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Their worried parents bring them to the doctor, fearing drug abuse or depression, but the evaluations come up empty. A doctor at Children's Hospital Boston says something else may be at work. "We see kids who are just gaming, and they appear to their parents to have all of the signs and symptoms of drug use,'' Dr. Michael Rich said about the seductive world of online games. "But in fact they are only hooked on the drug of electrons on their screen.''
Climbing levels in games like World of Warcraft, where unlimited numbers of role-playing competitors play around the clock and around the world, can be habit-forming and disruptive for both adolescents and adults. Other online activities, from visiting porn sites to incessantly checking e-mail, can also interfere with work, school, and relationships. In a world where always being connected seems as vital as breathing, how much is too much? And does excessive Internet use equal addiction?
A debate already divides behavioral addictions such as compulsive gambling or shopping from physiological addictions to alcohol or other drugs. People don't die when they unplug from the Internet, Dr. Ronald Pies points out.
"A person who is hooked on a barbiturate, taking tons and tons of it every day, and is suddenly cut off from the supply will go into a physiological withdrawal, which could kill him and often does,'' said Pies, a clinical professor of psychiatry at Tufts University School of Medicine. "I have yet to be convinced that a teenager who sits in his room using the Internet for five, six, seven hours a day, as troubled as he or she may be, has a condition that can reasonably be compared to barbiturate addiction. Which is not to say there aren't people with a severe, pathological use of electronic media.''
In fact, there have been a small number of reported deaths attributed to Internet addiction in Asia, where much of the academic research into the issue has focused and where many of the treatment centers are located. A 28-year-old Korean man died after not eating or sleeping during 50 hours of nonstop gaming, according to a commentary published last month in the Archives of Pediatric & Adolescent Medicine. A companion article said attention deficit hyperactivity disorder in girls and hostility in boys can predispose children to later Internet addiction, which they estimate affects 4 percent of children in Korea and 15 percent in China. A separate Stanford telephone survey of US adults found that 1 in 8 people consider themselves addicted.
Rather than "Internet addiction,'' Pies prefers to say "problematic use of electronic media,'' arguing that no one would make a distinction between Twinkie-induced obesity and nacho-induced obesity. But whatever you call it - and referring to the BlackBerry as a CrackBerry is just one term borrowed from the addiction lexicon - specialists say that when Internet use frays the fabric of daily life for adults or impedes development for children, something's wrong.
Online games can be particularly consuming because players are afraid of what they might miss if they walk away. In Asia, where gaming cafes are more common, people don't eat, sleep, or go to the bathroom for fear of giving up their seats. Other problematic use across cultures could be porn-site use to the point of sex addiction - another controversial diagnosis - or compulsive instant messaging.
"It's obviously to the detriment of their lives if they are instant messaging all day long at the job or surfing porn sites instead of crawling into bed with their wives'' at home, said Rich, the Children's pediatrician who specializes in media issues. "Typically there's a loss of sense of time, so they're sitting down for eight, 10, 12 hours and not responding to basic needs.''
The concern with children goes beyond their grades in school, Rich said. Developmental tasks of adolescents, such as learning how to control their impulses, can be delayed or derailed. Research in adults is exploring whether changes in the brain's reward pathway, akin to what happens in smokers and gamblers, might occur with excessive Internet use. Rich says problems show up predominantly in middle school boys, who may become socially isolated if they retreat to their computers rather than take part in after-school activities. Some do suffer from other problems.
"The kids I see for the most part, as far as I can tell, wouldn't necessarily meet the criteria of addiction, but would meet the criteria of problem Internet use or problem video gaming,'' he said. "It's the difference between an alcoholic and a problem drinker in the sense they probably wouldn't experience full-blown withdrawal symptoms, but they are 50 percent or 60 percent of the way there.''
Parents should expect push-back from their kids if they enforce the cold-turkey approach Rich recommends as treatment, before reintroducing limited computer use in a shared room in the house.
"They need to press the reset button and start living their lives without the 'drug,' '' he said. "Whether it's an addiction or not matters less to me than if it's affecting his or her function in the world and affecting his or her development and health.''
Cutting anyone's Internet connection is a sobering thought. Dr. Jason Elias of the OCD Institute at McLean Hospital said many people with obsessive-compulsive disorder use the Internet to manage anxiety. Other people might use online gaming or social media sites to escape from stress. But we're all hard-wired to keep checking our e-mail or monitoring our Facebook pages, he explained, and it takes a conscious effort to set limits.
The concept called "variable ratio reinforcement'' says that pressing a button and getting the same reward every time is less satisfying than never knowing when we might get a treat. That red light blinking on the BlackBerry might be spam or it might be gold. And often we can't resist seeing which one it will be.
"We all seem to be really hooked on this technology of e-mail and BlackBerries and the Internet,'' said Elias, who imposed rules on himself restricting how much time he can spend on e-mail.
Chris Latina, a computer science major at Tufts University, says he checks his messages or his Facebook page constantly.
"You feel the need to go back when you know nothing has happened,'' he said. "I want to check updates on Facebook in five minutes when I know it's inconsequential.''
He thinks his generation excels at being superconnected, with five tabs open on a computer screen, allowing them to balance "the nonsense and the truly beneficial.''
"I'd call it a controllable addiction, if you use it wisely,'' he said.
Smart phones with wireless Internet capability make the stereotypical Internet addict locked away in a room obsolete, he said. But just because you can walk around checking e-mail all the time doesn't mean social interaction is untouched, another Tufts student said.
Walker Holahan, a sophomore who is also a computer science major, has seen what happens when Internet access disappears. Two blackouts, one recently and one over Columbus Day weekend last year, knocked out electricity and Internet connections on campus.
"Everybody was freaking out because they couldn't check e-mail,'' he said, even though the very people they hoped to be in constant contact with were likely in the same boat.
The break had its benefits.
"It brought people closer together. During freshman year, it's how I got to know my friends really well,'' Holahan said. "It removed the space that the Internet supplies. It sounds lame, but if reality is shoved in your face, you have to deal with it.''
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