How to Raise a Healthy Gamer

End Power Struggles, Break Bad Screen Habits, and Transform Your Relationship with Your Kids

About the Book

A former gamer and Harvard-trained psychiatrist offers a proven, tested plan to help parents define, set, and reinforce healthy boundaries around video games and help kids who have developed an addiction to gaming.

“I highly recommend this calm, structured, and nurturing approach to better and less screen use.”—Tina Payne Bryson, PhD, New York Times bestselling coauthor of The Whole-Brain Child and No-Drama Discipline

How much should I let them play? How do I get them to be interested in anything else?!
When it comes to family rules around video games, most parents are at a loss. After all, our technologically invasive world is something previous generations didn’t have to wrestle with, so we have no model for how to guide our families through the rapidly changing landscape, no blueprint for setting healthy gaming boundaries and keeping them in place.
A former Harvard Medical School instructor and one of the foremost experts on video game psychology, Dr. Alok Kanojia—known as “Dr. K” to his millions of followers—has firsthand knowledge of this modern issue: He needed professional help to break his own gaming habits in college, an experience that fueled his interest in learning how to help others. Drawing on Dr. K’s professional specialization in working with people of all ages and varying degrees of addiction, and the most recent research from neuroscience and psychology, How to Raise a Healthy Gamer teaches parents a new skill set for negotiating gaming culture and offers solutions rooted in the science of treating addiction, including:
• An eight-week, step-by-step road map for setting, enforcing, and troubleshooting healthy gaming boundaries.
• Advice on how to react when your child becomes irritable, rude, or seemingly directionless.
• Essential communication strategies for reaching kids who have developed a serious gaming problem.
• The neuroscientific and psychological reasons that children gravitate to video games and how to help them meet these needs in real life.
• Insights and advice on dealing with behavioral issues that often accompany game use: ADHD, spectrum disorders, and substance abuse.
Whether your goal is to prepare your child for a healthy relationship to technology or to curb unhealthy amounts of time spent gaming, How to Raise a Healthy Gamer will help you better understand, communicate with, and—ultimately—empower your gaming enthusiast to live their best life.
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Praise for How to Raise a Healthy Gamer

“Of all the questions parents ask me as a child psychiatrist, the most common one—by far—is how to handle their children’s use of screens. This groundbreaking instant classic of a book answers that question definitively. Clear, persuasive, and rooted in the most current research as well as the wisdom of the ages, How to Raise a Healthy Gamer is the book you’ve been looking for—not only for your child but for yourself as well!”—Edward Hallowell, MD, author of Driven to Distraction and ADHD 2.0

“In homes everywhere, negotiations around gaming are tiresome and heated. Dr. Kanojia’s approach allows your child to be part of the solution—a valuable component to both reducing the combativeness that often accompanies these negotiations and to staying in close relationship with them. I highly recommend this calm, structured, and nurturing approach to better and less screen use.”—Tina Payne Bryson, PhD, New York Times bestselling coauthor of The Whole-Brain Child and No-Drama Discipline

“Among the most important decisions we make about our parenting, screen use and—in particular—gaming will define our family. This groundbreaking book will give you what you need to come to an informed and sensible resolution that works for you. It’s a book that will give you the strength to live within your values and that will support your hope for a family that is deeply connected.”—Kim John Payne, author of Simplicity Parenting and The Soul of Discipline
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How to Raise a Healthy Gamer

Chapter 1

What Makes Video Games So Addictive?

The Neurochemistry of Gaming Explained

When I am working with parents—parents like you, who have grown increasingly concerned with the direction their kids are headed—the first question most of them ask me is this: Is my kid addicted to video games? I mean, they know their child has a problem. Most of them have noticed some changes in their kids’ behavior, ones that worry them. Maybe their grades are slipping. They’re more isolated than they used to be. They’re a little bit more moody. But, Dr. K, is this actually an addiction? they ask.

There’s a lot of debate on the topic. In 2018, the World Health Organization (WHO) identified something called “internet gaming disorder.” But there’s another group of people who don’t think that gaming is an addiction in the same way as alcohol or opiates can be. And these two camps argue endlessly about which one of them is right. But, frankly, to me? It really doesn’t matter whether a group of psychiatrists agree on the terms of an addiction diagnosis. The so-called experts can battle that one out on the internet or in dueling research papers. This is about you and your kid.

If their gaming is causing a problem within your household, if it’s causing a problem for their future, then chances are it’s a problem, right? Whether we label it an addiction or not isn’t actually the point. The real point is that they need to move forward, to a better, healthier relationship with technology, whether they cross the threshold of “addiction” or not.

And, of course, sometimes it’s not just children and teenagers we’re worrying about. Some people who walk through our virtual door at Healthy Gamer are concerned about their adult child, perhaps the twenty-three-year-old who’s living in their basement. Is that person not moving in the direction that they need to be moving in? Are they having problems at school or problems at work? Are they even going to school or work? Are they getting moody, or throwing temper tantrums, or just being generally disrespectful?

From an academic standpoint, the common factor for all mental illness—addictions included—is that it interferes with your life. No matter the substance, addiction means “an impairment of function.” And many of the kids and young adults I’ve met in the past several years certainly have an impairment of function.

Bottom line: If you think it’s a problem, it is a problem. You don’t need an expert to tell you that. You are their parent. That makes you the expert.

Neuroscience Helps Explain Why Your Child Is Changing

In order to help your child, it’s really important for you to understand a few things about why they are playing video games. I want to help you appreciate the vital underlying needs that are being met when they play video games. These needs are firmly embedded in the teenage brain, as old as time, and, for what it’s worth, totally normal. To start, it’s important to understand the circuits in the brain that play a part in why your child loves gaming so much.

