December 1, 2005
Hooked on the Web: Help Is on the Way
By SARAH KERSHAW
THE waiting room for Hilarie Cash's practice has the look and feel of many a
therapist's office, with soothing classical music, paintings of gentle swans and
colorful flowers and on the bookshelves stacks of brochures on how to get help.
But along with her patients, Dr. Cash, who runs Internet/Computer Addiction Services
here in the city that is home to Microsoft, is a pioneer in a growing niche in
mental health care and addiction recovery.
The patients, including Mike, 34, are what Dr. Cash and other mental health
professionals call onlineaholics. They even have a diagnosis: Internet addiction
These specialists estimate that 6 percent to 10 percent of the approximately 189
million Internet users in this country have a dependency that can be as destructive
as alcoholism and drug addiction, and they are rushing to treat it. Yet some in the
field remain skeptical that heavy use of the Internet qualifies as a legitimate
addiction, and one academic expert called it a fad illness.
Skeptics argue that even obsessive Internet use does not exact the same toll on
health or family life as conventionally recognized addictions. But, mental health
professionals who support the diagnosis of Internet addiction say, a majority of
obsessive users are online to further addictions to gambling or pornography or have
become much more dependent on those vices because of their prevalence on the
But other users have a broader dependency and spend hours online each day, surfing
the Web, trading stocks, instant messaging or blogging, and a fast-rising number are
becoming addicted to Internet video games.
Dr. Cash and other professionals say that people who abuse the Internet are
typically struggling with other problems, like depression and anxiety. But, they
say, the Internet's omnipresent offer of escape from reality, affordability,
accessibility and opportunity for anonymity can also lure otherwise healthy people
into an addiction.
Dr. Cash's patient Mike, who was granted anonymity to protect his privacy, was at
high risk for an Internet addiction, having battled alcohol and drug abuse and
depression. On a list of 15 symptoms of Internet addiction used for diagnosis by
Internet/Computer Addiction Services, Mike, who is unemployed and living with his
mother, checked off 13, including intense cravings for the computer, lying about how
much time he spends online, withdrawing from hobbies and social interactions, back
pain and weight gain.
A growing number of therapists and inpatient rehabilitation centers are often
treating Web addicts with the same approaches, including 12-step programs, used to
treat chemical addictions.
Because the condition is not recognized in psychiatry as a disorder, insurance
companies do not reimburse for treatment. So patients either pay out of pocket, or
therapists and treatment centers bill for other afflictions, including the
nonspecific impulse control disorder.
There is at least one inpatient program, at Proctor Hospital in Peoria, Ill., which
admits patients to recover from obsessive computer use. Experts there said they see
similar signs of withdrawal in those patients as in alcoholics or drug addicts,
including profuse sweating, severe anxiety and paranoid symptoms.
And the prevalence of other technologies - like BlackBerry wireless e-mail devices,
sometimes called CrackBerries because they are considered so addictive; the Treo
cellphone-organizer ; and text messaging - has created a more generalized technology
addiction, said Rick Zehr, the vice president of addiction and behavioral services
at Proctor Hospital.
The hospital's treatment program places all its clients together for group therapy
and other recovery work, whether the addiction is to cocaine or the computer, Mr.
"I can't imagine it's going to go away," he said of technology and Internet
addiction. "I can only imagine it's going to continue to become more and more
There are family therapy programs for Internet addicts, and interventionists who
specialize in confronting computer addicts.
Among the programs offered by the Center for Online Addiction in Bradford, Pa.,
founded in 1994 by Dr. Kimberly S. Young, a leading researcher in Internet
addiction, are cyberwidow support groups for the spouses of those having online
affairs, treatment for addiction to eBay and intense behavioral counseling - in
person, by telephone and online - to help clients get Web sober.
Another leading expert in the field is Dr. Maressa Hecht Orzack, the director of the
Computer Addiction Study Center at McLean Hospital in Belmont, Mass., and an
assistant professor at Harvard Medical School. She opened a clinic for Internet
addicts at the hospital in 1996, when, she said, "everybody thought I was crazy."
Dr. Orzack said she got the idea after she discovered she had become addicted to
computer solitaire, procrastinating and losing sleep and time with her family.
