FALL CITY, WASH.— At an internet addiction recovery centre east of Seattle, six men huff their way through an early-morning cross-fit exercise, lifting weights while Timbaland’s “The Way I Are” blares over the speakers.
At the front, Cosette Rae, their psychotherapist, also works out. Her blue knee socks are emblazoned with Facebook’s “f” logo, an unusual choice for the co-founders of reStart, a facility based in Fall City, Washington.
Then, one of the addicts notices the socks. “Trigger! It’s a trigger!” he yells, jokingly, suggesting that the mere sight of Facebook blue could throw him off the wagon and back online.
The men, ranging in age from 17 to 41, drop their weights and burst into laughter.
The mental-health community is divided over whether Internet addiction actually exists, even with centres like reStart increasingly common around the world. Experts have debated its legitimacy ever since the early days of the web, in the mid-1990s.
But the American Psychiatric Association’s inclusion of “Internet use gaming disorder” as a topic bearing further research in May’s revised Diagnostic and Statistical Manual of Mental Disorders, the guidebook doctors use to diagnose psychiatric illness, has given proponents hope. Many view the move as the first step toward cementing internet addiction’s credibility inside the medical community.
Recent studies suggest the problem is widespread, with as much as 18.5 per cent of the U.S. population addicted to the web. One Stanford University survey found a staggering one in eight American adults showed signs of “problematic internet use.”
“Internet addiction, for me, is a compulsive action that you want to do over and over,” says Will, a 23-year-old Oklahoman who arrived at reStart on Nov. 5 last year. (He asked that his last name not be used.) After a few fruitless efforts to rein in his internet use, Will was a college dropout, wired for 12-hour stretches in his bedroom, gaming and browsing, which sometimes included five-hour YouTube benders. Plugging in had become a “habit, by nature,” he says, as necessary as eating or doing homework.
Eventually, Will’s concerned mother called reStart. Two days later, he boarded a flight to Seattle, crying as he said goodbye to his family.
ReStart co-founder and psychologist Hilarie Cash says internet addiction can induce self-involved behaviour, as well as foster dependency on family or friends. She, like many experts, firmly compares the disease to any substance addiction. “(Internet addiction) has to do with experience of a high, then development of tolerance over time and the requirement of more and more over time to achieve the desired effect,” she says.
But skeptics see this new field of research as rife with holes, especially since internet addiction has no clear-cut definition. They point out that diagnostic criteria differs from study to study, and there’s little biological evidence an Internet addict’s brain is fundamentally different than the average user’s. Diagnosing excessive internet use, they say, runs the risk of pathologizing what amounts to near-universal behaviour.
The first effort to identify symptoms came in 1996, when a University of Pittsburgh psychologist named Kimberly Young presented a groundbreaking study at the American Psychiatric Association’s annual conference in Toronto. She created a 20-question test that measures how seriously the web affects a person’s daily routine and social life. The questionnaire, still in widespread use, asks how often people feel frustrated when they can’t access the internet and how often they plug in longer than originally intended, among others.
As the field has evolved, researchers now probe for signs of moodiness, depression and social withdrawal stemming from unrestrained internet use; constant desires to plug-in; and unsuccessful attempts to curb usage.
Worldwide concern about how pervasive the internet has become has fuelled the spate of new research. A 2012 summary of research by Rae and Cash cited more than 70 scientific papers on internet addiction published in the last decade. Studies have shown internet and video game stimulation provokes an addictive dopamine kick in our brains.
But the next frontier of internet addiction is the search for genetic proof that some of us are biologically wired to become web addicts. Last September, German researchers found evidence that “problematic internet users” possessed a gene mutation similar to the one found in nicotine addicts. And last year, Chinese and U.S. researchers discovered so-called internet addicts had reduced “grey matter” in areas of the brain, including those responsible for memory and decision making.
Bruce Ballon, director of an internet addiction program at Toronto’s Centre for Addiction and Mental Health, calls excessive internet use a “public health issue.” The CAMH program, one of dozens of similar services across North America and Asia, provides counselling to about 200 young adults, 16 times more than when it began four years ago.
Université de Montréal psychologist Louise Nadeau, who is leading a five-year provincially funded study of 100 Quebec internet addicts, has also seen the effects firsthand. In 2010, she received case reports of her first 18 test subjects — all men, mostly in their 20s and 30s, who averaged 66 hours online each week. Nadeau was “flabbergasted” by the results, gleaned from a series of lifestyle assessments. The men said the internet had lulled the men into a sort of hypnosis, and they reported sensing a high similar to one experienced by gambling addicts.
