6: Hooked

Rethinking the Internet Addiction Debate

I am addicted to EQ [EverQuest] and I hate it and myself for it. When I play, I sit down and play for a minimum of twelve hours at a time, and I inevitably feel guilty about it, thinking there are a large number of things I should be doing instead, like reading or furthering my education or pursuing my career.

—twenty-six-year-old male online gamer

Up until this point I have deliberately avoided using one particular word in this book—addiction. When we asked young twenty-somethings to describe life in the digital age, the word addiction came up frequently. Users of social-network sites like Facebook and MySpace consistently told us that these digital destinations are impossible to resist. “Oh my God, I check Facebook at least ten times a day,” said Debra, a nineteen-year-old psychology major. “I have to admit that even when I’m in class, I have Facebook open. It is totally addicting.” Similarly, in our conversations with users of MMORPGs, the specter of addiction is never too far away. Many users of virtual worlds believe they have either experienced or witnessed firsthand how the intense compulsion to play games can lead to serious personal disruptions. “I definitely feel like I was addicted to World of Warcraft,” James said. “When I first started playing the game, it was so fun and exciting that I basically gave up everything and everyone around me.”

I often got the sense that the individuals who talked to us, especially users of social-network sites, were describing behavior that is more habitual than compulsive. Though social and mobile media are relatively new inventions, few of us can imagine going through life without them today. Like the cars that we drive, communication technologies are necessities that help us efficiently manage the details, small and large, of everyday life. In today’s mobile media world we are constantly interacting with a screen or some other device primarily because we can. Have you ever stopped to notice the assortment of people using a communication technology while you are sitting in an airport terminal? Seated across from you is a business traveler checking her e-mail on a BlackBerry. Spread out along a nearby wall are several women from a college volleyball team using their mobile phones to send and receive text messages. And sitting right beside you is a twelve-year-old boy who has powered up his Nintendo DS to play a quick game of Madden NFL. This is the digital lifestyle in action.

Meanwhile, addiction implies something altogether different and far more serious—a mental disorder that makes self-destructive behavior nearly impossible to stop.

Jerald J. Block, a psychiatrist at the Oregon Health & Science University in Portland, believes that Internet addiction is a valid mental disorder. Many of Block’s patients suffer from what he calls “pathological computer use.” In some cases they are addicted to porn. In other instances they may be addicted to a massively multiplayer online role-playing game (MMORPG). Since he began treating compulsive computer users, Block has heard it all. He has treated patients who could not pull themselves away from their computers long enough to take a shower. Others have lost their jobs or friends from the overuse of a virtual world. Some of Block’s patients even admit setting up toilets near their computers so that they can remain close to their online friends. Block maintains that the online gamers are harder to treat than other problematic Internet users.

“People feel a lot of shame around computer games,” Block says. Ultimately, Block argues that when you spend as many as fifteen hours a day on your computer, it becomes more than work or play. “The computer becomes a significant other, a relationship,” he says.

In a 2007 editorial that appears in the Journal of American Psychiatry, the Oregon-based doctor encourages his colleagues to include Internet addiction disorder (IAD) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the guide used by the American Psychiatric Association (APA) in diagnosing mental disorders. Block believes, because of the shame that excessive users experience, as well as minimization by the medical community, that America lags far behind other countries like China and South Korea in dealing squarely with what he calls “pathological computer use.” He adds that the issue is further complicated by comorbidity—the existence of multiple, independent medical conditions within patients. According to Block, “About 86% of Internet addiction cases have some other DSM-IV diagnosis present.” He believes that unless doctors are trained to look especially for problematic Internet use, it will continue to go largely undiagnosed and untreated. Block is not the first to urge the inclusion of Internet addiction in the DSM-IV.

As far back as 1995—the year that computers and the Internet began entering more American homes—there has been a surging suspicion that a growing number of people use the Internet not because they want to, but rather because they have to. People like these suffer a truly modern affliction, what is variously called pathological or problematic Internet use. IAD, some maintain, is a genuine diagnosis. Now that being digital is more ordinary than extraordinary, the debate about excessive Internet and new media use is even more urgent.

The idea of computer addiction, according to Internet lore, first gained momentum in 1995 when Dr. Ivan Goldberg, a New York psychiatrist located in the city’s Upper East Side, decided to have a little fun with a cyberclub he started in 1986 for his fellow psychiatrists called PsyCom.Net. The number of dependency disorders that are included in the DSM-IV astonished Goldberg. A provocateur at heart, he looked up compulsive gambling disorder in the DSM-IV and substituted Internet use for gambling. At the time, Goldberg thought the idea of Internet addiction was laughable. If anything, he thought, the widening list of addictions was causing its very own obsession—the need to characterize virtually all of human behavior as addictive. What happened next undoubtedly surprised Goldberg. A number of PsyCom.Net users e-mailed him back to indicate that they suffered from IAD and wanted to know what treatments were available. What started as a joke soon became a matter of serious debate among medical professionals, social scientists, and shortly thereafter, the media and general public.

