How a Washington-based clinic treats video game addiction

Learn what goes on at the reSTART Center for Technology Sustainability.

Dr. Hilarie Cash recognized a growing problem. As a Seattle-area general practitioner, in the '90s she began seeing patients come in with issues she knew nothing about: addictions stemming from the internet, from computers, from video games.

One was an adult male, 25, addicted to "various aspects of the internet, but mostly to games," she says. Another was a wife having an online affair. "I kept having people coming in," she says, "and the variable that they all had in common was an addiction to something that was online."

For people facing these new kinds of problems, "information junkies" as Cash calls them, there was no place to send them, nowhere for them to go. So, she took matters into her own hands.

Cash is one of three founders of the reSTART Center for Technology Sustainability, based in Fall City, Wash. A center focused on treating young adults suffering from various types of internet and gaming addiction. Polygon recently spoke to Cash and one of her patients about the facility, how internet and gaming addiction works, how reSTART treats these issues and how life can change after addiction.


Falling Apart

Typical patients at reSTART are between 18 and 28, male, and often admitted by worried family members. Cash frequently refers to them as "the guys" or "our guys."

She points to a couple different causes of addiction. The first being unhappiness: a kid coming from a troubled home life, or one having trouble fitting in at school. When a kid is unhappy, she says, they look for a distraction, something to take their minds off the way they’re feeling. That distraction oftentimes is the internet or video games, something that’s always there, easy to access and cheap to use.

She also points to the normalcy of screens in everyday life, saying, "I mean, these days I see parents putting interactive screens in the hands of toddlers, and so if you are a kid who grows up with screens and your parents are using screens all the time, it seems perfectly normal and the way life is. That is a kid who is much more likely to become addicted than the kid who grows up without all of that."

"Maybe they were mildly addicted before, but often [as adults] the addiction actually becomes much more severe."

reSTART offers access to counselling to anyone who thinks the internet is interfering with their lives. But, Cash says, a lot of its more severe patients patients come to the facility because their habits have had serious ramifications on their personal and professional lives.

"The most typical scenario is a gamer who [is] a bright young man who loved gaming, is kind of under control through high school because of parental control and then they get to college and college ends up being a freak out in some ways," says Cash. Social pressures or academic pressures, for example, begin to take their toll on someone, who in turn turns to a screen to cope. A lot of reSTART’s patients, she says, have even lost academic scholarships because of their problems.

"Their lives start falling apart and they get hooked," she adds. "Maybe they were mildly addicted before, but often [as adults] the addiction actually becomes much more severe."

At their worst, patients come to reSTART suffering from malnutrition, experiencing severe weight gain and loss. They are often times depressed, suicidal, experiencing health problems and are socially anxious to the point of becoming shut-ins. Some of its patients, Cash says, play games on average between 17 and 20 hours a day. She compares them to the Hikikomori, a Japanese term coined by psychologist Tamaki Saitō to describe adolescents or adults who have withdrawn from society almost entirely.

One such patient was Charles Bracke, and he says he owes the facility a lot.


The perfect drug

Charles Bracke had a plan. He knew how he was going to do it, who was going to find him and who was going to take care of his dog. That is, until coincidence intervened.

A 28 year old Indiana-native, Bracke has up until recently been playing games most of his life. He recalls playing Mega Man and other NES games with his cousins before being old enough to go school. He cites Warcraft: Orcs & Humans, released in 1994, as the first game that captured him. "[I] was probably five or six or so and I got very, very hooked on that game," he says. "I remember running off to the computer every week when we had family dinner because I just couldn’t wait to get in there and see more of it and move up through all the levels and everything."

He prefered open worlds, MMOs and games with lots of options allowing him to do anything he desired. "I could get out and do whatever it was I wanted to do. [I could] just experience the entire different world," he says.

"To say I got sucked into it is kind of an understatement, honestly."

He points to games like DayZ and the Grand Theft Auto and Elder Scrolls series as scratching that itch. But, the game that sunk its claws the furthest into him, he says, was Ultima Online. In fourth grade, on weekdays, he would spend at least five hours with the game after school. On weekends, between 10 and 14 hours. A habit, he says, that he continued all the way through middle school.

"Really, I look back on Ultima as being one of the games that was actually kind of like the perfect drug to me," Bracke says. "To say I got sucked into it is kind of an understatement, honestly."

But, to define addiction for Bracke, the youngest of three children, is a little more complicated than simply a love of games and open worlds. In fact, it’s a lot more familial.

Bracke idolized his older brother, but his admiration was often returned with hostility and bullying. When his brother, four years older than him, would fight with their parents, or when he was emotionally abusive, Bracke began to seek out escapism, worlds to hide in. He wanted to live in these other worlds, he says, because they were easier than living in the real world.

For most of his adult life, gaming stood in the way of Bracke’s success. He dropped out of college twice. He tried to quit playing twice at the behest of his family, he says, but each time found an excuse to go back.

"I was just going to put a sign on the door that instructed him that I was dead inside my bedroom and he was to call 911."

