A psychologist first coined the phrase "Internet addiction" in 1995, when the web was in its infancy. He meant it as a joke. But now, with the first hospital-based Internet addiction treatment center opening next week at the Behavioral Health Services at Bradford Regional Medical Center in Pennsylvania, Internet addiction is no longer considered a laughing matter.
The voluntary, 10-day in-patient treatment program will admit up to four people who have been diagnosed with severe Internet addiction. First, they'll undergo an extensive evaluation and a "digital detox" that prohibits phone, tablet or Internet use for at least 72 hours. Then they'll attend therapy sessions and educational seminars to help them get their Internet compulsion under control.
Kimberly Young, a psychologist and founder of the new program, defined Internet addiction by the consequences of Internet overuse rather than the number of hours spent online. She said there was a difference between people who depended on modern technology but could balance their online life with their offline life, and people whose obsession prevented them from functioning normally.
"Like any other addiction, we look at whether it has jeopardized their career, whether they lie about their usage or whether it interferes with relationships," she explained.
Young said typical Internet addicts were young, male and highly intelligent. They often struggle socially and have from low-self esteem, she said. The majority are obsessed with such games as "World of Warcraft," not social media or pornography.
"They go online because they can become someone else and be admired for their skills," she said.
The goal of the program is to allow patients to get back on the Internet but in a healthy way, Young explained. Computer use is so essential to modern life, Young doesn't believe it's practical for someone to stay completely offline.
Patients will have to pay the program's $14,000 fee out-of-pocket. Because Internet addiction isn't recognized as a mental health disorder by the psychiatric community, treatment isn't covered by insurance.
When the American Psychiatric Association released its Diagnostic and Statistical Manual of Mental Disorders 5, or DSM-5, earlier this year, "Gaming Disorder" was listed for the first time. But it was included only in Section III of the manual, which is reserved for conditions that require further research before can be formally identified as a disorder.
The manual deliberately excludes any mention of addiction to social media, email or general web surfing because there isn't a great enough body of research to form a consensus on these topics, O'Brien said. And, he said, anyone addicted to Internet pornography is likely covered under the manual's definition of sex addiction.
"We are trying to come to grips with something that is very new, and we don't want to define this as a disorder unless it is clinically important," said Dr. Charles O'Brien, a professor in the department of psychiatry at the University of Pennsylvania who was the chairman of the DSM-5 Substance Related Disorders work group. "We don't want to create an illness just to have another illness."
O'Brien said an addiction is defined as a compulsive need for something characterized by increasing tolerance, mental and physical harm caused by usage and well-defined withdrawal symptoms, such as depression and anxiety. Almost all universally recognized addictions are for substances such as drugs, alcohol and tobacco, because behavioral addiction is so difficult to pin down. Gambling is currently the only behavioral addiction recognized in the DSM-5.
O'Brien said a lot more research was needed, but he suspected that Internet addiction, at least as it applies to gaming, will eventually become an accepted diagnosis. While he doesn't believe many people would yet meet the criteria for addiction in the United States, he said it's a lot more prevalent in other countries. In North Korea, China and Japan hospital treatment programs for gaming addicts were established more than a decade ago, he said.
While the Bradford program is the country's first program to operate out of a hospital, there are other U.S. programs that address Internet addiction. For example, reSTART, a 45-day residential program near Seattle, has been treating Internet addicts for the past four years. Hillarie Cash, the co-founder of reSTART, said the majority of its patients are young, male gamers, though they are beginning to see some patients who also struggle with a social media obsession.
Young said that the DSM was not the only litmus test for what qualifies as a real mental disorder and what does not. She said she's been studying the idea for more than two decades and is convinced that as Internet usage grows, Internet addiction grows right along with it.
"There's over 20 years of research on this," she said. "If people are suffering and have a real problem, why wait? Why not give them an outlet to deal with it right now?"