Time for E-hab?
Treatment protocols emerge to address the growing problem of Internet and technology addiction
by Ethan Jacobs
Page 1
“What are you carving with that X-Acto knife?”
“Oh, I’m just shaving the resin off this mini,” Conor replied, holding up a jagged figurine to the webcam on his computer. He twisted the figure in front of the lens so I could admire the intricacies of the miniature model he built and was starting to paint. I couldn’t make out exactly what it was—some kind of warrior, or maybe a gun or a tank. But I could tell it required several hours of meticulous work to produce. “It’s a lot of fun,” he said. “It’s very time intensive, but it’s a great way to use my creative ability without going nuts.”
Conor was putting the finishing touches on a decorated model for a tabletop miniature war game called Warhammer 40,000, or WH40K, as it is more informally known. In this table-top game based in a sci-fi dystopian fantasy universe, players assemble miniature models of soldiers, weapons, and various creatures, collecting them over time so that their troops can compete with those of other players. “That part of my brain that’s all about conflict resolution in combat and military strategy and tactics—it’s still there. I still love it, and I always have,” he said.
During our conversation over Skype, Conor used words like “still” and “always” because between the ages of five and 18 – he’s now 21 – there was another way Conor satisfied his fascination with military strategy and combat tactics, which was much more destructive. For 13 years, Conor spent every waking hour he could playing video games. If he wasn’t playing them, he was scheming ways that he could. Addiction protocol classifies Conor as someone who has yet to fully thwart his dependence, even still. Recovery, he knows, is a life-long process.
Yet in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, Internet Gaming Disorder is listed in Section III’s appendix only as a condition that warrants more clinical research, not as a legitimate disorder. Furthermore, the more general classification of Internet Addiction Disorder does not even merit a “deserves more research” listing. Only gambling has qualified in the DSM-5 as a behavioral, non-substance related addiction, one that the pervasiveness of the Internet has also aggravated.
Although the dense glossaries of the DSM-5 have yet to include Internet and technology addiction, an increasing number of rehab facilities and services are popping up around the United States to address and treat the condition. This follows the lead of other heavily wired countries such as China and South Korea. As a result, more and more people are checking themselves into e-hab.
An elaboration of data by the International Telecommunications Unit and the UN’s Population Division indicates that more than one third of the global population uses the Internet. That makes more than three billion Internet users worldwide. Estimates are hard to come by but some studies by experts in the field, including Hilarie Cash and Cosette Rae, a team of Seattle-area clinicians, put prevalence rates as high as 18.5 percent of Internet users in the United States. That could mean Conor is one of nearly 59 million people in the country who suffer from an Internet-related addiction.
Conor may have no doubts about the nature of his condition, but clinicians have been debating the validity of Internet and technology addiction since the Internet became widely accessible in the late 1990s. Luckily for people like Conor, there are professionals in the field who have dedicated their careers to treating this condition that, from experience, they know is real. These efforts start in private practices and extend to include inpatient and outpatient treatment facilities and even online support groups and fellowships. Slowly but surely, Internet and technology addiction is gaining traction within the medical establishment, although not yet enough to gain official recognition as a full-fledged addiction.
Two years ago, Conor sought the help of an online fellowship and recovery program for people struggling with excessive and compulsive computer gaming. Since achieving sobriety with the help of this online community—“sober, clean, recovered, or whatever the hell you want to call it,” he groaned—Conor has reclaimed the time that his gaming habit used to consume. With more opportunity for leisure, Conor now directs his attention to outlets such as Warhammer 40K that have fulfilled both his creative impulses and his fascination with war tactics and strategy. “This is a safe means and a social means of getting that satisfaction,” he said, holding up a different model, “and that same part of the brain that’s tickled by gaming is just tickled a little bit less through the dice rolls of this game.”
As a recovering addict, Conor’s lucidity about his recovery over the past two years includes his understanding that the progress he has made thus far is only the beginning. As he explained, “I have to work on a daily basis to deal with this and that’s okay. I don’t really think too hard about the future because the future is fucking intense. You take it one step at a time. You have to or you go insane.”
A significant milestone in Conor’s recovery process was understanding that the magnitude of his gaming addiction was equal to that of the more common addictions. When he talks about his condition, he never differentiates it from drugs, alcohol or gambling. For him, gaming was always about escape. “There’s no addiction on the planet that is anything but escape,” he said, “and if anyone tells you otherwise, they’re completely wrong.”
Even over Skype talking to someone he had just met, the volume of Conor’s voice escalated quickly and his tone became aggressive when a question sparked his passion or a sharp counter. His hands gesticulated wildly. At certain points, I thought he was furious with me, and would shut off the connection or hurl himself through the interwebs to smack me over the head. It didn’t take him too long to share that he had been diagnosed with ADHD and bipolar disorder, both of which, he said, were exacerbated by an abusive relationship with his stepfather. “I have an intense personality and at times I’ve been told that people have to kind of brace themselves around me,” he said. “Because I’m just me.”
Every week via Skype or over the phone, Conor seeks help through a recovery community, a self-proclaimed fellowship known as Computer Gaming Addicts Anonymous. The sessions have helped him to become more aware of the impact that his demeanor has on others. In fact, he told me that he prefers the barriers provided by Skype, the chat rooms, or the phone calls because they keep his propensity for violent outbursts in check.
All the same, I found his abrupt, straight-forward style useful in understanding the nature of Internet-related addiction. Conor kept me on track when I asked him questions that struck him as glaringly unimportant.
“What kinds of games did you play in the worst phases of your addiction?”
He cut me off immediately. “What I played is largely irrelevant. You can probably name a game and I have played it or played a game like it and I would have played that game too, if I had the opportunity.”
“The thing with gaming,”—and addiction in general—“is that it affects the dopamine system and so it’s all about the adrenaline rush, the stimulation,” he said, “and basically getting as much of an adrenaline high as possible in as short a period of time as possible.” Conor’s substance of choice—video games—is merely the vehicle through which addiction consumes him. It could have been cocaine. He named this example because extreme uppers can amplify the outbursts of someone with as volatile a temperament as his.
Conor fully comprehended the problematic extent of his gaming when he filled out a modified Alcoholics Anonymous questionnaire at age 18. The answers to the questions on the usual questionnaire scale the magnitude of an alcohol problem, but a friend had sent him a version that replaced all the iterations of the word alcohol with the word gaming. “I fit all of the criteria,” Conor said. “There isn’t a single thing on that list that I don’t identify with.”
Conor’s experience with the questionnaire speaks for itself: there was no science or medical treatment involved. It allowed him to consider his sickness on par with other types of addiction, a comparison that is tough to make for a condition that has received so little attention. How different can Internet and technology addiction be from other types? From Conor’s perspective, they are one and the same.
Page 1
Page 2
In 2011, the American Society of Addiction Medicine modified the official definition of addiction to better pinpoint its real nature: a sickness, not a moral failure. The reworked version defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry.” Addiction, “which may or may not include alcohol and other drug use,” affects neurotransmission in the brain, altering motivational hierarchies and reward structures. Although this explanation is quite general, the “may or may not” language about drugs and alcohol involves what professionals call “process addictions,” or addictions that are not fed by substances. Internet and technology addiction falls under this classification.
Since part of the therapist routine during private sessions involves taking inventory of a patient’s mental well-being, which makes the therapist privy to a patient’s innermost struggles, it follows that therapists would be alert to signs of addictive behavior. However, the reality is that the overwhelming majority of clinical psychologists have not been trained in how to recognize the signs of addiction, let alone how to treat it.
