COMMENTARY Commentary on Baggio et al. (2016): Internet/gaming
addiction is more than heavy use over time
Heavy use over time is a necessary condition of addictive
disorders; however, in itself it is not a sufficient measure to
assess addiction, neither in the case of internet use in general
nor internet gaming disorder in particular.
In a recent study, Baggio et al. [1] pointed out that selfreport instruments suffer from a great many shortcomings,
and may therefore be unreliable in the assessment of addictive disorders. As an alternative form of assessment, they
examined whether heavy use of internet/gaming over time
(as a more objective measure) was an appropriate way to
estimate addiction. Results suggested that heavy use over
time was less suitable for the assessment of addictive-like
behaviours than traditional addiction scales, as it had
weaker associations with comorbid factors and only a moderate correlation with the addiction scales, meaning only a
slight overlap between the two concepts.
We fully agree with the importance of the problem
raised in the study. Unfortunately, self-report screening tests
are far less reliable than usually considered. In addition to
the issues listed by Baggio et al., a recent study pointed
out that in the case of low-prevalence disorders (e.g. addictions), screening instruments with average or even high
sensitivity and specificity have surprisingly low positive predictive values, meaning that a very large number of those
who screen positive do not, in fact, have the disorder [2],
leading to possible overpathologizing of the behaviours
measured [3]. Therefore, finding more accurate assessment
methods for large-scale surveys would be beneficial.
Examining the link between heavy use and addiction,
the first scientific papers concerning internet addiction
and the addictive use of video games described young males
who used the internet/games excessively, to a degree where
their performance and social relationships suffered [4,5].
Accordingly, heavy use appeared to be responsible for all
their problems. Shortly afterwards, however, internet use
and gaming had become mainstream activities, indispensable for work, study and entertainment, and prolonged
time spent on these activities became universal. Consequently, there are key differences between the concept of
heavy use in the case of substance use and the case of internet use. While the majority of addictive substances, when
used in excess, have both acute and chronic harmful effects
to some degree, internet and games used at a moderate
level are harmless; furthermore, they are now essential
parts of our lives. A person using the internet for work purposes, personal communication and entertainment may
appear to use it heavily, but in reality all these activities © 2016 Society for the Study of Addiction are an integral part of their life and usually do not decrease
(or even increase) general wellbeing.
None the less, gaming may be a more suitable behaviour to investigate this question, because it is (i)
much more specific, and more importantly (ii) pursued
solely for entertainment. Thus, if practised in excess, it
is more probable that gaming interferes with everyday
duties and routines.
The gaming literature has made several interesting
contributions to this question, although these were not
mentioned in the paper by Baggio et al. [1]. As early as
2002, for instance, Charlton [6] found that some of the addiction criteria (i.e. tolerance, euphoria and cognitive
salience) proposed by Brown [7,8] were somewhat indicative of high engagement rather than addiction. In a subsequent analysis, Charlton & Danforth [9,10] distinguished
addicted gamers clearly from highly engaged gamers. Both
groups played for a substantial amount of time (even
though the addiction group played significantly more);
however, only addiction was associated with negativity
on personality characteristics. Similarly, Brunborg et al.
[11] found that only gaming addicts had a greater risk of
health complaints; highly engaged gamers did not, despite the fact that both groups played equally frequently.
Skoric et al. [12] found that neither time spent playing
games nor video game engagement were associated
with low scholastic performance, only addiction tendencies. Moreover, a case study published by Griffiths [13]
focused entirely upon the importance of context in
distinguishing excessive gaming from addictive gaming.
He presented the cases of two gamers who both played
for up to 14 hours per day. However, based on the differences in their motives and the consequences of their activity, he argued that one of them appeared to be
addicted while the other was merely engaged. These
findings were supported further by the small-tomoderate correlations between gaming time and addiction reported in several studies [14–17].
