Neuroscientist and Recovering Video Gamer
I was first introduced to Dr. Andrew Doan while writing this book and became quite fascinated by him, as I believe that he has a unique perspective to add to our understanding of tech addiction. That’s because Dr. Doan is not just a Johns Hopkins–educated M.D. who also happens to have a Ph.D. in neuroscience and has extensively researched and studied tech addiction; he’s also a recovering video game addict. To the best of my knowledge, he’s the only neuroscientist/recovering video game addict.
But his bona fides are even more impressive: as previously mentioned, he’s a commander in the U.S. Navy and the head of addiction research for the navy and the Department of Defense.
I was amazed that this kind, compassionate, physically fit and respected physician had once been a very unhealthy, overweight and rage-filled video game addict. Interestingly, beyond coming to understand that his video game addiction was ruining his own life, he became aware of some of the darker aspects of tech addiction when he started realizing that many military vets who were involved in violent episodes—homicides and suicides—were also violent video gamers, and that more often than not, they were sleep-deprived gamers.
I think his story of video game addiction can help us better understand how even an intelligent medical student can get seduced by screen addiction. The following interview has been culled and edited from our talks together as well as from an interview that he gave to Vee Williams on September 17, 2014; it is both very personal and quite illuminating.
Q. Tell me a little about your gaming addiction. And what eventually was your bottom?
When I was in medical school, about 16 years ago, I was really heavily addicted to video games. For over ten years and all through medical school, I played 50 to 100 hours a week. . . . I was utilizing the games as a form of digital drug to reduce anxiety, to deal with stress, and to allow me to feel the adrenalin rush of online head-to-head competition.
I had played all the time and had just assumed it was a hobby. But the first time I thought that there was a problem . . . I wouldn’t sleep very much. So my schedule would be, I go to school—I had a full-ride scholarship at Hopkins—I used to joke around, look at all these losers—they have to pay money to go to med school and I got a full ride. So in a way, I was cocky and arrogant.
So I’d go to school, come home around five, get dinner ready for the kids (we had two young children) and then maybe attend to my wife for a little bit; spend some time with her. She was a nurse at the time working a hard schedule. She’d go to bed early, like 8:30. And I was like “sweet!” I’d sneak out of bed—I’d already played a couple of hours before dinner, then I’d play from 8:30 till 4:30 in the morning. It was customary for me to hear the birds sing in the morning . . . sleep a couple of hours and repeat the cycle again. So I’d be gaming eight hours a day and at school eight hours a day. I had two full-time jobs, basically.
So I was a functional addict, but the problem was that I was always sleep-deprived, so I was raging. I became real rageful and abusive to my wife. And so she left. She left with the kids and filed a restraining order. So I thought that the problem was just my rage, that it was my temper. So I promised her I’d work on it—you know, come back and let’s go to church together, I promised to change, get marriage counseling—all of that stuff.
But of course, in denial of the video game addiction because there’s no diagnosis, right? I’m a medical student at the time and I never heard of this addiction. So it’s not an addiction—it’s a hobby. I tried to moderate, but then the addiction starts building up again. So then I would only play four hours a day, but then four became six then eight then ten then 12. And before you know it, I was full-blown playing all the time like I used to.
Finally what kicked in, it was 2003 and I had been playing addictively for almost 11 years, when I finally developed carpal tunnel from clicking the mouse in the real-time strategy games. Because I played Starcraft—real-time strategy was my drug of choice. I loved playing StarCraft, Warcraft, Warcraft 2, Warcraft 3 . . . and I’d be clicking the mouse 80 hours a week.
I had pain from my clicking finger all the way up to my forearm. And my cortisol levels were shot—through my hypothalamus-adrenal-pituitary (HPA) axis, so I was getting fat because I had all of this cortisol floating around. I didn’t exercise, so I was retaining more body fat. And then finally my HPA axis was all disregulated so I was more prone to infection—I had pimples all over my face, I had stretch marks beginning. And then, finally, I got an infection in my armpit!