“We have failed miserably in helping people deal with their addictions,” said Dr. Robert Scholz, the deputy director of Pepperdine University’s counseling center. Last November, Dr. Scholz organized a conference called “Technology Addiction and the Modern Family.” Some 100 clinicians spent a full day in Malibu on Pepperdine’s Drescher Graduate Campus, learning about Internet and technology addiction from presentations by four noted experts in the field. “We need to challenge clinicians to think differently about their work,” he said, “because we haven’t seen enough improvements.”
The conference’s overarching purpose, then, was to both educate clinical psychologists about addiction in general and to galvanize them to recognize the signs of Internet and technology addiction. Dr. Scholz wants to help therapists either treat the condition or refer these patients to others, just as they would a patient who was dependent on drugs or alcohol.
Themes at Pepperdine that day included genetics, cyberbullying, and obsessive computer usage and video gaming, along with discussion of the generational gap between analog-oriented therapists and their digital younger patients.
“How many of you here are under the age of 30?” was how Robert Weiss, a sex addiction specialist, started his opening address, titled “Closer Together, Further Apart –The Effect of Digital Technology on Addiction, Psychotherapy and Our Daily Lives.” As he had anticipated, only a few participants raised their hands in response. “Sadly, this is not a lecture for you guys because you already know everything I’m about to say,” Weiss went on. His icebreaker emphasized the guiding point in his presentation: that the generational gap between therapists and younger patients often hinders patient progress when the underlying issue is dependence to Internet and technology.
To Weiss, the defining feature of the generation divide has moved from the “We won’t listen to you!” of the 1960s to the “We can’t see or hear you!” of today. The younger generation now disconnects, ironically enough, by plugging in.
“When I was writing this last book,” he told the audience, a reference to his latest title, Sex Addiction 101, “I couldn’t write another Baby Boomer, Gen X book about how technology is ruining our lives, because that just isn’t true.” Weiss, was referring to an “all or nothing” mentality he believes is common among psychologists in his Gen X age group when confronted with this new psychological phenomenon. The tendency of older clinicians is to dismiss the new information because they tend to be less tech savvy and therefore less understanding.
Weiss made this comparison: It took radio 38 years to reach 50 million U.S. homes against only nine months for smartphone apps to reach the same number of individuals. He comically compared the shift from an analog to digital world to the five stages of the grief process: denial or isolation, anger, bargaining, depression, and acceptance. His point was that clinicians should be able to recognize where they are on their journey into digitization before offering treatment to someone else.
He quoted Douglas Adams, author of Hitchhiker’s Guide to the Galaxy. Adams outlines patterns he has noticed in the public’s reaction to new technology: What existed when we were born seems ordinary and what comes into being when we are between the ages of 15 and 35 is exciting and new. However, in Adams’ view, Weiss said, “anything invented after we turn 35 is against the natural order of things.” Weiss said it will obstruct a younger patient’s progress if the therapist fails to recognize the importance of this generational difference.
Robert Weiss LCSW, CSAT-S
Dr. Scholz made a similar point. “You ask the person you’re evaluating about their relationships,” he said, “you ask about how much they drink, how much pot they smoke, but you don’t ask about the thing they spend eight hours of their day on?”
The rest of the day at Pepperdine was devoted to research and scientific data. Pamela Peeke, the senior science adviser at Elements Behavioral Health, gave a talk titled, “Put That Down and Talk to Me: How Digital Drama is Redefining Mind and Body Wellness in Psychotherapy.”
Among the topics Peeke addressed, her discussion about epigenetics was the most cutting-edge. In general, she explained, trauma or an addiction history can make some people more vulnerable to addiction. One common myth in the medical world, however, is that DNA decides destiny. Epigenetics, the study of cellular and physiological traits that are not caused by changes in the DNA sequence, debunks this myth. Epigenetics refers to altering gene expression by the dimming of some and the emphasizing of others. This does not involve a change in the nucleotide sequence of DNA. In other words, your DNA is not your destiny.
Applying this idea to topic of the conference, Peeke explained that certain people may be more vulnerable to Internet and technology because of trauma or mental health turmoil, not from a prediction contained in a person’s DNA sequence. If professionals apply the concept of epigenetics to other kinds of addictions – say, to narcotics – then they should also refer to it when addressing Internet and technology addiction.
When guests returned to the auditorium after lunch, Jaana Juvonen spoke about the online adolescent, emphasizing case studies about cyber bullying conducted at UCLA, where she is a professor of psychology. She cited studies that indicate how victims of cyberbullying experience a decrease in self-esteem that can, in turn, increase narcissism and the need to promote oneself positively via social media. Juvonen explained that the addictive cycle begins when continued levels of lowered self-esteem give way to an obsession to positively self promote online.
Kenneth Woog, a psychologist from the Computer Addiction Treatment Program of Southern California, explained that the biggest differences between addiction to heroin, for example, and addiction to the Internet and technology is that in the latter case it is not always necessary to cut the addict off completely. For many of his patients, his goal is to instill healthy moderation in their behavior, given the current reality that the Internet and related technologies are essentially unavoidable.
Woog has developed computer software for parents to install if their children show signs of obsessive gaming or computer usage. His inventions, the Computer Addiction Treatment Device PC Moderator™, and his Sentinel Gaming Systems™ MK 1 both provide parents with monitoring assistance, set time limits on computer usage, and provide daily time usage reports. To get around the most tech savvy of computer users, he said his software is impervious to tampering and hacking.
As the attendees filed out of the auditorium after the last presentation, they exchanged business cards and invitations to discuss the conference over lunch. I milled around the decaf coffee machine, catching variations of “You know, I can’t believe I never considered that,” from the huddles of psychologists. Others watched a golden sunset over the Pacific Ocean as they chatted on the rooftop plaza.
Dr. Scholz floated between the groups, chatting amiably. Ideally, he said, all the conference participants would walk away with at least two things they would now do different in treating their patients. “I’ve seen too much bad therapy,” he said.
Dr. Robert Scholz, MA, LMFT and Director of Alcohol and Drug Programs at Pepperdine University’s Counseling Center
Page 2
Page 3
The full day at Pepperdine left Risa Grueberger feeling ambivalent. She is a clinical therapist who specializes in couples. On the one hand, she was impressed by how cutting-edge the topic was, and especially by Weiss’ discussion of the generational divide. However, she said, the conference lacked sufficient information about hands-on application. “How can you really use this information in your work?” she asked. It would have been worthwhile, she said, to have had a presentation on what is known as patient intakes, the process therapists use to gather information about patients during a first meeting. How can Internet and technology addiction be incorporated into that part of the process?
Ultimately, and most importantly though, the conference inspired her to put her own practice under the microscope, which is exactly what Dr. Scholz wanted. Grueberger recalled when she used a paper calendar to schedule appointments with her patients – the kind with a new picture for each month. Now she schedules with the calendar application on her smartphone. “I’m opening my phone at the end of every session to look at my calendar, and so I see my texts or if I’ve gotten any emails. I’m really out of the moment with my client when I do that – even if it is at the end. . . . Why am I checking my phone between every session?” she asked herself.
In her practice treating couples in Westlake Village, California, she frequently encounters signs of an Internet or technology dependence. Time and again, she sees that the behavior interferes obtrusively with intimacy and communication, with one member of the couple – often a man – overusing Internet-related technologies and his spouse feeling unimportant as a result.
Yet any given session ends, and Grueberger whips out her trusty smartphone to schedule the next appointment. “I would be interested to know how many therapists are addicted,” she said. “Don’t rule us out.”
Grueberger did not mean to imply that she herself is an addict. Her point was to challenge the myth that therapists are not susceptible to addiction because they treat others. She also noted how underprepared most psychologists are to treat addiction. Under the standard curriculum, “you’re required to do maybe a two-day course on it or something,” she said. “There’s not even a class specifically for addiction treatment. It’s beyond weird – it’s wrong.”