Throughout the remainder of the 1990s a flood of scholarly papers were published in an effort to establish IAD as a viable sphere of research, medical intervention, and public discourse. Researchers used a variety of methods, including pencil and paper surveys, online surveys, and telephone interviews, to measure Internet addiction. They also created checklists and scales to identify the clinical symptoms and distinct profiles of problematic Internet use. Some of the questions in these scales included: “Have you jeopardized or risked the loss of significant relationship, job, education or career opportunity because of the Internet?” Or, “Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?”

One of the first and most consistently used metrics to determine Internet addiction is the amount of time spent online. Dependent users of all stripes, the research data suggests, have one thing in common: they spend significantly more time online than nondependent Internet users. Some of the earliest case studies report that the heaviest users spend up to forty hours a week or the equivalent of a full-time job online.

As the methods and approaches to studying excessive Internet use evolved, so did the findings. Take, for example, the gender aspects of excessive Internet use. Many of the early foundational investigations found that men were more likely to display symptoms of Internet addiction than women. Men tended to get hooked on games and pornography. Those claims can be partially attributed to the fact that during the initial rise of the Internet men were more likely to be computer users than women. But as computers and the Internet became more commonplace in the home and women more commonplace in the workplace, the gender gap in computer use essentially disappeared.

Some of the problems researchers associated with excessive Internet use include failure to manage time, a loss of sleep, skipped meals, social isolation, and poor performance at school or work. These, of course, are some of the same problems linked to the abuse of drugs and alcohol. One of the results of the outpouring of research on Internet addiction disorder is the creation of addiction clinics designed specifically to offer treatment to those who cannot pull themselves away from their computers.

Whether Goldberg liked it or not, a new disorder and domain of research and clinical practice, Internet addiction, emerged.

In 1996 Goldberg acknowledged that the Internet posed some challenges. Nevertheless, he insisted that the efforts to classify excessive Internet use as a medically recognized disorder were unwarranted. “I.A.D.,” Goldberg explained, “is a very unfortunate term. It makes it sound as if one were dealing with heroin, a truly addicting substance that can alter almost every cell in the body.” The doctor the New Yorker described as bearded and burly added, “To medicalize every behavior by putting it into psychiatric nomenclature is ridiculous. If you expand the concept of addiction to include everything people can overdo, then you must talk about people being addicted to books, addicted to jogging, addicted to other people.”

What Goldberg dismisses as ridiculous—the expansive definition of addiction—others in the medical community are thoroughly embracing as they seek to learn more about compulsive behaviors and, along the way, redefine how we think about and subsequently treat them.

Defining addiction is certainly no easy task. Even among the medical community there is very little consensus when it comes to discussing addictive behavior in definitive terms. Search for the word addiction in the DSM-IV and you will not find it. Instead, terms like substance dependence and substance abuse appear in the manual.

Here is how the American Psychiatric Association glossary defines addiction: “Dependence on a chemical substance to the extent that a physiological and psychological need is established.” This, of course, is the classic definition, the idea that the ingestion of a substance—namely alcohol or drugs—is an elemental part of any addiction. But a new generation of research and thinking about addiction inspired in part by fresh discoveries related to the human brain provokes new questions about compulsive human behavior. In research laboratories across the world, scientists are looking beyond “chemical addictions” to also consider what are referred to as “natural” or “behavioral” addictions; things like excessive gambling, eating, or sex. What are doctors learning from the new research?

Doctors have known for years that the ingestion of chemical substances into the human body triggers intense biological reactions. But the details of those reactions are becoming clearer. More precisely, researchers are now focusing on the brain reward pathways, an extraordinarily complex region of the brain made up of a series of integrated circuits that function as the emotional center of the brain, the gateway to feeling things like pleasure, motivation, and reward.

Eric Nestler, a psychiatric specialist at the University of Texas Southwestern Medical Center in Dallas, studies how chemical changes in the brain lead to addiction. Nestler believes that over the course of its evolution, the brain has been wired to capture rewarding experiences in such a way that our body desires them again. Discussing the reward region, Dr. Nestler writes, “It also tells the memory centers in the brain to pay particular attention to all features of that rewarding experience, so it can be repeated in the future.”

According to Nestler, this region of the brain is sensitive to environmental stimuli—natural or unnatural. The abuse of drugs over time, for example, can wield a biological influence so intense that it can change the chemical and structural forms of our brain reward pathways in such a way that makes stopping certain behaviors difficult. In extreme cases like these, people continue to take drugs not because they want to but because they have to. The overhaul of their reward pathways compels them to do things that may, in fact, be harmful to their own physical and mental health. Armed with this new body of evidence, doctors now believe that there is a neurobiological dimension to addiction.

