Game Addiction Expert Explains Rehab Process

by Annette Gonzalez on Apr 07, 2010 at 02:30 PM

Back in July a detox center opened its doors to adults suffering from video game addiction in order help them overcome dependence on gaming, find a healthy balance, and reconnect with the world. The reSTART: Internet Addiction Recovery Program is the first of its kind in the United States. Co-founders Cosette Dawna Rae, MSW, and Hilarie Cash, PhD, had worked with adults in the past who exhibited signs of gaming addiction that were unresponsive to outpatient treatment. With no other resources available they decided to create a 45-day residential stay program tailored toward technology addiction that could offer the services they need.

The reSTART program has received nearly 100 applicants from all over the world – mostly male – since the program’s inception, with the majority of gaming addictions cited as related to World of Warcraft and first-person shooters on Xbox Live. Services are offered just 13 miles from Microsoft’s headquarters in Washington. Patients under the age of 18 are seen on an outpatient basis, while adults 18 and older can participate in the residential program. Now that reSTART has been open for several months, we reached out to Rae to discuss the current state of the program, video game addiction, the process of gaming rehab, and more.

How would you classify gaming addiction? (How is it assessed, signs, symptoms, etc.?)

What we look for is someone who has a strong desire, impulse to game or use the internet. Somebody who, when they try to cut down their use, were unable to do that. If it is starting to have a negative impact on their life, social life, relationships or academics, maybe they’re spending too much time gaming or online. We’ve heard of people in their seventh year of college because gaming got in the way, and they were only able to do one class a quarter instead of maintaining a regular class schedule. We may find people that are working and miss work because they were gaming the night before and were too tired to get up, or it impacts their job in some way. We’re looking for a pattern of use that’s starting to impact all the other things occurring in their life.

In cases of video game addiction that you’ve treated in the past, are there any in particular that resonate with you?

What’s really interesting is the stories are very similar in nature; sometimes it’s just the games that are different, but the stories that you hear are quite the same. “I started playing when I was younger, I really enjoyed it, and I started spending more and more time. I thought I could manage the amount of use I had.” A lot of times they end up going off to college where they don’t have parental influence and end up spending more time gaming than actually doing their studies. The GPA had been affected by increased gaming use and eventually what happens is that parents decide they need to pull them out of school because it’s just too expensive to keep them there when they’re not performing well. What happens is they often come home and spend time gaming at home because they often reflect that they’re bored and have nothing to do, and that kind of becomes their world. That’s the pattern I hear over and over. There also tends to be a large correlation between people struggling with depression, people with A.D.H.D. or A.D.D., and people that have some social anxiety and gaming addiction. They’ll have A.D.D. and find they’ll really get into a game and can’t control their use.

There was a case, and one of the reasons I got into this, a young man had been diagnosed with depression and anxiety, and the way he felt better about those things was to spend his time in World of Warcraft. He dropped out of high school for three years and didn’t do anything but game. He eventually switched from WoW to Halo. It got worse and worse, and a lot of the therapists working with him didn’t know how to assess for it, didn’t know what questions to ask, didn’t know how to treat it, and so he eventually necessitated going into a different residential stay program.

The reSTART program has received nearly 100 applicants since it has opened, however only six spots are open for each 45-day session. How do you determine who gets accepted?

We only accept people into the program who are willing to work on their problems and are willing to do the program. The adults have to make the decision for themselves to work through the program. That takes a lot of time to move from one of the first phone calls made to me, because I spend a lot of time individually with families trying to understand what’s happening: Does this person even really need treatment? Are they a good candidate for our program? Who are the other people in the program right now? In one group I had a lot of young adults with A.D.D. and another time I had a group with cases of social anxiety, so I try to think of who’s here and who would be a good match to work together. We wouldn’t take anybody who is chronically mentally ill, say with schizophrenia; they wouldn’t be a good candidate for our program. We also wouldn’t take anybody whose primary problem is alcohol or drugs. If their primary problem is substance abuse they probably should be referred to a substance abuse program. We look at what is causing the most significant amount of problems to them in addition to the other co-occurring disorders whether it’s anxiety and gaming, or depression and gaming, or social anxiety and gaming, and they each have to have in common that there’s some sort of gaming component that’s very problematic.

People can enroll at any time whenever they’re ready if they actually have the application filled out and meet the screening criteria. Applications are accepted on a rolling basis. As long as there’s space in the program they can come into the program. Whenever full, a waitlist is maintained. 

What can you tell us about the residential rehab services offered through reSTART’s Heavensfield retreat center?

