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A Day at the First Video Game Rehab Clinic in the US

I toured the first in-patient treatment facility for video game and internet addiction.
June 18, 2014, 4:30pm
Image: Jagger Gravning

I'm somewhere in the hushed hinterlands beyond Bellevue and Redmond, Washington, the hometowns of Nintendo of America, Microsoft Game Studios, Valve, Sony Online Entertainment (Sony's MMO studio), Bungie, Sucker Punch, and perhaps dozens of other game developers whose creative works enthrall millions.

This part of Fall City is so rural there aren't even houses lining the streets, only a silent density of evergreens that occasionally yawned open to reveal gravel roads with Dead End signs posted at their entrances. Such was the road leading down to Heavensfield, the name of the five acre, ranch-like estate home to reSTART, the first in-patient treatment facility devoted exclusively to video game and internet addiction.


I don't have a car, so my friend Corey, with his piercing-eyed toddler strapped into the backseat, drove me the 30 or so miles east from Seattle to reSTART's center. It's here that we're greeted by Dr. Hilarie Cash, reSTART's co-founder and executive director, who tells us about her patients.

"These are young men," Cash explained, while showing off a garage converted into a gym and used for therapeutic exercise. "Testosterone is in their systems! They need to channel that into something useful."

Curiously, there are only men here. Recently, reSTART decided to no longer accept women as patients.

"We had a family whose father wanted his daughter to come in," Cash said. "This is before we had made our policy [of men only]. We had one of the guys here tour her around. She immediately began hitting on him. So we said, 'No. We're not going to take her. We can just see that there will be trouble.'"

"When and if we expand, we may have something just for women," she went on. But with only three bedrooms and up to six patients at a time, the way lodging would need to be segregated at reSTART would prove problematic, Cash said. And in any case, she said, most of her prospective patients are male.

Cash puts it bluntly: Guys are "socially engaged online, but isolated in front on their screens."

Cash has even taken a term, "intimacy disorder," originally used for sex addicts, and applied it to digital media addicts.


But it's not just gaming. The young men who come here, often at the behest of their families, for video game addiction as a primary issue often wind up needing to be treated for porn addiction as a secondary issue. In fact, video game addicts are screened when they arrive at reSTART to determine whether porn addiction is actually the primary problem. The two maladies are linked, not only because you can access them both, video games and naked women, through your computer, but also in how they stimulate and sometimes entrap the brain.

Cash, a psychologist who co-authored the book Video Games & Your Kids: How Parents Stay in Control, has even taken a term, "intimacy disorder," originally used for sex addicts, and applied it to digital media addicts. She argues that someone with intimacy disorder, in the context of digital media addiction, has either not developed or has lost the social skills needed to engage in satisfying real-life social interactions.

As we entered the clinic's spacious backyard—passing between rows of oversized chess pieces set up on a flagstone chessboard—we walked down a grassy pathway past a hammock, a gardening area, pens for doves and chickens, and a tiny cabin for private therapy or study.

Image: Jagger Gravning

Finally, we entered a second small cabin at the edge of the property. Inside were couches, chairs, and stuffed animals. If you've ever been to a therapist's office, it looked familiar. The woods outside filled the large windows.

It was here, before I met with with several of reSTART's patients, that Cash told me about "limbic resonance," and specifically how it relates to the more damaging aspects of video game and porn addiction.


"I'm going to assume you two are good friends," said Cash, referring to Corey and me.

"Yeah," I said.

"When you two are hanging out together, there is a neurochemical release in the limbic area of your brains that keeps you both regulated emotionally and physiologically. And for an infant, who is experiencing limbic resonance with you right now, as he stands there," she went on, motioning to Corey's toddler, Ethan, who gripped Corey's kneecap for support while looking curiously about the room, "the limbic resonance, the feeling of safety and love and attachment, keeps this child thriving. The release of neurochemicals keeps that child well-regulated physiologically as well as emotionally."

Ethan began to take a few steps, exploring the room.

To hear Cash tell it, research has been consistent in showing that as people spend more time online, the more depressed they become. "It's my theory that limbic resonance doesn't occur when you are not face-to-face with somebody. That it requires, perhaps, the stimulation of our senses," she explained. "We have to be able to see and hear and touch and feel and smell each other for that release to occur. But what happens is that people seek to satisfy their social needs online."

"It feels like you're interacting with people on Facebook," I said, "but you're not really getting the nutrients. It's like eating junk food."

