Substance use amongst individuals with internet gaming disorder and gaming disorder: A scoping review

Article type: Review Article

Keywords: internet gaming disorder, substance use, behavioral addiction, scoping review

Authors: Magdalena Liberacka-Dwojak ⚬, Christophe Tra ⚬, Monika Wiłkość-Dębczyńska ⚬, Joëlle Rosselet Amoussou ⚬, Marianthi Lousiana Deligianni ⚬, Daria Kukuła ⚬, Mariya Kuzyan ⚬, Jakub Piotrowski ⚬, Camilla Sculco ⚬, Didier Jutras-Aswad ⚬, Yasser Khazaal ⚬

Affiliations: Faculty of Psychology, Kazimierz Wielki University, Bydgoszcz, Poland; Addiction Medicine Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Medical Library-Cery, Lausanne University Hospital and University of Lausanne, Site de Cery, 1008, Prilly, Switzerland; Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland; Department of Psychiatry and Addiction, Université de Montréal, Montreal, Canada; Research Centre, Institut universitaire en santé mentale de Montréal, Montréal, Canada

License: © 2026 The Author(s) CC BY 4.0 Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

Article links: DOI: 10.1556/2006.2025.00170  |  PubMed: 41817607  |  PMC: PMC13132415

Relevance: Moderate: mentioned 3+ times in text

Full text: PDF (1.1 MB)

Background

In recent years, changes in Internet access, along with the multiplication of devices and platforms, have rapidly increased the role of technology in daily life and work, and have brought to the forefront important questions regarding the possible negative effects of technology on public health. According to the International Telecommunication Union, 63% of the population worldwide had access to the Internet in 2021 (ref. B51). While the democratization of Internet access has greatly enhanced productivity and connectivity, it also brings challenges: notably the problematic use of video games, a condition associated with negative educational outcomes (ref. Gentile, 2009; ref. Mihara & Higuchi, 2017) and psychiatric comorbidities such as depression, anxiety, social phobia, ADHD and obsessive-compulsive disorder (ref. González-Bueso et al., 2018).

Following the rapid growth of the gaming industry in the early 2000s (ref. Kuss, 2013), disorders related to video gaming were included in both the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (ref. B29) and the International Classification of Diseases ICD-11 (ref. World Health Organization, 2022), respectively as a diagnosis that warrant further research (Internet Gaming Disorder – IGD) and as a formal diagnosis (Gaming Disorder – GD). Its prevalence varies considerably from one country to another, in part due to cultural variations (ref. Brand et al., 2025; ref. Kim et al., 2022; ref. Király, Koncz, Griffiths, & Demetrovics, 2023; ref. Kuss, 2013; ref. Stevens, Dorstyn, Delfabbro, & King, 2021; ref. Strizek et al., 2020) and the heterogeneity in research methodologies (ref. Darvesh et al., 2020; ref. Kim et al., 2022; ref. King, Chamberlain, et al., 2020a; ref. Kuss, 2013; ref. Mihara & Higuchi, 2017; ref. Stevens et al., 2021). Concerns have also been raised about the validity of measurement tools, especially regarding very high prevalence measures (ref. King, Chamberlain, et al., 2020a). Prevalence estimates range from as low as 0.2% to as high as 57.5% (ref. Darvesh et al., 2020), with a metanalysis reporting a pooled prevalence of 3.3% (ref. Kim et al., 2022).

The COVID-19 pandemic has exacerbated the video games use (ref. King, Delfabbro, Billieux, & Potenza, 2020; ref. Ko & Yen, 2020; ref. Xu, Park, Kang, Choi, & Koo, 2021), whereas substance use patterns have shown a more complex and heterogeneous evolution. For example, the use of some psychostimulants such as MDMA temporarily declined during lockdowns, with an upward trend observed after restrictions were lifted (ref. Babicki, 2022; ref. European Monitoring Centre for Drugs and Drug Addiction, 2022; ref. Layman et al., 2022; ref. Mallet, Dubertret, & Le Strat, 2021; ref. Roberts et al., 2021; ref. Xu et al., 2021) Overall, both video games and psychoactive substances have been used as coping mechanisms for stress induced by the pandemic and related social restrictions, although the specific trajectories of use varied across substances(ref. King et al., 2020; ref. Ko & Yen, 2020; ref. Mallet et al., 2021; ref. Xu et al., 2021). Additionally, the co-usage of video games and substances could have a significant clinical impact, as it does in gambling disorder. For example, a systematic review by Markouris et al. identified lower alcohol use among individuals with gambling disorder as a positive prognosis factor for favorable outcomes following psychological treatment (ref. Merkouris, Thomas, Browning, & Dowling, 2016).

Nascent literature looking into this dyad has found a possible association between the occurrences of gaming and substance use (ref. AlSayyari & AlBuhairan, 2018; ref. Andre et al., 2021; ref. Coeffec et al., 2015; ref. Di Carlo et al., 2023; ref. Gallimberti et al., 2016; ref. Munoz-Miralles et al., 2016; ref. Padilla-Walker, Nelson, Carroll, & Jensen, 2010; ref. Ream, Elliott, & Dunlap, 2011; ref. Strizek et al., 2020; ref. VAN Rooij et al., 2014; ref. Walther, Morgenstern, & Hanewinkel, 2012; ref. Wicki, Studer, Marmet, Khazaal, & Gmel, 2025; ref. Škařupová, Blinka, & Ťápal, 2018). ref. Strizek et al. (2020) proposed three hypotheses to explain this association: 1) common etiological, psychosocial and biological factors may underlie both behaviors, 2) substances and gaming may be used synergistically, either to enhance one another or to cope with the adverse effects of the other, and 3) gaming may be negatively associated with substance use, such as alcohol, as increased gaming time may reduce social situations where drinking usually occurs. However, for substances typically consumed at home, such as cannabis or tobacco, gaming and use may co-occur or even reinforce each other (ref. Jobin, Légaré, Lehmann, & Monson, 2025). While the literature on the interplay of gaming and substance use is still in its early stages, a deeper understanding of these interactions is essential to addressing gaming disorder as a multifaceted issue.

