Brain Biology and Preventing Excessive Video Gaming (encore)

Summary

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Parenting in the Screen Age - The Screenagers Podcast

Episode: Brain Biology and Preventing Excessive Video Gaming (Encore)
Host: Delaney Ruston, MD
Date: June 15, 2026

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Episode Overview

In this encore episode, Dr. Delaney Ruston explores the neuroscience behind video gaming, particularly focusing on the brain’s reward system and how excessive gaming can impact motivation, attention, and emotional well-being in youth. She’s joined by Dr. Clifford Sussman, a psychiatrist specializing in tech overuse, and Andrew, a former gaming addict now working in recovery, as well as Ty, a 15-year-old gamer. The episode dives into research and real-life perspectives, offering practical, actionable advice for parents on navigating video games with their kids and fostering balanced habits.

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Key Discussion Points and Insights

1. Video Games as Connection and Entertainment

• Ty (00:03): Describes playing multiplayer online games during periods of social isolation:
  “I know a lot of people, including myself, have been playing more video games, like online or like multiplayer games... we can do stuff together since we can't really see each other in person.”

2. Understanding the Brain’s Reward System

• Dr. Sussman (03:00): Outlines how video gaming escalates dopamine release, which can affect how the brain experiences pleasure and motivation.
  “Excessive use of anything that produces the heavy release of dopamine... will cause changes in the brain, like down regulation of dopamine receptors.”

• Delaney Ruston clarifies (03:25):
  “For dopamine to cause a pleasure feeling, it has to be taken up by receptors on a neuron. But if there starts to be lots and lots of dopamine, the neuron will make less receptors, so not to be flooded by dopamine.”

• Dr. Sussman (03:45):
  “If you have fewer dopamine receptors, it's like you have fewer receptors for pleasure… You feel more bored by everything. You feel worse at rest. Like when you're not getting reward. It's like reward withdrawal, if you will.”

3. Brain Imaging and Effects of Excessive Gaming

• Dr. Sussman (05:12): Discusses functional MRI research:
  “They can show... much less response to dopamine and much less response to reward in the group that games excessively.”
• Delaney Ruston (05:27): Sums up:
  “Less response to rewards, less pleasure from everyday things. We don't want that for our kids.”

4. High Dopamine vs. Low Dopamine Activities

• Dr. Sussman (05:39, 06:02): Introduces the concept of balancing “high dopamine” (immediate reward) and “low dopamine” (delayed gratification) activities:
  “I look to see if there’s a balance between what I call high dopamine and low dopamine activities.”
  “I'm talking about activities like doing homework or even playing a sport or doing exercise or a board game. All those activities have more delayed gratification.”

• Explains why this balance is crucial for upregulating dopamine receptors in the brain.

5. Delayed Gratification Explained

• Dr. Sussman (07:01):
  “It’s not the level of fun. It’s more how long you’re waiting to get a reward... Baking is the perfect example. Even once you prepared the food, you have to wait for it to cook and certainly has a great reward when you get to eat the food, but it has a pretty significant delay.”

6. Practical Parenting Guidance on Video Gaming

• Dr. Sussman (07:49): Suggests a simple, flexible structure:
  “If their kid’s on for, let’s say, an hour, then the low dopamine activity should last at least that long before they’re allowed to have another high dopamine block.”

• This “block scheduling” helps prevent long, unbroken gaming binges and encourages brain recovery.

7. The ‘Pro Gamer’ Question

• Delaney Ruston (08:45): Asks how to handle teens who aspire to professional gaming:
• Dr. Sussman (08:54, 09:37):
  “You can actually be a professional gamer without being addicted... I completely respect professional gaming as a sport. I get it.”
  “Oftentimes it’s not necessarily a good road for kid to take. They may be using it as sort of an excuse to game more, or... as a way for them to stay in their virtual world without having to be in the real world.”

8. Lived Experience: Andrew’s Story

• Andrew (10:11): On the reality of competitive gaming:
  “To be really, really good at that, you have to give up a lot of other things. And most people will never be good enough to be in the top.”

• Andrew (10:29): On the psychological component:
  “I think there's an inherent need for people to have a sense of competency... and so a lot of people that I’ve seen have sort of destroyed their well being over pursuing something that really got them nowhere.”