"Exactly," Cash said.

A sudden beeping and whirring interrupted our conversation. Ethan had discovered a Roomba and switched it on. The robot vacuum suddenly was trundling across the room towards us. Ethan observed it cautiously.


This cracked up Cash, who laughed at some length. "Welcome to the digital world," she said.

reSTART co-founder and director Hilarie Cash, PhD, in a moment of limbic embrace with Ethan.

Cash recommended I check out a book called A General Theory of Love, and in it I looked into some of these concepts further.

The books speaks to the Triune Brain Concept, a streamlined, if controversial, way of thinking about the brain. Essentially, with the Triune brain model you have the reptilian brain, literally the basal ganglia, which is the seat of your innate instincts—your flight or flight reflexes, in other words. And then you have the outermost, neomammalian brain, commonly known as the neocortex, which handles complex stimulus analysis, and in humans, abstract thought and language.

Between these two is the paleomammalian brain, which is literally the limbic system and its connecting brainstem structures. The limbic system seems to be primarily responsible for our emotional life. It's also the seat of the reward system, and thus also involved with addiction.

Interacting with people online, through video games or through internet comments for example, we are unable to read body language and other nonverbal emotional cues that allow us to fully empathise with them. In effect, it makes us partially mindblind.

This seems to be why internet comments descend into blame and insults so immediately, in a way that rarely happens in face-to-face interactions. Limbic resonance, indeed, seems to be failing to fully engage.

A reSTART patient does work therapy at Heavensfield, from reSTART's press kit. Image: reSTART

There are five patients living at the reSTART facility as of this writing. Two declined to speak for this article. But the other three all told remarkably similar stories. Each had experienced a significant social change before their habits began or took a turn for the malignant.

There's Cole, whose friend committed suicide after being cyber-bullied.

There's Andrew, who went from being captain of the football team and "not without a girlfriend for any stretch of time" throughout high school, to being lonely enough in college that he built a gaming computer into which he poured all his energy, to the point that his "hygiene habits fell through." Soon enough, he "stopped looking for anything that didn't have immediate gratification."

And then there's Taylor, who experienced a drugging and sexual assault as well as the passing of his grandfather and spiritual mentor. He built a gaming computer in his sophomore year at college, and dove into digital mindscapes, going from "200 pounds of muscle with a pick of the girls" to a ghost of his former self.

The young men all spoke of the intent and the relative success of finding friends online when having difficulty in real life. Cole even studied French to better communicate with some of the people he played with.

But for Taylor, it was all about the rush of ascending as an alpha figure in the gaming universe.


"If I didn't talk to people [in real life] I couldn't get hurt," he told me. "I lived my whole social world through gaming. In games, I was the leader. In real life, I used lies and manipulation to keep the parents at bay. All structure left my life. I skated by, just doing enough so I could get back to the game."

Studies have shown that, at least in men, video games can double dopamine levels in the reward system—which is similar to sex, incidentally. Why men are more affected by video games is a subject of some speculation, but Professor Allan Reiss, who led a study at Stanford investigating gender differences in video game's effect on our reward system (the mesocorticolimbic system) speculated that males tend to be more intrinsically territorial.

If I didn't talk to people in real life, I couldn't get hurt. I lived my whole social world through gaming. In games, I was the leader.

"It doesn't take a genius to figure out who historically are the conquerors and tyrants of the species," Reiss wrote. "They're the males. Most of the computer games that are really popular with males are territory and aggression-type games."

As for compulsive video game playing's alluring cousin, compulsive online porn consumption also seems to affect innate processes of some young men, essentially trapping them inside a digital Skinner Box.

To be clear, it's not porn itself that hypnotizes men. A Playboy magazine wouldn't do it. It's the internet's unlimited pornocopia that gets them. The unending novelty of video games and porn keep the dopamine levels high. What we are discussing here, both for video games and porn, are what psychologist Philip Zimbardo calls arousal addictions.


"Drug addictions, you simply want more," Zimbardo said. "Arousal addictions, you want different."

Arousal addictions stem from the Coolidge Effect, which was named, witheringly, after a joke involving President Calvin Coolidge and the First Lady. The Coolidge Effect is when a sexually spent male mammal experiences a renewal of arousal with the introduction of new, willing females.

"This old mammalian program, the Coolidge Effect," says YourBrainOnPorn's Gary Wilson, "perceives each novel female on a guy's screen as a genetic opportunity. To keep a guy fertilizing the screen, his brain releases the 'go get it' neurochemical dopamine for each novel mate or image."