Study rationale

One key rationale for this scoping review is the need to address limitations in prior studies, which often included scales predating the publication of DSM-5 or relied on measurements that lack alignment with current diagnostic criteria (ref. Burleigh, Griffiths, Sumich, Stavropoulos, & Kuss, 2019; ref. King, Chamberlain, et al., 2020b). Previous research (ref. King, Chamberlain, et al., 2020b) noted that research remains divided between studies employing older and the newest measurement tools, creating heterogeneous conclusions. This study was undertaken to update the literature and specifically includes only studies that utilized DSM-5 or ICD-11 criteria, and measurement tools developed after the publication year of the DSM-5. By restricting the scope to such studies, this review seeks to enhance the homogeneity of the data. Given the early stage of research and limited data, a scoping review was chosen to map the existing literature and identify knowledge gaps, as heterogeneity in measurement tools complicates systematic reviews and meta-analyses (ref. King, Chamberlain, et al., 2020).

This scoping review primarily aimed to provide a descriptive overview of substance use patterns amongst individuals with IGD/GD. In this review, substances refer to those not scheduled under international drug control conventions (e.g., alcohol, tobacco, caffeine) and those scheduled under these conventions (e.g., cannabis, stimulants, opioids), while recognizing that national jurisdictions may regulate these substances differently. The secondary research questions were: 1) to examine factors underlying the co-occurrence of gaming and substance use and 2) to determine the moderating factors impacting the strength of this association.

Methodology

The study protocol was registered on Open Science Framework (https://osf.io/kyf6b) on 25/03/2022.

This scoping review was carried out in accordance with the JBI manual for scoping reviews (ref. Peters et al., 2020). Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines (ref. Tricco et al., 2018).

Eligibility criteria

• Population: all individuals diagnosed with IGD or GD based on the DSM-5 or ICD-11 criteria, or assessed using scales based on these criteria, published after 2013. There were no restrictions regarding age, sex/gender, ethnicity, or comorbidity.
• Concept: primary focus on substance use, with no restrictions on substance type. Gambling and other behavioral addictions were excluded.
• Context: no restrictions on the context in which the studies were conducted.

Information sources and search strategy

A literature search was conducted in August 2025, in collaboration with a medical librarian (JRA), in seven bibliographic databases: Medline ALL Ovid, Embase.com, APA PsycInfo Ovid, CINAHL EBSCO, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley and the Cochrane Central Register of Controlled Trials Wiley. Databases were searched from 2013 onward, without language restrictions. The search equation explicitly included multiple substances of interest, such as alcohol, tobacco, cannabis, and stimulants (e.g., amphetamines), to ensure a comprehensive coverage of the literature. The final search strategies were peer-reviewed by a second information specialist and are documented in the publication’s appendix with the search syntax, keywords and index terms used. Additional records were identified through backward and forward citation tracking of included studies, using Citationchaser, ResearchRabbit and the Web of Science Core Collection (Fig. 1).

Selection of sources of evidence

Studies meeting all the following criteria were included:

• fit into the PCC framework (Population, Concept, and Context),
• published after 2013 to provide a clear definition of IGD/GD for participants selection based on DSM-5/ICD-11 criteria,
• include both qualitative and quantitative studies,
• provide a clear definition of IGD/GD for participants selection based on DSM-5/ICD-11 criteria.

Studies were excluded if they were not based on empirical data (e.g. case reports, protocols, theses, reviews, metanalysis), used scales based on alternative diagnostic criteria (e.g. gambling disorder) adapted to video gaming or published before 2013 or measured substance use by compounding it into a broader context of “problematic behaviors” or “at-risk behaviors”.

Study selection process

Deduplication of references exported from the databases was performed in Endnote 20 (Clarivate Analytics, USA) (JRA). The selection process was conducted in two stages using Rayyan, a software designed for article selection in systematic reviews: (1) review of titles and abstracts for preliminary inclusion, (2) full-text review using the inclusion and exclusion criteria. Six independent reviewers (CT, CS, MLD, MK, DK, JP) conducted the review at each stage, resolving discrepancies through discussion. Each record was independently screened by two reviewers. Discrepancies were resolved through discussion, with unresolved cases adjudicated by a senior reviewer (YK). The extracted data included the following variables: title, authors, year of publication, country, aims, population/sample size, recruitment procedure, type of study, data collection method, IGD or GD identification method, substances studied, substance use measurement method, follow-up duration, main results, and key findings. The results were synthesized into a narrative review to provide an overview of substance use patterns among individuals with IGD/GD, the mechanisms underlying the association, and the moderating factors influencing the strength of this association. The literature was mapped in terms of types of studies and substances investigated in order to identify knowledge gaps and provide guidance for future research. In addition, the methodological quality of all included studies was assessed using the appropriate JBI Critical Appraisal Checklists (ref. Barker et al., 2023; ref. Munn et al., 2023). Each study was independently evaluated by two reviewers, with discrepancies resolved through discussion and, if necessary, adjudicated by a senior reviewer (YK). This ensured consistency and transparency in the quality appraisal process.

Results

The systematic search identified 35 studies (see Appendix 1) published between 2013 and 2023, primarily conducted in North America, Europe, and Asia, reflecting cultural differences. Thirty-two studies (90.3%) employed a cross-sectional design. Only three studies (9.7%) used longitudinal designs, providing insights into temporal relationships between IGD and substance use. Sample sizes ranged from 64 participants in clinical settings to 3,939 in large-scale surveys. Most studies targeted adolescents and young adults, ranging from 13 to 30 years. The majority of participants were males, accounting for approximately 70–85% of the samples, reflecting the possible higher prevalence of gaming disorders among males. The appraisal revealed that the majority of cross-sectional studies exhibited moderate-to-high methodological quality. Most used validated self-report instruments, ensuring internal consistency and construct validity, although reliance on self-assessment measures may have introduced response bias, particularly regarding sensitive behaviors such as substance use or gaming. Inclusion criteria and sample characteristics were generally well described, but confounding control was usually limited to demographic variables (e.g., age, sex, education). In contrast, the cohort studies showed somewhat higher methodological rigor, particularly through the use of prospective designs and standardized diagnostic tools. However, they also faced challenges such as attrition bias and limited follow-up duration. Only a minority of studies in both groups applied multivariate adjustments that incorporated psychosocial or contextual factors (see Tables 1 and 2).

