Since Lee Ann Phie was eight years old, video games have been opening up new worlds for her.
"I really like the social aspect of it … I've met a ton of people on [gaming platforms]," the Adelaide teenager said.
"I've seen gaming as a way to see how far I can push myself without my age restricting me."
But during the COVID-19 pandemic her hobby crossed the line into addiction.
"I would stay up to 2am playing games," the 15-year-old said.
"It did affect my health.
"I might have averaged eight to 10 hours a day [of gaming].
"I would often just stay in my room and game — I wouldn't interact with my friends out of school, or really my family either."
Before long, she had missed a lot of school.
"I think it was during the end of year eight, when my attendance rate dropped to like 64 per cent, [that] I realised, 'Oh, this is probably not the best idea,'" she said.
Researchers are concerned stories like Lee Anne's are becoming more common, as design tactics used in modern video games make it harder for people to play in moderation.
Mental and physical health concerns
Last year, almost 3.5 billion people around the world played video games, including 92 per cent of Australians aged five to 24, according to the Interactive Games and Entertainment Association's Australia Plays report.
Researchers estimate about 100,000 Australian teenagers are clinically addicted to gaming, based on a 2022 Macquarie University study that found 2.8 per cent of teenagers surveyed met the criteria.
Child and adolescent psychiatrist Kim Le, based in Adelaide, has seen firsthand what this looks like.
"I've had people collapse from playing video games," he said.
"I've seen people who have suffered medical episodes and suffered [what looked like] a mini-stroke.
"I'm seeing kids who are ignoring the urge to sleep … and then in the morning when their parents are waking them up they just can't even shake them to get awake to go to school."
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Rates of school refusal have increased in recent years and Dr Le believes excessive gaming during the pandemic — when many young people were socially isolated — is partly to blame.
But he said it was no surprise they got hooked in the first place.
"Everyone needs to be aware that these are simply not just video games anymore," Dr Le said.
"These are very sophisticated, highly polished games which are designed to keep people gaming every day."
Players chase rewards
Associate Professor of Psychology at Flinders University Daniel King said one strategy game companies used to engage players was a variable-ratio rewards schedule — the same system that drives gambling.
It means rewards such as points, money or new abilities in games are delivered on a random schedule, so players cannot predict when the next one will arrive.
"Players are invested in striving towards getting to that next level, getting that next item, but it can often take a lot more time than you anticipate to get to that next reward," Professor King said.
In some games, rewards can look like "loot boxes" — mystery bundles of virtual items that players either win through certain actions or purchase with real-world money.
The use of these boxes has long concerned researchers and anti-gambling advocates, who fear they normalise gambling and encourage compulsive gaming behaviour.
Lee Anne knows how compelling they can be.
"You reach the high of, 'Will I get something special?' and then the low of, 'No, I didn't,'" she said.
A hobby or a problem?
When assessing players for addiction, Professor King said the level of a control they had over their gaming habit mattered more than the time it took up.
"We're distinguishing between gaming that is fun and enjoyable and gaming that is starting to have problems for a person's life," he said.
"It becomes quite challenging to distinguish in some cases, because it's very common now for people to spend tens of dozens of hours a week playing games.
"We distinguish it based on certain psychological characteristics — when a person's starting to lose control over how long they play … when it's becoming the dominant focus of their life.
"There's [also] what we call functional impairment, when it impacts on your sleep, on your eating, on your work, on your school."
Gamers stress that the activity can have positive impacts too.
Twitch streamer Steven "Bajo" O'Donnell, who has made gaming a full-time job, believes it can enrich people's lives as long as they find the right balance.
"It's how I found my friends, all the way through primary school ... [to] adult life," Mr O'Donnell, also a former host on the ABC's Good Game, said.
"What a joy to be able to experience a great game with friends and make friends while doing it."
Tackling addiction
Dr Le said research from the University of Adelaide and Flinders University had found even taking a weekend off gaming could help gamers stop viewing the activity as an irreplaceable part of their lives.
He encouraged gamers to reflect on their values and life goals when deciding whether their gaming habits were serving them, but also wanted to see stricter government regulation.
"When we leave the companies to self-regulate … they don't necessarily do what is in the interest of the customer," Dr Le said.
"I think games need to be redesigned to eliminate some of those gambling mechanics … and not just to try and keep people playing mindlessly."
Lee Ann found taking time away from gaming was crucial to breaking her addiction while allowing her to keep the hobby in her life.
"I think I have more fun gaming one to three hours a day than seven to eight hours on end," she said.
"I've achieved a lot more this year than I have the past two, because I didn't put gaming as such a high priority."