The findings related to the brain reward region provokes an interesting question: does the overconsumption of natural rewards—that is to say, non-substance-related rewards such as gambling or gaming—trigger activity in the brain similar to substance-based stimuli? Brain specialists maintain that the pleasures our bodies experience, natural or unnatural, act on the same circuitry system in the brain. Behaviors that the brain finds pleasurable release the chemical dopamine in our bodies, triggering a powerful process that mediates the rewarding effects of environmental stimulus—natural or unnatural. Researchers like Dr. Nestler believe that the brain reward pathways can indeed be chemically and structurally altered by excessive exposure to natural awards.

In a 2008 experiment, researchers from the Stanford University School of Medicine asked eleven young women and eleven young men to play a simple video game. Both the men and the women figured the game out and appeared to enjoy doing so. When researchers looked at the functional magnetic resonance imaging, or fMRI, the brain imaging data repeatedly showed that men felt a more intense feeling of reward from the game than women. In a paper that appears in the Journal of Psychiatric Research, the Stanford investigators write that “these gender differences may help explain why males are more attracted to, and more likely to become ‘hooked’ on video games than females.”

It is easy to imagine how online games can trigger powerful activity in the reward pathways of the brain. We know from previous studies that games can produce physiological arousal, including, for instance, increased heart rate and blood pressure. Additionally, it makes sense that epic virtual worlds like World of Warcraft can be psychologically tantalizing for millions of users. Complete with fantastic quests, persistent worlds, real-time social interactions, intense battles, and the chance to build a whole new self, virtual worlds provide substantial opportunity for pleasure and reward. Brain research may one day show that the enhanced but computer-enabled sensation of power, influence, status, and control experienced in virtual environments can trigger chemical reactions in the brain reward pathways that make massively multiplayer online worlds alluring, and in the case of some, simply irresistible. For now, though, all of this remains mostly speculative until there is more clinical evidence on the relationship between gaming and the brain’s reward region.

This is precisely why in June 2007 the American Psychiatric Association (APA) decided against a recommendation by the American Medical Association (AMA) to officially include games addiction in the DSM-IV. Still, the APA’s debate that summer set the stage for a new era in research and public discourse about what our relentless engagement with digital technologies may be doing to the human brain and consequently to human behavior.

For many people the idea that we could become as addicted to the Internet as to drugs or alcohol is downright silly. What’s more, because few randomized controlled trials have been conducted, the empirical evidence some believe is necessary to confirm Internet addiction is scarce at best. Critics claim that problematic use of the Internet is not a disease but rather a symptom of other emotional and mental disorders. For instance: A young man spends excessive amounts of time online looking for excitement and rewards because he suffers from a confirmed disorder like depression. Similarly, a young woman develops an attachment to strangers online because she suffers from loneliness and low self-esteem off-line.

In a 2007 policy report prepared by the AMA’s Council on Science and Public Health, heavy video-game use is defined as playing games more than two hours a day. The open-ended and free-form structure of virtual worlds leads the AMA to write in its policy statement that “video game overuse is most commonly seen among MMORPG players.” Read the AMA’s deliberations in the policy report carefully and it appears as though the nation’s most powerful medical body is poised to characterize excessive game use as a mental illness. Despite the leanings of some AMA members, definite consensus regarding games addiction has not been established.

During the AMA’s 2007 annual meetings a group of medical researchers decided that more empirical evidence was necessary before listing games addiction in the DSM-IV. The APA explained its decision this way: “The APA does not consider ‘video game addiction’ to be a mental disorder at this time.” However, they did leave the door open for 2012, the next year that revisions to the directory were scheduled. “Revising DSM,” the APA concludes, “requires a years-long, rigorous process—one that is transparent and open to suggestions from our colleagues in the medical and mental health communities and the public.”

Even though the scientific debate about Internet addiction remains foggy, one thing is strikingly clear: both substance-based addictions and natural addictions can dominate people’s lives. Block believes that excessive Internet use can lead to a wide array of problems, including “arguments, lying, poor achievement, social isolation, and fatigue.” Just as spouses, family, and friends of substance abusers have created support groups to ease their emotional pain and suffering, the companions of excessive gamers maintain their own distinct ways of coping too. Take EverQuest Widows, a community that says it is “a forum for partners, family, and friends of people who play EverQuest compulsively.” Group leaders explain, “We turn to each other because it’s no fun talking to the back of someone’s head while they’re retrieving their corpse or ‘telling’ with their guild-mates as you speak.”

