Treatment of Gaming Addiction
Cognitive Behavioral Therapy (CBT) should be the initial treatment approach for gaming addiction, with naltrexone as the pharmacological agent with strongest evidence when medication is needed—but always as an adjunct to behavioral treatment, never as monotherapy. 1, 2
Primary Treatment Approach
Psychological Interventions (First-Line)
CBT has the strongest evidence base and should be initiated first, targeting gaming-specific cognitive distortions through individual, group, or imaginal desensitization formats. 1, 2
Motivational Interviewing (MI) combined with CBT is particularly effective for patients who are ambivalent about change, which is common in gaming addiction where insight may be limited. 1, 2
The treatment approach mirrors that used for gambling disorder, as gaming disorder shares neurobiological features with behavioral addictions, including activation of similar brain reward pathways. 3, 4
Pharmacological Treatment (Adjunctive Only)
When to Consider Medication
Naltrexone is the medication with the strongest evidence for reducing impulses and addictive behaviors, acting on dopaminergic reward pathways in the nucleus accumbens. 1
Critical principle: Pharmacotherapy must always be administered as an adjunct to behavioral treatment, never as monotherapy, as CBT improves responses that plateau with medication alone. 1, 2
The mechanism involves blocking opioid receptors and reducing dopamine release associated with addictive behavior patterns. 1
Essential Clinical Considerations
Comorbidity Assessment and Management
Systematically screen for and address comorbidities, as gaming disorder frequently co-occurs with ADHD (attention problems), impulse control disorders, obsessive-compulsive symptoms, depression, anxiety, and substance use disorders. 1, 2, 5
A systematic review found 75% of treatment-seeking patients with behavioral addictions have one or more comorbidities, making comprehensive psychiatric evaluation essential. 6
Gaming addiction is often accompanied by psychological disorders requiring long-term medical treatment that addresses the individual's psychological background. 7
Treatment Sequencing Algorithm
Initial assessment: Screen for gaming disorder criteria (excessive hours, preoccupation, loss of control, functional impairment) and comorbid conditions. 5, 3
First-line intervention: Initiate CBT with motivational interviewing, focusing on cognitive distortions about gaming and developing alternative coping strategies. 1, 2
Consider pharmacotherapy: Add naltrexone only if behavioral treatment alone shows inadequate response or when severe impulse control problems are present. 1
Address consequences: Target achievement failure, social isolation, family conflicts, and unemployment that commonly accompany gaming disorder. 5
Common Pitfalls to Avoid
Do not prescribe medication without concurrent behavioral therapy, as this violates evidence-based treatment principles and reduces overall efficacy. 1
Do not overlook family involvement, as relatives (particularly mothers) often initiate treatment and family conflicts are present in one-third of cases. 5
Do not miss comorbid conditions, particularly ADHD and depression, which require concurrent treatment for optimal outcomes. 1, 4
Gaming disorder patients are predominantly male (96%) with average age of 22 years, but the condition can affect a broader age range (13-47 years). 5
Prevention and Long-Term Management
Prevention requires action at three levels: government regulation, game developer responsibility, and household-level interventions. 7
Long-term treatment is necessary, including approaches to the individual's psychological background and ongoing cognitive-behavioral therapy. 7
Gaming disorder leads to loss of time and money, negative impacts on family and social life, evolving into a significant social problem requiring sustained intervention. 7