She went on, “I think what’s happening is we’re having a great affirmation by nature that we are addictive people.” As human beings, we are biologically made to over-attach, whether ito drugs, alcohol, love, gambling, food, or the Internet. “Addiction is part of human nature, so it would behoove us to know a heck of a lot about it whether we’re addressing Internet and technology addiction or anything else. And that’s the thing,” she said, “who knows what could be next?”
In 1994, Hilarie Cash’s career as a clinical psychologist took a fortuitous turn. She was treating a 25-year-old man at her private practice in Redmond, Washington—at that time the flourishing hub of the tech universe—who had recently lost a job at Microsoft. His marriage was suffering, and he was severely depressed. Cash eventually learned that the young man was profoundly addicted to Dungeons and Dragons, an online, text-only multi-user domain game that was beginning to consume his life. Surrounded by Redmond’s aggressively burgeoning tech industry, Cash intuited she was witnessing the start of a condition that would inevitably grow. She was right.
Hilarie Cash, Ph.D., cofounder of reSTART
Cash launched an outpatient clinic called Internet and Computer Addiction Services in 1999, where she focused on the condition she recognized was destroying the Redmond professional’s life. At that point, the only traction the issue had gained was thanks to psychologists Dr. Kimberly Young, whose book Caught in the Net was published in 1998, and Dr. David Greenfield, who published Virtual Addiction: Help for Netheads, Cyber Freaks, and Those Who Love Them the following year. Besides few concentrated efforts in the field, however, the issue was being largely mishandled or dismissed. “Families were sending their kids to programs like Outward Bound or programs for drug addicts and alcoholics. It’s a very different population for the most part,” she said. “I knew there was a need for a specialized treatment facility.”
Cash didn’t have the wherewithal to create the envisioned program until she met Cosette Rae, who reached out to her after seeing some brief news coverage on Cash’s outpatient group. Rae had semi-recently become a therapist after a 20-year career in web design and computer programming. Attracted to Rae’s unique perspective on the issue – which married her dual expert perspectives in technology and therapy – Cash knew she had found a promising partner.
“Most people in mental health are not trained in addiction work. So you’ve got a lot of people treating something they don’t understand well or even if they recognize it don’t know what to do about it effectively,” she said. “They want to view it as a symptom of depression or anxiety or some other mental health disorder rather than understanding that it is an addiction. Cosette was not like that.”
Two decades after her sessions with the professional in Redmond, as the co-founder and co-CEO of reSTART Center for Technology Sustainability, Cash still attributes the surprising trajectory of her career to what she observed and learned during those private sessions with the young man in Redmond.
Tucked away in a scenic, wooded area outside of Seattle, the capacious reSTART cabin houses men who suffer from gaming and other Internet-related addictions for 45 to 90 days at a time. The reSTART staff decided to exclusively treat men about four years after its launch in 2009 because only five women checked into reSTART over the course of that time. Recognizing that men are the most likely sufferers of Internet-related addiction, the staff decided to consolidate the center’s mission to make the enterprise more manageable.
The reSTART cabin
In the manner of all addiction treatment protocols, first the reSTART client has to detox. Detox must be the starting point, Cash explained, as the gateway to whatever underlying issues might exist for the client. So reSTART starts with stopping all access to the Internet and related technologies.
After detox, the clients develop a plan for how they will move forward with their lives after the treatment ends. This includes naming their “bottom lines” or behaviors that support the addiction. “A bottom line could be ‘I’m not going to game anymore’ or ‘I’m not going to look at porn anymore’,” Cash said, naming examples off the top of her head.
A client’s mental power is not enough to uphold these commitments, though. To say, “I won’t watch porn” is much different than actually stopping to watch it. The remaining steps of reSTART’s treatment program facilitate the transition between saying and doing, helping clients regard their goals as achievable and exciting rather than daunting and heavy.
Cash said her main concern is what happens after clients complete the program. “They’re going to have to use the technology when they leave,” she said, “but how are they going to use it in a healthy way?” Given the sedentary lifestyle of a typical Internet and tech addict, the program promotes a steady physical fitness regimen, personal cleanliness habits and orderly living and work environments. Rae’s husband, Mark, a partner in the reSTART enterprise, is a certified fitness trainer. He organizes and customizes fitness schedules for reSTART’s clients, leads daily hikes through the surrounding wilderness, and offers lessons on practical matters such as how to clean a toilet or build with wood.
Cash and Rae serve as mentors who oversee the entire process. Their driving goal is to help the people they treat become full-functioning adults before they leave the facilities. Reminding clients to take regular showers or keep their rooms tidy, for example, is customary. The goal, she said, is to get them “just habituated to healthy habits.” Cash has noticed that emphasizing physical health clears the floor for gaining insight into the deeper issues that perpetuate struggles with the Internet. Healthy body; healthy mind.
Four counselors visit the reSTART facilities weekly to conduct psychoeducational support groups and private one-on-ones. When the clients aren’t exercising or learning useful life lessons, they are practicing introspection with clinical professionals. Cash and Rae encourage reSTART clients to develop meaningful relationships with the visiting therapists because they should ideally keep seeing them during the next phase of treatment. Phase Two is a trial run of sorts for clients to reemerge in the outside world and test out their new and improved lifestyle. At that point, they leave reSTART’s facilities and become outpatients. To supplement Phase Two, Cash and Rae are in the process of developing an Oxford House, or a sober living community, specifically for those who need more transitional support.
“We’re just growing in different ways,” she said. “They’re all very small developments because we’re a small program. We don’t have much capital. We have to do all of this slowly.” Even so, reSTART has begun to gain recognition on an international scale. A couple times a year for the past two years, Cash has been traveling to Poland to conduct training sessions and to spread the reSTART recovery ideology. “In Poland, they’re really interested in this problem and trying to get a handle on it and nip it in bud as much as they can.”
Besides the growing interest in Poland, psychologists in some Asian countries have been working aggressively over the past decade to isolate and treat the condition. South Korea, the most wired country in the world, declared Internet addiction to be its most exigent public threat in 2011, and China has over 300 treatment centers and bootcamps allocated for Internet and technology addiction treatment.
When Cash was in South Korea for a conference a few years ago, she learned from a local student that young people spend a majority of their extracurricular time at Internet cafés because there are few other offered activities. The same happens in China, where, the single child government mandate makes parents apt to spoil their children, often with various Internet related technologies. There also have been tragedies as horrific as when two Korean parents let their baby die because they could not stop playing a video game. In response, parents in both countries have formed grassroots parent groups, terrified by what they have seen happening to their children, pressuring the government to officially recognize Internet and technology addiction and to begin funding for research and education.
Internet addiction-related tragedies happen in the United States, as well, Cash said, but are rarely publicized. Here, she said,” it’s all very private.”
She talked about how gamers who value their gaming community, their own prowess, and their ability to ascend the ranks also value their privacy while gaming online. But that privacy can lead to profound isolation as an addiction develops. A gamer may look up to the gaming overlords who created his favorite game, in the way an avid porn viewer would praise his favorite stars. But an addiction can transform that admiration into compulsive subjugation. Often, she said, the men who check into reSTART are living testaments to these ideas. The only relationship they have maintained up until the point they arrive at reSTART is with the Internet.
“And so the great tragedy,” Cash let out an innocent laugh as if she were being overly dramatic, though she really was not, “is that what they think is helping them forge these important relationships is tragically getting in their way.” That is why reSTART’s philosophy encourages the development of deep offline relationships. “People most definitely need face-to-face interaction,” she said. “We are social animals.”
Page 3
Page 4
Treatment protocols vary widely. While programs like reSTART use a more traditional long-residency rehab model, other programs have found ways to expedite the process.