So in addition to the carpel tunnel, I had this armpit infection that was streaking down my arm. And on top of that, because my blood pressure was going up because of the gaming adrenaline rush—my blood pressure was high, my cholesterol was high. And because my blood pressure was high and I was sitting all the time, I had hemorrhoids the size of walnuts—I mean, literally! I was a young man—I was pissed off. Why do I have hemorrhoids like some pregnant women do? We’re talking bloody, painful hemorrhoids.
So I had this triad—you know, I had carpel tunnel, this armpit infection and these hemorrhoids. I was in surgery at the VA and I go, man, I’m killing my career; I can barely operate or work as a physician without taking these maximum pain killers.
So finally, I was like, man, maybe I can’t play video games. But still calling it a “hobby”—that’s causing me hemorrhoids, carpel tunnel and an armpit infection! So finally in 2004 I stopped playing completely.
But I did have a relapse in 2007. One of my residents dropped a CD-ROM of World of Warcraft [WoW] on my desk. Now I knew I was more prone to real-time strategies, but I’m also a fanatic for RPGs [role playing games]. So I’m like, man, maybe I can play and moderate now because I’m a staff doctor now, I make plenty of money and there’s less stress in my life so I don’t have to use it to escape.
Uh-uh. I was wrong. I played a year of that . . . and all of my old habits came back. My son, who was in his early teenage years—and I looked over at him one day and he was bawling his head off because I was yelling at him for not being able to keep up with me. Yelling at him! Here’s my son who all he wants to do is spend time with me, but because of my rageful, addict nature when I was playing these games, that bad side came back again.
So what I started noticing [was that] my marriage started going back to the way it was before; my relationship with my kids was hurting; I was being rageful, I kicked the dog . . . I was not sleeping a lot so I’m more grouchy because [with] this kind of addiction, you have to trade something, and most gamers who are addicted trade sleep. That’s the number-one thing they trade. So they stay up until two or three in the morning. I did too.
So I started falling asleep at the wheel. There are days when I drove—I had like a 60-minute commute one way—there were days when I dozed off in the car and woke up five minutes later, not knowing where I am. I should be dead, you know?
That’s when I finally saw that I had this addiction and I started using the word addiction. And then you know what it was? I saw my son—I saw my son getting addicted at around 12 or 13 where he was sneaking out in the middle of the night playing Call of Duty. And then you know when you see a quality of someone else that you know is a quality that you have? It really irritates you, right? I saw that and it really irritated me. And I’m like, I’m really getting irritated at my own son for doing the same thing I do!
So we finally took him away from gaming and he just blossomed! He went from this kid who was insecure who—I used to not pour into him, so he used to run into the bathroom at school and cry. When we took the gaming away, he found his love in track and field . . . he’s getting recruited by 15 Division I schools now, his confidence is up, everything is going better for him. So I saw how gaming damaged him as well.
So I’m convinced that if people are addicted to this thing, it’s going to ruin your lives. It almost ruined mine—and it almost ruined my son and almost destroyed his confidence and his opportunities.
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As mentioned, Dr. Doan has come up with the term “digital pharmakeia” to describe digital screen drugs and their effects on the brain. He believes that such screen drugs are dopamine-elevating stimulants that hyperarouse our HPA axis. He also believes that some are more potent than others. TV can be considered the mildest on the stimulation continuum, then perhaps a game like Tetris, culminating with high-arousal games like Call of Duty or World of Warcraft.
From both his own experience and his work in the military, he also came to understand the important role that sleep deprivation plays in gaming addiction. “With alcohol, people usually pass out and sleep with severe intoxication. In contrast, video games require being awake in order for the addict to engage in the behavior. As a result of sleep deprivation, there will be HPA dysregulation.”
