Rehab Clinic for Gamers – ReStart
The following interview with Hilary Cash of the
target=”_blank”>netaddictionrecovery.comsite, and was conducted for the Polish MMO Magazine mmozin.pl. We have republished it with their permission, hope you enjoy it!
M: Hello. Can you tell
us a few words about
yourself and your role in the restore clinic?
R: Hello. I am the
co-founder of the
clinic and we started it just this summer. I have been
developing my work with internet addicts since 1994 when I met my first video
game addict. 11 years ago I co-
founded an out-patient clinic called
internet/computer addiction services and last year i co-offered a book called
"Video Games and your kids – How Parents stay in
M: So how did you meet
your first game addict?
R: He came to my w:st=”on”>Seattle
office when I have just moved to
area. He was one of my early clients and he was depressed and his marriage was
falling apart. And as we worked together it
became clear that he was addicted
to an early Dungeons & Dragons game, text only, no graphics. But he was classically
addicted. He had lost 2 jobs because he could
not stop playing and he did lose
M: Can you tell us
the clinic itself? Where it’s located? How many patients you have
now and how many a year? How long does the therapy last?
class=”MsoNormal”>R: Sure. The clinic
started just at the end of July, so we are just new. We have had four clients –
men and a woman in her thirties. They have all finished and we are w:st=”on”>Redmond
on a break until the New Year. It’s located in
people come, they come for 45 days. It is only for adults, no children – have
to be 18 or
older. When they first come, they come for a minimum 2 days to be
interviewed and interview us, because we don’t want anyone there who doesn’t
want to be there. So if
they decide they want to be there then they stay for 45
days or longer if they choose. During that time they don’t have access to the
internet. The idea is that it
takes at least 30 days for the brain to make some
adjustments it needs to make to get over this addiction, so the brain can begin
to rewire back to normal. During that
time we are helping them look at why they
got addicted, what motivated their addiction and we’re assessing to see what
the skills they are lacking so they can be
successful in their adult lives. We
try to make a good start at helping to build those skills. The way we do that
is multi-faceted. They live on a regular, daily routine
of waking up at a
normal hour, having breakfast, cleaning up, after breakfast doing chores in the
house and on the property with the animals and in the garden. After
have psychotherapy and education related to their addiction and skills they need
to develop. Then it’s lunch and after it is a group psychotherapy and life
skills couching. Then it is time for them to work with Cossetes husband, Gary,
who is in construction – they help him with building projects in the
M: The girl also?
style=”mso-ansi-language:EN-US”>R: No, she had art people come together and there are responsibilities one twelve-step meeting during the day on Monday these structure activities the addicts clients will be like them and develop social as are not good at that. And then, starting to look at psychological ADD.
projects. She didn’t want to work outside so she was able to do work on them –
she’s an artist. In the evening
that are shared for preparing the evening meal, cooking planning, all of that.
There’s also meditation training and
and another in the evening on Friday. Then it’s free time for the rest of the
evening. So the idea is that through all
and in particular most of our clients will be like most of young men who have
come, who have been 18, 19 and 25. Most of our
they will be behind in social skills, because their social lives have been
lived online and not enough in real life. So, helping them
skills and beginning to address the lack of just simple daily skills that they
need to develop if they’re going to take care of themselves independently
adults. Taking care of their personal hygiene, learning to cook, clean up their
physical space and just be adults in the real world. We find that they
factors they need. Sometimes they’re on medication for depression, anxiety,
style=”mso-ansi-language:EN-US”>R: No, she had art
people come together and there are responsibilities
one twelve-step meeting during the day on Monday
these structure activities the addicts
clients will be like them and
are not good at that. And then, starting to look at psychological
M: You have a doctor
class=”MsoNormal”>R: We work with a
that they can
visit and they sometimes choose to go off medication or they can
stay on medication or they might need for the first time medication. What I
have certainly found over
the years is that depression and anxiety and even
attention deficit disorder are conditions that are sometimes brought by some
spending too much time online and playing
video games. When they get a break
from that and begin to engage with life and begin to develop the skills to feel
successful in life, the depression and anxiety begin
to lift and go away
without the medication.
M: Do you think that
addicted person can help himself or herself or is it that kind of addiction
really needs a help from specialists?
R: I think it depends.