The first time Bracke relapsed, he says, was because he felt he deserved a reward. His family asked him to quit because gaming was getting in the way of his career, selling real estate in Virginia — a job he got thanks to his older brother. But one day he made a big sale, and he decided to set up his computer to play games just for one night. The next morning, he felt like one evening wasn't enough for all the work he had put into the sale. "I should let myself have a week of gaming," he says. "I never took my computer down again."

The second time he relapsed because of his brother. As if history was repeating itself.

After then being confronted by his parents, who realized he was playing again, Bracke gave up video games for about three months, he says. Until asked to housesit by his brother while he and his family went on vacation. He realized he wanted in life what his brother had. He realized he was making no progress towards getting those things for himself. He began having feelings of inadequacy and not living up to his potential. His only method of dealing with these issues was to not deal with them, and to hide in game worlds as he had in the past.

"It was after I relapsed that second time that I sank into a really, really deep depression," Bracke says. "It got to the point where I was no longer just gaming because I didn’t know what else to do. I was gaming specifically because I hated myself for gaming."

His depression got out of control, he says, until eventually his mind wandered to suicide. He had a "really well-fleshed out" plan for what he was going to do, how he could kill himself painlessly. He even began buying the necessary supplies, he says.

"I had planned it out that I was going to schedule a meeting with my landlord at the apartment. He was going to be the one to find me," Bracke says. "I was just going to put a sign on the door that instructed him that I was dead inside my bedroom and he was to call 911.

"[Addiction] is something that can hit anyone."

"Inside [my bedroom, there was] another door to get to my bathroom, which is where I was going to actually have killed myself. There would be a note on the bathroom door that instructed people to call my brother, who lived nearby, to come pick up my dog and care for her, as well as instructions with what to do with me, where I wanted to be buried and all that sort of thing."

Bracke says he believes he would be dead if it weren’t for a coincidence, a simple travel inconvenience.

Bracke’s birthday, his nephew’s birthday and his parents’ anniversary all land in August. As everything was happening, his parents had planned to travel to Virginia in August to spend time with him and his brother. Kinks in their travel plans, though, caused them to postpone until September. This gave Bracke time to sink further into his depression.

"I still firmly believe that if they had come out when they initially planned," he says, "I would have still had things together well enough that they would not have noticed just how far off the wagon I’d fallen and then there would have been nothing in the way of me and completing my plan."

With the added month, Bracke kept preparing, which, in turn, made his depression worse. He began to stop caring about his apartment and his hygiene. By the time his parents made it to Virginia in September, there was no hiding the fact something was up. Bracke’s parents realized a serious problem required a solution. They began researching rehab clinics to send their son to.

Bracke went to Fall City, Wash. and on October 21, 2015 began the first phase of reSTART’s three phase program.


Dreams and headaches

When playing for such extreme hours, as some of reSTART’s patients have been in the past, the brain is producing too much dopamine, too many opiates and other neurochemicals, Cash says.

The brain adapts to function as normally as possible to this overstimulation. But, when the stimulant goes away, some patients fall victim to psychological withdrawal. This withdrawal is the first step in reSTART’s rehabilitation program: an eight to 12 week detox period on its Heavensfield campus in Fall City.

During this period, it’s not uncommon for patients to have trouble focusing or for their minds to wander to a dark place. As the brain works to function at a regular level again, patients report issues with concentration, depression, irritability and anger. "Some guys report a lot of difficulty with sleep, a lot of dreams about gaming, that kind of thing," says Cash.

"Some guys report a lot of difficulty with sleep, a lot of dreams about gaming, that kind of thing."

Bracke cites three big symptoms of his own withdrawal: He found himself, for the first time, having intense, vivid dreams that were, above all else, really weird. For a while he tried to log them in a journal, he says, but it quickly became overwhelming trying to write them all down every time a dream would wake him up — which was often several times a night.

Bracke also found himself very agitated, he says, about things that in hindsight weren’t important, such as getting mad at someone for waking up earlier than him and using Heavensfield’s stoves before he could. Lastly, he had constant headaches that he couldn’t get rid of no matter what medicine he took. All in all, he says, these symptoms lasted about three weeks — between 19 and 20 days — before they began to subside.

The first phase of reSTART’s program is heavily focused on different groups. The patients, six at a time, live communally on reSTART’s Heavensfield campus, a repurposed home where the entirety of the first phase takes place. They do things together, go to groups, hang out, take on household responsibilities and sleep nine hours a night, Cash says. "And whether it’s a severe or mild withdrawal, they’ll all do the same kinds of things," she adds.

For Bracke, one of the biggest parts of this first phase was learning to open up emotionally. He explains he began coping with repressed emotions, learned how to be vulnerable around others and how to begin living an honest life. "I think it’s kind of a trait of addicts [that] we all end up really good at lying to everyone around us. It becomes almost just such an ingrained habit," he says, explaining he would find himself lying about trivial things.

"It can and will strike at literally anyone out there."

A lot of his issues, Bracke says, came from feeling a lack of self-worth. He didn’t feel like he deserved to be at reSTART. Who was he to put this "very significant financial burden" on his parents, causing them to take out a loan on their house, he remembers wondering. But, reSTART helped him recognize that his addiction was not only a problem, but a problem worth solving.