Maressa Hecht Orzack, a clinical psychologist and founder and coordinator of Computer Addiction Services at McLean Hospital in Belmont, Massachusetts, traces games addiction back to the late 1990s. Devices that were once luxuries, the personal computer or a gaming console, gradually grew into commonplace technologies in the steadily rising number of wired castles across America. “Video games,” Orzack explains, “used to be contained in arcades, so there were certain limits imposed on the amount of time that you could play them.” But with the rise of computers, the Internet, and broadband, games are now available in the home. And with the invention of mobile-gaming platforms, games are available anytime and anywhere. Even if it turns out that games addiction is in fact a mental disorder, the successful marketing and selling of game-based platforms suggests that there are important industry strategies and consumer behaviors that must be considered in any conversation about excessive game play.

Games addiction is not something that only behavioral scientists and doctors talk about; it is a fairly common topic of conversation among gamers and those close to them. In one national survey, 50 percent of respondents, when asked a direct yes or no question, considered themselves addicted to an MMORPG. Many of the young WoW users we conducted in-depth interviews with acknowledge that playing the game incessantly interferes with their social lives and personal relationships. Some of the young women we met complained that their boyfriends express more interest in games than in their relationship. Darlene, a twenty-two-year-old college junior, summed it up best: “He spends all of his free time playing that fantasy game [WoW]. We rarely go out or do anything together because of his need to get his game fix.”

Her language, and that of others we met, is strikingly similar to how a drug addict or alcoholic might be described. In the end the language reflects the widespread belief among young people that addiction to games, specifically, and the overuse of the Internet, more generally, are real issues confronting their generation.

America is not the only nation concerned about the addiction to games, computers, and the Internet. In South Korea, a country where more than 70 percent of the population connects to amazingly fast and affordable broadband, anxiety about the overuse of games runs extraordinarily high. South Korea is infamous for the thousands of Internet parlors—locals call them PC Bangs—that spread across the country and offer twenty-four-hour access to the Web. In 1998 South Korea hosted an estimated 3,000 PC Bangs. By 2002 the number of PC Bangs had grown to 22,500. In South Korea, PC parlors are the domain of young people. A generation of South Korean youth, primarily males, is coming of age in a cultural milieu in which online gaming is a source of celebrity, cultural ritual, and, according to some critics, a daily obsession.

South Korea is a great case study for better understanding what can happen in a country when a generation of young people aggressively adopts the Internet to the near exclusion of other social and leisure activities. During a 2007 international symposium on Internet addiction hosted in Seoul, it was reported that the average South Korean high school student spends about twenty-three hours a week gaming. The South Korean government estimates that 2 percent of South Korean youth, ages six to nineteen, suffer from Internet addiction and may require some form of intervention—medication, or in extreme cases, hospitalization.

In October 2002 South Korea’s Internet dilemma made international headlines after Kim Kyung-Jae, a twenty-four-year-old PC Banger, allegedly died from exhaustion after playing an online game for more than eighty-six hours straight. One detective investigating the case told the BBC that Kim “briefly stopped to smoke cigarettes and use the toilet.” In 2006, ten South Koreans reportedly died from blood clots suffered while sitting for extended periods playing games in a local PC Bang. These tragedies, admittedly sensational, underscore what South Korean officials believe has become a serious public health problem in one of the most wired nations on the planet—a generation of youth who spend sizable chunks of their day sitting in front of a computer screen.

South Korean officials link the allure of computer-mediated leisure and the widespread availability of PC Bangs to a host of social problems. Lee Sujin, a South Korean psychologist who studies Internet use, says “youngsters who become obsessed by the Internet have [experienced] failure at school. They have less interaction with their family and friends and get lonelier.” The South Korean government has declared war on Internet addiction by training counselors and creating treatment centers. In 2007 South Korea also created what amounts to an Internet rehab boot camp, believed to be one of the world’s first. Jump Up Internet Rescue School’s primary mission is to encourage young South Koreans to put down their keyboards and turn off their computers. As one counselor from the boot camp told the New York Times in 2007, “It is most important to provide them experience of a lifestyle without the Internet.”

In South Korea, much of the speculation about Internet addiction focuses on the young men who spend their days and nights inside PC Bangs. Move beyond the user statistics and the sensational headlines concerning excessive gaming, and it is clear that there is much that we do not know about the young people who play games to the detriment of their own social, emotional, and physical health. In the case of South Korea, several important questions go largely unasked. Who are these young men and why are they spending so much time in Internet cafés? Is this problem common across society or does it disproportionately involve youth from certain sectors of South Korean life? Could it be that young South Koreans are hanging out in PC Bangs not because they suffer a mental disorder but rather because of a broader societal disorder that gives them very little else to look forward to in their lives? So-called natural addictions are not only psychological and behavioral; they are also societal.

