For Charlie, it was clear that rehab was necessary when, after months of obsessively playing a smartphone game called Spirit Lords, her mother called her at college worried that she had taken up gambling. Her savings account was drained. Multiple overdraft notices had arrived at her parents' house. Over five months, she had blown $8,000 on "spirit upgrades" and in-app purchases like rare weapons to help her beat the game.
“I thought that at some point I would probably stop and say, ‘This is enough.’ But it didn’t happen," Charlie* told me. “That was a sign to my family and myself that I had an addiction.”
But 19-year-old Charlie wasn’t just addicted to Spirit Lords. Screens ruled her life. She spent hours on Tumblr talking to people she's never met that she counts as her “closest friends." She idled on Reddit. She chatted in forums. She Skyped. Online was where she felt most herself.
“My mom had been saying for years that I spent too much time online,” said Charlie, who wears her hair in a close-cropped pixie cut and usually speaks in absolutes. “But I could defend myself: I was making friends, I was learning, I was staying up to date with the news.”
But Charlie's online time was taking a toll on her offline life. In high school, her grades had begun to slump. Now she was failing classes in her first semester of college. She needed help.
So, in June, she checked into reSTART, an internet addiction rehab center in rural Washington State.
The center is 25 miles east from Seattle, a drive that takes you through the suburb of Bellevue, past Microsoft's home in Redmond, and then onto a desolate stretch of Route 202 that is just miles and miles of evergreens. The first thing you notice when you arrive at reSTART's five-acre estate in Fall City is the absence of all that cacophonous buzzing, dinging and ringing that usually crowds the aural space of daily life. Instead, the wind rustles through cedars and doves coo in the distance.
It feels like an idyllic woodland retreat, but inside the center's main house are reminders of the reason people come here. A sign at the entrance asks visitors to turn off their phones. A wall in the dining room is covered in post-it notes responding to the prompt, “How does digital media use get in the way of living your life to the fullest?” On them clients admitted to wasting their day on Pinterest, becoming a slave to e-mail and giving in to the sense of false accomplishment they felt from playing an online game. One scrawled: "More likely to sit and watch something then go out and do something." In the living room, a digital picture frame flashes motivational phrases, like, “Social media: update less. connect more.”
Five people lived at reSTART when I visited in July: four guys and Charlie, all paying at least $25,000 for their 45-day treatments. The oldest was Adam, a 26-year-old from Louisiana who at one point was misdiagnosed with bipolar disorder before his parents decided he might instead be addicted to online gaming. The youngest was an 18-year-old who, despite being near the end of his 45 day-minimum stay, still seemed in denial that he was an addict at all.
People wind up at reSTART, generally, because they’re spending so much time online that their offline lives have begun to unravel. When the center first opened in 2009, it received a call from a parent whose son had played an online game for so long that he lost blood circulation in his leg and had to have it amputated. Most patients are college drop-outs or have trouble holding down a job. Many were so wrapped up in their online lives that they never learned to do very basic things, like drive, balance a budget or scramble eggs.
Hilarie Cash, reSTART’s executive director and co-founder, moved to Seattle in the early 90s to set up a therapy practice. She became interested in internet addiction after taking on a client whose marriage and job seemed to be falling apart because of the time he spent gaming online. He was the first of many.
“I kept seeing the same variable showing up again and again and that was the internet,” said Cash, who speaks with perfect enunciation and exudes a kind of professorial zen. The Seattle area is a tech hub, home to Microsoft, Amazon and Nintendo America, so many of her clients were early adopters.
Cash wasn’t an addiction specialist, but she thought her clients exhibited classic signs of behavioral addiction. When someone becomes addicted to drugs their body becomes chemically dependent, seeking out more and more of a substance to keep their brain's reward centers revved up. Behavioral addictions, like gambling, share many of the same characteristics, like cravings and loss of control over how frequently you indulge in an activity no matter the consequences. And research has shown that behavioral addictions similarly stimulate the brain's reward pathways. The brain gets hooked on the little bursts of dopamine transmitted each time it experiences reward. Seeking that hit of dopamine – through eating, gambling, video games, texting – becomes a compulsion.
reSTART's treatment begins with a detox; patients have to give up cellphones, computers or anything else connected to the web. They make calls to the outside world from an old-timey pay phone in the living room.The bookshelves are lined with rows of paperbacks. There are clocks everywhere, since no one carries a phone in their pocket.
Then, they're forced to deal with the underlying issues that might have led to their addiction, figuring out what triggers them and how to stop it. That means lots of therapy, mindfulness classes and ample self-reflection.
Most people at reSTART say their addiction began with some kind of personal trauma. Everyone I spoke with told me they turned to the internet mainly because they were feeling lonely, bored and wanted to escape whatever was going on around them. Reid, 20, told me he started gaming and seeking out relationships online as a teen after his father left his family. His mother moved them from Israel to California where he became isolated because his English wasn't great.