A question helped change his tune: If he had cancer, would he think twice if his parents took out a loan on their house to help him afford treatment? His answer was, "Well, of course not," he says.

A big breakthrough for Bracke was reframing ideas he already had, seeing things in a different way. Recognizing his addiction was just that, an addiction: a disease of the mind. How is it any different than a disease of the body?

"[Addiction] is something that can hit anyone," Bracke says. "It doesn’t care if you’re rich or poor, if you come from the south, the north, the east [or] west, whatever. It doesn’t care. It can and will strike at literally anyone out there."

Bracke came to reSTART wanting help, knowing he had a problem, but not knowing if he deserved the help. In the first phase, he learned self-worth, he accepted the help he wanted. Then it was time to move out of Heavensfield and onto the second phase of reSTART’s program.


A balancing act

In 2016, Cash recognizes it isn’t practical to completely abstain from technology. But, she says, it’s up to the patient to dictate what kind of access they give themselves, what they can handle once back in a screen-filled world.

"[They] create a plan," Cash says. "We call it the ‘life balance plan,’ and in that we ask them to think through very carefully and in careful detail how it is that they are going to re-incorporate computers into their lives, but this time in a healthy way, and how are they going to do that and how are they going to [be held] accountable to those commitments that they make."

Some patients, Cash says, decide for their own health they need stop playing games entirely because it’s too dangerous for them. From there, they decide things such as what they may or may not allow themselves to do online or whether or not they can have a smartphone.

In the second phase, those willing move into one of "The reSTART Houses" — self-run group apartments — with other patients from the program, where a rule of thumb lives: If you break your life balance plan, you’re kicked out and lose your home. Cash says about 50 percent of patients who graduate from the first phase move into the apartments. Then they begin looking for jobs and often start planning on returning to school. reSTART provides access to continued counseling and the patients learn to live with responsible independence.

"We ask them to think through very carefully and in careful detail how it is that they are going to re-incorporate computers into their lives."

"They usually want to work and build their confidence out in the world, because they have to cope with things like working someplace where all the other employees want to talk about games," Cash says.

Bracke has cut video games out of his life entirely. "I break sobriety if I game at all," he says. But he’s slowly been implementing some technology back into his life. He has a smartphone again, but with limitations: No Netflix, for example, and he has a monitoring app called CovenantEyes installed on it. He allows himself to use computers, but only for two hours a day on public library computers. This time restriction helps keep him from procrastinating on another large part of his recovery: the 12 step program — a method created by Alcoholics Anonymous to outline a course of action for recovering from addictive behavior.

Though he says there isn’t a big community for technology addiction yet, Bracke adopted the 12 steps and a sponsor he found through Love and Sex Addicts Anonymous because he recognized it was more a way of becoming a good person. Recently, as part of the program, he’s been tasked with writing his entire life’s story, detailing everything he can possibly remember from his earliest memory to the present. He’s also been working out his resentments in life and how he may have contributed to different conflicts in the past.

reSTART’s second phase is all about setting goals, be them short term or long term. It’s about taking everything learned in the first phase and carrying it over to life. It’s about comfortably transitioning from inpatient rehab back into the real world.

And for Bracke, it’s time to take that big step.


An "actual life"

When Polygon talked to Bracke, he was moving out of his reSTART home. He and a few other patients from the program were moving into their own apartment, with their names on the lease. They were moving forward with their lives.

He works at Costco now, saving up money to go back to school. He wants to get his Bachelor’s degree. He wants to get a pilot’s license. He wants to fly. He’s rebuilding certain relationships with his family. He wants to become closer to his brother and to his nephew. When the time and the person is right, he wants to get married.

He’s in reSTART’s third phase. "[There’s] less structure, more on your own, wanting it for yourself and developing it for yourself to move forward," he says. He and his roommates decided to stay in Redmond, Wash. to be close to reSTART, to be able to continue to support it. It’s the biggest benefactor in allowing him to lead an "actual life," he says.

"I feel like I’m actually starting to accomplish things," Bracke adds, "that I’m actually being, not to sound too down on myself, but I feel like I’m being a more worthwhile person, that I’m not just being a leech, that I’m not just mooching off of society and my parents and family. I can now actually contribute to the world." Babykayak

Update: Since posting this story, Polygon has received feedback over the use of the word “addiction” to describe players who spend abnormally large amounts of time playing games, with some questioning whether it is an appropriate description. While reSTART’s founders and many others use the term, the American Psychiatric Association has said it needs to study the issue further before determining whether it will classify video game addiction as a medical term in the same way it does other disorders.

“Video game ‘addiction’ is a colloquial, loaded term with no real scientific or medical definition or broad support,” says Dan Hewitt, vice president of media relations and event management for the Entertainment Software Association, a group that represents and lobbies for the game industry. “And it is important to remember that video game enthusiasm is often misinterpreted as ‘addiction.’ As such, ESA rejects any attempt by medical societies other than the APA, groups or for-profit entities to term this and we support the APA’s call for more research into computer and video games.”

Hewitt suggests that parents looking to limit their children’s time with games look into the time controls offered on modern game consoles.

Photos: reSTART