Reward Circuitry

When you read about or hear talk of addictions, the first term you’re likely to hear tossed around is dopamine. Dopamine is what scientists call a “neurotransmitter,” which is a chemical signal one neuron uses to talk to another—basically, ways for our brain to communicate.

Dopamine happens to be one of the major neurotransmitters—but its effect depends on which neurons are involved. In the substantia nigra, a very small structure in our mid-brain, dopamine is used to help us move our muscles in a smooth and coordinated fashion. In Parkinson’s disease, for example, the dopamine-production neurons in the substantia nigra get destroyed, which is why people with Parkinson’s have difficulty with movement. This is why we give Parkinson’s patients dopamine as medicine.

But dopamine is mostly known for its involvement in reward and behavioral reinforcement because it is the primary neurotransmitter of our reward circuitry, a cluster of nerves located in the Nucleus Accumbens (NAcc) of the brain. Achievement, success, triumph, pleasure—these are all mediated by dopamine being released in the NAcc.

Dopamine is also involved in shaping behavior, because whenever we get that dopamine release in the NAcc, we “feel good”—and when we “feel good,” we repeat the behaviors.

A good example of this: Historically, calorie-dense foods have led to survival. When something increases our chances of survival, we have evolved to enjoy it. As a result, what we think of as “pleasure” is just our brain pointing us in a direction and saying, “Do more of this, because this is good for us.” Since this thing is good for us, we are going to crave it again. Then when we eat that thing again, we get a second release of dopamine, which makes us feel pleasure and reinforces the behavior. If eating a calorie-rich food leads to pleasure, or enjoyment, we tend to look for it again—this is anticipation. Dopamine governs all three of these responses—pleasure, reinforcement, and anticipation—all of which evolved to help us survive.

The problem is, in today’s world, one signal that governs all three things can get hijacked by video games. Game designers have figured out how to control our dopamine switch, offering us all that pleasure, reinforcement, and anticipation, but without contributing a survival benefit.

Dopamine isn’t the enemy here, not at all. Even in our modern world, dopamine can help us learn and grow. A helpful analogy is the process of learning to play a piece of music. The first time you sit down to try to play it, you may struggle a little. You make a mistake, you make another mistake, but, eventually, if you keep at it, you’ll learn how to play the piece properly. The satisfaction that you get when you succeed after failure is also mediated by dopamine. The harder something is, the more we feel challenged, the more dopamine gets released when we succeed. When something is challenging, and we fail at it a few times before we succeed, that success feels especially good, and that kind of success-seeking behavior gets reinforced.

Game designers have gotten especially good at figuring out how to maximize that dopamine release in the brain. They know that if the game is too easy, people get bored and leave. If the game is too challenging, they’ll quit, because the dopamine release isn’t worth the effort. So, game designers titrate the difficulty to optimize dopamine release—thus reinforcing the behavior, and maximally increasing anticipation.

Recent research shows this—that the reason video games are addictive is not necessarily just because they provide a reward, but because they actually deny you the reward for an extended period of time. Like learning that piece of music—we actually want to play and fail over and over, because when we finally succeed, it feels really good.

The tricky thing, though, is that our brain has a natural tendency to achieve homeostasis, or balance; for this reason, our brain can start to develop tolerance for particular things. The first cookie you eat is very tasty; the second one is pretty good, too. But after you’ve polished off three or four more cookies, you probably can barely even taste them, let alone enjoy them.

That’s exactly what we see with video games—eventually, with hours of play, the dopamine circuits can develop physiological tolerance. Tolerance is the principle of our brain balancing things to keep them within a “normal” or healthy range. If anything rises above that range, we’ll modulate the high external signal by adjusting the volume and turning down the signal. Think of it like a music player and a set of headphones: If the volume is too high to listen to comfortably, we can turn down the volume to keep the experience enjoyable.

What happens with video games is that our dopamine signals get jacked up, then our dopamine receptors downregulate—literally turning down the “volume” on the dopamine signal. We essentially are removing receptors from our neurons, so that even a ton of dopamine release leads to a “regular” amount of enjoyment.

Now the problem is that if we stop playing video games and read a book, we’ll get a “normal” amount of dopamine signal, but with our downregulated receptors, the total “volume” is too low—thus making reading feel not at all fun. Our brain is physically less capable of enjoying reading when we game too much.

You may have observed this in your child even when it comes to gaming itself. For the first hour or so that they’re playing video games, they’re having fun. But by the time they’ve been playing for four hours, they’re not having fun anymore—they’re just zombies who’ve stopped smiling and laughing and talking. Furthermore, anytime you try to get them to do anything besides the video game, they just feel bored all the time, and they resist it with all their strength, right? That’s because of the dopamine tolerance—if they’ve been playing endless hours of video games, it is going to take some time for them to get acclimated to enjoying other activities.

About the Author

Alok Kanojia, MD, MPH
Alok Kanojia, MD, MPH, also known as “Dr. K,” is a graduate of Tufts University School of Medicine and did his psychiatric residency at Massachusetts General Hospital in Boston and McLean Hospital in Cambridge, Massachusetts. A former Harvard Medical School instructor specializing in mental health for the gaming community, he is the president and cofounder of Healthy Gamer, a mental health platform that provides content, coaching, and community resources to help young people take control of their mental health and their lives. A highly sought-after speaker and media expert, he and his wife live in Texas with their two gamer daughters. More by Alok Kanojia, MD, MPH
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