Dr. David Greenfield runs The Center For Internet and Technology Addiction in West Hartford, Connecticut. Like Dr. Young, he too had proposed an official classification for Internet and technology addiction as far back as 1999. The treatment program he has since developed has a much shorter timeline than reSTART’s. “My program is more of a direct therapeutic treatment program,” he said, “spending four hours or more a day with one to one interaction between a doctor and a patient.” He said the program can be reduced to two days if necessary. Think of it as a therapy session that lasts 20 hours.
Dr. David Greenfield, founder of the Center for Internet and Technology Addiction
Dr. Greenfield’s process involves identifying urges and cravings, developing an identification of triggers and how to respond to them. He works on relapse prevention, and motivating his patients to manage their gaming or Internet use. Similar to all addiction treatment protocols, after these steps he can move to any underlying mental health issues that might be contributing to or manifesting as a result of the addiction.
Dr. Greenfield has identified three principal arenas of Internet addiction: video and Internet gaming; sexual behaviors including pornography, webcams, and hook up sites; and what he calls “infotainment” – obsessive and generalized Internet surfing or social media use. The last one he is still developing. On top of that, the Internet can aggravate other better known forms of addiction. Sex addiction, for example. Also, there is literature which indicates that video game designers purposely incorporate the addictive aspects of gambling into the games. The addiction’s many facets makes Dr. Greenfield ask rhetorically if we are addicted to technology itself or to the access it provides to the Internet. “The answer,” he said, “is both.”
Crucial to understanding Internet addiction is grasping the interaction between the content of the device and then the device itself, which is Dr. Greenfield’s area of specialty. As he explains it, there is the attraction to the content, be it porn, social media, or gaming, that exists independently of the device that delivers it. At the same time, there is what psychologists call a “variable ratio reinforcement schedule,” or the system of unpredictable notifications that the Internet fosters. Facebook birthday reminders, photo tags, news alerts, and offers from merchants are examples. They elevate the dopamine levels in the brain, creating a sense of excitement and anticipation for what might arrive next. “In a sense what’s happened,” Dr. Greenfield said, “is that the smartphone has become the world’s smallest slot machine.” Slot machines function on the same variable ratio reinforcement schedule. Every time you pull the handle, the windows spin. With some level of unpredictable regularity, you will get a reward but you don’t know when that reward is going to come or what that reward is going to be. And it may not be much. “And that’s why the Internet, in turn,” he said, “is the world’s biggest slot machine.”
In addition to e-hab facilities and the work of individual therapists, online support groups have also emerged. Self-identified addicts like Conor often crave the support of other addicts on the road to sobriety. As Conor put it, “The No. 1 way to work with an addict is to know what they’re feeling. In other words, being an addict.” Apart from his struggles with ADHD and bipolar disorder, Conor chooses to participate in his online fellowship as his means of treatment because of the communal support.
Conor especially enjoys the open-ended nature of the fellowship. Its end goal of sobriety or responsible usage is clear, but the flexible path it takes to get there allows participants to fill in the blanks. “And this is because the intrinsic nature of addiction is that you can’t organize it,” Conor said. “It’s addiction, it’s chaos. It is total chaos.”
Overbearing attempts to organize addiction inspired Conor to join the online fellowship. He initially sought help from OLGANON, or Online Gamers Anonymous, an earlier online community for gamers seeking treatment. In fact, ex-OLGANON members developed Conor’s current fellowship to improve on what he and others considered OLGANON’s flawed approach.
“The reason why [OLGANON] ‘s certainly a dangerous and difficult place is because it is run by addicts who are very sick. They’re not sober or clean in any sense of the word. They are very codependent. They try hard to control people,” Conor said. In this way, the same thing that attracted him to the new fellowship – communal support from other addicts — is what convinced him that OLGANON was a poisonous environment. Conor said that the addicts who took charge of OLGANON would routinely withhold addiction and recovery information from the other members, forcing them to rely completely on the “authorities” to learn what was new. He told the story of how an OLGANON member was effectively banned from the group for taking it upon himself to organize all 12 steps and other recovery information into a webpage. It was perceived as a threat to the group’s chain of command. “It’s not a club that you belong to,” Conor said. “It’s addiction.”
“Thanks for the example, OLGA,” Conor sneered, “at CGAA we’re going to do the exact opposite of that.” As a result, the online fellowship attempts to strike a healthy balance between order and chaos. Its members make all information available immediately to everyone, first and foremost.
Page 4
Page 5
At this stage Internet and technology addiction is so amorphous, it makes sense that the treatment options compared to other forms of addiction are so much broader. That does not mean they are any less legitimate as a form of addiction – they are simply different.
No_Mas_Amigo on Reddit identifies himself as a 24-year-old “petroleum land man” who lives in Oklahoma, where he seeks support as a recovering gaming addict under one of Reddit’s ongoing subReddit’s, or message threads, called “Stopgaming.” If he ever feels like he might relapse, he goes to Stopgaming for support. Although he did have a minor relapse about two months ago when he downloaded an iPhone game and binged on it for two hours, the support of other addicts in this online environment has proved helpful.
Some might say the decision to seek recovery help online — the very entity that feeds their addictions — is contradictory. However, what it really speaks to is the inherent blessing-curse duality of using the Internet and technology.
No_Mas_Amigo thinks contemporary society has entered into a state of affairs where we are constantly distracted and will do anything to avoid tedium. As a result, we’ve lost the ability to fully concentrate on just one thing. “For example,” No_Mas_Amigo said, “When I was in school and I had to write papers, I would say to myself, ‘Well I can put in the work, feel good about it and enjoy the accolades and praise or I can turn on a video game and get all of that more within minutes.’ That’s what No_Mas_Amigo calls rat brain, because “You’re going to pick the cheese every time.
“There’s a level to it of fear of suffering,” he said, “not physical suffering, but of tedium. We hate tedium.” To demonstrate his point, he took me back a generation or three. “Old Grandpa No_Mas_Amigo is tilling potatoes in Scotland. That guy, all he does is tedium! But he doesn’t have a choice. He has to eat, and he has discipline. And he has no avenues. He can’t just check his iPhone every three minutes.” He jumped forward to the present day. “Now we live in a world where we’ve been promised everything for nothing and forever. You can be productive, you can be successful, and you can get distracted every two minutes.” He sighed, “And that’s just not true. It’s a lie.”
The Internet has made being lazy easier than ever, No_Mas_Amigo said. “It’s easier to give a child an iPhone and have them touch a bunch of goldfish than it is to take the child to the aquarium. It’s easier for me to feel self-fulfilled by beating a video game than it is for me to work hours and hours on an academic paper.” We rats are inclined to pick the cheese every time because the Internet and technology serve the cheese up on a platter. The attractiveness of convenience can so easily trump hard work and determination.
To illustrate his point, No_Mas_Amigo called up some literature from C.S. Lewis. “Everything in the world has a purpose, a nature,” he said. “We expect a rock to do certain things, we expect a buffalo to do certain things, we expect the sun to do certain things. We have standards for these things – rocks, buffalos, the sun – and we will never be disappointed by them because they will always live up to their standards. Except for humans,” No_Mas_Amigo said. “We have an understanding of what humans ought to do, and yet we consistently don’t do those things.”
Then he suddenly deviated. “But we can get better at it. There is no easy way, you have to suffer, you have to sacrifice. And it sucks. So badly. But the more you do it, the better you get at it. It’s a skill.”
For No_Mas_Amigo, it is up to the individual to find a balance between exploiting the convenience of the Internet and its related technologies and maintaining some sense of intrinsic motivation that is independent of life online. “The internet is just humans,” No_Mas_Amigo said. “We can be terribly kind and terribly horrible at the same time.“
Page 1
“What are you carving with that X-Acto knife?”
