FALL CITY, Wash. – Ben Alexander spent nearly every waking minute playing the video game "World of Warcraft." As a result, he flunked out of the University of Iowa.
Alexander, 19, needed help to break an addiction he calls as destructive as alcohol or drugs. He found it in this suburb of high-tech Seattle, where what claims to be the first residential treatment center for Internet addiction in the United States just opened its doors.
The center, called ReSTART, is somewhat ironically located near Redmond, headquarters of Microsoft and a world center of the computer industry. It opened in July and for $14,000 offers a 45-day program intended to help people wean themselves from pathological computer use, which can include obsessive use of video games, texting, Facebook, eBay, Twitter and any other time-killers brought courtesy of technology.
"We've been doing this for years on an outpatient basis," said Hilarie Cash, a therapist and executive director of the center. "Up until now, we had no place to send them."
Internet addiction is not recognized as a separate disorder by the American Psychiatric Association, and treatment is not generally covered by insurance. But there are many such treatment centers in China, South Korea and Taiwan — where Internet addiction is taken very seriously — and many psychiatric experts say it is clear that Internet addiction is real and harmful.
The five-acre center in Fall City, about 30 miles east of Seattle, can handle up to six patients at a time. Alexander is so far the only patient of the program, which uses a cold turkey approach. He spends his days in counseling and psychotherapy sessions, doing household chores, working on the grounds, going on outings, exercising and baking a mean batch of ginger cookies.
Whether such programs work in the long run remains to be seen. For one thing, the Internet is so pervasive that it can be nearly impossible to resist, akin to placing an alcoholic in a bar, Cash said.
The effects of addiction are no joke. They range from loss of a job or marriage to car accidents for those who can't stop texting while driving. Some people have died after playing video games for days without a break, generally stemming from a blood clot associated with being sedentary.
Psychotherapist Cosette Dawna Rae has owned the bucolic retreat center since 1994, and was searching for a new use for it when she hooked up with Cash. They decided to avoid treating people addicted to Internet sex, in part because she lives in the center with her family.
According to Dr. Kimberly Young of the Center for Internet Addiction Recovery in Bradford, Pa., addiction warning signs are being preoccupied with thoughts of the Internet; using it longer than intended, and for increasing amounts of time; repeatedly making unsuccessful efforts to control use; jeopardizing relationships, school or work to spend time online; lying to cover the extent of Internet use; using the Internet to escape problems or feelings of depression; physical changes to weight, headaches or carpal tunnel syndrome.
Exactly how to respond is being debated.
For instance, Internet addiction can be a symptom of other mental illness, such as depression, or conditions like autism, experts say.
"From what we know, many so-called `Internet addicts' are folks who have severe depression, anxiety disorders, or social phobic symptoms that make it hard for them to live a full, balanced life and deal face-to-face with other people," said Dr. Ronald Pies, professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y.
"It may be that unless we treat their underlying problems, some new form of `addiction' will pop up down the line," Pies said.
There is debate about whether to include Internet addiction as a separate illness in the next edition of the "Diagnostic and Statistical Manual of Mental Disorders," due in 2012, which determines which mental illnesses get covered by insurance.
Pies and Dr. Jerald Block, of Oregon Health Sciences University in Portland, said there is not enough research yet to justify that.
"Among psychiatrists there is general recognition that many patients have difficulty controlling their impulses to chat online, or play computer games or watch porn," Block said. "The debate is how to classify that."
Cash, co-author of the book "Video Games & Your Kids," first started dealing with Internet addiction in 1994, with a patient who was so consumed by video games that he had lost his marriage and two jobs.
Internet addicts miss out on real conversations and real human development, often see their hygiene, their home and relationships deteriorate, don't eat or sleep properly and don't get enough exercise, Rae said.
Alexander is a tall, quiet young man who always got good grades and hopes to become a biologist.
He started playing "World of Warcraft," a hugely popular online multiplayer role playing game, about a year ago, and got sucked right in.
"At first it was a couple of hours a day," he said. "By midway through the first semester, I was playing 16 or 17 hours a day.
"School wasn't interesting," he said. "It was an easy way to socialize and meet people."
It was also an easy way to flunk out.
Alexander dropped out in the second semester and went to a traditional substance abuse program, which was not a good fit. He graduated from a 10-week outdoors-based program in southern Utah, but felt he still had little control over his gaming.
So he sought out a specialized program and arrived in Fall City in July. He thinks it was a good choice.
"I don't think I'll go back to `World of Warcraft' anytime soon," Alexander said.