The ESRB has defended its guidelines for depicting drugs after a study from Archstone, an addiction awareness group, found that video games commonly depict narcotic usage as having a positive in-game effect.
Archtone's study looked at real and fictional drug use in the top 100 best-selling games across all consoles. In particular, it considered how drug use was depicted, what in-game effects it had, and whether the player was encouraged to create drug cocktails for enhanced abilities.
The report notes: "The most common combination of drugs? Multiple stimulants. Nearly one-quarter of the games we looked at included more than one stimulant.
"Used to stay awake, gain energy, and get high, stimulants are extremely addictive.
"Common examples include cocaine, crack cocaine, and meth."
The study found that in 32% of cases, drugs provided a power-up of some kind, while 28% boosted a character's health.
In response to the report, a spokeswoman from the ESRB said: "The ESRB's robust rating submission process ensures accurate, detailed and reliable rating information that parents are aware of, regularly use and trust to help decide which games and apps are appropriate for their children and family."
Archstone head Logan Freedman noted that certain titles, such as the Fallout series, do demonstrate the adverse effects of long-term drug use as the game progresses.
Speaking with the BBC, the ESRB said it took time to consider the context of substance use when determining guidelines for parents.
"The ESRB rating system weighs factors that are unique to an interactive medium, such as the reward system, frequency, and the degree of player control among others," it said.
"Therefore, the mere presence of something like a health pack in a game may not result in a restrictive rating being assigned.
"However, given the context in which drugs appear in a game, the ESRB may assign a restrictive age rating, along with either the drug reference or use-of-drugs content descriptor."
Despite noting its concern, Archstone is not calling for the games to be modified in anyway.
"It comes down more to parents and what their kids play," Mr Freedman concluded.
"They're made for adults. It says [so] directly on the box."