Jesse Fagan

Screening and brief intervention for substance use in health care systems is recommended to identify and intervene with patients who abuse alcohol and other substances. However, there is limited research on the utility of short, single-item questions to identify illicit substance users. Pilot validation of two single-item screening questions to detect illicit substance use, one for marijuana and one for other illicit drugs. The goal was to identify sensitive, time-efficient screening questions that can be easily integrated into busy health care settings. A cross-sectional design was used. At intake, along with questions for tobacco and alcohol, nurses administered two brief screen questions to adult patients seen in designated areas in a large urban medical center. After patients were triaged to rooms, health educators (blind to brief screen responses) administered the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the reference standard. On the ASSIST, 14% and 9% of participants reported risky marijuana and illicit (nonmarijuana) drug use, respectively. Sensitivity values for the marijuana and street drug questions were 72% (95% confidence interval [CI] 67% to 78%) and 40% (95% CI 32% to 48%), respectively. Specificity values for the marijuana and street drug questions were 96% (95% CI 95% to 97%) and 99% (95% CI 98% to 99%), respectively. Values differed minimally as a function of patient characteristics. It is important to use validated questions to identify substance misuse so that individuals are not missed in the screening process. It is the possible that administration protocols play a role in detection rates. Future research is needed to identify easy-to-administer drug use screening questions.

We use ethnographic, interview, and survey data to examine problematic play within the popular online game, World of Warcraft, or ‘WoW’ for short. Research shows that players drawn to the interpersonal dimensions of online games are more prone to experience negative outcomes associated with their computer use. Our study suggests that it is not only whether online gamers seek meaningful social interactions that determine if WoW play becomes problematic, but exactly how players interact with others in online game-worlds. Specifically, levels of problematic WoW play depend on the extent gamers play with offline or ‘real-life’ friends and relations. Our survey data reveals both a direct relationship between playing WoW with offline friends and problematic online gaming and also an indirect one mediated by ‘immersion’ (defined as the extent that players feel like they are in a virtual world and in some cases actually their character). Interpreting these results through ethnographic and interview data, we suggest that playing WoW with real-life-friends allows gamers to transfer in-game accomplishments and experiences into offline social networks. Rather than competing and conflicting with the world outside of the game, WoW played in this way tends to enhance gamers’ offline lives. Further, by keeping gamers in touch with perspectives outside of WoW, playing with real-life-friends instills critical distance and greater awareness of how excessive play can damage offline commitments and relationships, allowing gamers to better monitor, evaluate, and ultimately regulate excessive game-play.► Playing MMOs with offline friends and relations allows for healthier online gaming. ► Playing MMOs with real-life-friends allows gamers to enhance their offline lives. ► Playing MMOs with offline friends allows for better monitoring and control of online play. ► Playing MMOs with real-life-friends can lessen players’ experience of immersion. ► Less immersion in these online gaming contexts can also lead to healthier play.

Videogame players commonly report reaching deeply “immersive” states of consciousness, in some cases growing to feel like they actually are their characters and really in the game, with such fantastic characters and places potentially only loosely connected to offline selves and realities. In the current investigation, we use interview and survey data to examine the effects of such “dissociative” experiences on players of the popular online videogame, World of Warcraft (WoW). Of particular interest are ways in which WoW players’ emotional identification with in-game second selves can lead either to better mental well-being, through relaxation and satisfying positive stress, or, alternatively, to risky addiction-like experiences. Combining universalizing and context-dependent perspectives, we suggest that WoW and similar games can be thought of as new “technologies of absorption”—contemporary practices that can induce dissociative states in which players attribute dimensions of self and experience to in-game characters, with potential psychological benefit or harm. We present our research as an empirically grounded exploration of the mental health benefits and risks associated with dissociation in common everyday contexts. We believe that studies such as ours may enrich existing theories of the health dynamics of dissociation, relying, as they often do, on data drawn either from Western clinical contexts involving pathological disintegrated personality disorders or from non-Western ethnographic contexts involving spiritual trance.