Inside Redmond's rehab center for Internet addicts

The jury is still out on whether Internet overuse is pathological, but Redmond is home to one of the nation's first treatment facilities.
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Dr. Hilarie Cash cofounded the Restart Addiction Center, the nation's first Internet addiction treatment center

The jury is still out on whether Internet overuse is pathological, but Redmond is home to one of the nation's first treatment facilities.

The Restart Addiction Center is nondescript by design. The modest, five-acre compound, just a short drive from Microsoft’s campus in Redmond, is not marked by any signs. The main house is set far back on a private drive. With wide lawns, a communal dining room and an away-from-it-all atmosphere, Restart resembles hundreds of similar retreats where people escape their everyday lives and work to re-center themselves.

But Restart’s clients are not working out drug or alcohol issues. Restart is the first Internet addiction treatment center in the United States. And, if current research on the issue is any indication, it’s the first of many.

When I arrive at Restart, a delegation from the Chinese government has just left. Hilarie Cash, psychotherapist and Restart co-founder, explains that Internet addiction is a growing problem for China. The delegation came on a fact-finding mission. "They’re very worried right now,” says Cash. “Whatever they’re doing isn’t working, and the situation is getting worse.”

Many professionals in the psychology community remain skeptical about whether so-called Internet Use Disorder (IUD) is real. Maybe Internet overuse is simply a symptom of other problems, such as social anxiety, agoraphobia or depression. For those who subscribe to its existence, however, IUD is a mental health epidemic unlike any the world has ever seen.

While not officially recognized by the American psychological community, some regions of Asia have already deemed IUD a major threat to their societies. Young people are losing complete interest in school and work, they believe, and reports of parents neglecting their children and teenagers becoming violent when separated from their tech are starting to appear in the press.

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The outside of the Restart Addiction Center in Redmond.

In South Korea, Internet addiction has been declared a “public health crisis.” Pre-K and high schools teach the dangers of Internet overuse, and the government has opened treatment centers for the condition. This month the Japanese government released a study claiming that nearly 1 in 10 junior-high and high-school students are “pathologically” addicted to the Internet. China labeled Internet addiction an official disorder in 2008, before smartphones even took off. Since then, a cottage industry of “Internet boot camps” has sprung up in the country, where teens are forcibly divorced from the Net.

Cash recaps her discussion with the Chinese as we tour the outside of the Restart facility. “The boot camps aren’t fixing things,” she says, passing Restart’s chicken coop, where patients tend to the chickens as a way to learn more about responsibility. “They want to hear about our different approach.”

To hear Cash tell it, some parts of Asia were primed for this sort of addiction. In South Korea, Samsung’s home country, more than 90 percent of homes have high-speed internet. Smartphone ownership is far higher in Asia than in the U.S. and in many of these countries, notes Cash, “there’s less for young people to do than in America.” Cash believes that Internet overuse in the U.S. may rival the problem in Asian countries someday.  According to some experts, it already is a real issue, growing by the year and hiding in plain sight.

When two current Restart residents pass Cash and me on their way back to the main house, I ask them why they’re there. “I’d just waste so much time on the Internet,” says the college-aged guy with shaggy hair and wire rim glasses. “I’d just be reading stuff and watching Netflix and just cruising around on it all day. I couldn’t get anything done. ”

”When people leave here, they can’t avoid the Internet forever,” explains Cash. “It’s always going to be there. You just have to find a way to make it less central to your life.”

A Mainstream Addiction?

Internet addiction is usually seen as a problem for video gamers, those social recluses, mostly male, who disappear into fantasy lands like World of Warcraft for days on end.

It’s true, says Cash, that most stone-cold addicts are gamers. The vast majority of Restart clients are young men who derailed their lives because they couldn’t stop playing online games. However, the definition of Internet addiction is expanding.

This year a clinic named Digital Detox opened a few hours outside San Francisco. It allows adults to spend three Internet-free days on a scenic ranch, so they can leave “feeling rejuvenated and truly relaxed after a few days off the grid.” In September an in-patient clinic for Internet addicts will open in Pennsylvania’s Bradford Regional Medical Center. The clinic’s director, Dr. Kimberly Young, is one of the first psychologists to focus on the issue.

Young wants to broaden the definition of Internet addiction to encompass such behaviors as compulsive “surfing” and the focus on virtual relationships, such as those developed through social networking sites and instant messaging. Cash agrees the condition can express in a number of ways, insisting that anyone who has a smartphone is at least mildly addicted.

“I want people to wake up to that mild addiction, if it is in fact mild,” she says. “It’s like someone who recognizes they’re smoking weed too much. Sure it’s legal now, but at some point you may want to stop or slow down. If you can’t in spite of your efforts, well, maybe the addiction’s not so mild then. Maybe it’s more serious than you thought, and maybe you need some help.”

This past July marked the fourth anniversary of Restart, which Cash launched with fellow psychotherapist Cosette Rae in 2009. The clinic has treated over 100 patients, and Cash has become an outspoken advocate for official recognition of the disorder – with limited success so far.

The American Psychiatric Association did not include Internet Addiction in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) – the bible of the psychiatric profession – when it was published in May. The association did note that Internet gaming was worthy of “further study,” but recent studies have focused on general Internet use, not gaming. Researchers have looked at the effects of Internet overuse on the human mind and psyche, and so far their findings are almost universally troubling.