Wilson argues that the porn and video game addicted brain suffers structural brain changes consistent with those seen in other addicts, leading to a numbed pleasure response, and an erosion of willpower.

Zimbardo wrote in his book The Demise of Guys about the experience of being hooked on either video games or porn. "This new kind of addictive arousal traps users into an expanded present hedonistic time zone," he wrote. "Past and future are distant and remote, as the present moment expands to dominate everything."

Celebrity addiction medicine specialist Dr. Drew, again speaking of both pornography and video games, says that this form of escape is called dissociation. "They disconnect, they get in the flow where time passes without them even being aware," Drew explained. "It's a way of disconnecting from unpleasant feeling states."


You dissolve into a dissociative state, a total liberation from the self. It's like the Zen precept of mindfulness gone critically wrong. You soon find yourself not in hell, but in limbo. And the deeper you are into it, the less you care.

Video game addiction has not yet been recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM), so insurance doesn't cover it. So for now, it is something only the wealthy, or their offspring, can see about getting treated.

But just looking around in my own life I saw several friends suffering the same thing. In fact, my ride to reSTART, Corey, had sold his game console six times because of the negative impact all-day playing was having on his life, only to repurchase the console each time an exciting new game came out.

Another friend lost his job at Amazon for repeatedly playing World of Warcraft during work hours in the wake of a divorce. Being jobless led to further depression and more WoW with his online guild. Ultimately, his grandmother connected him to AA and the Twelve Steps to recover.

Tragically, we can also consider Elliot Rodger, who recently rampaged through Isla Vista, California, killing six people before turning the gun on himself. Rodger left a very detailed account of his nearly decade-long addiction to World of Warcraft as a refuge from his sexually frustrated life. Rodger even used that word, "addiction," in My Twisted Worldhis sprawling manifesto. He only finally gave up on the game months before the shooting because it had become less of an escape:


More and more 'normal' people who had active and pleasurable social lives were starting to play the game. WoW no longer became a sanctuary where I could hide from the evils of the world because the evils of the world had now followed me there. I saw people bragging online about their sexual experiences with girls. And they used the term 'virgin' as an insult to people who were more immersed in the game than them. The insult stung, because it was true. Us virgins did tend to get more immersed in such things because our real lives were lacking.

Gamers tend to mock pundits who blame the violence in games for mass shootings. It's easy to mock because the argument is pretty unsophisticated: Millions see the same horror films, or play the same action games, and only the tiniest fraction of a fraction ever become violent in any way, let alone mass shooters.

But if we look hard at how games are used to ease social and sexual frustrations, and the structural changes they can make in the brain, it's maybe not the violence in games we should be most concerned about. Maybe there is something more concerning in the addictive cycle of gaming—any type of video game, violent or not—which channels the addict ever further away from nurturing human contact, love, and social ambition.

"I am so struck by how complex social interaction is," Cash told me. "So, if you're going to be successful in building and maintaining relationships, you have to have a lot of skill at it. But if we are isolated and not in the mix, then we are falling behind, and we aren't learning those skills. And then we aren't so successful socially. But people don't realize how important it is to be face-to-face to get those social needs met."

Gamers tend to mock pundits who blame the violence in games for mass shootings. It's easy to mock because the argument is pretty unsophisticated: Millions see the same horror films, or play the same action games, and only the tiniest fraction of a fraction ever become violent in any way, let alone mass shooters.

On the way back to Seattle, we pulled over by the Snoqualmie river. Corey had a gas-powered camping stove and he wanted to make coffee out of river water. The only thing nearby was a lone cherry stand by the road, so I bought some cherries for a dollar while Corey filtered and boiled the water. Then he, Ethan, and I sat by the Snoqualmie drinking our river water coffee.

I had spoken with people, both friends and strangers, who have been crippled with depression and social phobia by arousal addiction to digital media, seeing alienation so totally calcified that greatly important things were lost—school, jobs, health—as the addiction channeled the addict ever further away from nurturing human contact, social bonding and love.

"There's such a difference in personality, I find," Cash told me as our visit wrapped up, "between drug addicts and alcoholics versus our guys. The drug addicts and alcoholics have a certain comfort with being in the world, you know. They're street smart. They've had to figure out how to go get their drugs and they've done their drugs socially and been sexually active. It kind of gives them a comfort in the world that a lot of our guys completely lack."