Various diagnostic tools were employed to assess IGD, with the Internet Gaming Disorder Scale (IGDS) (ref. Pontes & Griffiths, 2017) being the most commonly used, which was used in 28 studies (80.0%). Some studies employed diagnostic criteria from the DSM-5 and ICD-11 (used in 8 studies; 23.0%). For substance use, a variety of tools were employed, with: The Alcohol Use Disorder Identification Test (AUDIT; ref. Saunders, Aasland, Babor, De La Fuente, & Grant, 1993) being most frequently used for alcohol consumption (used in 15 studies; 42.9%), The Cigarette Dependency Scale (CDS-5; (ref. Etter, Le Houezec, & Perneger, 2003) for nicotine (used in 6 studies; 17.1%), the Drug Abuse Screen Test-10 (DAST; ref. Skinner, 1982) for drugs (used in 6 studies, 17.1%), and self-reported frequency and intensity of use for cannabis and other stimulants which was used in 12 studies (34.2%) (see Table 3). Data collection methods predominantly involved self-reported surveys and standardized questionnaires, often administered online. Alcohol use was the most frequently examined behavior. 15 studies (42.9%) employed the Alcohol Use Disorders Identification Test (AUDIT), which primarily identifies risky drinking patterns. Other studies relied on single-item measures capturing frequency or quantity of alcohol consumption. A smaller subset of studies (n = 3; 13.6%) specifically examined the co-occurrence of alcohol use during gaming sessions, indicating simultaneous engagement in both behaviors. Thus, the operationalization of alcohol use measurement varied across studies, ranging from general consumption to risky patterns and simultaneous gaming-related drinking.

The main objectives of the included studies aligned with the rationale of this review, focusing primarily on the prevalence of substance use among individuals with IGD/GD, the examination of co-occurrence patterns, and the identification of associated psychosocial and personality factors.

Substance use patterns

Studies explored the use of various substances, including alcohol, tobacco, cannabis, and stimulants such as amphetamines. Tobacco use was particularly prevalent among adolescents and young adults, often reported as a parallel behavior with gaming ranging from 20.09% to 78–88% among high-risk groups (ref. Brandao, Sanchez, de, & da Silva Melo, 2022; ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Di Carlo et al., 2023; ref. Seproo et al., 2022). Alcohol use was widespread, and often linked to cultural acceptance and accessibility, with prevalence rates ranging from 43.9 to 75.3% (ref. Borges et al., 2023; ref. Brandao et al., 2022; ref. Isralowitz et al., 2022; ref. Wang, 2022). Stimulant use, such as amphetamines, was less frequently studied but observed in certain contexts, especially among competitive gamers. This group often used stimulants to prolong gaming sessions or enhance performance with prevalence around 4.9% (ref. Horvath et al., 2022; ref. Ip, Urbano, Caballero, Lau, & Barnett, 2022). Polysubstance use, involving combinations of alcohol, tobacco, and cannabis, was particularly reported in clinical samples of individuals with IGD/GD, especially in those with psychiatric comorbidities (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Di Carlo et al., 2023). Polysubstance use was assessed in four studies (18.2%). Reported prevalence rates ranged from 12 to 28% of IGD/GD participants, depending on the sample and measurement approach.

Shared risk factors

Studies indicate that IGD and substance use can be particularly linked in clinical populations, where impulsivity and emotional dysregulation play a significant role (ref. Ayala-Rojas et al., 2024; ref. Sucha, Dolejs, Dostal, Pipova, & Pontes, 2024). Other studies noted significant similarities between IGD and substance use, suggesting impulsivity, sensation-seeking, and coping strategies for stress as risk factors (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Gerdner & Hakansson, 2022). These traits were especially significant among adolescents engaging in problematic gaming, who were more likely to use substances such as cannabis and synthetic drugs, highlighting their vulnerability to addictive behaviors (ref. Di Carlo et al., 2023). Moreover, a higher prevalence of maladaptive coping strategies, such as substance use to manage emotional dysregulation, was highly evident in this group (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Horvath et al., 2022). Moreover, research suggest that anxiety and depression can increase the co-occurrence of addictive behaviors (ref. Mbarki et al., 2023).

Furthermore, a few moderating factors were highlighted in the studies, with age and gender being the most significant. These differences indicate that males and younger individuals are more likely to show associations between gaming and substance use, a relationship shaped by social interactions and sensation-seeking behaviors (ref. Borges et al., 2023; ref. Granero et al., 2021). In addition, personality traits, such as neuroticism, impulsivity, and sensation-seeking emerged as relevant traits moderating this association (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Paik, Cho, Chun, Jeong, & Kim, 2017). Similarly, clinical groups exhibited higher rates of substance use, including ADHD which also involves traits such as impulsivity and sensation-seeking, along with depression, and anxiety, suggesting cross-addiction mechanisms (ref. Borges et al., 2023; ref. Granero et al., 2021). A few studies also indicated that single individuals were at higher risk of engaging in both IGD and substance use, potentially due to social isolation and the absence of supportive relationships (ref. Mallorqui-Bague et al., 2017). Poor sleep hygiene, which exacerbates emotional dysregulation, was also reported (ref. Moreno et al., 2022).

Longitudinal evidence is limited and inconsistent. For example, ref. Wartberg et al. (2023) found that IGD symptoms predicted higher problematic alcohol use at 12-month follow-up, while ref. Borges et al. (2023) did not identify significant associations between IGD and subsequent substance use, The co-occurrence of IGD and substance use has also been linked to poor mental health outcomes, including increased levels of anxiety and depression, further complicating treatment efforts (ref. Gerdner & Hakansson, 2022; ref. Granero et al., 2021).

Discussion

The primary objective of this scoping review was to map substance use patterns among individuals with IGD/GD. The findings revealed a significant co-occurrence of IGD/GD with the use of substances, most notably alcohol, tobacco, cannabis, and stimulants such as amphetamines. Substance use was also observed, particularly among clinical populations, indicating complex co-occurrence mechanisms. ref. Burleigh et al. (2019) also observed the association between substance use and behavioral addictions, suggesting overlapping psychosocial vulnerabilities. The current review expands on prior research by focusing exclusively on studies utilizing DSM-5 or ICD-11 criteria for IGD/GD. Potential key mechanisms and moderating factors underlying the relationship between IGD/GD and substance use have been identified, including behavioral reinforcement, psychological vulnerabilities, and sociocultural influences.