“Oh, I’m just shaving the resin off this mini,” Conor replied, holding up a jagged figurine to the webcam on his computer. He twisted the figure in front of the lens so I could admire the intricacies of the miniature model he built and was starting to paint. I couldn’t make out exactly what it was—some kind of warrior, or maybe a gun or a tank. But I could tell it required several hours of meticulous work to produce. “It’s a lot of fun,” he said. “It’s very time intensive, but it’s a great way to use my creative ability without going nuts.”
Conor was putting the finishing touches on a decorated model for a tabletop miniature war game called Warhammer 40,000, or WH40K, as it is more informally known. In this table-top game based in a sci-fi dystopian fantasy universe, players assemble miniature models of soldiers, weapons, and various creatures, collecting them over time so that their troops can compete with those of other players. “That part of my brain that’s all about conflict resolution in combat and military strategy and tactics—it’s still there. I still love it, and I always have,” he said.
During our conversation over Skype, Conor used words like “still” and “always” because between the ages of five and 18 – he’s now 21 – there was another way Conor satisfied his fascination with military strategy and combat tactics, which was much more destructive. For 13 years, Conor spent every waking hour he could playing video games. If he wasn’t playing them, he was scheming ways that he could. Addiction protocol classifies Conor as someone who has yet to fully thwart his dependence, even still. Recovery, he knows, is a life-long process.
Yet in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, Internet Gaming Disorder is listed in Section III’s appendix only as a condition that warrants more clinical research, not as a legitimate disorder. Furthermore, the more general classification of Internet Addiction Disorder does not even merit a “deserves more research” listing. Only gambling has qualified in the DSM-5 as a behavioral, non-substance related addiction, one that the pervasiveness of the Internet has also aggravated.
Although the dense glossaries of the DSM-5 have yet to include Internet and technology addiction, an increasing number of rehab facilities and services are popping up around the United States to address and treat the condition. This follows the lead of other heavily wired countries such as China and South Korea. As a result, more and more people are checking themselves into e-hab.
An elaboration of data by the International Telecommunications Unit and the UN’s Population Division indicates that more than one third of the global population uses the Internet. That makes more than three billion Internet users worldwide. Estimates are hard to come by but some studies by experts in the field, including Hilarie Cash and Cosette Rae, a team of Seattle-area clinicians, put prevalence rates as high as 18.5 percent of Internet users in the United States. That could mean Conor is one of nearly 59 million people in the country who suffer from an Internet-related addiction.
Conor may have no doubts about the nature of his condition, but clinicians have been debating the validity of Internet and technology addiction since the Internet became widely accessible in the late 1990s. Luckily for people like Conor, there are professionals in the field who have dedicated their careers to treating this condition that, from experience, they know is real. These efforts start in private practices and extend to include inpatient and outpatient treatment facilities and even online support groups and fellowships. Slowly but surely, Internet and technology addiction is gaining traction within the medical establishment, although not yet enough to gain official recognition as a full-fledged addiction.
Two years ago, Conor sought the help of an online fellowship and recovery program for people struggling with excessive and compulsive computer gaming. Since achieving sobriety with the help of this online community—“sober, clean, recovered, or whatever the hell you want to call it,” he groaned—Conor has reclaimed the time that his gaming habit used to consume. With more opportunity for leisure, Conor now directs his attention to outlets such as Warhammer 40K that have fulfilled both his creative impulses and his fascination with war tactics and strategy. “This is a safe means and a social means of getting that satisfaction,” he said, holding up a different model, “and that same part of the brain that’s tickled by gaming is just tickled a little bit less through the dice rolls of this game.”
As a recovering addict, Conor’s lucidity about his recovery over the past two years includes his understanding that the progress he has made thus far is only the beginning. As he explained, “I have to work on a daily basis to deal with this and that’s okay. I don’t really think too hard about the future because the future is fucking intense. You take it one step at a time. You have to or you go insane.”
A significant milestone in Conor’s recovery process was understanding that the magnitude of his gaming addiction was equal to that of the more common addictions. When he talks about his condition, he never differentiates it from drugs, alcohol or gambling. For him, gaming was always about escape. “There’s no addiction on the planet that is anything but escape,” he said, “and if anyone tells you otherwise, they’re completely wrong.”
Even over Skype talking to someone he had just met, the volume of Conor’s voice escalated quickly and his tone became aggressive when a question sparked his passion or a sharp counter. His hands gesticulated wildly. At certain points, I thought he was furious with me, and would shut off the connection or hurl himself through the interwebs to smack me over the head. It didn’t take him too long to share that he had been diagnosed with ADHD and bipolar disorder, both of which, he said, were exacerbated by an abusive relationship with his stepfather. “I have an intense personality and at times I’ve been told that people have to kind of brace themselves around me,” he said. “Because I’m just me.”
Every week via Skype or over the phone, Conor seeks help through a recovery community, a self-proclaimed fellowship known as Computer Gaming Addicts Anonymous. The sessions have helped him to become more aware of the impact that his demeanor has on others. In fact, he told me that he prefers the barriers provided by Skype, the chat rooms, or the phone calls because they keep his propensity for violent outbursts in check.
All the same, I found his abrupt, straight-forward style useful in understanding the nature of Internet-related addiction. Conor kept me on track when I asked him questions that struck him as glaringly unimportant.
“What kinds of games did you play in the worst phases of your addiction?”
He cut me off immediately. “What I played is largely irrelevant. You can probably name a game and I have played it or played a game like it and I would have played that game too, if I had the opportunity.”
“The thing with gaming,”—and addiction in general—“is that it affects the dopamine system and so it’s all about the adrenaline rush, the stimulation,” he said, “and basically getting as much of an adrenaline high as possible in as short a period of time as possible.” Conor’s substance of choice—video games—is merely the vehicle through which addiction consumes him. It could have been cocaine. He named this example because extreme uppers can amplify the outbursts of someone with as volatile a temperament as his.
Conor fully comprehended the problematic extent of his gaming when he filled out a modified Alcoholics Anonymous questionnaire at age 18. The answers to the questions on the usual questionnaire scale the magnitude of an alcohol problem, but a friend had sent him a version that replaced all the iterations of the word alcohol with the word gaming. “I fit all of the criteria,” Conor said. “There isn’t a single thing on that list that I don’t identify with.”
Conor’s experience with the questionnaire speaks for itself: there was no science or medical treatment involved. It allowed him to consider his sickness on par with other types of addiction, a comparison that is tough to make for a condition that has received so little attention. How different can Internet and technology addiction be from other types? From Conor’s perspective, they are one and the same.
Page 1
Page 2
In 2011, the American Society of Addiction Medicine modified the official definition of addiction to better pinpoint its real nature: a sickness, not a moral failure. The reworked version defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry.” Addiction, “which may or may not include alcohol and other drug use,” affects neurotransmission in the brain, altering motivational hierarchies and reward structures. Although this explanation is quite general, the “may or may not” language about drugs and alcohol involves what professionals call “process addictions,” or addictions that are not fed by substances. Internet and technology addiction falls under this classification.
Since part of the therapist routine during private sessions involves taking inventory of a patient’s mental well-being, which makes the therapist privy to a patient’s innermost struggles, it follows that therapists would be alert to signs of addictive behavior. However, the reality is that the overwhelming majority of clinical psychologists have not been trained in how to recognize the signs of addiction, let alone how to treat it.