When she started the clinic, she saw two patients a week at most. Now she sees
dozens and receives five or six calls daily from those seeking treatment elsewhere
in the country. More and more of those calls, she said, are coming from people
concerned about family members addicted to Internet video games like EverQuest, Doom
3 and World of Warcraft.
Still, there is little hard science available on Internet addiction.
"I think using the Internet in certain ways can be quite absorbing, but I don't know
that it's any different from an addiction to playing the violin and bowling," said
Sara Kiesler, professor of computer science and human-computer interaction at
Carnegie Mellon University. "There is absolutely no evidence that spending time
online, exchanging e-mail with family and friends, is the least bit harmful. We know
that people who are depressed or anxious are likely to go online for escape and that
doing so helps them."
It was Professor Kiesler who called Internet addiction a fad illness. In her view,
she said, television addiction is worse. She added that she was completing a study
of heavy Internet users, which showed the majority had sharply reduced their time on
the computer over the course of a year, indicating that even problematic use was
She said calling it an addiction "demeans really serious illnesses, which are things
like addiction to gambling, where you steal your family's money to pay for your
gambling debts, drug addictions, cigarette addictions." She added, "These are
But Dr. Cash, who began treating Internet addicts 10 years ago, said that Internet
addiction was a potentially serious illness. She said she had treated suicidal
patients who had lost jobs and whose marriages had been destroyed because of their
She said she was seeing more patients like Mike, who acknowledges struggling with an
addiction to online pornography but who also said he was obsessed with logging on to
the Internet for other reasons. He said that he became obsessed with using the
Internet during the 2000 presidential election and that now he feels anxious if he
does not check several Web sites, mostly news and sports sites, daily.
"I'm still wrestling with the idea that it's a problem because I like it so much,"
Three hours straight on the Internet, he said, is a minor dose. The Internet seemed
to satisfy "whatever urge crosses my head."
Several counselors and other experts said time spent on the computer was not
important in diagnosing an addiction to the Internet. The question, they say, is
whether Internet use is causing serious problems, including the loss of a job,
marital difficulties, depression, isolation and anxiety, and still the user cannot
"The line is drawn with Internet addiction," said Mr. Zehr of Proctor Hospital,
"when I'm no longer controlling my Internet use. It's controlling me." Dr. Cash and
other therapists say they are seeing a growing number of teenagers and young adults
as patients, who grew up spending hours on the computer, playing games and sending
instant messages. These patients appear to have significant developmental problems,
including attention deficit disorder and a lack of social skills.
A report released during the summer by the Pew Internet and American Life Project
found that teenagers did spend an increasing amount of time online: 51 percent of
teenage Internet users are online daily, up from 42 percent in 2000. But the report
did not find a withering of social skills. Most teenagers "maintain robust networks
of friends," it noted.
Some therapists and Internet addiction treatment centers offer online counseling,
including at least one 12-step program for video game addicts, which is
controversial. Critics say that although it may be a way to catch the attention of
someone who needs face-to-face treatment, it is akin to treating an alcoholic in a
brewery, mostly because Internet addicts need to break the cycle of living in
A crucial difference between treating alcoholics and drug addicts, however, is that
total abstinence is usually recommended for recovery from substance abuse, whereas
moderate and manageable use is the goal for behavioral addictions.
Sierra Tucson in Arizona, a psychiatric hospital and behavioral health center, which
treats substance and behavioral addictions, has begun admitting a rising number of
Internet addicts, said Gina Ewing, its intake manager. Ms. Ewing said that when such
a client left treatment, the center's counselors helped plan ways to reduce time on
the computer or asked those who did not need to use the Web for work to step away
from the computer entirely.
Ms. Ewing said the Tucson center encouraged its Internet-addicted clients when they
left treatment to attend open meetings of Alcoholics Anonymous or Narcotics
Anonymous, which are not restricted to alcoholics and drug addicts, and simply to
listen. Or perhaps, if they find others struggling with the same problem, and if
those at the meeting are amenable, they might be able to participate.
"It's breaking new ground," Ms. Ewing said. "But an addiction is an addiction."
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