There are people who
are capable of recognizing that they seem to have an
addiction and they pull back and cut down the amount of time they’re spending
online or take a fast and stay away
from it for a while. They’re definitely
people like that and many can do that in fact, but there are some that can’t,
who are so deep into their addiction they have
lost all the control and seem
powerless and those people need to seek professional help. I want to say one
more thing. If the person is young enough and living at home,
the problem can
usually be handled pretty easily once the parents understand how to set
appropriate limits and are effective in that. Once parents can structure their
lives in a way to regain control over the computer and that technology, and if
the kid is young enough that they will listen to parents even if they are mad,
works very well. If i have parents of younger teenagers I only work
with the parents, I don’t worry with working with the kids usually.
class=”MsoNormal”>M: But these teenagers
are still minors or adults?
style=”mso-ansi-language:EN-US”>R: When I work with a adults.
family I’m working with minors. When they come to me at Restart we’re working
style=”mso-ansi-language:EN-US”>R: When I work with a
M: What’s the average
age of an addicted player?
R: Well, I’m not sure.
The people who come, that I see, are almost always between the ages 10 and 30.
There are certainly people older that are addicted.
M: Okay, can i
there are more boys addicted than girls usually?
R: I think that if you
internet as a whole and include social networking and shopping and the whole
internet, it is pretty even in terms of addiction. When it comes to the MMOs
it’s far more
boys than girls.
M: When we are talking
about MMO or other games, but i think MMO
mostly, are there addicted players
identifying themselves with their virtual identities when they come to you or
is it an addiction like spending too much time playing
R: That is an
interesting question. I’m not sure what the answer is. I think
play and create an avatar they do identify very strongly with their avatars and
they certainly like often who they are more in the game than how they are
the real world. They prefer the way they are in the games over their real world
experiences. So I think there is a very strong identification with that. As a
therapist my challenge is getting the people who are helping players understand
what it is in the game that they like so much about themselves and help them
to bring that forward into real world.
M: Is there any time
limit that says you
played too much or no?
R: You’re not going to
like my answer. There is some
research which shows a correlation between the
amount of time and the sings and symptoms of addiction. This is early research
so i don’t know if it still true. But
early research done in the 90s show that
people who spent more than 2h a day online in entertainment – you know, not
work, but online socializing and entertainment –
then they started showing
signs and symptoms of addiction. As a rule of summit people ask "What
should be the time limit" i will always say "Don’t spend
more than 2h
if you want to be sure you don’t want to be addicted".
but it can be
hard sometimes, really. So little time that it flies so fast that everybody can
style=”mso-ansi-language:EN-US”>R: Remember that part get a high, because you’re enjoying it so pick those neurochemicals out – spending time online you stuff begins to develop tolerance to that new level. That’s how it works. Because you’re hooked in being on the internet and playing video games even though there are could be physical health problems because you aren’t of there, need to be there for us to call
of the definition of addiction; all addictions have some things in common. It
means at least at the beginning you
much. Then the brain makes adjustments, because it’s getting too much of the
neurochemicals and withdraws the receptors to
that is called tolerance. If you spend too much online or in video games, your
brain is making that adjustment and then if you’re not
are at risk of going into withdrawal, when you’re unhappy, discontented and
uncomfortable because you’re not engaged in that activity. Once
happen, once you’re body develops tolerance, then you need more time or
something new in order to achieve the pleasure you are seeking. Then you
into that, then if you start to feel out of control, that’s when you start
now and going to be negative consequences. They can be alienation from your
friends and family. It
getting enough sleep or it could be problems with work or school and so for.
Those are the elements that are kind
something an addiction.
style=”mso-ansi-language:EN-US”>R: Remember that part
get a high, because you’re enjoying it so
pick those neurochemicals out –
spending time online you
stuff begins to
develop tolerance to that new level. That’s how it works. Because you’re hooked
in being on the internet and playing video games even though there are
could be physical health problems because you aren’t
of there, need to be there for us to call
M: What do you
about the psychologist opinion that games are evil and teaching players to be
aggressive? Do you think that the games are as bad as psychologists say or do
have any positive aspects to themselves? How do you see that being a
therapist in game addiction?
class=”MsoNormal”>M: What do you think
about the methods used in Chinese clinics?
class=”MsoNormal”>R: Methods of beating,
electric shock and so forth are horror stories, those are terrible. . I visited
and that is not one of the clinics that has reported any terrible things
happening. It was a
fascinated to go there, because it was a combination of a
military boot camp – a lot of very rigorous, vigorous physical activity,
wearing a uniform, learning to handle
weapons – it was like a military
training. It was this, but also western style psychotherapy. They had sound
trade play therapy, music therapy, group therapy, individual
anger release therapy. Those are good techniques. I came away from my tour of
basically positive outlook on it. Although I would love to spend a month or so
just really observing what it was like, but my impression was fairly positive.