“We have failed miserably in helping people deal with their addictions,” said Dr. Robert Scholz, the deputy director of Pepperdine University’s counseling center. Last November, Dr. Scholz organized a conference called “Technology Addiction and the Modern Family.” Some 100 clinicians spent a full day in Malibu on Pepperdine’s Drescher Graduate Campus, learning about Internet and technology addiction from presentations by four noted experts in the field. “We need to challenge clinicians to think differently about their work,” he said, “because we haven’t seen enough improvements.”
The conference’s overarching purpose, then, was to both educate clinical psychologists about addiction in general and to galvanize them to recognize the signs of Internet and technology addiction. Dr. Scholz wants to help therapists either treat the condition or refer these patients to others, just as they would a patient who was dependent on drugs or alcohol.
Themes at Pepperdine that day included genetics, cyberbullying, and obsessive computer usage and video gaming, along with discussion of the generational gap between analog-oriented therapists and their digital younger patients.
“How many of you here are under the age of 30?” was how Robert Weiss, a sex addiction specialist, started his opening address, titled “Closer Together, Further Apart –The Effect of Digital Technology on Addiction, Psychotherapy and Our Daily Lives.” As he had anticipated, only a few participants raised their hands in response. “Sadly, this is not a lecture for you guys because you already know everything I’m about to say,” Weiss went on. His icebreaker emphasized the guiding point in his presentation: that the generational gap between therapists and younger patients often hinders patient progress when the underlying issue is dependence to Internet and technology.
To Weiss, the defining feature of the generation divide has moved from the “We won’t listen to you!” of the 1960s to the “We can’t see or hear you!” of today. The younger generation now disconnects, ironically enough, by plugging in.
“When I was writing this last book,” he told the audience, a reference to his latest title, Sex Addiction 101, “I couldn’t write another Baby Boomer, Gen X book about how technology is ruining our lives, because that just isn’t true.” Weiss, was referring to an “all or nothing” mentality he believes is common among psychologists in his Gen X age group when confronted with this new psychological phenomenon. The tendency of older clinicians is to dismiss the new information because they tend to be less tech savvy and therefore less understanding.
Weiss made this comparison: It took radio 38 years to reach 50 million U.S. homes against only nine months for smartphone apps to reach the same number of individuals. He comically compared the shift from an analog to digital world to the five stages of the grief process: denial or isolation, anger, bargaining, depression, and acceptance. His point was that clinicians should be able to recognize where they are on their journey into digitization before offering treatment to someone else.
He quoted Douglas Adams, author of Hitchhiker’s Guide to the Galaxy. Adams outlines patterns he has noticed in the public’s reaction to new technology: What existed when we were born seems ordinary and what comes into being when we are between the ages of 15 and 35 is exciting and new. However, in Adams’ view, Weiss said, “anything invented after we turn 35 is against the natural order of things.” Weiss said it will obstruct a younger patient’s progress if the therapist fails to recognize the importance of this generational difference.
Robert Weiss LCSW, CSAT-S
Dr. Scholz made a similar point. “You ask the person you’re evaluating about their relationships,” he said, “you ask about how much they drink, how much pot they smoke, but you don’t ask about the thing they spend eight hours of their day on?”
The rest of the day at Pepperdine was devoted to research and scientific data. Pamela Peeke, the senior science adviser at Elements Behavioral Health, gave a talk titled, “Put That Down and Talk to Me: How Digital Drama is Redefining Mind and Body Wellness in Psychotherapy.”
Among the topics Peeke addressed, her discussion about epigenetics was the most cutting-edge. In general, she explained, trauma or an addiction history can make some people more vulnerable to addiction. One common myth in the medical world, however, is that DNA decides destiny. Epigenetics, the study of cellular and physiological traits that are not caused by changes in the DNA sequence, debunks this myth. Epigenetics refers to altering gene expression by the dimming of some and the emphasizing of others. This does not involve a change in the nucleotide sequence of DNA. In other words, your DNA is not your destiny.
Applying this idea to topic of the conference, Peeke explained that certain people may be more vulnerable to Internet and technology because of trauma or mental health turmoil, not from a prediction contained in a person’s DNA sequence. If professionals apply the concept of epigenetics to other kinds of addictions – say, to narcotics – then they should also refer to it when addressing Internet and technology addiction.
When guests returned to the auditorium after lunch, Jaana Juvonen spoke about the online adolescent, emphasizing case studies about cyber bullying conducted at UCLA, where she is a professor of psychology. She cited studies that indicate how victims of cyberbullying experience a decrease in self-esteem that can, in turn, increase narcissism and the need to promote oneself positively via social media. Juvonen explained that the addictive cycle begins when continued levels of lowered self-esteem give way to an obsession to positively self promote online.
Kenneth Woog, a psychologist from the Computer Addiction Treatment Program of Southern California, explained that the biggest differences between addiction to heroin, for example, and addiction to the Internet and technology is that in the latter case it is not always necessary to cut the addict off completely. For many of his patients, his goal is to instill healthy moderation in their behavior, given the current reality that the Internet and related technologies are essentially unavoidable.
Woog has developed computer software for parents to install if their children show signs of obsessive gaming or computer usage. His inventions, the Computer Addiction Treatment Device PC Moderator™, and his Sentinel Gaming Systems™ MK 1 both provide parents with monitoring assistance, set time limits on computer usage, and provide daily time usage reports. To get around the most tech savvy of computer users, he said his software is impervious to tampering and hacking.
As the attendees filed out of the auditorium after the last presentation, they exchanged business cards and invitations to discuss the conference over lunch. I milled around the decaf coffee machine, catching variations of “You know, I can’t believe I never considered that,” from the huddles of psychologists. Others watched a golden sunset over the Pacific Ocean as they chatted on the rooftop plaza.
Dr. Scholz floated between the groups, chatting amiably. Ideally, he said, all the conference participants would walk away with at least two things they would now do different in treating their patients. “I’ve seen too much bad therapy,” he said.
Dr. Robert Scholz, MA, LMFT and Director of Alcohol and Drug Programs at Pepperdine University’s Counseling Center
Page 2
Page 3
The full day at Pepperdine left Risa Grueberger feeling ambivalent. She is a clinical therapist who specializes in couples. On the one hand, she was impressed by how cutting-edge the topic was, and especially by Weiss’ discussion of the generational divide. However, she said, the conference lacked sufficient information about hands-on application. “How can you really use this information in your work?” she asked. It would have been worthwhile, she said, to have had a presentation on what is known as patient intakes, the process therapists use to gather information about patients during a first meeting. How can Internet and technology addiction be incorporated into that part of the process?
Ultimately, and most importantly though, the conference inspired her to put her own practice under the microscope, which is exactly what Dr. Scholz wanted. Grueberger recalled when she used a paper calendar to schedule appointments with her patients – the kind with a new picture for each month. Now she schedules with the calendar application on her smartphone. “I’m opening my phone at the end of every session to look at my calendar, and so I see my texts or if I’ve gotten any emails. I’m really out of the moment with my client when I do that – even if it is at the end. . . . Why am I checking my phone between every session?” she asked herself.
In her practice treating couples in Westlake Village, California, she frequently encounters signs of an Internet or technology dependence. Time and again, she sees that the behavior interferes obtrusively with intimacy and communication, with one member of the couple – often a man – overusing Internet-related technologies and his spouse feeling unimportant as a result.
Yet any given session ends, and Grueberger whips out her trusty smartphone to schedule the next appointment. “I would be interested to know how many therapists are addicted,” she said. “Don’t rule us out.”
Grueberger did not mean to imply that she herself is an addict. Her point was to challenge the myth that therapists are not susceptible to addiction because they treat others. She also noted how underprepared most psychologists are to treat addiction. Under the standard curriculum, “you’re required to do maybe a two-day course on it or something,” she said. “There’s not even a class specifically for addiction treatment. It’s beyond weird – it’s wrong.”