Two researchers, Dal Yong Jin and Florence Chee, pursued answers to these questions in their ethnographic investigation of PC Bangs. They concluded that a complex web of factors explain what some characterize as an overuse of Internet parlors. Some use PC Bangs for social contact—that is, to avoid playing alone at home. Others, Jin and Chee note, spend considerable time in PC Bangs because access to broadband is cheap and convenient in the wired parlors. For many others, the researchers discovered, games are a secondary rather than a primary factor for frequenting PC Bangs.

In an article published in the journal Popular Communication, Chee refers to PC Bangs as a third place and goes out of her way not to call the users of PC Bangs addicts. She writes, “The PC bang is the site of numerous significant social interactions.” PC Bangs are used to gather with friends. In other instances, young people use PC Bangs to engage in courtship practices. And then there are those who turn to PC Bangs during difficult times. In these instances, Chee writes, “A PC bang also has been known to be a cheap place for shelter in the middle of the night, or within the broader context of an unkind job market, a place for the unemployed to spend the day.” In other words, the attraction to PC Bangs tends to be socially motivated.

Rather than medicating or hospitalizing heavy users of online games—a view that is gaining momentum in some professional circles in the United States—an equally viable intervention should include addressing the underlying social conditions implicated in heavy Internet use. What is happening in South Korea and other parts of the globe is certainly eye opening, but it is not strictly a medical matter.

Virtual worlds are free and open spaces. The very design of computer-generated environments encourages users to spend extensive amounts of time in-world exploring, leveling, battling, building, or simply hanging out and chatting with other users. And yet these same reasons that make virtual environments such a compelling experience for some can make them an unpleasant experience for others.

As I note in the introduction, the leisure of choice among the four-pack is games. And yet none of the four-pack were active in MMORPGs during the time we spent with them. Three of them held a subscription to either WoW or EverQuest at one point in their lives but were no longer actively involved with either game. Character abandonment, it turns out, is not unusual in MMORPGs. In one longitudinal study of WoW, it was found that of the 75,314 characters observed in the first week of one month, 46 percent were not observed in the first week of the following month. It turns out that some users love everything about massively multiplayer online role-playing games—the adventure, the chance to meet other gamers, and the challenges associated with leveling. And then there are those who try a game like WoW and conclude that it simply requires too much time and effort. They turn instead to less time-intensive online gaming experiences. This was certainly true with Derrick and Chase.

“I started World of Warcraft in high school, but decided very early on that I was not willing to commit the kind of time that it takes to really advance in the game,” Chase told me during one of our conversations.

Derrick’s primary reason for giving up WoW was similar. “To be good at World of Warcraft, I mean really good, you have to give up hanging out with your friends and doing stuff with them.” After pausing for a few seconds, Derrick added, “And I was not willing to do that. You know, spend more time with a game than I did with my friends.”

Their decision to leave WoW underscores a key point about the online world. While participation in the “possibility spaces” enabled by computer-generated environments is truly exciting, there are consequences too, especially for the lives users maintain off-line. In addition to the neurobiological effects of compulsive behavior, there are important social consequences. In the case of young people, excessive media use has been linked to problems like obesity, poor body image, and decreased school performance.

Derrick was a first-hand witness to a former dorm mate who suffered socially and academically from what Derrick characterized as an obsession with WoW.

“The guy played World of Warcraft all of the time,” Derrick recalled. “Whenever we would ask him if he wanted to go out with us, he always said no because he had to stay in and help his guild mates conquer the next raid or pillage the next town.”

Derrick not only witnessed the young man withdraw from his friends; he also noticed that the time his peer spent playing the game was most likely responsible for the poor grades that eventually forced him to withdraw from school.

“I don’t think any of us who knew him were surprised to learn that he had academic problems,” Derrick said, adding that the young man played the game all night, opting to get his rest during the day when he was supposed to be in class.

Derrick’s observations are more than speculation. In one national survey of virtual-world users, nearly 20 percent agreed that their use of MMORPGs had caused them some kind of harm—academic, health, financial, or interpersonal. Those who play the most, one study found, are more likely to feel the worst about their involvement in the game. Fifty percent of those surveyed by researcher Nicholas Yee considered themselves hooked. In other words, once they started playing an MMORPG, they could not stop. One of the most enduring consequences of the human migration to the virtual planet is the seemingly insatiable appetite for the social interactions made possible there.

As I got to know Derrick better, he acknowledged his own fight against the impulse to play games all the time. During one of our conversations I learned about an interesting method the college sophomore was using to establish stricter limits on the amount of time he played games. It all started from a conversation with his dad.

“My dad is convinced that games are a waste of time,” Derrick told me. “He doesn’t get it.”