Both IGD/GD and substance use seem to share behavioral reinforcement mechanisms such as immediate gratification. Engaging in gaming and substance use can serve as negative reinforcement by temporarily alleviating stress, anxiety, and other negative emotional states. These behaviors can also provide positive reinforcement through immediate gratification and pleasurable experiences, such as in-game rewards or substance-induced euphoria (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Granero et al., 2021). Both types of reinforcement – negative (e.g., stress avoidance) and positive (e.g., euphoria, gaming rewards) – may contribute to the development of dependency and the maintenance of problematic involvement in IGD/GD (ref. Imataka, Sakuta, Maehashi, & Yoshihara, 2022).

From a neurological perspective, prolonged gaming can disrupt baseline dopamine levels and neural responses, diminishing the brain’s sensitivity to natural rewards. This desensitization may heighten vulnerability to substance use as an alternative source of stimulation and reward (ref. Greenfield, 2022). Individuals with addictive disorders often prioritize short-term rewards from gaming and/or substance use over long-term consequences, reinforcing such behaviors (ref. Bickel, Madden, & Petry, 1998). Both disorders involve overlapping pathways in the brain’s dopaminergic reward system, where dopamine release enhances reward-seeking and tolerance over time (ref. Ma et al., 2024). This mechanism could be especially important in competitive gaming, where stimulants like caffeine or amphetamines can be used to enhance focus and performance (ref. Ip et al., 2022; ref. Park, Han, Potenza, & Zhao, 2025). The findings suggest potential differences in the neurobiological mechanisms underlying model-based behavior in IGD and AUD (ref. Kwon, Choi, Park, Ahn, & Jung, 2024). Furthermore, from a contextual and cue-reactivity perspective, gaming and substance use may also be maintained by similar environmental cues and triggers, such as stress, boredom, or social pressure (ref. Jang et al., 2022). Beyond these shared triggers, one can hypothesize potential interactions between in-game behaviors and substance use – for instance, using psychoactive substances to enhance focus, prolong gameplay, or intensify the immersive experience of gaming. Such combinations may potentiate the rewarding aspects of gaming (e.g., achievement, escapism), while simultaneously reducing self-regulation and inhibitory control, thereby exacerbating problematic use. To deepen our understanding of these complex dynamics, ecologically grounded research designs – capturing real-time behaviors, contextual influences, and emotional states – are critically needed.

Moreover, emotional dysregulation also emerged as another mechanism for both addictions. Individuals with high levels of neuroticism are more likely to engage in maladaptive behaviors to manage psychological discomfort (ref. Sanchez-Llorens et al., 2021). Poor emotional regulation skills can make individuals rely on external mechanisms, such as gaming or substance use, to alleviate distress (ref. Paulus, Ohmann, Möhler, Plener, & Popow, 2021; ref. Schreiber, Grant, & Odlaug, 2012). Additionally, social isolation, which is a common characteristic in both behaviors, may intensify emotional dysregulation and heighten the risk of maladaptive coping strategies (ref. Matthews et al., 2016). This reliance on external mechanisms can be also reinforced by cognitive biases and expectancies. Cognitive distortions, such as overestimating the benefits of gaming or substances in relieving stress or enhancing social interaction, may contribute to greater dependency on these behaviors. Individuals may also develop expectancies that gaming and substance use will fulfill unmet psychological needs, which reinforces the behaviors (ref. Billieux et al., 2020). Personality and temperament traits, such as impulsivity, novelty-seeking, and sensation-seeking are common risk factors for both IGD and substance use. These traits, commonly associated with ADHD, may exacerbate the development of maladaptive behaviors in gaming and substance use (ref. Ip et al., 2022; ref. Mitchell, Kromash, Holt, & Ginley, 2021).

Furthermore, psychological vulnerabilities play a crucial role in the development and maintenance of both IGD and substance use. These vulnerabilities include difficulties in emotional regulation, impulsivity, sensation seeking, comorbid mental health disorders, and cognitive biases. The reviewed studies also reported that concomitant GD/IGD with other mental health conditions, such as depression, anxiety, and ADHD, may increase vulnerability to IGD and substance use (ref. Granero et al., 2021; ref. Isralowitz et al., 2022). These comorbidities often impair self-regulation, making individuals more vulnerable to the reinforcing effects of both behaviors. Gaming and substances are high-arousal activities that offer immediate rewards, appealing to impulsive individuals (ref. Zuckerman, 1971). Sociocultural influences also play a significant role in IGD/GD and substance use. In certain social circles, particularly among adolescents and young adults, late-night gaming and recreational substance use are normalized or even glamorized (ref. Palma-Ruiz, Torres-Toukoumidis, González-Moreno, & Valles-Baca, 2022). This normalization may lead to sleep deprivation, which in turn exacerbates the engagement in these activities, creating a cyclical pattern difficult to break. Emotional dysregulation caused by lack of sleep may drive individuals toward gaming or substance use, to cope with negative emotions. Cognitive impairments resulting from sleep deprivation, including reduced attention and executive control, further diminish the capacity to resist addictive behaviors (ref. Gujar, Yoo, Hu, & Walker, 2011; ref. Kristensen, Pallesen, King, Hysing, & Erevik, 2021; ref. Wang, Mati, & Cai, 2021; ref. Zhang, Lau, & Hsiao, 2019). Moreover, in some cultures, gaming and substance use are widely accepted as recreational activities, leading to increased exposure and participation (ref. McCauley, Nguyen, McDonald, & Wearing, 2020). Cultural factors were also linked to substance use patterns. Studies conducted in Western countries frequently reported alcohol as a commonly used substance, indicating its cultural acceptance (ref. Borges et al., 2023; ref. Brandao et al., 2022). In contrast, tobacco use was more prevalent in studies conducted in Asian regions, aligning with cultural norms and the availability of smoking in gaming cafes (ref. Liu et al., 2021; ref. Paik et al., 2017). Marketing strategies for games and substances often exploit this acceptance, emphasizing themes of excitement, escape, and achievement. Loot boxes and microtransactions in games mimic gambling mechanics, which are strongly linked to substance use behaviors (ref. Lobstein, Landon, Thornton, & Jernigan, 2017; ref. Thorens, Khan, Khazaal, & Zullino, 2009).

