More nightmare than fantasy?

I liked competing with my peers, and gaming online was exciting. Going up levels, I started making money as well. Gaming gave me something to do since I was looking for a job. Some days, I spent 14 hours! Yes, it messed up my sleep but I loved the high and how it empowered me,” says Mumbai-based PK Dey*, 23, who indulged in griefing (angering other players) and camping (hiding in a safe area for a kill) on multiple player platforms.

It was a while before he realised he was isolating himself, had few real friends, and was battling sleep, weight and anxiety issues. He has now sought counselling, but it is a long road ahead.

PUBG was 16-year-old L Rahul’s favourite game, which soon became an obsession. He often missed meals, and sleep, and had no physical activity. This urge to win, get points, and go to the next level had become uncontrollable; more so because of the monetary benefits. Soon, he was clocking nine to ten hours a day. His grades slipped, anxiety and irritability set in, and depression too.

Thankfully, his parents, who witnessed this debilitating change, sought help at an internet addiction clinic in Delhi and Rahul was diagnosed with Internet Gaming Disorder. It can be recalled that last year, a 15-year-old boy from Alwar in Rajasthan was taken to a care facility for playing PUBG, Battle Royale and Free Fire. It was also reported that he would scream, “Fire, fire,” in his sleep, such was his addiction.

Often what starts as a way to while away time soon becomes an addiction impossible to get rid of. Internet Gaming Disorder (IGD) has been recognised by WHO and ICD–11, the eleventh revision of the International Classification of Diseases. This is a public health crisis brewing silently in India as official statistics and data are hard to come by and no one thus really knows the extent of the problem.

Anecdotal evidence is strong; one comes across many youngsters addicted to these fantasy games. This umbrella term includes fantasy sports, which is high on the popularity index among online games (see box). Mental health professionals also confirm a steady increase in young adults visiting behavioural clinics for addiction-related issues.

A survey by the All India Gaming Federation in 2021 reported that about 85 per cent of urban teenagers engage in some form of online gaming. The fantasy gaming industry in India is projected to attain a revenue of Rs 25,240 crore by 2027, with the user base spiking to 50 crore, according to a 2023 report by Deloitte and the Federation of Indian Fantasy Sports (FIFS). 

Negative greater than positive

Mumbai-based Dr Samir H Dalwai, developmental behavioural paediatrician and other experts agree that there are some undeniable positive aspects of gaming when played in moderation — an improvement in problem-solving and teamwork skills, focus, self-esteem, virtual connections, and providing a sense of purpose. Yet, Dr Dalwai cannot stress its negative aspects enough.

“Excessive gaming can disrupt human relationships, cause anxiety, depression and social isolation,” he says, adding, “Gaming works on a reward mechanism, where dopamine is released in the brain’s reward centre while an individual is playing a game. The pursuit of this dopamine rush causes the individual to continue gaming for longer durations; each virtual win triggers an even larger release of dopamine, prompting the individual to seek out gaming even at the cost of other aspects of their lives.”

Gamers today are logged on, night and day, triggered by rewards which most fantasy games are designed to trigger. Behavioural scientists are thus seeing lives unravel. Bleary-eyed, triggered, sleep-deprived, addicted to wins, wagers, points, and nowadays, moolah, studies have also established a link between gaming and the likelihood of indulging in gambling. The lack of policy and governmental response to this growing crisis is glaring. 

Dr Manoj Sharma at SHUT (Services for the Healthy Use of Technology) Clinic at NIMHANS has treated 611 youths to date with varied technology-related addictions — online gaming, gambling, social media, pornography, etc. SHUT Nimhans was among the first to address this pervasive addiction.

“Post Covid, the increase (in IGD) has been phenomenal. Children find it intellectually stimulating since it’s easy to talk and speak on a platform rather than in real life,” he explains.

Dr Samir Dalwai says, “A recent Indian Psychiatric Society study indicated that roughly 20 per cent of gamers show signs of addiction. The prevalence is highest in adolescents and young adults, especially in Bengaluru and Hyderabad. Roughly 30 per cent of gamers spend more than 20 hours a week playing fantasy games. This adversely impacts interpersonal relationships and other aspects. Worryingly, about 40 per cent of compulsive gamers report feelings of distress and loneliness — this highlights how gaming addiction is very real and pervasive in young India.”

The lure of moolah

Dr Rachna Bhargava, professor of Clinical Psychology, AIIMS, Child Guidance Clinic and Behaviour Addiction Clinic (BAC) along with Dr Yatan Pal BAC, AIIMS have been visiting schools in Delhi and Chandigarh to spread awareness, and research IGD. They evaluated 1,000 students on mental health and behavioural issues. “Many youth looking for jobs often spend time on fantasy gaming,” she says. 