She went on, “I think what’s happening is we’re having a great affirmation by nature that we are addictive people.” As human beings, we are biologically made to over-attach, whether ito drugs, alcohol, love, gambling, food, or the Internet. “Addiction is part of human nature, so it would behoove us to know a heck of a lot about it whether we’re addressing Internet and technology addiction or anything else. And that’s the thing,” she said, “who knows what could be next?”
In 1994, Hilarie Cash’s career as a clinical psychologist took a fortuitous turn. She was treating a 25-year-old man at her private practice in Redmond, Washington—at that time the flourishing hub of the tech universe—who had recently lost a job at Microsoft. His marriage was suffering, and he was severely depressed. Cash eventually learned that the young man was profoundly addicted to Dungeons and Dragons, an online, text-only multi-user domain game that was beginning to consume his life. Surrounded by Redmond’s aggressively burgeoning tech industry, Cash intuited she was witnessing the start of a condition that would inevitably grow. She was right.
Hilarie Cash, Ph.D., cofounder of reSTART
Cash launched an outpatient clinic called Internet and Computer Addiction Services in 1999, where she focused on the condition she recognized was destroying the Redmond professional’s life. At that point, the only traction the issue had gained was thanks to psychologists Dr. Kimberly Young, whose book Caught in the Net was published in 1998, and Dr. David Greenfield, who published Virtual Addiction: Help for Netheads, Cyber Freaks, and Those Who Love Them the following year. Besides few concentrated efforts in the field, however, the issue was being largely mishandled or dismissed. “Families were sending their kids to programs like Outward Bound or programs for drug addicts and alcoholics. It’s a very different population for the most part,” she said. “I knew there was a need for a specialized treatment facility.”
Cash didn’t have the wherewithal to create the envisioned program until she met Cosette Rae, who reached out to her after seeing some brief news coverage on Cash’s outpatient group. Rae had semi-recently become a therapist after a 20-year career in web design and computer programming. Attracted to Rae’s unique perspective on the issue – which married her dual expert perspectives in technology and therapy – Cash knew she had found a promising partner.
“Most people in mental health are not trained in addiction work. So you’ve got a lot of people treating something they don’t understand well or even if they recognize it don’t know what to do about it effectively,” she said. “They want to view it as a symptom of depression or anxiety or some other mental health disorder rather than understanding that it is an addiction. Cosette was not like that.”
Two decades after her sessions with the professional in Redmond, as the co-founder and co-CEO of reSTART Center for Technology Sustainability, Cash still attributes the surprising trajectory of her career to what she observed and learned during those private sessions with the young man in Redmond.
Tucked away in a scenic, wooded area outside of Seattle, the capacious reSTART cabin houses men who suffer from gaming and other Internet-related addictions for 45 to 90 days at a time. The reSTART staff decided to exclusively treat men about four years after its launch in 2009 because only five women checked into reSTART over the course of that time. Recognizing that men are the most likely sufferers of Internet-related addiction, the staff decided to consolidate the center’s mission to make the enterprise more manageable.
The reSTART cabin
In the manner of all addiction treatment protocols, first the reSTART client has to detox. Detox must be the starting point, Cash explained, as the gateway to whatever underlying issues might exist for the client. So reSTART starts with stopping all access to the Internet and related technologies.
After detox, the clients develop a plan for how they will move forward with their lives after the treatment ends. This includes naming their “bottom lines” or behaviors that support the addiction. “A bottom line could be ‘I’m not going to game anymore’ or ‘I’m not going to look at porn anymore’,” Cash said, naming examples off the top of her head.
A client’s mental power is not enough to uphold these commitments, though. To say, “I won’t watch porn” is much different than actually stopping to watch it. The remaining steps of reSTART’s treatment program facilitate the transition between saying and doing, helping clients regard their goals as achievable and exciting rather than daunting and heavy.
Cash said her main concern is what happens after clients complete the program. “They’re going to have to use the technology when they leave,” she said, “but how are they going to use it in a healthy way?” Given the sedentary lifestyle of a typical Internet and tech addict, the program promotes a steady physical fitness regimen, personal cleanliness habits and orderly living and work environments. Rae’s husband, Mark, a partner in the reSTART enterprise, is a certified fitness trainer. He organizes and customizes fitness schedules for reSTART’s clients, leads daily hikes through the surrounding wilderness, and offers lessons on practical matters such as how to clean a toilet or build with wood.
Cash and Rae serve as mentors who oversee the entire process. Their driving goal is to help the people they treat become full-functioning adults before they leave the facilities. Reminding clients to take regular showers or keep their rooms tidy, for example, is customary. The goal, she said, is to get them “just habituated to healthy habits.” Cash has noticed that emphasizing physical health clears the floor for gaining insight into the deeper issues that perpetuate struggles with the Internet. Healthy body; healthy mind.
Four counselors visit the reSTART facilities weekly to conduct psychoeducational support groups and private one-on-ones. When the clients aren’t exercising or learning useful life lessons, they are practicing introspection with clinical professionals. Cash and Rae encourage reSTART clients to develop meaningful relationships with the visiting therapists because they should ideally keep seeing them during the next phase of treatment. Phase Two is a trial run of sorts for clients to reemerge in the outside world and test out their new and improved lifestyle. At that point, they leave reSTART’s facilities and become outpatients. To supplement Phase Two, Cash and Rae are in the process of developing an Oxford House, or a sober living community, specifically for those who need more transitional support.
“We’re just growing in different ways,” she said. “They’re all very small developments because we’re a small program. We don’t have much capital. We have to do all of this slowly.” Even so, reSTART has begun to gain recognition on an international scale. A couple times a year for the past two years, Cash has been traveling to Poland to conduct training sessions and to spread the reSTART recovery ideology. “In Poland, they’re really interested in this problem and trying to get a handle on it and nip it in bud as much as they can.”
Besides the growing interest in Poland, psychologists in some Asian countries have been working aggressively over the past decade to isolate and treat the condition. South Korea, the most wired country in the world, declared Internet addiction to be its most exigent public threat in 2011, and China has over 300 treatment centers and bootcamps allocated for Internet and technology addiction treatment.
When Cash was in South Korea for a conference a few years ago, she learned from a local student that young people spend a majority of their extracurricular time at Internet cafés because there are few other offered activities. The same happens in China, where, the single child government mandate makes parents apt to spoil their children, often with various Internet related technologies. There also have been tragedies as horrific as when two Korean parents let their baby die because they could not stop playing a video game. In response, parents in both countries have formed grassroots parent groups, terrified by what they have seen happening to their children, pressuring the government to officially recognize Internet and technology addiction and to begin funding for research and education.
Internet addiction-related tragedies happen in the United States, as well, Cash said, but are rarely publicized. Here, she said,” it’s all very private.”
She talked about how gamers who value their gaming community, their own prowess, and their ability to ascend the ranks also value their privacy while gaming online. But that privacy can lead to profound isolation as an addiction develops. A gamer may look up to the gaming overlords who created his favorite game, in the way an avid porn viewer would praise his favorite stars. But an addiction can transform that admiration into compulsive subjugation. Often, she said, the men who check into reSTART are living testaments to these ideas. The only relationship they have maintained up until the point they arrive at reSTART is with the Internet.
“And so the great tragedy,” Cash let out an innocent laugh as if she were being overly dramatic, though she really was not, “is that what they think is helping them forge these important relationships is tragically getting in their way.” That is why reSTART’s philosophy encourages the development of deep offline relationships. “People most definitely need face-to-face interaction,” she said. “We are social animals.”
Page 3
Page 4
Treatment protocols vary widely. While programs like reSTART use a more traditional long-residency rehab model, other programs have found ways to expedite the process.