At one group therapy session I sat in on, Adam, who had only been there a week, said his addiction to gaming spiraled out of control when his relationship with his high school sweetheart soured during his freshman year of college. That started a years-long cycle of depression and addiction. His reSTART housemates listened quietly in knowing silence, then peppered him with piercing questions. How did the girlfriend treat him? Is anyone else in his family an addict? What kind of relationship did he have with his parents? Adam said that his parents' house had huge flat-screen TVs in nearly every room and his dad seemed pretty into tech. Everyone nodded.
Much of the treatment is similar to that for drug addicts; reSTART’s basic recovery philosophy is an adaption of Alcohol Anonymous’s 12-steps program. What makes internet addicts unique, Cash said, is that so many of them missed out on learning to be basic, functioning adults because they spent so much time glued to a screen. Thus, chores and socializing with their housemates are a huge part of the program. Everyone has a job, from feeding the chickens to cooking the meals. Charlie said one of the things she liked most was cleaning the bathroom. Adam began phoning home to Louisiana for his mother’s recipes, earning clout with his housemates for being the only one who could really cook.
Residents are encouraged to get active and go outdoors, a new experience for many. Every morning and afternoon there are CrossFit-inspired exercise sessions. On the weekends, residents go on trips to hike, kayak and camp.
In describing her patients' problems, Cash cites "iDisorder," an idea psychologist Larry Rosen popularized in his 2012 book that screen time begets personality disorders such as dependence, narcissism, being anti-social or avoiding life.
"I can see it getting worse when you’ve got generations coming up with even more screen time," she said.
The truth is, no one knows how to best treat internet addiction because we still don't completely understand it.
When reSTART first opened in 2009, China had already declared internet addiction a national epidemic and had been running treatment centers for five years — but researchers in the U.S. were not convinced that internet addiction was real. A person couldn’t be addicted to the Internet — a medium — some argued. That would be akin to saying an alcoholic was addicted to the glass, not the wine.
“Therapists don’t know how to think about it," said Cash. "They think the gaming or internet use is symptomatic of the depression, but often it's the other way around.”
But recently, many researchers have come around. In 2008, The American Journal of Psychiatry published an editorial encouraging internet addiction be included in the next Diagnostic and Statistical Manual. "Internet addiction is resistant to treatment, entails significant risks, and has high relapse rates,” the author, psychiatrist Jerald Block, wrote. In 2013, the latest update to the Diagnostic and Statistical Manual of Mental Disorders included Internet Gaming Disorder as a “condition for further study.”
The classification spurred a flurry of research on tech-based addictions. A study published last December in the journal Cyberpsychology, Behavior, and Social Networking estimated that internet addiction occurs in 6 percent of the global population. Another study published that month found that not only did 10 percent of participants exhibit addictive behaviors in the way they used social media like Twitter, Facebook and Instagram, it seemed to be associated with other impulse control disorders, like substance abuse. A literature review presented at the American Psychiatric Association's 2014 annual meeting found that people with internet addiction tended to exhibit certain brain abnormalities, like reduced levels of dopamine transporters, something commonly seen in the brain's of drug addicts.
This fall, a white paper on internet addiction is due out and California will host a first-of-its-kind conference about the impact of screen-time and digital media on development. Most of the researchers I spoke with were confident that some form of internet addiction will be listed in the next edition of the DSM.
If you’ve reached this far in the story, you might be wondering if you fit the bill. Maybe you catch yourself compulsively scrolling through Instagram, itching for that hit of dopamine you get when someone “likes” a photo you post. Maybe your phone feels like an appendage, both a phantom limb you can’t function without and a constant, anxiety-inducing distraction.
I wondered the same thing as I sat in on the morning meeting that reSTART residents attend everyday. Each person takes a turn expressing their mood and something they are grateful for, then lists all the things they hope to accomplish that day. People said they were thankful for sunshine and rattled off names of books they were planning to finish and chores they would do. I had been without a connection to the outside world for an hour, and could already feel my fingers twitching during lulls in the conversation.
A few hours later, I snuck out of the house and hid in my car to check Twitter, Slack, texts and e-mail. My phone buzzed phrenetically from all the notifications and I could sense the pleasure centers of my brain firing away as I sat there, crouching in the hot car, while reSTART’s residents lounged in the afternoon sun reading books, meditating, and feeding chickens. It was a personal low.
“Honestly, I think most people have a minor addiction to their smartphone,” Cash told me.
I'm don't think that I'm an "internet addict" — usually, I'd rather be outside than staring at a screen and my Twitter browsing habits haven't cost me a boyfriend or a job. (As a journalist, Twitter browsing has probably in fact made me better at my job.)
But at what point does internet use become "problematic"?
Megan Moreno, who runs the Social Media and Adolescent Health Research Team at the University of Washington, is working on a diagnostic tool that would help pediatricians screen teens for signs of “problematic internet use.” Proposed criteria for what makes someone an addict includes loss of control over internet use, mood changes, withdrawal and destructive impacts on a person’s social life, work or school. But Moreno's research has found that there is an entire spectrum of problematic internet use. Addiction is only the far end of the scale. Just because you're not an addict, doesn't mean you don't have a problem.
"Our thinking has evolved away from thinking of addiction as characterized by the number of hours someone spends online," said Moreno. "It's more a question of whether it becomes a long term crutch. What is your relationship with the internet?"
