We evaluated whether a brief 3-week family therapy intervention would change patterns of brain activation in response to affection and gaming cues in adolescents from dysfunctional families who met criteria for on-line game addiction. Fifteen adolescents with on-line game addiction and fifteen adolescents without problematic on-line game play and an intact family structure were recruited. Over 3 weeks, families were asked to carry out homework assignments focused on increasing family cohesion for more than 1 hour/day and 4 days/week. Before therapy, adolescents with on-line game addiction demonstrated decreased activity as measured by functional magnetic resonance imaging (fMRI) within the caudate, middle temporal gyrus, and occipital lobe in response to images depicting parental affection and increased activity of the middle frontal and inferior parietal in response scenes from on-line games, relative to healthy comparison subjects. Improvement in perceived family cohesion following 3 weeks of treatment was associated with an increase in the activity of the caudate nucleus in response to affection stimuli and was inversely correlated with changes in on-line game playing time. With evidence of brain activation changes in response to on-line game playing cues and images depicting parental love, the present findings suggest that family cohesion may be an important factor in the treatment of problematic on-line game playing.
An association between dysfunctional family structure and adolescent substance use has been suggested by several public health studies (Frojd et al., 2007 and Roustit et al., 2007). In a smoking survey involving 32,961 youth, smoking, alcohol, and drug use were associated with non-intact families (Mak et al., 2010). Moreover, a perceived lack of family closeness and love has been suggested to increase the risk of health threatening behavior, such as drug taking in adolescents (Reynolds and Rob, 1988). In a study of family factors contributing to internet addiction, Yen et al. (2007) reported that higher levels of parent-adolescent conflict and lower family function were associated with internet addiction. China's “left behind children,” due to parental migration from rural to urban areas for work, have been reported to be at increased risk of physical inactivity, internet addiction, and smoking (Gao et al., 2010). In a study of 1369 university students, Tsai et al. (2009) reported that deficient social support was a significant risk factor for internet addiction. Further, loneliness and familial discord have also been reported to lead to internet addiction (Young, 1996 and Nalwa and Anad, 2003).
Although there is some controversy in terms of the feasibility of providing treatment, family therapy has been suggested for patients with substance dependence (Crane, 2007 and Morgan and Crane, 2010). Compared to a psychoeducational drug treatment intervention, integrated family and cognitive behavior therapy has been reported to reduce rates of marijuana use and improve problem solving and learning strategy skills in adolescents with substance dependence (Latimer et al., 2003). Parental monitoring and interest in their children has also been reported to be important for the treatment and management of adolescents with internet addiction (Lin et al., 2009). Young (2009) have emphasized that parental efforts such as limit setting with respect to playing time and switching computer usage from game playing to doing homework are important elements for the treatment of adolescent internet addiction. In addition, family therapy modified by short-term Brief Strategic Family Therapy for substance addiction is useful in reducing compulsive gaming in adolescents (Robbins et al., 2011).
