A record number of people in the United States died from drug overdoses last year as the death toll rose by 30 percent from 2019 to over 93,000, according to the National Center for Health Statistics. Almost 70,000 deaths involved opioids. In San Francisco, more than twice as many people died from drug overdoses than covid-19, reflecting a statewide 45.9 percent increase in drug overdose deaths.
“PlaySmart” is one of several games that have been funded over the past decade by the National Institutes of Health and developed by Yale University’s play2PREVENT Lab, which designs games to promote “health, wellness, education and social intelligence.”
The game was made in part thanks to a grant from NIH’s Helping to End Addiction Long-term (HEAL) fund, which launched in 2018. The fund aims to help public health officials and health care providers better understand the root causes of the opioid crisis as well as research optimal treatments for opioid addiction and chronic pain.
The play2PREVENT Lab, founded in 2009, has created five video games about issues related to adolescent drug use, STI/HIV testing and prevention, and mental resilience. Akin to its other offerings, “PlaySmart” is a character-driven, cartoon choose-your-own-adventure style game where the players are placed into various situations, such as a party, and shown what happens if they make certain choices, such as kissing a person with herpes. The player is then taken through the consequences of that decision before being allowed to “go back in time” and make a different choice. The game also involves mini games that enable players to build up various skill sets, like persuasion, to better equip their characters to handle certain situations in the game.
But much like a blockbuster pharmaceutical, creating a video game, much less a good one, is a difficult, time-intensive process — especially when the goal is education and patient treatment.
Her lab’s development process — done in partnership with Pittsburgh-based game developer Schell Games and software maker Digitalmill in Portland, Maine — takes about a year. They start with focus groups of teens and incorporate into the game the stories they hear, pervasive blind spots of focus group participants, and photos that teens give them of their rooms, clothes and more.
Beyond attempting to teach young people how to respond to difficult situations, the games have also been a source of data collection, allowing researchers to better understand what players know about opioid abuse and other high-risk behaviors. Results from the lab’s studies have been published in peer-reviewed journals including Elsevier, Oxford University’s Health Education Research and Health Promotion Practice.
“It’s the ability to use something that’s fun and engaging, and that people really like, to deliver serious health information and skills building,” she said.
Vladimir Poznyak, head of the World Health Organization’s Alcohol, Drugs and Addictive Behaviors Unit based in Geneva, shares Fiellin’s thinking that games could be an effective measure in countering the drug crisis.
“We know, and now it’s a very rapidly developing area of gaming, [that] different types of interventions have prevention and even treatment potential,” Poznyak said. Earlier this year, the FDA approved a video game to help improve children’s attention spans.
On one level, Poznyak’s view that video games can help battle addiction would seem at odds with a recent controversial stance the WHO took on gaming. In 2018, Poznyak’s unit included “gaming disorder” in its International Classification of Diseases, a decision that did not resonate well with gamers.
The WHO defines gaming disorder as “a pattern of gaming behavior (‘digital-gaming’ or ‘video-gaming’) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” A diagnosis of gaming disorder requires at least a year-long pattern of behavior resulting in “significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
“There are many examples in the health arena when some substances, on one hand, have clearly documented beneficial properties if they’re used properly with the right indication and the right cases, and [on the other hand] the same substances can cause substance use disorders,” he said. “The treatment games are usually implemented and delivered in the context of an overall therapeutic strategy, which has controlled elements.”
Poznyak also noted that addictive games are different in nature to so-called “serious” games, like “PlaySmart.”
Fiellin said she hopes her game finds an audience among younger people who can internalize its lessons and also engage with a preventive program, one which she says is otherwise lacking in the U.S.
“From all perspectives, gaming and all the elements of gaming are becoming more used and important in more areas of our lives,” he said. “And of course this potential and this trend should be used also for public health objectives that can bring benefits to people.”