That is run by doctor Tau who is a very smart, capable and caring man. I think
he’s created a fairly good program Chinese style, very different from our own –
American style. The other places may be absolutely awful. It’s awful if
anybody is being beaten, electric shocked and all of that is terrible.
M: Do you think that
different nations can have a different method for addict therapy?
R: I think it’s
inevitable that different cultures are going to produce different solutions. I
you that i have been contacted by people in china who are very
interested in trying to model what we are doing over there. So they’re
interested in learning in a
gentler approach. So we’ll see what comes about.
M: Are there any
how many addicted players there are in US,
there any statistics at all?
R: Well, in the region>
most recent research is suggesting that addicted video game players range of
about 8.5% overall of kids between the age of 8 and 18; they meet
M: And adults?
class=”MsoNormal”>R: For adults it’s w:st=”on”>
actually very similar. It’s interesting though, the research by someone in
Yee spent his young career – he’s pretty young, about 30 – his research has
been inside the
MMOs. I haven’t read his most recent research, but i knew
earlier his research suggested that among MMO players the rates of addiction
were probably pretty much higher.
R: The most unusual
case? I’ll give you two. One is a 25 year old man whose wife has brought him.
He had been a
star in high school and earned a scholarship into a very
exclusive university. He was an athlete, very socially popular and loved to
play games as well, but it wasn’t a
problem. His life was good and he played
games appropriately. When went off to the university he got very anxious that
he won’t be good enough to succeed in the
university. So, instead of working
harder to be competitive, he escaped his anxiety by playing MMOs and he was
kicked out. He married his high school sweetheart and
industry. The game he had gotten so addicted was
Everquest. He made a promise
to his wife that he will never play Everquest again. For one year he didn’t
class=”MsoNormal”>M: But he played other
M: Did it turn out
good in the end?
class=”MsoNormal”>R: Yes. It was great.
He was easy to work with, because he had lived his life to adulthood as a very
young man. So, he knew what it felt like to be healthy. It was easy,
really. In the end, he knew he had to stay away from video games entirely, like
an alcoholic has to
stay away from alcohol. He just knew that about himself.
Once he made that commitment he started doing some twelve step work and as far
as I know he’s fine. They moved
away and i lost touch with them, but as far as
i know they’re fine. Another case is a young man from this area who, again, had
a pretty normal life up until he went off
to college. He played video games,
but in moderation, he was a good scholar, he ran across country, he had friends
and social life. When he went off to college, what was
very significant about
him, although he had friends he was socially shy and he hated his father who
was abusive. When he went to college he met other gamers in the dorm
and he squeaked
by passing the first term, those courses. But, thereafter he would sign up to
courses and then he would withdraw by the withdrawal deadline. He pretended
his parents that he was still in college, taking all the college courses,
creating a fake transcript which he would show them that he was doing well. For
he kept up that deceit and his parents paid for his university. He
didn’t have anything to show for. He eventually was kicked out and too was suicidal
and depressed. He
was much more difficult to work with. He has been gaming at
this level at that time for about 5 years. He was socially very far behind in
his social skills. He was
really scared to be out in the world, he had become
agoraphobic – didn’t want to leave the safety of his room. So in the end he was
unwilling to end his gaming
entirely. I couldn’t make him do it. It was a very
long, slow process of working with him.
R: I worked with him
on a regular basis
for 2 years. The best thing that happened to him, he did
eventually have to work, because he ran out of money. Then he got a horrible
job, so he wanted a better job and
he got that. Then he didn’t like that job
and he realized that he needed his university degree. That motivated him to
return to university. They made him to write a
whole essay about what happened
to him and why they should take a chance on him one more time. He wrote that,
they accepted him back and he’s a graduate. His life is
slowly improving, but
he’s now 26 and he doesn’t date. He’s way behind his peers socially.