• Andrew (10:59): Shares his past of excessive gaming, internet use, and binge-watching.

• Now, Andrew helps others at Restart, a recovery program, as its first staff member who is also an alumnus.

9. Recognizing Problematic Gaming

• Andrew (12:08):
  “The biggest sign is that it’s taking away from other aspects of someone’s life in a significant way... binge watching or the playing video games or whatever it is becomes priority number one. It’s pretty hard to have a balanced life when you’re prioritizing watching shows or playing video games over having friends, working out, eating healthy, working...”

10. The Value of Other Interests

• Ty (14:38): Lists his non-gaming passions:
  “If I’m not playing a video game, I’m typically outside, you know, riding a skateboard or I’m playing baseball or I’m working out or I’m playing the guitar or at school or I’m reading.”

11. Additional Tips for Parents

• Dr. Sussman (15:05): On managing time:
  “Kids, and even older kids, lose track of real world time when they're on a screen. We call it time distortion... Visual timers are great. They make one called the Time Timer where you just turn a dial and you see a visual representation of how much time is remaining.”

• Routine and Consistency: Consistent screen schedules reduce power struggles.

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Notable Quotes & Memorable Moments

• Dr. Sussman (03:45):
  “It’s almost like being desensitized for pleasure. You feel more bored by everything. You feel worse at rest...It’s like reward withdrawal, if you will.”

• Andrew (10:29):
  “There’s an inherent need for people to have a sense of competency in anything. And for most gamers... that’s video games... a lot of people have destroyed their well being over pursuing something that really got them nowhere.”

• Dr. Sussman (07:49):
  “If their kid’s on for, let’s say, an hour, then the low dopamine activity should last at least that long before they’re allowed to have another high dopamine block.”

• Ty (14:38):
  “If I’m not playing a video game, I’m typically outside... riding a skateboard... playing baseball... working out... playing the guitar... at school... or reading.”

• Andrew (13:57):
  “The main reason is seeing other people come to the same realizations that I did and start to make those positive changes... that’s why I continue to work there.”

• Dr. Sussman (15:05):
  “Visual timers are great... you see a visual representation of how much time is remaining. It’s kind of like a more modern version of Hourglass.”

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Timestamps for Major Segments

• 00:03 – Ty on games as social connection
• 02:05 – Dr. Sussman on weekend binges, attention, and school
• 03:00 – Brain changes linked to continuous dopamine from gaming
• 04:41 – Brain imaging studies and diminished reward response
• 05:39 – High vs. low dopamine activities
• 07:49 – Scheduling “high dopamine” and “low dopamine” activity blocks for balance
• 08:54 – The “Pro Gamer” question and real-world considerations
• 10:11 – Andrew on the sacrifices and realities of pro gaming
• 12:08 – What distinguishes problematic gaming from regular use
• 14:38 – Ty’s non-gaming hobbies and balance
• 15:05 – Dr. Sussman on “time distortion” and the value of visual timers

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Practical Takeaways for Parents

• Balance “high” and “low” dopamine activities: Aim for equal or longer periods of delayed gratification activities after video game sessions.
• Avoid long, unbroken gaming binges: Use time blocks and consistent patterns in gaming schedules.
• Watch for red flags: Prioritizing games over health, social life, and achievement may signal a problem.
• Support a variety of interests: Encourage sports, music, reading, and other meaningful non-screen activities.
• Use visual timers: Tools like the “Time Timer” can help keep gaming sessions within agreed limits and reduce battles over screen time.
• Stay engaged and curious: Open, honest conversations with your child about their motivations, ambitions, and experiences with gaming are key to understanding and guiding healthy habits.

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Final Thoughts

The episode challenges parents to rethink how they address gaming—not as something inherently harmful, but as an activity that requires mindful moderation. Drawing from both clinical insight and lived experience, Dr. Sussman and Andrew show that with the right supports and routines, kids and teens can enjoy technology as a positive part of balanced, fulfilling lives.

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Transcript

[Ty]

I know a lot of people, including myself, have been playing more video games, like online or like multiplayer games they can play with each other. So, you know, we can like, you know, do stuff together since we can't really see each other in person.

[Dr. Clifford Sussman]

Like, I look to see if there's a balance between those, what I call high dopamine and low dopamine activities when I'm trying to assess whether somebody is gaming excessively.

