Alexander is the first patient at the newly opened ReSTART, a video-game and Internet addiction recovery program in Fall City, Wash., about 30 miles east of Seattle. It's hard to imagine Alexander, now merrily giving a tour of the woodsy facility, glued to a computer game for more than 16 hours a day, but he says, "It was pretty much all I was doing when I was in college."
Nearly a year ago, Alexander had gotten so consumed with the online fantasy game World of Warcraft that he would skip meals and forgo sleep to keep up with the action. Several times he tried unsuccessfully to wean himself off the game. On the brink of failing out of school, Alexander approached his dad for help. "I had a brief moment of clarity," he says.
Alexander's parents were supportive, and checked him into an addiction treatment center in Eastern Washington. But his fellow patients at the center were battling alcoholism, heroin addiction and other serious substance abuse problems — issues Alexander couldn't relate to. "It wasn't really working for me," he says. He left the center to try a wilderness adventure program in the Utah desert (which didn't help either), until his parents discovered ReSTART, where, for $15,500 (including application, screening and treatment fees), "guests" could spend 45 days cut off from the computer, integrated into a real family's home with chores, daily counseling sessions and weekly therapy.
Not every psychologist would agree that Internet or video-game dependency is a legitimately diagnosable problem. Some suggest that pathological game-playing or Internet surfing is not an addiction per se, but a symptom of a deeper issue, such as depression or anxiety. But Cash believes the virtual world can be no less addicting than other activities, such as gambling. She describes her first patient who exhibited signs of compulsion: He had come to her in a moment of crisis 15 years ago — having discovered a text-only role-playing computer game that was conceptually similar to Dungeons and Dragons, he had begun dedicating nearly all of his time to the game. He got fired from his job at nearby Microsoft, and his marriage was falling to pieces. Cash realized he was showing the classical signs of addiction. "I was so intrigued," says the co-author of the recent book Video Games and Your Kids: How Parents Stay in Control. "That was what started me on my path."
Since then, Cash has focused her practice on video-game and Internet addiction, treating patients who use their electronic media so obsessively that they stop sleeping and eating properly, ruin relationships with loved ones, suffer repetitive use injuries such as eye strain and carpal tunnel syndrome, and develop depression and anxiety, among other things. Cash's private practice is located in Redmond, Wash., the home of Microsoft — not an entirely surprising hub of compulsive Internet and video-game use, she says. Indeed, the Seattle-Tacoma area is the nation's 13th largest media market, and has the highest level of Internet use in the country; according to a recent study, more than 45% of adults in the area regularly play video games. "There's nothing wrong with this technology," says Cash, who is careful to note that it's not the medium that is to blame, but rather, the lack of education about it. "It's all in how it's used."
Although extreme cases of Internet and video-game addiction have not been widely publicized in the U.S., it's a different story in Europe and in East Asia, where game-playing has even been linked to player death. In 2006 an in-patient addiction facility for Internet and video-game abuse was opened in Amsterdam, and there are several similar programs operating in China. Cash visited one such facility — run out of a military hospital — last November. "It was half boot-camp and half-psychotherapy," she says, theorizing that the wider recognition of the problem overseas may stem from the more public nature of gaming there, as people often rely on Internet cafes to play. In the U.S., however, most people use the Internet or have a game console in their own home, so problems of abuse may be going unnoticed.
That may continue for some time, given the lack of study on the topic. Although the term "video game addiction" appeared in the research as early as 1983 — in reference to kids getting hooked on arcade games — the scientific evidence hasn't progressed much since. Anecdotally, therapists who now specialize in video-game and Internet addiction say it's a growing and serious problem. But it will be some time before it meets the threshold for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). "The central issue is the absence of research literature on this," says Dr. Charles O'Brien, director of the University of Pennsylvania's Center for Studies in Addiction and the current chair of the DSM-V committee to revise the manual, adding that with the backdrop of the health-care debate, now is a precarious time to introduce new disorders that will require more money to treat.