Fully aware of his son’s passion for games, Derrick’s father told him that he probably spends more time playing games than he does studying. Derrick disagreed. But deep down he knew that he could strike a better balance between the two. His grades in college the first year were fair, but Derrick admitted they could have been better.

Before the beginning of his second year, Derrick and his dad made a wager to determine which activity—studying or playing games—absorbed more of Derrick’s time. If Derrick spent more time studying than playing games, his dad agreed to pay him $250. As part of the wager, Derrick agreed to keep a journal that tracked the time he spent doing both. A few weeks after learning about the journal, I asked him how the bet was going.

“I’m learning a lot about myself and how much I play games,” he told me.

Shortly after starting the journal, Derrick began confirming what his dad suspected—games were taking up a lot of his time. On his floor, somebody was always playing a game. It was hard to resist the pull of a good game and the enjoyment it usually produces with his gaming buddies. Derrick acknowledged that he did spend a lot of time playing games, but he also believed that he was spending more time studying as a result of the wager.

“The journal,” Derrick said, “helps me keep games in their proper place. I feel like I have a lot more balance in my life.”

Derrick was not the only person we met whose gaming behavior impacted their academic performance. Remember Curtis from chapter 5? When we met him, he was logging in some hefty hours in WoW—eight to ten a day. Curious about the influence of WoW on his grades, I asked him when he found time to study.

“I’m currently not enrolled in classes. I decided to take some time off,” he said. Curtis intimated that his life was in a state of transition and that he was trying to figure out what was next for him. For one of the few times during our conversations with him, Curtis’s voice, usually buoyant, sounded vulnerable.

I did not ask Curtis if he plays WoW so much because he is not in school or that he is not in school because he plays so much. As I digested the notes from our conversations with him, I suspect both factors are likely. Research scientists have long suspected that excessive amounts of time spent in front of a screen—for instance, a television or video game—correlates with low academic achievement. Poor academic outcomes are not a result of technology per se, but rather the choices humans make regarding technology. A student, for example, who spends a lot of time watching television or playing games will likely have less time to devote to studying. In one of its policy statements, the American Academy of Pediatrics writes, “Time spent with media often displaces involvement in creative, active, or social pursuits.”

And then there is the other issue: does time spent with media interfere with some of our most intimate social ties, namely the ones with our family? From the moment media technologies entered our homes, families have been adapting to their presence. The computer is no exception, as a growing number of families grapple with what it means to manage more and more of their lives through the Internet. Problematic Internet use, we are learning, leads to a host of unintended consequences for families and their personal lives.

As our attachment to the social Web evolves, we can only hope that the public dialogue about problematic Internet use evolves too. The new discoveries about the brain reward pathways are truly groundbreaking. However, one of the dangers of these discoveries is the likelihood that we will soon treat excessive Internet use strictly as a mental illness. A more complete conversation about the overuse of the Internet must comprehend how the relationship between the biological pathways in the brain and the sociological pathways in everyday life combine to influence human behaviors, compulsive or otherwise. Beyond the molecular machinations in the brain, what else makes the online world so irresistible?

The tragic story of three-year-old Brianna Cordell and her mother, thirty-six-year-old Christina Cordell, offers some additional perspective on the Internet addiction debate.

On August 8, 2003, Brianna was found dead in the front seat of her mother’s car. A few days later, Ms. Cordell was charged with manslaughter. The autopsy indicated death by environmental hyperthermia. Brianna, doctors believe, died of a heatstroke. A Springdale, Washington, detective assigned to the case told reporters, “We also believe that on the day in question, Ms. Cordell was playing an Internet game, EverQuest, for a period of time exceeding two hours, during which she had no knowledge concerning the whereabouts of her daughter.”

It was not, the detective noted, the first time Brianna had been seen playing inside of a vehicle with no adult supervision. The local headlines read, “‘Addiction’ to computer fantasy game may have led to child’s death.”

Ms. Cordell’s compulsion to game was especially curious given her own embattled history with virtual worlds. She was a member of the group Spouses Against EverQuest, an online forum for those who felt abandoned as a result of their partner’s fixation with the game they not so jokingly referred to as EverCrack. After finishing her posts on the message boards of the group, Ms. Cordell regularly signed off, “A Survivor of EQ Addiction.” The mother of two was a frequent presence in the forum, using it to share her struggles with both the virtual and physical worlds. According to Ms. Cordell, her husband’s obsession with EverQuest lead to spousal and familial neglect and eventually a divorce. Her ultimate struggle in the end was not with the online fantasy game but rather with an off-line life marred by social, financial, and familial instability.