It is also worth noting that while the exclusion of studies using scales published before 2013 and those not based on DSM-5 or ICD-11 criteria brings greater homogeneity to the review, it also resulted in the exclusion of widely used scales such as the Young Internet Addiction Test and GAS-7. Nevertheless, it has been stated that no single scale has been consistently shown to be superior (ref. King et al., 2020). Several limitations in the existing literature were also identified. Most of the studies were cross-sectional and based on self-report assessments only, highlighting the need for more longitudinal and ecological research. Studies have emphasized shared mechanisms between IGD and substance use; however, they do not explore how these mechanisms interact or contribute to the progression of these behaviors over time. There is also a lack of research on protective factors that could mitigate the risks associated with IGD and substance use.

It is important to note that the majority of included studies relied on cross-sectional designs. Consequently, observed relationships between gaming and substance use reflect statistical associations and should not be interpreted as evidence of causal mechanisms. For example, while problematic gaming and alcohol use often co-occurred, it remains unclear whether gaming contributes to increased alcohol use, whether alcohol use influences gaming behavior, or whether both share underlying vulnerability factors such as impulsivity or difficulties in emotion regulation (ref. Müller, Antons, & Brand, 2023; ref. Stellern et al., 2023).

Future studies should explore how media influence, impulsivity, emotional dysregulation, and family dynamics contribute to IGD and substance use. Unstructured parenting (ref. Bussone, Trentini, Tambelli, & Carola, 2020) and stigma-related isolation (ref. Room, 2005) may heighten vulnerability. Sleep deprivation, as both cause and effect, can impair impulse control and heighten reward sensitivity, reinforcing maladaptive behaviors (ref. Burleigh, Griffiths, Sumich, Wang, Stavropoulos, et al., 2022; ref. Granero et al., 2021; ref. Imataka et al., 2022). Research should further examine the bidirectional and temporal links between IGD/GD and substance use, as well as cultural and gender differences in risk and protective factors. Mixed-method, ecological, and multilevel designs can help capture lived experiences and contextual influences. Including individuals with lived experience in intervention design is essential, as are school-based programs promoting emotional regulation in adolescents (ref. Bussone et al., 2020). Moreover, future research should employ longitudinal and ecological momentary assessment (EMA) methods to capture temporal dynamics of gaming and substance use (ref. Zhou, Zhou, Zhou, Shen, & Zhang, 2022). The role of digital environments, such as loot boxes and in-game advertising, should also be examined (ref. Kim et al., 2023; ref. Villalba-García, Griffiths, Demetrovics, & Czakó, 2025). Additionally, cross-cultural studies may clarify sociocultural influences on co-occurring gaming and substance use. Furthermore, when interpreting the current body of evidence, it is important to note that the potential for residual confounding and self-report bias remains, given the reliance on cross-sectional, self-reported data. Nevertheless, overall reporting and measurement rigor across the included studies were consistent with required JBI standards, and the inclusion criteria for eligible studies probably explain the relative homogeneity of the scores observed on some of the quality appraisal items.

From a clinical perspective, these findings underscore the importance of systematically screening for substance use among individuals presenting with symptoms of IGD/GD. Early detection of co-occurring behaviors may help prevent escalation and chronicity. Integrated prevention and intervention strategies that simultaneously target gaming and substance use behaviors could simultaneously enhance treatment outcomes. Such assessments should focus not only on the co-occurrence of both conditions but also on the dynamic interplay between them – for example, the use of cannabis or alcohol during gaming sessions. This approach may facilitate the delivery of tailored cognitive-behavioral interventions and improve psychoeducation on risky digital and substance-related behaviors. Given the high frequency of these concomitant behaviors, close collaboration between addiction specialists, psychiatrists, and clinical psychologists at the organizational level appears essential to ensure interventions are adapted to individual needs.

Conclusions

The findings revealed that individuals with IGD/GD frequently engage in substance use, including alcohol, tobacco, cannabis, and stimulants such as amphetamines as well as substance use. The relationship between IGD and substance use is complex shaped by various interrelated mechanisms and moderating factors. Based on insights from research and theoretical frameworks, key mechanisms and moderating factors can be identified. These include behavioral reinforcement, psychological vulnerabilities (e.g., coping mechanisms, personality traits, and temperament), co-occurring mental disorders, as well as. sociocultural influences, including the impact of media and peers.

