This study found that concurrent use with some situational pattern or effect-seeking motivation behind it is, like PVP [21], not universal among those who engage in the prerequisite behavior, but still observable in an appreciable fraction: 42% of the entire valid sample of video gamers were concurrent users, and 66% of concurrent users at least partially endorsed one or more patterns/motivations. The reliable correlation of most patterns/motivations with PVP and substance use problems suggests that concurrent use is part of a shared underlying addictive process [47], as other research on concurrent use of substances with self-reinforcing behaviors [3–6,48,49] suggests.

Moreover, demographics, genre of concurrent use, and substance of concurrent use variables were all uniquely and differentially related to concurrent use frequency and patterns/motivations. Concurrent use to enhance an already enjoyable or positive experience – either being with certain friends, or use of certain substances to enhance the experience of certain games – was more strongly endorsed by younger participants. An example of this factor’s operation in context might be evident in ethnographic findings on parties among young marijuana users, where video games were commonly part of the entertainment [50]. Others of our results indicate differences among concurrent users in how concurrent use fits into the context of their lives, including that respondents with lower degrees of education reported longer hours/day of concurrent use, and non-working respondents reported greater degrees of use to pass time or regulate negative emotion.

Both intuitive and counterintuitive findings emerged for genre of concurrent use, which may further inquiry into connections between specific game features and problem video gaming behaviors [35]. In spite of the problem use potential of MMORPG’s [37,38], concurrent users of MMORPG’s were no more likely than others to endorse particular concurrent use patterns or motives. Other (non-MMO) RPG’s, in contrast, were associated with more days of concurrent use, greater endorsement of use to pass time or regulate negative emotion, and higher degrees of concurrent use to enhance an already-positive or enjoyable experience. This may have to do with differences in game play—one possible explanation is that it is easier to use a substance with non-MMO RPG’s because players can take non-MMO RPG’s at their own pace and do not have to remain engaged with other players in real time. First-person shooters (FPS) were also distinct from other shooters, significantly related to the same factors as RPG’s while other shooters were not. This may be because many FPS games are designed for team or competitive play among players gathered in person, and concurrent users use substances at these gatherings. Alternatively, perhaps the intensity of seeing the game from the character’s perspective—e.g., bullets flying right at the player’s face—occasionally causes a concurrent user to want something to calm them down. Board/card games were also associated with both concurrent use to pass time or regulate negative emotion and concurrent use to enhance an already-enjoyable or positive experience while gambling games were not, perhaps because even fictional money is enough to alter the experience of a board/card game. Finally, the category of other sports games, which included mostly multiplayer team sports simulations, was associated with concurrent use to enhance a positive experience, while the mostly motion-control sports-general games were not. This could be because of a special association between team sports simulation games and gatherings involving substance use, or perhaps because use of some substances makes the coordinated full-body motion required to play motion control games more difficult.

Substance use problems were not positively related to simple frequency or duration of concurrent use. They were, however, reliably related to the pattern/motivation factors, with some exceptions: For example, caffeine is understandably not helpful for calming down from video game related frustration (“rage quit” in gamers’ own parlance), nor does its withdrawal syndrome usually cause enough impairment to distract from normal activities. These and other non-significant findings among the general pattern of significant associations between substance use problems and pattern/motivation factors are potentially relevant to the concern of addiction specificity [34], in that every behavior/substance combination may have its own unique complementarity of effects, context of use, expectations among users as to what they will get out of it, and other unique considerations which ultimately affect which patterns of addictive behaviors will develop. Our measures were not, however, set up to directly operationalize addiction specificity itself, e.g., clinically significant substance use problems without PVP and vice-versa. It will be up to future work to explore those associations. Ideally, questions about media and other behavioral addictions would be added to existing nationally representative panel studies addressing substance use and health like NSDUH [44] or Monitoring the Future [51].

One way in which this study uniquely contributes to the literature is that, rather than focusing on specific game genres, game features, playing behaviors, or substances, it allowed for an open field of possible correlates. It also departed from this area’s frequent focus on youth problem behavior [15] by including a nationally representative sample of adults. It is limited, however, in that our survey’s 10-minute median length meant that established measures [42,44] had to be abridged. Hence, our references to “substance use problems” rather than actual abuse/dependence diagnoses. Also, as an internet survey, it was vulnerable to same risk of invalid response endemic to any survey method that does not have interviewers engaged in-person with participants. One symptom of this was that 15% of our respondents did not provide even one valid video game title. The online nature of the survey in and of itself, however, probably cannot be argued to be a limitation, as experiments have shown point estimates to be consistent across methods of obtaining random, representative survey samples [52]. Finally, our cross-sectional data can only contemporaneous association; they cannot address development of motivations for and patterns of behavior over time.

Although this study’s results did not coalesce into a simple story, we believe that this is actually a more authentic representation of the phenomenon under study than could have been achieved by focusing on specific demographics, substances, gaming behaviors, and game genres, or by oversimplifying the question into “are video games addictive?” Our results represent a complex issue in its complexity, suggesting that social situation, playing behaviors, genre and substance of concurrent use, and motivations for concurrent are all potentially relevant to the effect of concurrent use on individuals’ lives.