By Marc Cieslak
BBC Technology correspondent
For Stephen and Louise, life with their 16-year-old son Alex can be tough.
Alex's compulsive desire to play first-person shooters like Counter-Strike late into the night, has caused years of anguish for the family. He has also recently been diagnosed with autism.
He has been a patient at the NHS's specialist clinic for treatment of addiction to video games, since earlier this year.
The National Centre for Gaming Disorders is the only treatment facility of its kind in the UK.
His parents referred him to the clinic themselves, but he hasn't engaged with the treatment. Louise feels that although the treatment might not be working for her son, there has been an unexpected benefit for the rest of the family: "What is most helpful for us is talking to other parents whose children have the same gaming needs. Our support group meets once a fortnight on Zoom."
Her husband Stephen adds: "More than anything else, I think the greatest thing is to realise that you're not alone. There are loads of other people up and down the country, and all across the world, that are going through the same situation.
"For us as a couple, as a family, it's been challenging in as much as it's quite difficult to have interaction outside the house. And for the duration of people visiting, he's just upstairs gaming all the time, shouting and cursing. For us sleeping has been a huge issue, so often we will sleep in separate rooms. I'll have to have a fan on to drown out his game."
BBC News has gained exclusive access to the clinic, which opened its doors nearly two years ago.
The (mostly teenage) patients' compulsion to play is so extreme that it often leads to violent outbursts and confrontations with parents or carers. If access to games consoles or computers is denied, many of the people treated at the clinic have threatened suicide. Their social interactions are almost always restricted to online or gaming activities.
Gaming Disorder is a controversial condition defined by the World Health Organization by three characteristics:
Some psychologists, along with the games industry itself, question the evidence used to define the disorder. Until quite recently in the UK, help with problematic gaming could only be sought through private healthcare.
But this clinic – based in west London – is part of the the National Centre for Behavioural Addictions. It is well established in treating problems with gambling, but gaming is new territory for the staff, according to consultant clinical psychologist Dr Rebecca Lockwood.
"We know that gaming disorder is quite a rare condition. The symptoms can be really quite severe, which has surprised us," she says.
"Often people are really struggling in managing their emotions. They can struggle with anger, anxiety and low mood. They also experience physical symptoms in terms of loss of sleep. That's because people will be playing at night to connect with gamers abroad."
Becky Harris is the manager and a family therapist at the clinic. She says they've treated more than 300 people – with 200 of those referrals occurring in 2021. She says 89% of the people treated in the gaming disorder centre are male, but there's a surprising range of ages.
"We start treatment at 13. We've had a few 12-year-olds who've been referred, we've also heard from parents of people as young as eight, but we haven't been able to see them. The age of people being referred goes right up to the 60s."
It's the only NHS clinic in the UK treating this condition, and its patients are spread out across England and Wales – often treated via video chat. Dr Lockwood thinks there are some advantages to video therapy sessions: "It enables us to engage with people who might be quite reluctant to come to the clinic, because their motivation for engagement and treatment can be quite low."
For millions of people, video games are a mainstream pastime, a source of entertainment and connection. So, when does the amount of time spent playing cross the line into problematic behaviour?
Evidence gathered by Ofcom suggests that 62% of adults in the UK played video games during the pandemic. And a recent study by Oxford University's Internet Institute concluded that playing video games is actually good for gamers' wellbeing. Prof Andrew Przybylski, the institute's director of research, believes games themselves might not be the problem.
"As far as I can tell, there's no quantitative scientific evidence that there's anything special about games that causes any form of psychological harm. There's a wide range of activities or behaviours that you can do to excess, whether it's eating or exercising, that actually have arguably much stronger evidence bases.
"If you have somebody who is suffering and gaming is part of that, I have to say that, like any passion, it's part of what a client is presenting as their life and their perspective and their experience. And so, I think probably the best way to think about games right now… is to think about them like any other hobby, and use that as a way for the therapist to engage a client."
At the National Centre for Gaming Disorders, Becky Harris is quick to point out the clinic is not anti-video games: "We completely accept that for a lot of people, gaming is a really positive thing in their life. We are really talking about that small percentage of people who are having a massive problem with it, and it's genuinely affecting their quality of life and their ability to interact, and their ability to function."
Another former patient of the clinic – Mike – realised he had an addiction with video games in his mid-20s. He played World of Warcraft up to 14 hours a day. It badly affected his relationship with his family, and interfered with his studies. He completed an eight-week course of therapy which gave him a new perspective on games and his life.
"I stopped playing video games as much. So, my relationship with my wife has been better. My relationship with my parents has improved. I've made steps towards fixing all the problems, but it was just this last push that I needed that got me on the right path."
Mike hasn't stopped playing games completely, but he says they now play a smaller part in his life: "It's not like I consider video games to be bad. It's just I do it in moderation."
It is stories like Mike's that give Stephen and Louise hope that one day their own son will resolve some of his issues.
Louise says: "I feel optimistic because on Facebook, I follow a lot of people who are very like our son, but they're adults now. And I follow them because they're hugely insightful. But also, it really helps me feel he will find his way."
Names of former and current patients have been changed.
If you have been affected by the issues raised in this story please visit the BBC Action Line.
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By Marc Cieslak