This is Your Brain on the Net

Once considered a content delivery system similar to television, the Internet has become something more. A recent survey found the vast majority of people under 50 check email, social networks and their phones on an almost reflexive basis – every 15 minutes or so. Dr. Larry Rosen, who conducted that study, also found that people who spend lots of time online display diminished self-control and “compulsive personality traits,” the same kinds of behaviors common in heavy drug and alcohol users.

Sure enough, a study using MRI brain scans revealed many similarities between substance abusers and heavy internet users, suggesting that Internet use is changing the actual structure of the brain.

Stanford University psychiatrist Elias Aboujaoude points to Internet use as a possible culprit in the rise of people diagnosed with Obsessive-Compulsive and Attention Deficit disorders. Numerous studies have connected Internet overuse to feelings of depression and anxiety, and to an over-stimulation of the brain’s dopamine delivery system, which is responsible for our feelings of pleasure and satisfaction.

Crosscut archive image.But research on the Internet’s effects is still limited, and the American Psychiatric Association is hesitant to label Internet addiction an official disorder. Critics like Duke University professor Allen Frances believe that doing so could open the floodgates to over-diagnosis. People with otherwise harmless Facebook fixations could be labeled mentally ill.

Insurance companies won’t cover any treatment until Internet addiction is officially recognized as a disorder. But that hasn’t stopped pricey rehab options such as Restart (above) from springing up.

Restart charges $14,500 for a 45-day stay. Clients pay more for the “Phase 2” program, in which Restart graduates stay in Internet-free apartments, maintain regular contact with Restart staff and are gradually transitioned back into real life. The 3-day program at California’s Digital Detox can run as much as $1,400. According to the director of Bradford, Pennsylvania’s new inpatient clinic for Internet addiction, the facility is opening because there’s a demand for it.

If Internet addiction is eventually reclassified as a mental disorder, its treatment could be big business. A survey by Stanford Medical School found that as many as 1 in 8 Americans display signs of the condition. That survey was conducted in 2006, years before the iPhone ushered in the era of near constant Internet access.

The New Normal

This summer, after years of passenger complaints and non-compliance, the Federal Aviation Administration said it might relax the rules around the use of electronic devices on airplanes. Under the new rules, cellphones, laptops and tablets could be used during taxi, take-offs and landings. A flurry of supportive articles appeared in the wake of the FAA announcement, decrying the current restrictions as frustrating, infuriating and illogical.

Crosscut archive image.Toward the end of our talk, Cash wonders aloud why these device-free airline minutes were such a hot button issue for people, and suggests gauging the level of my own Internet addiction by trying to curb my use for a bit.

In the week after we spoke, I decided to give it a try. I limited the number of times I could check my smartphone in a given day and the number of hours I could spend aimlessly cruising between articles and art, which is what I mostly do on line. It was surprisingly difficult to stay off-line. Sometimes the urge to reach for my smartphone reminded me of the urge to reach for a cigarette when I was trying to quit smoking. Like that effort, I was often unsuccessful.

Out at bars, restaurants and other public places, I began to notice how many people have their eyes glued to their phones, how many drivers check their phones at red lights. At a dinner, my girlfriend’s six-year-old niece spends much of the meal glued to her mini tablet. She’s loaded it up with educational games, and partly because of this, she’s far ahead of her grade level in both reading and math. But it’s clear that, like her, we are often more comfortable staring at screens than engaging with the world around us.

In an unscientific survey of my friends, nearly all admit that they spend more time using the Internet than nearly any other activity. Unlike the patients at Restart, the Internet is not threatening our jobs or relationships. However, with smartphones, laptops, tablets and the soon-to-be released Google Glass – which would attach Internet connections directly in front of our eyes – there’s a growing concern among psychologists and non-experts alike about the pervasiveness of the Internet in our lives.

Pulitzer-nominated author Nicholas Carr has argued that the Internet is making us stupider, even as it gives us greater access to all kinds of information. But in the case of my girlfriend’s niece, it certainly shows a lot of educational potential. Most of my post-college education has come from the Internet. And in my time in the corporate world, constantly being plugged-in was seen not only as a career booster, but as a job requirement. Indeed, Restart sprang from Hilarie Cash’s private practice in Redmond, where her clientele included many Microsoft employees.

“Microsoft definitely takes advantage of the current situation, where people feel like they’ve got to always be online to get ahead,” said Cash. “The separation between work and life is eroding.”

That may well be, but younger employees are always online anyway, and not just to get ahead. Whether via smartphones or computers, being connected is the new normal, especially for people who’ve grown up on the grid.

The question for experts like Hilarie Cash is whether we are able to moderate our time on the Internet in the same way we’d limit our drinking. If we can’t, and if research continues to show bad side effects from too much Internet use, then today’s mild fixation may become tomorrow’s mainstream addiction.


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About the Authors & Contributors

Drew Atkins

Drew Atkins

Drew Atkins is a journalist and writer in Seattle, and the recipient of numerous national and regional awards. His work has appeared in the New York Times, Seattle Times, The Oregonian, InvestigateWest, Geekwire, Seattle Magazine, and others. He also previously served as the managing editor of Crosscut. He can be contacted at