[Delaney Ruston]

Hello, I'm Delaney Reston. I'm a physician and filmmaker and this is the Screenagers podcast where we explore the complexities of growing up in the digital age and find ways to promote healthy screen time. For almost a decade, I've been researching solutions for families, including my own, because this is not easy. My films, Screenagers and Screenagers Next Chapter show my struggles parenting around screen time issues, video games, social media, mental health challenges and so much more. And I'm still on this journey with you and all the kids and teens in our lives. Today's episode is about video gaming. Video games provide plenty of entertainment. And now with COVID So many young people have told me how happy they are that they have video games as a way to stay connected to their friends. But what are some of the concerns when playing video games for long stretches? And what are practical tips for parenting around video games? We explore these issues with Dr. Clifford Sessman and we'll hear from Andrew who was in Screenagers getting help with excessive gaming. And you might be surprised to learn what he's doing now. But first, here is ty again, the 15 year old you heard at the start of the show.

[Ty]

I really, really like a game. I think the longest I've ever gone like non stop is probably like three hours. If I play for a longer time, then other things will seem boring or hard to focus and I'll just be tired from like, you know, playing the game and stuff.

[Dr. Clifford Sussman]

If a kid binges on games all weekend, they may not pay as well attention in school and they may be more bored than they usually are.

[Delaney Ruston]

That's Dr. Clifford Sussman.

[Dr. Clifford Sussman]

I'm a gamer myself.

[Delaney Ruston]

Dr. Sussman is a child and adolescent psychiatrist who specializes in helping youth regain balance from tech overuse.

[Dr. Clifford Sussman]

It was never my idea to stop kids from gaming or from using screens. My goal is to help families and kids find more of a balance.

[Delaney Ruston]

Dr. Sussman Co wrote a review of the biology of the brain in video gaming. He's interested in how the reward system of the brain relates to how many hours of gaming can make Other things feel more boring. Can you speak a little bit about research related to high use of video games and other screen activities and the reward system?

[Dr. Clifford Sussman]

Yeah. A lot of those brain changes are in the parts of the brain that are most associated with the dopaminergic pathways, which is the reward system of the brain. Excessive use of anything that produces the heavy release of dopamine and continuous release of dopamine will cause changes in the brain, like down regulation of dopamine receptors,

[Delaney Ruston]

downregulation of receptors, meaning less receptors. For dopamine to cause a pleasure feeling, it has to be taken up by receptors on a neuron. But if there starts to be lots and lots of dopamine, the neuron will make less receptors, so not to be flooded by dopamine.

[Dr. Clifford Sussman]

If you have fewer dopamine receptors, it's like you have fewer receptors for pleasure. And it's almost like being desensitized for pleasure. You feel more bored by everything. You feel worse at rest. Like when you're not getting reward. I mean, I see it all the time in practice. Parents will report to me that my patients will be in a completely different state when they binge for hours on a game. They're just like a different person with a different personality. And most gamers who've binged for many hours in a row will notice that when they get off, they're just irritable. They're not feeling quite, quite right. It's like reward withdrawal, if you will. It seems like the only thing that will make them feel better is to get back on a game, but it doesn't quite make them feel as much better as they like.

[Delaney Ruston]

Doctor Sussman mentions brain imaging studies done with people who've experienced really problematic, excessive video game use.

[Dr. Clifford Sussman]

They have done studies where they've taken people who game excessively and they've taken people who don't game excessively, and they've compared the way their brains respond to different reward activities.

[Delaney Ruston]

Researchers use brain imaging devices called functional MRIs that show not just the structure of the brain but also the activity of the brain in real time.

[Dr. Clifford Sussman]

They can show how there's significant differences in the brains of both groups and how there's much less response to dopamine and much less response to reward in the group that games excessively.

[Delaney Ruston]

Less response to rewards, less pleasure from everyday things. We don't want that for our kids. And from a brain perspective, what does Dr. Sussman think is excessive?

[Dr. Clifford Sussman]

I look to see if there's a balance between what I call high dopamine and low dopamine activities. When I'm trying to assess whether somebody is using screens or gaming excessively high

[Delaney Ruston]

dopamine activities and low dopamine activities, I'd never heard of anything discussed this way. What are some of the low dopamine activities that Dr. Sussman is referring to?