Dr. David Greenfield runs The Center For Internet and Technology Addiction in West Hartford, Connecticut. Like Dr. Young, he too had proposed an official classification for Internet and technology addiction as far back as 1999. The treatment program he has since developed has a much shorter timeline than reSTART’s. “My program is more of a direct therapeutic treatment program,” he said, “spending four hours or more a day with one to one interaction between a doctor and a patient.” He said the program can be reduced to two days if necessary. Think of it as a therapy session that lasts 20 hours.
Dr. David Greenfield, founder of the Center for Internet and Technology Addiction
Dr. Greenfield’s process involves identifying urges and cravings, developing an identification of triggers and how to respond to them. He works on relapse prevention, and motivating his patients to manage their gaming or Internet use. Similar to all addiction treatment protocols, after these steps he can move to any underlying mental health issues that might be contributing to or manifesting as a result of the addiction.
Dr. Greenfield has identified three principal arenas of Internet addiction: video and Internet gaming; sexual behaviors including pornography, webcams, and hook up sites; and what he calls “infotainment” – obsessive and generalized Internet surfing or social media use. The last one he is still developing. On top of that, the Internet can aggravate other better known forms of addiction. Sex addiction, for example. Also, there is literature which indicates that video game designers purposely incorporate the addictive aspects of gambling into the games. The addiction’s many facets makes Dr. Greenfield ask rhetorically if we are addicted to technology itself or to the access it provides to the Internet. “The answer,” he said, “is both.”
Crucial to understanding Internet addiction is grasping the interaction between the content of the device and then the device itself, which is Dr. Greenfield’s area of specialty. As he explains it, there is the attraction to the content, be it porn, social media, or gaming, that exists independently of the device that delivers it. At the same time, there is what psychologists call a “variable ratio reinforcement schedule,” or the system of unpredictable notifications that the Internet fosters. Facebook birthday reminders, photo tags, news alerts, and offers from merchants are examples. They elevate the dopamine levels in the brain, creating a sense of excitement and anticipation for what might arrive next. “In a sense what’s happened,” Dr. Greenfield said, “is that the smartphone has become the world’s smallest slot machine.” Slot machines function on the same variable ratio reinforcement schedule. Every time you pull the handle, the windows spin. With some level of unpredictable regularity, you will get a reward but you don’t know when that reward is going to come or what that reward is going to be. And it may not be much. “And that’s why the Internet, in turn,” he said, “is the world’s biggest slot machine.”
In addition to e-hab facilities and the work of individual therapists, online support groups have also emerged. Self-identified addicts like Conor often crave the support of other addicts on the road to sobriety. As Conor put it, “The No. 1 way to work with an addict is to know what they’re feeling. In other words, being an addict.” Apart from his struggles with ADHD and bipolar disorder, Conor chooses to participate in his online fellowship as his means of treatment because of the communal support.
Conor especially enjoys the open-ended nature of the fellowship. Its end goal of sobriety or responsible usage is clear, but the flexible path it takes to get there allows participants to fill in the blanks. “And this is because the intrinsic nature of addiction is that you can’t organize it,” Conor said. “It’s addiction, it’s chaos. It is total chaos.”
Overbearing attempts to organize addiction inspired Conor to join the online fellowship. He initially sought help from OLGANON, or Online Gamers Anonymous, an earlier online community for gamers seeking treatment. In fact, ex-OLGANON members developed Conor’s current fellowship to improve on what he and others considered OLGANON’s flawed approach.
“The reason why [OLGANON] ‘s certainly a dangerous and difficult place is because it is run by addicts who are very sick. They’re not sober or clean in any sense of the word. They are very codependent. They try hard to control people,” Conor said. In this way, the same thing that attracted him to the new fellowship – communal support from other addicts — is what convinced him that OLGANON was a poisonous environment. Conor said that the addicts who took charge of OLGANON would routinely withhold addiction and recovery information from the other members, forcing them to rely completely on the “authorities” to learn what was new. He told the story of how an OLGANON member was effectively banned from the group for taking it upon himself to organize all 12 steps and other recovery information into a webpage. It was perceived as a threat to the group’s chain of command. “It’s not a club that you belong to,” Conor said. “It’s addiction.”
“Thanks for the example, OLGA,” Conor sneered, “at CGAA we’re going to do the exact opposite of that.” As a result, the online fellowship attempts to strike a healthy balance between order and chaos. Its members make all information available immediately to everyone, first and foremost.
Page 4
Page 5
At this stage Internet and technology addiction is so amorphous, it makes sense that the treatment options compared to other forms of addiction are so much broader. That does not mean they are any less legitimate as a form of addiction – they are simply different.
No_Mas_Amigo on Reddit identifies himself as a 24-year-old “petroleum land man” who lives in Oklahoma, where he seeks support as a recovering gaming addict under one of Reddit’s ongoing subReddit’s, or message threads, called “Stopgaming.” If he ever feels like he might relapse, he goes to Stopgaming for support. Although he did have a minor relapse about two months ago when he downloaded an iPhone game and binged on it for two hours, the support of other addicts in this online environment has proved helpful.
Some might say the decision to seek recovery help online — the very entity that feeds their addictions — is contradictory. However, what it really speaks to is the inherent blessing-curse duality of using the Internet and technology.
No_Mas_Amigo thinks contemporary society has entered into a state of affairs where we are constantly distracted and will do anything to avoid tedium. As a result, we’ve lost the ability to fully concentrate on just one thing. “For example,” No_Mas_Amigo said, “When I was in school and I had to write papers, I would say to myself, ‘Well I can put in the work, feel good about it and enjoy the accolades and praise or I can turn on a video game and get all of that more within minutes.’ That’s what No_Mas_Amigo calls rat brain, because “You’re going to pick the cheese every time.
“There’s a level to it of fear of suffering,” he said, “not physical suffering, but of tedium. We hate tedium.” To demonstrate his point, he took me back a generation or three. “Old Grandpa No_Mas_Amigo is tilling potatoes in Scotland. That guy, all he does is tedium! But he doesn’t have a choice. He has to eat, and he has discipline. And he has no avenues. He can’t just check his iPhone every three minutes.” He jumped forward to the present day. “Now we live in a world where we’ve been promised everything for nothing and forever. You can be productive, you can be successful, and you can get distracted every two minutes.” He sighed, “And that’s just not true. It’s a lie.”
The Internet has made being lazy easier than ever, No_Mas_Amigo said. “It’s easier to give a child an iPhone and have them touch a bunch of goldfish than it is to take the child to the aquarium. It’s easier for me to feel self-fulfilled by beating a video game than it is for me to work hours and hours on an academic paper.” We rats are inclined to pick the cheese every time because the Internet and technology serve the cheese up on a platter. The attractiveness of convenience can so easily trump hard work and determination.
To illustrate his point, No_Mas_Amigo called up some literature from C.S. Lewis. “Everything in the world has a purpose, a nature,” he said. “We expect a rock to do certain things, we expect a buffalo to do certain things, we expect the sun to do certain things. We have standards for these things – rocks, buffalos, the sun – and we will never be disappointed by them because they will always live up to their standards. Except for humans,” No_Mas_Amigo said. “We have an understanding of what humans ought to do, and yet we consistently don’t do those things.”
Then he suddenly deviated. “But we can get better at it. There is no easy way, you have to suffer, you have to sacrifice. And it sucks. So badly. But the more you do it, the better you get at it. It’s a skill.”
For No_Mas_Amigo, it is up to the individual to find a balance between exploiting the convenience of the Internet and its related technologies and maintaining some sense of intrinsic motivation that is independent of life online. “The internet is just humans,” No_Mas_Amigo said. “We can be terribly kind and terribly horrible at the same time.“