HPA dysregulation is associated with depression, anxiety, psychotic breakdowns and mental disorders. Dr. Doan described one sleep-deprived video gaming marine whom he worked with who was homicidal and wanted to cut people’s heads off. According to Dr. Doan, the solution was removing video games and removing sleep medications that were not working because of excessive gaming and stimulation from gaming. “With sleep and rest, the homicidal ideation dissipated.”1
Would that marine have gotten violent if he hadn’t unplugged and taken a nap? We can’t know for sure; human behavior is hard to predict. But Doan believes that many of the suicides and homicides committed by PTSD (Post Traumatic Stress Disorder, a mental disorder that used to be commonly referred to as “shell shock”) vets are also influenced by violent video games and sleep deprivation. “Many of these soldiers—they’re young kids who are already gamers when they come into the military. Then when they’re on base, they can’t drink or do drugs because they get tested for that, so they play video games for hours on end as an escape. Add in some combat trauma and sleep deprivation and you have a recipe for disaster.”
The attack by the infamous Washington Navy Yard shooter Aaron Alexis, who shot and killed 12 people in 2013,2 was the incident that first got Dr. Doan to look more closely at veteran violence and video games. Alexis seemed to have some psychotic symptoms (hearing voices, he believed he was being influenced by electromagnetic waves)—but he was also a sleep-deprived gamer. He would play the ultraviolent Call of Duty for up to 16 hours a day, and in the weeks before the shooting, he went to the VA emergency room seeking medication for his insomnia. Did the sleep deprivation and gaming cause the psychotic symptoms that pushed him over the edge? We will never know. But we do know that Dr. Doan’s other homicidal marine patient became “normal” after he stopped gaming and got some sleep.
Neurologically, Dr. Doan uses a five finger/hand analogy to demonstrate the effect that gaming has on the brain. “Observe your left hand. The thumb will represent the cortical areas associated with all the benefits of video gaming and use of technology: quick analytical skills, improved hand-eye coordination, and perhaps improved reflexes. The index finger will represent the cortical areas associated with communication skills. The middle finger will represent behaviors associated with social bonding with family and friends. The ring finger will represent the capacity to recognize emotions of both self and others (empathy). Lastly, the little finger will represent the cortical areas associated with self-control.”
In essence, with excessive gaming, just one part of the brain is being developed—or overdeveloped: the thumb, representing the region associated with quick reflexes and pattern recognition. But this creates a potential imbalance as that gamer grows up: “As the brain matures, the possible end product is a young adult who is all thumbs in their thinking: possessing quick analytical skills and quick reflexes, but not as developed in communication skills, having few bonds with people, exhibiting little empathy, and showing minimal self-control.”
Finally, Dr. Doan also brings up a subject that most people may not consider when they think of gaming: that it may be a national security threat as terrorists are turning to social media, Internet discussion forums, and online gaming to seduce new recruits. According to Doan, gamers are easy pickings: “Internet addicts are isolated, lonely, and low-hanging fruit for recruitment.”
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Dr. Doan’s compelling personal narrative, describing his descent deeper and deeper into gaming addiction—and how his health and family life suffered as a result of it—reads like the story of any other drug addict. Even the manner in which he rationalized his way into a relapse after a period of abstinence, thinking that he might be able to moderate his usage, is familiar territory in drug addiction.
Despite stories like Dr. Doan’s and the growing body of research that shows the drug-like effect of digital media on the brain, there are still screen-addiction “deniers,” both laypeople and some mental health experts, who haven’t quite tuned in to the potential depth and severity of the growing problem. Yes, video games can most definitely be a hobby for some, but they are quite clearly an addiction for others.
We should also keep in mind that screen addiction and other problematic clinical disorders are not just limited to video game effects. In our hyperconnected world, we have a couple of other suspects as well: social media and texting.
But how can that be, you might ask. As social animals, what can possibly go wrong with a little technology-assisted connection?
Note
* Opinions and points of view expressed are those of Dr. Doan and do not necessarily reflect the official position or policies of the U.S. Navy or the Department of Defense.