[Dr. Clifford Sussman]

I'm talking about activities like doing homework or even playing a sport or doing exercise or a board game. All those activities have more delayed gratification. And you can even do activities with delayed gratification on a screen, for example, using a word processor or using Photoshop editor. Those delays in gratification, even if they're subtle, even if it's just a few minutes here and there, that make a huge difference in how much the brain releases dopamine during that time, that gives the brain a chance to upregulate those dopamine receptors.

[Delaney Ruston]

Studies suggest that with these low dopamine activities, the neurons can replenish their dopamine receptors, which is called upregulation. Can you say a little bit more about delayed gratification? Is, for example, when someone's doing their homework, is it that someday they'll, in a few hours they'll get it done? Or is it. Or playing a board game just that you're having fun, but it's just at a lower level.

[Dr. Clifford Sussman]

It's not the level of fun. It's more how long you're waiting to get a reward. Even doing an activity like playing a board game that's, let's say, entirely based on a video game and entirely based on some of the types of rewards you get in a video game, because a lot of board games now are wonderful because they're inspired by video game creators. The point is that you've got to set up the board, you've got to read the instructions, you have to wait for your turn. It's not all just coming at you continually. Baking is the perfect example. Even once you prepared the food, you have to wait for it to cook and certainly has a great reward when you get to eat the food, but it has a pretty significant delay.

[Delaney Ruston]

So what does this mean for parenting video games?

[Dr. Clifford Sussman]

So what I say to parents, just so they have sort of a simple rule to go by, is that if their kid's on for, let's say, an hour, then the low dopamine activity should last at least that long before they're allowed to have another high dopamine block. So that means that if you've just been playing Fortnite for an hour, that whatever activity you do Next needs to be low dopamine. So could be, for example, doing exercise. That's not to say that we're talking about an hour a day. Remember this is an hour at a time. So a teenager could have several hour long blocks in one day. They're just getting into the habit, the pattern of gaming for an hour at a time so that they can't get into these, you know, really long binges.

[Delaney Ruston]

What do you do when a teen says I want to be a professional video game player and you know, they have scholarships to college and whatnot.

[Dr. Clifford Sussman]

Well, I've actually worked with more than one patient who were professional gamers who had that with addiction or without. Because you can actually be a professional gamer without being addicted to video games. I've even worked on some sort of training schedules for gamers that allow for more of a balance between on screen and off screen activities. I completely respect professional gaming as a sport. I get it.

[Delaney Ruston]

And so if a teen says, look, I'm really trying to be a professional, you're still gonna screen for okay. Do you have healthy relationships? Are you still meeting other goals that you would have or is it truly just taking over? And then that would be a red flag.

[Dr. Clifford Sussman]

Right? And oftentimes it's not necessarily a good road for kid to take. They may be using it as sort of an excuse to game more, or they may be in this fantasy world where they see it as a way for them to stay in their virtual world without having to be in the real world. Professional gaming looks like a nice sort of way out to them or sort of a shortcut to life.

[Andrew]

Competitive video gaming is becoming more socially acceptable. The problem is that to be really, really good at that, you have to give up a lot of other things. And most people will never be good enough to be in the top.

[Delaney Ruston]

That's Andrew who experienced true video game addiction.

[Andrew]

I think there's an inherent need for people to have a sense of competency in anything. And for most gamers, you know, that's video games is their competency. And so a lot of people that I've seen have sort of destroyed their well being over pursuing something that really got them nowhere.

[Delaney Ruston]

Andrew received treatment at a recovery center called Restart and I filmed him for screenagers when he was there.

[Andrew]

My main thing was video games and you know, Internet use, binge watching videos and crawling message boards and things like that.

[Delaney Ruston]

Now Andrew actually works at Restart. For three and a half years he's been helping people there who are going through recovery. And he's the first Graduate of the program to come on board as staff. What are the people that you help serve? What are they coming in for?

[Andrew]

The client base is always so diverse, but all of them had problems with playing too many video games. I don't know specifically a lot of the video games that they were playing. I know a lot of them were binge watching shows and anime and things like that. On top of playing a lot of video games. I know some of them mentioned Fortnite. One of them mentioned Counter Strike Global Offensive. It's a competitive first person shooter, kind of like Call of Duty.