A behavioural expert is treating a 26-year-old middle-class, unemployed, male engineer from Delhi who was playing excessively, and has now turned to gambling. “He does not perceive the difference between gaming and gambling and has now started watching porn too. He believes it is not gambling — just casual bets for fun between friends,” he says, not wishing to be quoted.

Experts believe that therapy is key, with comorbidities treated with medicine. “We have witnessed children left with grandparents as parents work also end up gaming. The complete family dynamics needs to change,” avers Dr Bhargava.

With the high risk of gamers switching to gambling, intervention is crucial. A 23-year-old youth in Goa lost Rs 80 lakh in online gaming. Hugely in debt, he is devastated, and reeling with its repercussions. “They (games) make it lucrative, and attractive. It’s difficult to stop, and you keep hoping you’ll make more money,” he admits.

Public health priority

Even as the diagnostics of ADHD improve, experts feel that many ADHD children are prone to gaming. Dr Samir Dalwai has witnessed children as young as seven to eight years of age coming home from school, with both parents at work, turning to screens.

This exacerbates the addiction. “In many ways, social isolation is driving children towards screens. There is also a progression in how a child engages with screens — over time, a child develops a tolerance for watching the same programmes and wants something more stimulating. This drives them towards gaming. It is a vicious cycle.”

More worrying is the lack of proper studies pan India. “While there is no comprehensive study across India, guidelines are constantly developing. We found use of almost 10-11 hours in Bangalore adults,” says Dr Sharma.

“We need to treat this issue as a public health priority, create awareness, identify those with addiction and offer evidence-based treatments, and focus on prevention. A balance will help ensure that we prevent children and adolescents from the harms due to excessive and problematic gaming while the country aims to take a leadership role in the global gaming landscape,” adds Dr Balhara who has conducted a study on IGD, published in the Indian Journal of Psychological Medicine.

Tackling addiction

The ‘Three Ds’ can help improve the digital health of India — digital hygiene, fasting and literacy. While minimum use is most effective, digital literacy is key. “Every 30 to 40 minutes one should take a short break. Movement helps, blinking eyes, exercising them, physical activity, quality time with friends and family, digital detox (fasting), etc.,” advises Dr Sharma. 

While most countries are grappling with how to curb addiction, Australia, China and Korea have issued bans. In India, where a child does not even have space to play, bans are not the answer, experts opine. Dr Dalwai laments the lack of playgrounds for children, and helicopter parenting, without any real-time interactions. 

He explains that when a child has no time to forge relationships due to packed schedules, his interactions remain transactional and hollow. “This is not healthy. It makes the children lonelier and less resilient and this is when they turn to gaming and other addictions.” 

* Some names have been changed to protect identities.

What's a fantasy sport?

A fantasy sport is an online game where participants assemble imaginary or virtual teams of real players of a professional sport. This could be cricket (which is unsurprisingly most popular in India), football, baseball, etc. These teams compete based on the actual performance of the real players in actual games.

As in real sports, team owners can trade, drop or get in new players. Some countries have questioned the legality of such games with critics saying they too closely resemble sports betting. The fantasy gaming industry in India is expected to reach a market size of around 20 billion USD by 2025, with fantasy cricket contributing to around 85% of the revenue.

Protection from online wagering

The new amendments set by the Ministry of Electronics and Information Technology (MeitY) to the existing Information Technology (Intermediary Guidelines and Digital Media Ethics Code) Rules, 2021 recommends “addressing the twin challenges of catalysing and expanding online gaming innovation while protecting citizens from illegal betting and wagering online”. The thrust is on limiting the availability of games that put users at a higher risk of experiencing financial and/or psychological harm. 

A 2023 study published in the Indian Journal of Psychological Medicine recommends displaying warning labels on online games. It also suggests that policymakers and researchers must better understand parental involvement and control in reducing problem gaming and school-based prevention strategies. Some countries have initiated measures to limit accessibility. 

The South Korean government has introduced the ‘shutdown’ policy — for children aged 15 years or below. The Chinese government has introduced the “fatigue system” in which minor players (less than 18 years old) are discouraged from playing online games after crossing a certain time limit, by progressively cutting down in-game rewards.

Are you addicted?

Ask yourself the following five questions to gauge the severity of your addiction:

1. Craving: Do you feel a continuous desire or preoccupation to game or play?

2. Control: Do you scroll for hours on end without self-control, missing meals, sleep, etc?

3. Coping: Do you use technology to feel good, relax, overcome boredom, or manage your mood?

4. Compulsion: Has it become a habit that controls other basic activities — sleep, exercise, work, study?

5. Consequences: Do you suffer from digital strain, fatigue, social isolation, marital or family problems, employment and academic issues?

If four of these five is a 'yes' then consider visiting a mental health professional.

(Inputs from Dr Manoj Sharma. SHUT Clinic's helpline number is 9480829675.)