References

1. An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R).. Drug and Alcohol Dependence,, 2010. [DOI | PubMed]
2. Relationship of media exposure to substance use among adolescents in Saudi Arabia: Results from a national study.. Drug and Alcohol Dependence,, 2018. [DOI | PubMed]
3. The prevalence of illicit substance use among students of medical sciences in Tehran: Results from four repeated surveys from 2006 to 2009.. Journal of Child & Adolescent Substance Abuse,, 2016. [DOI]
4. A cross-sectional study on extensive gaming in adolescents.. Journal of Public Health Research,, 2021
5. Game addiction scale for adolescents—Psychometric analyses of gaming behavior, gender differences and ADHD.. Frontiers in Psychiatry,, 2022. [DOI | PubMed]
6. Depression, anxiety, and stress in young adult gamers and their relationship with addictive behaviors: A latent profile analysis.. Journal of Affective Disorders,, 2024. [DOI | PubMed]
7. Online gaming disorder and sports betting addiction: Convergences and divergences.. International Journal of Mental Health and Addiction,, 2024. [DOI]
8. Use of alcohol, cannabinoids, psychostimulants, and sedatives before and during the COVID-19 pandemic among students in 40 European countries.. International Journal of Environmental Research and Public Health,, 2022. [DOI | PubMed]
9. Development and validation study of game overuse screening questionnaire.. Psychiatry Research,, 2020. [DOI | PubMed]
10. Revising the JBI quantitative critical appraisal tools to improve their applicability: An overview of methods and the development process.. JBI Evidence Synthesis,, 2023. [DOI | PubMed]
11. Berman, A., Wennberg, P., & Källmén, H. (2012). AUDIT och DUDIT – Identifiera problem med alkohol och droger [AUDIT and DUDIT – Identifying problematic use of alcohol and drugs]. Stockholm: Gothia förlag.
12. The price of change: The behavioral economics of drug dependence.. Behavior Therapy,, 1998. [DOI]
13. Chapter 16—Cognitive factors associated with gaming disorder. In. Cognition and addiction (pp., 2020. [DOI]
14. Internet gaming disorder does not predict mood, anxiety or substance use disorders in university students: A one-year follow-up study.. International Journal of Environmental Research & Public Health [Electronic Resource],, 2023
15. DSM-5 internet gaming disorder among a sample of Mexican first-year college students.. 2019. [DOI]
16. Mental health predictors of internet gaming disorder: A longitudinal study.. Revista Brasileira De Psiquiatria (Sao Paulo, Brazil: 1999)., 2024. [DOI]
17. The reliability and predictive validity of the heaviness of smoking index and its two components: Findings from the international tobacco control four country study.. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco,, 2010. [DOI | PubMed]
18. Current advances in behavioral addictions: From fundamental research to clinical practice.. The American Journal of Psychiatry,, 2025. [DOI | PubMed]
19. Mental health and behavioral problems associated with video game playing among Brazilian adolescents.. Journal of Addictive Diseases,, 2022. [PubMed]
20. Association of internet gaming disorder symptoms with anxiety and depressive symptoms and substance use: An international cross-sectional study.. Middle East Current Psychiatry-Mecpsych,, 2022
21. A systematic review of the co-occurrence of gaming disorder and other potentially addictive behaviors.. Current Addiction Reports,, 2019
22. Coping and co-occurrence of gaming disorder and substance use in recovering substance users.. Journal of Clinical Medicine,, 2022
23. Co-occurrence of gaming disorder and other potentially addictive behaviours between Australia, New Zealand, and the United Kingdom.. International Journal of Environmental Research & Public Health [Electronic Resource],, 2022
24. Early-life interpersonal and affective risk factors for pathological gaming.. Frontiers in Psychiatry,, 2020. [DOI | PubMed]
25. Associations between game use and mental health in early adulthood: A nationwide study in Korea.. Journal of Affective Disorders,, 2022. [PubMed]
26. The questionnaire of experiences associated with video games (CERV): An instrument to detect the problematic use of video games in Spanish adolescents.. Adicciones,, 2014. [PubMed]
27. Early substance consumption and problematic use of video games in adolescence.. Frontiers in Psychology,, 2015. [PubMed]
28. Exploring the prevalence of gaming disorder and internet gaming disorder: A rapid scoping review.. Systematic Reviews,, 2020. [DOI | PubMed]
29. High-risk gaming is associated with frequent substance use: An exploratory survey among young adults.. European Addiction Research,, 2023. [DOI | PubMed]
30. Diagnostic and statistical manual of mental disorders: DSM-5TM (5th ed., pp. xliv, 947). (2013). American Psychiatric Publishing, Inc. 10.1176/appi.books.9780890425596https://doi.org/10.1176/appi.books.9780890425596
31. The scale of risk behaviour in adolescents (SRBA or VRCHA).. 2019
32. Cross-addiction risk profile associations with COVID-19 anxiety: A preliminary exploratory study.. International Journal of Mental Health & Addiction,, 2022
33. Occurrence of problematic internet use and its correlates among Egyptian adolescent students in international schools in Cairo.. Middle East Current Psychiatry-Mecpsych,, 2022
34. A self-administered questionnaire to measure dependence on cigarettes: The cigarette dependence scale.. Neuropsychopharmacology,, 2003. [DOI | PubMed]
35. European Monitoring Centre for Drugs and Drug Addiction. (2022). European drug report 2022: Trends and developments. Publications Office. 10.2810/75644https://doi.org/10.2810/75644
36. Problematic use of video games and substance abuse in early adolescence: A cross-sectional study.. American Journal of Health Behavior,, 2016. [PubMed]
37. Pathological video-game use among youth ages 8 to 18: A national study.. Psychological Science,, 2009. [DOI | PubMed]
38. Prevalence and comorbidity in a Swedish adolescent community sample—Gambling, gaming, substance use, and other psychiatric disorders.. BMC Psychiatry,, 2022. [PubMed]
39. Co-occurrence of common biological and behavioral addictions: Using network analysis to identify central addictions and their associations with each other. PS – First posting.. International Journal of Mental Health and Addiction., 2023
40. Factor structure of ten psychoactive substance addictions and behavioral addictions.. Journal of Behavioral Addictions,, 2022
41. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: A comprehensive review.. International Journal of Environmental Research and Public Health,, 2018. [DOI | PubMed]
42. Profile of treatment-seeking gaming disorder patients: A network perspective.. Journal of Gambling Studies,, 2021
43. Clinical considerations in internet and video game addiction treatment.. Child and Adolescent Psychiatric Clinics of North America,, 2022. [DOI | PubMed]