[Delaney Ruston]

What makes it a kind of a problem versus just teens who watch a lot? What are the signs or what do you see in people who makes you concerned?

[Andrew]

I think the biggest sign is that it's taking away from other aspects of someone's life in a significant way. So, you know, watching shows occasionally is fine as long as you still have, you're still getting out and forming, you know, relationships and keeping yourself physically healthy and mentally healthy and you have good habits and you're pursuing something that gives you meaning or fulfillment. The problem is, like all addictions, the binge watching or the playing video games or whatever it is becomes priority number one. It's pretty hard to have a balanced life when you're prioritizing watching shows or playing video games over having friends, working out, eating healthy, working, you know, so wonderfully stated.

[Delaney Ruston]

And you know, just I have to tell you that every time in screenagers, people, teenagers, kids, young adults see you play the piano and to hear you say, you know, I often wonder how much better I would even be if I hadn't spent so much time playing games or being online. You just, you see, it resonates with them and they start to really think for themselves. That kind of decisions that we all have to make. But particularly when the, you know, that age where learning and self identity are just so, so primed. We just don't want to lose that sense of self and confidence that comes from having a host of skills and experiences.

[Andrew]

Yeah.

[Delaney Ruston]

So I just want to thank you so much because that much more than any parent or me saying anything, you see them really start to contemplate. Oh yeah, I gotta think about that too.

[Andrew]

Yeah. I'm so glad that that's having a positive effect. I mean that that really justifies all the experiences I went through. And that's really the main reason I was actually talking with the clients about this, because some of them were like, why do you still work here? And I said the main reason is seeing other people come to the same realizations that I did and start to make those positive changes and realize that they can have a real and lasting permanent effect on your life and positive change in your life. That's why I continue to work there.

[Delaney Ruston]

Here's Ty again.

[Ty]

If I'm not playing a video game, I'm typically outside, you know, riding a skateboard or I'm playing baseball or I'm working out or I'm playing the guitar or at school or I'm reading. Those are the main, like five, six things that I do when I'm not playing video games.

[Delaney Ruston]

And when it comes to parenting around video games, Dr. Sessman mentioned a few other pointers.

[Dr. Clifford Sussman]

Kids, and even older kids lose track of real world time when they're on a screen. We call it time distortion. In other words, you don't really realize how much time is passing in the real world. Visual timers are great. They make one called the Time timer where you just turn a dial and you see a visual representation of how much time is remaining. It's kind of like a more modern version of Hourglass. If you have a consistent amount of time that you give your kid for their screen time, then usually they're expecting it when it's time to get off. And there's not as much of a power struggle when it's time to get off.

[Delaney Ruston]

It's so hard to have consistency around video gaming. With COVID 19 and with summer here, there's lots of ways to parent and we're all going to do this the best we can. So this whole episode is so much about inspiring conversations between you and youth in your life to talk about video gaming, people's experiences and research today. Dr. Sessman shared one theory that scientists have about the brain and dopamine in trying to explain why longer stretches of video playing causes some people to feel more bored and restless afterwards. Of course, the brain science around video gaming and other screen time activities is still in its infancy and we have a long way to go to really understand everything. What do your kids think about what Dr. Sussman talked about? Thanks for listening to the show and at screenagersmovie.com you can find more information and resources on what we cover today as well as other episodes and how you can see the screenagers movies and Sign up for my weekly blog called Tech Talk Tuesdays. What topics do you want covered in this podcast? Email [e-mail] we would love your help to spread the news of this new show and when you subscribe and rate it on itunes or wherever you get your podcasts, it truly helps people find it and tell your friends. In coming episodes, I talk with teens about TikTok's takeover and hear their solutions as well as I talk to some of my favorite parenting experts on issues like overcoming parent conflicts. When it comes to screen time, I want to give a huge thank you to Dr. Clifford Sessman and Andrew and Ty for being on the show, but also letting us use their music. And thank you to my team, my co producer Lisa Tabb, and our sound engineer Chris Mann. I'm your host Delaney Rustin, also the producer and editor of the Screenagers podcast, and I really look forward to our time together. On the next episode Sat.