Gaming seems to be the worst "tech drug" out there. Most reSTART clients are male gamers between the ages of 18 and 28. There is only one other major inpatient internet addiction program in the U.S., founded in 2013 by a psychologist named Kimberly Young at the Bradford Regional Medical Center in Pennsylvania. (Her program consists of just 72 hours of digital detox, 10 to 21 days in recovery and then outpatient behavioral therapy.) Young also sees mainly young men who game.
Occasionally, reSTART gets 30- and 40-somethings and people whose main addiction is something else like social media or just browsing the web. The center had gotten so few applications from women that it had decided to give up on the hassles of operating a co-ed facility until Charlie enlisted her local TV station to petition reSTART to let her in.
Cash says it's not necessarily true that millennial male gamers are most susceptible to internet addiction; they may simply be the most obvious addicts. Some research has suggested that gaming is a particularly addictive online behavior, because so many opportunities for reward are built into the game. But social media platforms seem to be learning from this, seeking to "gamify" and "quantify" our interactions on their platforms; instead of slaying a monster, we get 100 'likes.' For technology companies, "addicted" customers are necessary for survival.
“Only time is really going to reveal the effects, but my fear is around disconnection from the real world in all its aspects,” said Cash. "Kids are going to be attaching to devices more than they are their parents.”
Cash was alluding to what is probably the most controversial area of research into how technology impacts our brains: how technology impacts the brain's development. We know that, among people who appear to be internet addicts, the brain seems to display patterns consistent with addiction. What else might be true is much murkier. Nearly every academic I spoke with cited The American Pediatric Association's suggestion that kids under the age of two get zero time in front of a screen, along with research that suggests tons of screen time for young kids may impact the development of the brain. Some research has even suggested a possible connection between time in front of a screen during early childhood and autism and others have hypothesized that there may be a link between the technology and a rise in autism diagnosis.
“You’re going to have broader problems,” said Young, who runs the other addiction center, “not just with addiction but with what technology does to our personality.”
But there is also a contingency of researchers who say evidence that the internet can impact our brain's wiring is scant.
“There is currently no evidence to suggest that Internet use has or has not had a profound effect on brain development," Kathryn Mills of the Institute of Cognitive Neuroscience wrote of teenage brains in the journal Trends in Cognitive Sciences last September. Mills noted that neuro-imaging studies of the brain and the internet have focused on teens who use the internet excessively.
If we want to know how this highly-connected world is impacting our brains, we will need to conduct studies that investigate brain measures and their relationship to behavior, cognition, and well-being in a representative sample of the population. Some studies have shown positive impacts of internet use for teens, like one 2009 study that found online interaction boosted teens’ self-esteem when they were feeling socially excluded. Of course, that is exactly why many of the young addicts I interviewed said they went online.
On my second day at reSTART, I stopped missing my phone and instead dreaded going back to a life attached to it. My brain felt less scattered. I felt weirdly, disturbingly calm.
When I told 19-year-old inpatient Charlie about this, she said that when she came to reSTART, she experienced about three days of withdrawal. At first, she felt totally numb and disassociated from reality. Then she was just tired. Then she was cranky.
“A lot of the reason I gamed was so I could not think,” she said. “When I got here I was very scared of silence. Silence meant having to think. But my mind is no longer a scary place.”
Charlie spends her days meditating, reading, working on an impossible, entirely orange puzzle in the living room. She’s gotten into mindfulness and learned things about herself, like that she’s too self-critical and afraid of being judged.
Everybody at reSTART enthuses about how peaceful they feel now that they’ve unplugged. It was hard not to feel like the reSTART lifestyle was one in which we all might all be a little better off – a life dedicated to being present and peaceful and grounded in reality. But can these addicts maintain that calm once re-immersed in the plugged-in world? Can any of us?
The addiction to technology is a societal one. Breaking it would require a cultural commitment to rethinking the way we live today. reSTART is trying. If you e-mail an employee there, a message in the signature politely warns that it may take as many as three days to respond “as we practice sustainable digital media use as an organization.” Cash has refused to set up social media accounts for the center, even though she knows it would be good for publicity. “It’s just not worth it,” she said.
After finishing the 45-day initial treatment, about half of reSTART's clients stay on in Redmond to complete “phase two,” during which addicts live with other recovering addicts, find jobs, volunteer and continue attending meetings and therapy while still living with minimal tech. reSTART issues them dumb phones and a staffer performs unannounced “tech checks” of their apartments.
As they pull their lives back together, addicts in recovery can “apply” to regain more technology privileges. A number of "phase two" patients told me that living life with a dumb phone and just a couple of hours a day of computer time was perfectly fine. Most spend about a year living with minimal tech.
But one "phase two" graduate named Tim illustrated just how hard it is to be a recovering internet addict in a world filled with technology.
Tim, who is also an alcoholic and porn addict, told me that he immediately relapsed the minute he got an iPhone in his hand during a brief trip back home.
"I would spend days watching stuff on YouTube. Just click a random link, watch it, click a random link, watch it. Repeat that for 12 hours, all the while drinking Scotch," he said. "There is a very real desire to do that again."
*The names of reSTART patients have been changed.