44. Sleep deprivation amplifies reactivity of brain reward networks, biasing the appraisal of positive emotional experiences.. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience,, 2011. [DOI | PubMed]
45. Child maltreatment and substance-use-related negative consequences: Longitudinal trajectories from early to mid adolescence.. Addictive Behaviors,, 2020. [DOI | PubMed]
46. The Fagerström test for nicotine dependence: A revision of the Fagerström tolerance questionnaire.. British Journal of Addiction,, 1991. [DOI | PubMed]
47. Polysubstance use is positively associated with gaming disorder symptom severity: A latent class analytical study.. European Addiction Research,, 2022. [PubMed]
48. Current status of internet gaming disorder (IGD) in Japan: New lifestyle-related disease in children and adolescents.. Journal of Clinical Medicine,, 2022. [DOI]
49. The video gamer 500: Prevalence of performance-enhancing drug use and internet gaming disorder among adult video gamers.. JACCP Journal of the American College of Clinical Pharmacy,, 2022
50. Toward uniform data collection and monitoring of Israeli and Palestinian adolescent drug use.. 2016. [DOI]
51. Gaming disorder and psycho-emotional wellbeing among Male university students and other young adults in Israel.. International Journal of Environmental Research & Public Health [Electronic Resource],, 2022
52. ITU Facts and Figures 2021 | Tableau Public. (2021). https://public.tableau.com/app/profile/ituint/viz/ITUFactsandFigures2021/InternetUse01.
53. The kynurenine pathway and mediating role of stress in addictive disorders: A focus on alcohol use disorder and internet gaming disorder.. Frontiers in Pharmacology,, 2022. [DOI]
54. Video gaming and cannabis use: A scoping review.. Journal of Behavioral Addictions,, 2025. [DOI | PubMed]
55. Validation of the 30-day version of the brief young adult alcohol consequences questionnaire for use in longitudinal studies.. Journal of Studies on Alcohol and Drugs,, 2008. [PubMed]
56. Clinical reappraisal of the composite international diagnostic interview screening scales (CIDI-SC) in the army study to assess risk and resilience in servicemembers (Army STARRS).. International Journal of Methods in Psychiatric Research,, 2013. [DOI | PubMed]
57. A scoping review of the association between loot boxes, esports, skin betting, and token wagering with gambling and video gaming behaviors.. Journal of Behavioral Addictions,, 2023. [DOI | PubMed]
58. Prevalence of gaming disorder: A meta-analysis.. Addictive Behaviors,, 2022. [DOI | PubMed]
59. Screening and assessment tools for gaming disorder: A comprehensive systematic review.. Clinical Psychology Review,, 2020a. [DOI | PubMed]
60. Screening and assessment tools for gaming disorder: A comprehensive systematic review.. Clinical Psychology Review,, 2020b. [DOI | PubMed]
61. Problematic online gaming and the COVID-19 pandemic.. Journal of Behavioral Addictions,, 2020. [DOI | PubMed]
62. Ten-item internet Gaming Disorder Test (IGDT-10): Measurement invariance and cross-cultural validation across seven language-based samples.. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors,, 2019. [DOI | PubMed]
63. Gaming disorder: A summary of its characteristics and aetiology.. Comprehensive Psychiatry,, 2023. [DOI | PubMed]
64. Impact of COVID-19 on gaming disorder: Monitoring and prevention.. Journal of Behavioral Addictions,, 2020. [DOI | PubMed]
65. Problematic gaming and sleep: A systematic review and meta-analysis.. Frontiers in Psychiatry,, 2021. [DOI | PubMed]
66. Internet gaming addiction: Current perspectives.. Psychology Research and Behavior Management,, 2013. [DOI | PubMed]
67. Neural correlates of model-based behavior in internet gaming disorder and alcohol use disorder.. Journal of Behavioral Addictions,, 2024. [DOI | PubMed]
68. Substance use among youth during the COVID-19 pandemic: A systematic review.. Current Psychiatry Reports,, 2022. [DOI | PubMed]
69. The internet gaming disorder scale.. Psychological Assessment,, 2015. [DOI | PubMed]
70. Insecure attachment and addiction: Testing the mediating role of emotion dysregulation in four potentially addictive behaviors.. Addictive Behaviors,, 2020. [PubMed]
71. Longitudinal predictors for incidence of internet gaming disorder among adolescents: The roles of time spent on gaming and depressive symptoms.. Journal of Adolescence,, 2021. [PubMed]
72. The commercial use of digital media to market alcohol products: A narrative review.. Addiction (Abingdon, England),, 2017. [DOI]
73. Wanting-liking dissociation and altered dopaminergic functioning: Similarities between internet gaming disorder and tobacco use disorder.. 2024. [DOI]
74. Addictions in the COVID-19 era: Current evidence, future perspectives a comprehensive review.. Progress in Neuro-Psychopharmacology & Biological Psychiatry,, 2021. [DOI | PubMed]
75. Internet gaming disorder and online gambling disorder: Clinical and personality correlates.. Journal of Behavioral Addictions,, 2017. [PubMed]
76. Problematic gaming is associated with some health-related behaviors among Finnish vocational school students.. International Journal of Mental Health and Addiction,, 2020
77. Social isolation, loneliness and depression in young adulthood: A behavioural genetic analysis.. Social Psychiatry and Psychiatric Epidemiology,, 2016. [DOI | PubMed]
78. Cross-sectional study of co-occurring addiction problems among high school students in Tunisia.. Eastern Mediterranean Health Journal,, 2023. [DOI | PubMed]
79. Digital gaming culture in Vietnam: An exploratory study.. Leisure Studies,, 2020. [DOI]
80. Predictors of outcomes of psychological treatments for disordered gambling: A systematic review.. Clinical Psychology Review,, 2016. [DOI | PubMed]
81. Cross-sectional and longitudinal epidemiological studies of internet gaming disorder: A systematic review of the literature.. Psychiatry and Clinical Neurosciences,, 2017. [DOI | PubMed]
82. Exploring differences in substance use among emerging adults at-risk for problem gambling, and/or problem video gaming.. International Gambling Studies,, 2020
83. Concurrent gaming disorder/internet gaming disorder and electronic nicotine delivery systems dependency in emerging adults.. International Journal of Mental Health and Addiction,, 2021
84. Assessing nicotine dependence in adolescent E-cigarette users: The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) nicotine dependence item Bank for electronic cigarettes.. Drug and Alcohol Dependence,, 2018. [DOI | PubMed]
85. Measuring problematic internet use, internet gaming disorder, and social media addiction in young adults: Cross-sectional survey study.. JMIR Public Health and Surveillance,, 2022. [PubMed]
86. Facets of impulsivity in gaming disorder: A narrative review.. Current Addiction Reports,, 2023. [DOI]
87. Assessing the risk of bias of quantitative analytical studies: Introducing the vision for critical appraisal within JBI systematic reviews.. JBI Evidence Synthesis,, 2023. [DOI | PubMed]