R: The young who have
come to us on the Restart Program have all
had similar stories. What i have
found is that if somebody can come for treatment when they are young enough and
I can work with the parents then treatment is easy. If
they are older, in their
twenties and they have already enough maturity to realize what of a fiasco
they’re in, they have created for themselves and they’re ready to
work and not
in denial about their trouble then that’s easy as well. What is difficult is
when they are older teenagers or young adults who do not yet admit they have
severe problem. Then they’re harder to reach. When somebody is still too
strongly in denial, they haven’t experienced enough pain to be willing to get
MEN AND THE ADDICTION
M: Is there any
difference between women and men
when they are addicted and any difference in
R: Well, therapy
to be adjusted to each individual. In general, the women that i
worked over the years have been far fewer in number and their issues have often
been around falling in
love with people in the game, whole fantasy life around
relationships. It’s different what motivates a lot of men.
style=”mso-ansi-language:EN-US”>M: That’s an
interesting point of view.
style=”mso-ansi-language:EN-US”>M: That’s an
R: One of
that is very popular with women is Second Life. It can be a place to live out
fantasies and relationships.
class=”MsoNormal”>M: There was a
psychologist named John Carlton, who said that addiction is a feature of
personality. Are the
persons who come to your clinic easily addicted to other
factors, for example smoking or something else before coming to your clinic?
class=”MsoNormal”>R: No. I do think once
a person develops an addiction then they’re very much more vulnerable to
addiction. So i think they’re often all called addictions and it might be
to drugs and the internet, smoking and the internet or whatever. Most of the
people i have
worked with over the years haven’t been addicted to anything
except the internet.
Not that i know of,
except that i do a lot of work in that program in our clinic called
Internet/Computer addiction services in-patient – we work with a lot of sex
addicts and their partners. Those sex addicts are for the most part very
vulnerable once they give up their addiction to pornography or sexual acting
out. They have to
be very careful to not be addicted to something else.
M: Does the Ministry
give any refunds for the therapy for addicted players?
R: Not at our
setting, but we can use… You’re with Diagnostic Statistic Manual
which has categories of psychological disorders and there’s a category called
Disorder". If somebody, like a video game addict,
comes to visit me at my office i can build the insurance for that.
class=”MsoNormal”>M: Is there any
scientific name for the game addiction or was that "Impulse Control
Disorder" the name
for the game addiction?
R: No, it is called
Impulse Control Disorder, not otherwise
specified. So it is a general category
that’s not specified. In the next version of the manual which will they will be
coming out in two more years, there’s going to
be a large category for
non-substance use addictions. We know gambling will be there, because there’s a
lot of research on gambling. We’re hoping that they will also
game addiction and perhaps sex addiction, but we don’t know yet what will they
decide to include. It’s all a matter of evidence, good research and it
M: Will it change
anything if they include it in?
R: I think it will be
huge, because then the insurance companies that pay for
health insurance will
have to cover it in the same way as they cover chemical dependency, drugs and
alcohol. And it will be huge in terms of people in my profession. So
people in my profession don’t take this as a serious problem. They don’t like
to think of this as an addiction and don’t know much about addiction in the
first place. So if it gets into DSM that will change the landscape a lot. So I
hope it happens.
R: Yes. Direct our
readers to our website: netaddictionrecovery.com . There
is a signs and
symptoms checklist that they can go over and we tell them how to score that.
It’s not definitive, but it does certainly give them an idea of whether
have a problem or not.
M: Thank you very much
for explaining everything to
us. It was a very interesting talk. I think me and
our readers will have a different view on gaming or at least think in different
light about it. That was really
educative. Thanks again.
M: Do you play games?
What kind of?
R: No. But I have a
son who is 19 and he enjoyed video games and so i
tried to play some video
games with him, but i was so bad it was no fun. Oh, there were some Mario games
and… I don’t remember the name… Soccer, you know
M: I’m bad at them
too, so it’s nothing.
class=”MsoNormal”>R: So you understand.
M: But i
games because of that.
R: What games do you
M: Online games, MMO.
style=”mso-ansi-language:EN-US”>R: World of Warcraft?
style=”mso-ansi-language:EN-US”>R: World of Warcraft?
M: No. Not this one
R: I have never played
an MMO. I have watched other people play, but I
myself do not play.