They were “literally losing their lives,” Nadeau says. “I’m ready to stamp (internet addiction) as a mental health disease under the DSM and the World Health Organization.”
Mid-afternoon, 11 men settle in on the plush couches in reStart’s living room — six from the 45-day core program and five graduates, who room together at an outpatient centre in nearby Redmond but return to Fall City almost daily for treatment. Patients pay $14,000 for 45 days, though some have been at the centre for months.
After finding internet addiction treatment centres sorely lacking in the U.S., Rae and Cash started reStart four years ago. The facility occupies an isolated two-storey house on five acres about 40 km east of Seattle. Technology is checked at the door and locked in a safe upstairs, where Rae lives with her husband Gary, also the centre’s recreation director. The current residents, all men, struggle mostly with internet gaming and mobile technology abuse, but Rae says past patients, who have included women, were hooked on social media and texting.
One by one, the men, wearing sweatpants and hoodies and draped with heavy blankets, go around the room sharing stories about what brought them to reStart with a visiting University of Washington student who is considering checking himself in. The tales about their lives crumbling would not have been out of place at a support group for drug addicts or alcoholics.
A 41-year-old father of two, who did not want to share his name because his wife’s family lives in Ontario, says he spent every available hour gaming on his iPhone or iPad, even at work, even as his marriage foundered. Will, the Oklahoman, casually explains how he once played World of Warcraft for 41 hours straight. Scott Hubbard, a 27-year-old Alaskan fisherman who started gaming four years ago, says he hid his habit from family and friends, spiraling into a “constant cycle of loneliness that starts to get to you after a while.”
Then, with Rae’s encouragement, Mark Browning, a lanky 19-year-old with a mop of brown hair, speaks up. Browning arrived here in mid-November in sharp decline.
After he quit college with a ruinously low GPA, Browning’s parents sent him to a life-coaching program for young men called Insight Intensive. He then moved to his own apartment in Boulder, Colorado. But he quickly relapsed.
He would spend hours each day playing the online video game League of Legends in his apartment building’s business centre, where the internet connection was stronger than his own unit. He slept in the business centre, in front of his computer, woke up at 7 a.m. and started again.
The internet, he says, had become one of the “essentials of life,” along with air, water and food – though he rarely ate.
The conversation shifts to life at reStart. Participants undergo weekly 12-step meetings, mindfulness training and cognitive behavioural therapy. Otherwise, reStart feels much like a summer camp. The men sleep two to a room in bunk beds, work out together, hold game nights and do chores. They keep detailed schedules in day planners, and receive stipends when they complete weekly chores. Rae says the routine helps the men learn responsibility; many of them have previously depended on their parents for everyday needs.
Caffeine, often the fuel for all-hours internet use, is banned and the patients keep to a healthy diet. On occasion, they dine at a nearby pizzeria or venture to Costco with Rae and Gary. The group is putting together an indoor soccer team.
Throughout the afternoon’s discussion, Rae nods her head and offers fulsome praise. She calls them “pioneers,” some of the first to admit they’re suffering from what she believes is an increasingly global issue. “People here tell me, ‘Cosette, we think this is the hardest addiction to break, more than any chemical, because it’s free, legal, accessible, everywhere and everybody’s doing it,” she says in an interview.
Indeed, 95 per cent of teenagers age 12 to 17 and 96 per cent of 18-to 29-year-olds are online, according to the Pew Research Center’s Internet and American Life Project. Surveys suggest we’re spending at least 11 hours online each week, but experts believe that’s a conservative figure.
With that in mind, it has become tempting for more devout users to declare themselves web addicts. Like other behavioural or substance addictions, it’s the impact on your life, not the amount of time spent online that matters
“The way to define (internet addiction) is not by the number of hours you spend in front of your browser, it’s really by the offline consequences,” says Elias Aboujaoude, a Stanford psychiatrist and author of Virtually You: The Dangerous Powers of the E-Personality. “Is your productivity at work affected? Is it affecting your relationship, whether romantic or personal? Is it affecting your academic performance? You look at the offline effects, not so much at what the person is doing online or how much time they’re spending in front of their browser.”
Researchers warn those effects are apparent in even the most casual internet users. Aboujouade, for one, believes a majority of people nowadays experience internet addiction on a wide spectrum of severity.