88. The problematic use of Information and Communication Technologies (ICT) in adolescents by the cross sectional JOITIC study.. BMC Pediatrics,, 2016. [PubMed]
89. More than a just a game: Video game and internet use during emerging adulthood.. Journal of Youth and Adolescence,, 2010. [DOI | PubMed]
90. Gaming device usage patterns predict internet gaming disorder: Comparison across different gaming device usage patterns.. International Journal of Environmental Research & Public Health [Electronic Resource],, 2017
91. An overview of the gaming industry across nations: Using analytics with power BI to forecast and identify key influencers.. Heliyon,, 2022. [DOI]
92. The effect of caffeine use in the relationship between gaming and sleep in adolescents: A mediation analysis.. Journal of Behavioral Addictions,, 2025. [DOI | PubMed]
93. Emotional dysregulation in children and adolescents with psychiatric disorders. A narrative review.. Frontiers in Psychiatry,, 2021. [DOI | PubMed]
94. Scoping reviews. In. JBI manual for evidence synthesis., 2020. [DOI]
95. The development and psychometric evaluation of the Internet Disorder Scale (IDS-15).. Addictive Behaviors,, 2017. [PubMed]
96. Problem Oriented Screening Instrument for Teenagers | www.euda.europa.eu. (n.d.). Retrieved November 28, 2024, from https://www.euda.europa.eu/drugs-library/problem-oriented-screening-instrument-teenagers_en.
97. Playing video games while using or feeling the effects of substances: Associations with substance use problems.. International Journal of Environmental Research and Public Health,, 2011. [DOI | PubMed]
98. Prevalence of internet gaming disorder in German adolescents: Diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample.. Addiction,, 2015. [DOI | PubMed]
99. Empirical validation of the CRAFFT abuse screening test in a Spanish sample.. Adicciones,, 2019. [DOI | PubMed]
100. Alcohol and other substance use during the COVID-19 pandemic: A systematic review.. Drug and Alcohol Dependence,, 2021. [DOI | PubMed]
101. Stigma, social inequality and alcohol and drug use.. Drug and Alcohol Review,, 2005. [DOI | PubMed]
102. Yale Food Addiction Scale 2.0 (YFAS 2.0) and modified YFAS 2.0 (mYFAS 2.0): Rasch analysis and differential item functioning.. Journal of Eating Disorders,, 2022. [DOI | PubMed]
103. Personality traits and psychopathology in adolescents with videogame addiction.. Adicciones,, 2021
104. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol Consumption-II.. Addiction,, 1993. [DOI | PubMed]
105. Emotion regulation and impulsivity in young adults.. Journal of Psychiatric Research,, 2012. [DOI | PubMed]
106. Risk-taking behaviors considering internet gaming disorder among Iranian university students: A latent class analysis.. Journal of Research in Health Sciences,, 2022. [PubMed]
107. Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID).. The Journal of Clinical Psychiatry,, 2010. [DOI | PubMed]
108. Stress, internet use, substance use and coping among adolescents, young-adults and middle-age adults amid the ‘new normal’ pandemic era.. Clinical Epidemiology and Global Health,, 2021. [DOI]
109. Gaming under the influence: An exploratory study.. Journal of Behavioral Addictions,, 2018. [DOI | PubMed]
110. The drug abuse screening test.. Addictive Behaviors,, 1982. [DOI | PubMed]
111. Unravelling the web of addictions: A network analysis approach.. Journal of Behavioral Addictions,, 2022
112. Emotion regulation in substance use disorders: A systematic review and meta-analysis.. Addiction (Abingdon, England),, 2023. [DOI | PubMed]
113. Assessing the symptoms of internet gaming disorder among college/university students: An international validation study of a self-report.. Psihologija,, 2020. [DOI]
114. Global prevalence of gaming disorder: A systematic review and meta-analysis.. The Australian and New Zealand Journal of Psychiatry,, 2021. [DOI | PubMed]
115. Perceived problems with adolescent online gaming: National differences and correlations with substance use.. Journal of Behavioral Addictions,, 2020. [PubMed]
116. Internet gaming disorder and risky behaviours among Czech adolescents: A nationally representative study.. Journal of Behavioral Addictions,, 2024. [DOI | PubMed]
117. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). (n.d.). Retrieved November 28, 2024, from https://www.who.int/publications/i/item/978924159938-2.
118. World of warcraft and alcohol: A secret love story?. The Canadian Journal of Addiction,, 2009. [DOI]
119. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation.. Annals of Internal Medicine,, 2018. [DOI | PubMed]
120. Evaluation of internet gaming disorder, social media addiction, and levels of loneliness in adolescents and youth with substance use.. Substance Use & Misuse,, 2021. [PubMed]
121. The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents.. Journal of Behavioral Addictions,, 2014. [DOI | PubMed]
122. The relationship between loot box buying, gambling, internet gaming, and mental health: Investigating the moderating effect of impulsivity, depression, anxiety, and stress.. Computers in Human Behavior,, 2025. [DOI]
123. Co-occurrence of addictive behaviours: Personality factors related to substance use, gambling and computer gaming.. European Addiction Research,, 2012. [DOI | PubMed]
124. Alcohol consumption in Chinese young adult gamers: Factor structure and measurement invariance of the alcohol use disorders identification test (audit).. International journal of mental health and addiction., 2022
125. The link between problematic internet use, problematic gaming, and psychological distress: Does sleep quality matter?. BMC Psychiatry,, 2021. [DOI | PubMed]
126. Problematic use of video games, social media, and alcohol: Associations with mother-child relationship.. Psychopathology,, 2023. [PubMed]
127. Problematic use of video games, social media, and alcohol: Exploring reciprocal relations with the big five personality traits in a longitudinal design.. European Journal of Investigation in Health, Psychology and Education,, 2025. [DOI | PubMed]
128. Behavioral addictions and their reciprocal associations with each other, substance use disorders, and mental health problems: Findings from a longitudinal cohort study of young Swiss men.. Journal of Behavioral Addictions,, 2025. [DOI | PubMed]
129. ICD-11: International classification of diseases (11th revision).. 2022
130. Problematic use of alcohol and online gaming as coping strategies during the COVID-19 pandemic: A mini review.. Frontiers in Psychiatry,, 2021. [DOI | PubMed]
131. Using emotion regulation strategies after sleep deprivation: ERP and behavioral findings.. Cognitive, Affective & Behavioral Neuroscience,, 2019. [DOI]
132. Attentional biases and daily game craving dynamics: An ecological momentary assessment study.. Journal of Behavioral Addictions,, 2022. [DOI | PubMed]
133. Dimensions of sensation seeking.. Journal of Consulting and Clinical Psychology,, 1971. [DOI]