Overall, there is increasing evidence that the amount of
time spent on gaming is not a sufficient indicator of addictive behaviour. Addiction can only be assessed properly if
motives, consequences and contextual characteristics of
the behaviour are also part of the assessment. Declaration of interests
None. Addiction, 111, 523–524 524 Zsolt Demetrovics & Orsolya Király Acknowledgements
The present work was supported by the Hungarian
Scientific Research Fund (grant numbers: K83884
and 111938). Z.D. acknowledges financial support of
the János Bolyai Research Fellowship awarded by the
Hungarian Academy of Science.
Keywords Assessment, heavy use over time, internet
addiction, video gaming
Z. DEMETROVICS & O. KIRÁLY
Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
E-mail: demetrovics@t-online.hu References
1. Baggio S., Dupuis M., Studer J., Spilka S., Daeppen J.-B.,
Simon O. et al. Reframing video gaming and internet use
addiction: empirical cross-national comparison of heavy use
over time and addiction scales among young users. Addiction
2016; 111: 513–22.
2. Maraz A., Király O., Demetrovics Z. The diagnostic pitfalls of
surveys: if you score positive on a test of addiction, you still
have a good chance not to be addicted. A response to Billieux
et al. 2015. J Behav Addict 2015; 4: 151–4.
3. Billieux J., Schimmenti A., Khazaal Y., Maurage P., Heeren A.
Are we overpathologizing everyday life? A tenable blueprint
for behavioral addiction research. J Behav Addict 2015; 4:
119–23.
4. Griffiths M. D., Hunt N. Dependence on computer games by
adolescents. Psychol Rep 1998; 82: 475–80.
5. Young K. S. Internet addiction: the emergence of a new clinical disorder. Cyberpsychol Behav 1998; 1: 237–44.
6. Charlton J. P. A factor-analytic investigation of computer
‘addiction’ and engagement. Br J Psychol 2002; 93:
329–44. © 2016 Society for the Study of Addiction 7. Brown R. I. F. Gaming, gambling and other addictive play. In:
Kerr J. H., Apter M. J., editors. Adult Play: A Reversal Theory Approach. Amsterdam: Swets & Zeitlinger; 1991, pp. 101–18.
8. Brown R. I. F. Some contributions of the study of gambling
to the study of other addictions. In: Eadington W. R.,
Cornelius J. A., editors. Gambling Behavior and Problem
Gambling. Reno, NV: University of Nevada; 1993, pp. 241–72.
9. Charlton J. P., Danforth I. D. W. Distinguishing addiction and
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Comput Hum Behav 2007; 23: 1531–48.
10. Charlton J. P., Danforth I. D. W. Validating the distinction
between computer addiction and engagement: online
game playing and personality. Behav Inf Technol 2010;
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11. Brunborg G. S., Mentzoni R. A., Melkevik O. R., Torsheim T.,
Samdal O., Hetland J. et al. Gaming addiction, gaming engagement, and psychological health complaints among
Norwegian adolescents. Media Psychol 2013; 16: 115–28.
12. Skoric M. M., Teo L. L. C., Neo R. L. Children and video
games: addiction, engagement, and scholastic achievement. Cyberpsychol Behav 2009; 12: 567–72.
13. Griffiths M. D. The role of context in online gaming excess and
addiction: some case study evidence. Int J Ment Health Addict
2010; 8: 119–25.
14. Peters C. S., Malesky L. A. Problematic usage among highlyengaged players of massively multiplayer online role playing
games. Cyberpsychol Behav 2008; 11: 480–3.
15. Zanetta D. F., Zermatten A., Billieux J., Thorens G., Bondolfi G.,
Zullino D. et al. Motivations to play specifically predict excessive involvement in massively multiplayer online roleplaying games: evidence from an online survey. Eur Addict
Res 2011; 17: 185–9.
16. Rehbein F., Kliem S., Baier D., Mößle T., Petry N. M. Prevalence of internet gaming disorder in German adolescents:
diagnostic contribution of the nine DSM-5 criteria in a
statewide representative sample. Addiction 2015; 110:
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17. Lemmens J. S., Valkenburg P. M., Gentile D. A. The internet
gaming disorder scale. Psychol Assess 2015; 27: 567–82. Addiction, 111, 523–524 This document is a scanned copy of a printed document. No warranty is given about the
accuracy of the copy. Users should refer to the original published version of the material.

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