Heavensfield is the retreat center where people stay while they’re receiving treatment through the program. Heavensfield offers room and board, and then the therapy is offered through the reSTART: Internet Addiction Recovery Program. Heavensfield is a 5-acre retreat center designed to be a home-like setting as opposed to a clinical hospital setting. We feel when you go to the hospital to receive treatment for something then you’ve just got nurses and doctors, and nothing feels really familiar. We wanted to create a place where you have chores to do, you can mingle with people, you have dinners and breakfasts to eat, you prepare your own meals, you do your own laundry, and just simulate a cooperative living environment, like living in a dorm or with family or friends. [All featured photos are of the Heavensfield facility -Ed.]

How does this help with video game addiction?

We find that somebody is spending a lengthy amount of time gaming, and maybe they’re in therapy, but they’ll go into a session for an hour, and then they’ll go home and game all week long. That makes it really hard to implement strategies because they’re still spending so much time in that virtual world, so we basically ask them to unwire and unplug for 45 days to help them develop some sort of clarity of thought, and help them be more open and receptive to self-examination: “What’s happening in my life? How do I create meaning for myself? How is my excessive gaming getting in the way?” It’s a lot of insight-oriented work to try and really understand what the problem is. We’re really just trying to get an assessment of the problem and help them develop a plan on how to manage their technology use. We’re not anti-technology, we just want people to, for themselves, make a determination of what is a manageable amount of use, and still maintain a healthy, balanced lifestyle.

Is there some sort of assessment near the end of the program to gauge whether participants are ready to return to their regular lifestyle?

Sure. The first two days of the program are spent doing a BioPsychoSocial assessment to understand all the things that come into play, the factors contributing to the person’s excessive use. Then over the 45 days we uncover more and do a lot of therapy, coaching, and counseling, and then toward the end we begin to prepare for integration back into a healthy lifestyle. We help develop a relapse prevention plan. In other words they may say, “I’m going to spend two hours a day on my computer looking for jobs and maybe interacting with some friends, but I’m not going to return to play 10 hours of WoW.” They develop that plan for themselves and typically share it with their loved ones. We try and encourage the whole team to support them in their recovery plan so that everybody is on the same page and knows what their plan is so there’s not this “Well, how come you’re online for an hour?!” That way everyone understands how they can support this person and their desire for a healthier life balance.

Fees for the program are $14,500 plus $1,000 in application fees ($200 for application, $800 for assessment). How were fees decided on?

That’s $325 a day, which includes room, board, and food. Participants receive two to three hours of face-to-face group and individual counseling each day. We wanted to run a very small, individualized treatment program, and to do that, we hire different types of consultants. For example, we’ll bring in HR people to help out-of-work participants find jobs. The fees are quite reasonable considering the amount of one-on-one therapy that they receive here.

The reSTART program is still fairly young, but are there specific success stories that you can tell us? Any cases of relapse?

We try to stay in touch with people if that’s something they’re interested in, and as far as the ones we’ve stayed in touch with they’ve been able to maintain their plans. Whenever they experienced any problems of potentially returning to prior use patterns we’ve been successful at helping them implement a strategy so they can be successful in maintaining their own recovery plans. That’s been very encouraging. Relapse is a part of any addiction, and the problem is we don’t want to wait for people to reach rock bottom before they ask for help.

For some of our clients who have A.D.H.D., the medication Adderall seems to promote a user being able to hyper-focus in a game where they may be able to stay up for 52 hours at a time. In a case like that, we want to work with their psychiatrist or different people to help let them know that this may not be the best medication. It’s about getting everyone on board in the environment and family system.

Sometimes to get clients back on track it means coordinating with their mental health workers, finding a good therapist for the family, and so far we’ve been fairly successful in helping them get reintegrated and restarted in their lives. There’s no way in six weeks that you’re ever going to “cure” a behavioral addiction. It’s all about managing.

What services do you offer aside from outpatient and residential stays?

A lot of times we feel it’s a “family system situation” meaning that it’s not just a problem with the person, but there’s a lot of things contributing to maintaining the addiction. We offer family sessions so they can learn about technology, behavioral addiction, teach them what they can do to help be supportive and understand what’s going on in their loved one’s life. We offer training to therapists and people across the country to learn more about behavioral addictions and present workshops. Sometimes we may travel to someone’s location and see what’s going on in the family system to observe what’s happening and give an assessment. The center also provides a centralized place for research and information regarding any kind of technology-related behavioral addiction so be it gaming, internet use, forum surfing, texting, those kinds of things.

For more information on reSTART: Internet Addiction Recovery Program be sure to check out their website, netaddictionrecovery.com.