Like other men at reStart, web use had consumed Browning’s life. During those all-day binges in the business centre of his apartment building he would break only for short runs to a nearby Wendy’s. In one of his lowest moments, he hadn’t changed his clothes for two weeks. Online, he felt strangled by a hold he couldn’t escape. “It’s the only thing you want to do, and everything else falls to the wayside,” Browning explains. “It’s an activity that becomes uncontrollable by yourself.”
Yet, many researchers contend internet addiction cannot exist on its own. They say it is most likely a symptom of depression, social anxiety or obsessive-compulsiveness. Tufts University psychiatrist Ron Pies offers an example: If a clinically depressed person holes himself up in his room and spends all of his time on the internet, that seemingly addictive online activity could merely be a manifestation of his depression.
In that situation, “it would seen unnecessary to invoke a separate ‘disorder’ called internet addiction, in order to explain this person’s behaviour,” he says. “In an earlier era, he might have spent 17 hours a day secluded in his room reading or writing morbid poetry. We would not have diagnosed Morbid Poetry Fixation Disorder in addition to (depression).”
At CAMH’s internet addiction program, Ballon’s assessments go beyond his patients’ internet habits, probing for evidence of past trauma or symptoms of mental illness. That tactic often unearths underlying psychiatric issues — such as depression, PTSD or Asperger’s — he believes are the root causes of internet addiction. He then concentrates on those. For that reason, Ballon is skeptical of centres like reStart that focus exclusively on, and profess a reliable treatment for, internet abuse. (ReStart says it does address co-occuring mental disorders.) “One problem with having an assumption ahead of time is you’ll try to spin all the facts for your hypothesis,” he says.
One morning after breakfast, the men are in a familiar position, curled up on the living room sofas. Rae and Gary sit in the middle, firing off questions: What were some of the problems you noticed associated with your technology use? Do you think spending a lot of time online affects social skills?
Orderly discussion is fleeting in these morning meetings. Eli Jacobson, a 19-year-old outpatient from Florida, complains about the gratuitous flatulence at the house. Hubbard, the Alaskan fisherman, suggests a remedy: more women.
In their more serious moments, ReStart’s graduates praise the centre. Cold turkey separation from technology, they say, has allowed to them to focus on their health and repair broken relationships. The patients, Rae says, need to relearn, or in some cases learn, how to hold conversations and behave appropriately with other people.
For Jacobson, full recovery remains elusive, even after the 45-day intensive program. The teenager’s problems became evident after he left home in August 2011. He worked as a secretary at the University of Florida, in Gainesville, but would game into the early morning, sometimes skipping sleep altogether. Once, a month and a half passed before Jacobson showered and brushed his teeth.
By the time he quit his job and landed at reStart last summer, he had an 11-hour-a-day internet habit. He was gaunt, weighing just 143 pounds, and had begun drinking heavily.
At reStart, he threw himself into exercise and piano, one of his pre-addiction passions, and developed a therapeutic relationship with Dakota, the centre’s Australian shepherd. Now 180 pounds — “all muscle,” he says – he lives with another outpatient in a Redmond apartment, a short drive from the centre, and plans to study veterinary medicine.
But the cash-strapped teen is struggling to find a job and, during a case management session last month with three other outpatients, worried about the faulty brakes on his car, which he needs to check in at reStart. Despite a two-hour daily technology limit imposed by Rae and Cash, Jacobson has found himself drifting to Facebook or videos while job hunting online.
His rehabilitation has been a success thus far — but he has a ways to go. “I kind of treated it as 45 days and you’re done,” he says. “Then it was 45 days, and you’re still not done.”
Are you an addict?
Hilarie Cash, co-founder of reStart, an internet addiction recovery centre in Fall City, Wash., looks at 12 signs and symptoms when diagnosing internet addiction. If you answer yes to five or more, Cash suggests you may have a problem.
- Increased amounts of time spent on computer and Internet activities
- Failed attempts to control behaviour
- Heightened sense of euphoria while involved in computer and Internet activities
- Craving more time on the computer and Internet
- Neglecting friends and family
- Feeling restless when not engaged in the activity
- Being dishonest with others
- Computer use interfering with job or school performance
- Feeling guilty, ashamed, anxious or depressed as a result of behaviour
- Changes in sleep patterns
- Physical changes such as weight gain or loss, backaches, headaches or carpal tunnel syndrome
- Withdrawing from other pleasurable activities