Along with understanding what is going on in the minds of those who spend several hours a day in the online world, we also need to understand what is going on in their lives. In his book Synthetic Worlds: The Business and Culture of Online Games, Edward Castronova suggests shifting the conversation regarding the powerful pull of games in this direction. Castronova, a gaming scholar, writes, “For some people,” especially those with children and familial obligations, “Earth is where they really ought to spend their time.” He notes, however, that “for others, perhaps the fantasy world is the only decent place available.” Rather than treat all virtual-world users as a monolith, Castronova challenges us to consider the social place from which they enter into virtual worlds. Thus, what might on the surface appear to be an instance of addiction to a virtual world could, Castronova contends, be a sign of someone “making an understandable choice.”

Ms. Cordell admits that EverQuest was not a good place for her and her husband. The young mother’s life was in a constant state of turmoil. In one of the many references to her ex-husband, she writes, “He didn’t want much to do with the kids or me, and then came EQ. It became his obsession.” She resented the time he spent playing the game.

“He freaking raided nightly and daily,” she wrote to her online peers in Spouses Against EverQuest. “Hell, had to put a porta potty under his fat ass since he wouldn’t move practically.”

As the couple’s marriage descended into emotional pain, jealousy, and spousal abuse, Ms. Cordell managed to find a silver lining in her husband’s obsession with EverQuest. “In a way,” she writes, “I was glad because he wasn’t focused on destroying my life as much anymore.”

Whatever her misgivings about EverQuest, Ms. Cordell began to play it—a lot.

Her reasons for playing were not neurobiological; they were sociological. She was drawn to the online world not because of the powerful pull in her brain rewards pathway, but because of the tragic pathway she traveled in the physical world. A part of her actually loathed EverQuest for what it did to her marriage, her family, and her own self-esteem. Still, EverQuest was a place to make, if only virtually, a better life for herself. In the virtual world, Ms. Cordell was able to feel things—love, cooperation, trust—that she rarely experienced in the physical world. If she felt powerless off-line, she experienced the sensation of power and control online. If she felt abandoned by her husband in the physical world, she felt desirable when the men she met in the virtual world dueled for her attention and affection. Her journey into the virtual world is not an isolated one.

Over the last two decades a growing number of humans have established residence in virtual worlds for a variety of reasons. In many cases, curiosity or simple intrigue with managing a virtual self or second life is enough to crossover into the computer-generated universe. Some go into virtual worlds to practice elaborate forms of identity play. In cases like these, the virtual universe is a stage to express and experience a new self—bigger, braver, smarter, wealthier, better looking. And then there are those who travel to virtual worlds with a more serious goal in mind—to escape a physical world they find depressing, lonely, or, quite simply, unfulfilling.

Ms. Cordell, a working mother struggling with her own personal demons and an abusive husband, offered constant analysis of the compulsion to play online games. Is it driven by an overwhelming sense of despair? Her response: “The players are acting out their fantasies of what they’d like their lives to be or have more control over their situations, and in reality, they can’t.”

Is the intense attachment to virtual worlds a way to escape a life full of gloom? Many of her posts suggest that this drove her deep plunge into the virtual world. Immersed in a physical world of pain, the troubled mother of two puts the Internet addiction debate in perspective.

“Although EQ may have only been a symptom of a cause, it definitely doesn’t lessen it. It amplifies it,” she wrote to her online peers. EverQuest did not throw Ms. Cordell’s life into a tailspin of despair. The day-to-day costs of living life on the economic and emotional edge did.

Despite playing the game day and night, Ms. Cordell repeatedly expressed regrets, offering this philosophical nugget: “I feel sorry that people get wrapped up into this and destroy their relationships. I just hope that one day they will wake up before it’s too late and realize they are alone with no real friends and their family is gone.”

While it is true that most of the interactions in MMORPGs take place between people who will likely never meet each other face-to-face, there are exceptions. Games researcher Nicholas Yee reports that a quarter, 25.5 percent, of his male survey respondents and just about four in ten, or 39.5 percent, of his female respondents participate in MMORPGs with a family member—a parent, child, or sibling. In our research we came across an interesting tendency: off-line romantic partners playing massively multiplayer online role-playing games together. For at least two decades, men and women have been using computer-mediated communication to find romance, love, and what MIT scholar Sherry Turkle calls “tiny sex.” Scholars studying Internet use have long identified sex as a main motivation for going online. In her book Life on the Screen: Identity in the Age of the Internet, Turkle contends that the pursuit of virtual sex “is not only common but, for many people, it is the centerpiece of their online experience.” From the moment humans began role-playing, exploring, and participating in computer-mediated communities, sex has been an established fact of online life.

But the journey of romantic partners into the virtual universe is different. In the cases we encountered, couples were not looking for virtual sexual encounters. Rather, they were looking for social interactions with each other. In his survey, Yee found that roughly 16 percent of men and 60 percent of his female respondents participate in virtual worlds with a romantic partner. In some cases the decision by a woman to play WoW with her husband or boyfriend is a way of maintaining a connection in the face of the virtual world’s demand on her partner’s time, energy, and passions. Most women, though, play games for the same reason most men play—they enjoy the identity experimentation and social exploration made possible by virtual worlds.

