With the well-known serious effects of alcohol and nicotine dependence on adolescents’ well-being, and knowing that males are more exposed to violent video gaming, this study was conducted to examine the association between exposure to violent video gaming and alcohol, cigarette, and waterpipe dependence among male Lebanese adolescents.

This was a cross-sectional observational study conducted with Lebanese male students (13–17 years old) between October and December 2019. The Video Game Questionnaire was utilized to assess the content of violence in video games. For the assessment of alcohol, cigarette, and waterpipe dependence, the Alcohol Use Disorders Identification Test scale (AUDIT), Fagerström Test for Nicotine Dependence (FTND), and Lebanese Waterpipe Dependence Scale (LWDS) were used, respectively. Log transformation was used for the three addiction scores. Four linear regressions were performed taking the AUDIT, FTND, LWDS, and violent video gaming scores as dependent variables.

From the 388 students enroled (mean age= 15.83 ± 1.93 years), 190 (48.8%) were classified as having violent video gaming. Older age (beta=0.049) and more violent video gaming (beta=0.006) were significantly associated with more cigarette dependence. More violent video gaming (beta=0.003) was significantly associated with more waterpipe dependence. Older age (beta=−0.090) was significantly associated with lower alcohol use disorder, whereas more violent video gaming (beta=0.005) was significantly associated with more alcohol use disorder.

The study supports an association between higher exposure to violent video game and higher alcohol and smoking dependence among male teenagers in Lebanon. Hence, support and guidance should be implemented to raise awareness and protect teenagers.