, including online role-playing games, esports games, single-player games, and mobile games. The para-exploratory analysis comparing thematic distribution among those who met and did not meet the IGDT-10 cutoff revealed minimal differences, except for a higher prevalence of practical reasons among those who did not meet the cutoff. This suggests that current diagnostic criteria may not adequately capture the full range of problems that lead adults to seek help.

The findings demonstrate that adults seek treatment for diverse gaming-related problems, extending beyond the criteria of gaming disorder in the ICD-11. Issues such as financial harms and the loss of meaning in gaming are not explicitly addressed in the current diagnosis. The low rate of participants meeting the IGDT-10 cutoff despite seeking treatment highlights a potential mismatch between existing diagnostic criteria and the experiences of many adult treatment-seekers. The variety of games mentioned underscores the need for a broad perspective, avoiding narrow focus on specific game types. The study's emphasis on the significant role of social factors, personal meaning, and practical problems in treatment-seeking underscores the need for holistic intervention strategies. The prevalence of the "wish for support" theme suggests that social and emotional support are essential aspects of effective treatment. The Finnish context, with its focus on open dialogue and holistic treatment approaches, may influence the motivations for treatment-seeking.

This study is the first to explicitly focus on the treatment-seeking experiences of adult gamers. The five themes identified highlight the diverse reasons behind their help-seeking behaviors, extending beyond a simple diagnosis of gaming disorder. Future research should explore the relationship between specific game types and treatment-seeking motivations, further investigate the limitations of current diagnostic criteria, and develop more inclusive and holistic treatment approaches that address the full spectrum of gaming-related problems experienced by adults. Further investigation is needed into the cultural context's influence on treatment-seeking behaviors.

The study's reliance on open-ended survey questions, rather than in-depth interviews, limits the richness of the data. The absence of clinical diagnoses prevents a definitive assessment of how many participants met criteria for gaming disorder or other mental disorders. The wording of the third open-ended question may have influenced the prevalence of the "wish for support" theme. The para-exploratory analysis comparing thematic distributions between those meeting and not meeting the IGDT-10 cutoff requires further confirmation in future studies.