The 2006 Active Gamer Benchmark Study by Nielsen Entertainment found that more than half, 56 percent, of the nation’s 117 million active gamers play online. Sixty-four percent of those, Nielsen reports, are women. According to the report, women play mostly casual online games. But industry reports also show that a small yet noteworthy percentage of women devote their time and energy to the often serious business of collaborative play found in MMORPGs. Though the data varies slightly from study to study, most observers believe that women represent about 20 to 30 percent of the subscriber base to massively multiplayer online role-playing games.

Couple’s exploring virtual worlds together is another example of how human behavior is evolving right along with the social and mobile media lifestyle. For those young men and women who find computer-mediated worlds a routine and rewarding source of leisure, the idea of spending time in a virtual world with a romantic partner may one day take its place right alongside other courtship rituals such as dining out or going to the movies. Talking about the joy of playing a MMORPG with her husband, one young woman said, “Overall it can be a cheaper form of entertainment where you can spend quite a bit of time with a significant other.” Our discussion with Lisa, a wife in her middle twenties, offers further insight into the reasons why some couples are electing to jump into virtual worlds together.

Lisa was no stranger to games when she and her husband began playing WoW together. “I’ve been playing games most of my life,” she told me. She and her husband had been playing WoW, in her words, “on and off” for nearly three years when we spoke with her.

“Why did you start playing together?” I asked.

“We like playing games together, particularly cooperative games,” she told me. “But, there aren’t that many games with a two-player cooperative option. He had already been playing World of Warcraft and thought we’d enjoy it.”

Initially, Lisa did not think that playing WoW with her husband would be fun. But soon after they started she realized how enjoyable it was. Unlike some couples, Lisa and her husband did not start playing together for fear that his attraction to the online world was tearing them apart. “We’ve played games together ever since we first met,” Lisa explained. Games are something that they both enjoy and have in common. They play together not out of desperation, but rather in anticipation of the collaborative play that makes their shared experiences online a meaningful part of their relationship. Underscoring this very point, Lisa said, “Gaming, whether World of Warcraft or another game, is a fun activity we can do together, so it’s mainly a form of recreation.”

But how, I wondered, does playing with a romantic partner work? “Do you log on together, go on quests together, join the same guilds?” I asked.

When they play WoW together, they log on at the same time and go on quests in a group. Computer-generated worlds like WoW are expansive, even majestic in scope and offer users a variety of people and places to experience. Lisa added, “We each have a Horde character we use for this purpose, kept at the same level. Our Horde characters belong to the same guild. Sometimes, if I’m not available, he’ll play on an Alliance character in a different guild.” Lisa and her husband do not compete against each other in WoW. “It’s also fun to form a group and play cooperatively,” she said, “because that requires teamwork, which is also a little different than some of the other activities we enjoy.”

Think of some of the typical things that couples do together—watch television, go to the movies, or dine out. While couples can certainly do these things with others, it is certainly not unusual to do them only with each other. WoW, Lisa maintained, is a unique form of play that she can share with her husband and other WoW users who visit the epic world known as Azeroth to have fun, live out their fantasies, and gather among others.

Lisa and her husband are fortunate. Rather than tearing them apart, their mutual attachment to the online world brings them together physically, socially, and emotionally. There is mounting evidence that in many American households a serious challenge to the maintenance of personal and intimate relationships occurs when family members choose to spend more time online than with each other. Dr. Block believes that the intense attachment to the Internet can undermine the quality of our most personal relationships. Talking about the Internet and excessive users, Block says, “First it [the computer] becomes a significant other to them. Second, they exhaust emotions that they could experience in the real world on the computer, through any number of mechanisms: e-mailing, gaming, porn. Third, computer use occupies a tremendous amount of time in their life.”

For Ms. Cordell and her husband, EverQuest became a significant other. Both of them also developed an attachment to users who presented themselves as members of the opposite sex in the game. Seemingly scoffing at people who develop an unhealthy dependence on the online world, Ms. Cordell proudly insists at one point, “I still have a foot in reality, and school WILL come first before the game. People just need to keep the real world in perspective and not forget what is the real reason to live.”

In post after post, Ms. Cordell tried to convince herself that she had control over the game and, more important, her life, telling Spouses Against EverQuest users, “I’m going back to school in over a month to get my degree and become a database administrator and support my two kids since I can’t count on a man to do it.”

Ms. Cordell’s experience with the computer-generated world gave me greater insight into the young people we were meeting like Curtis. It also helped me to better understand the young PC Bangers in South Korea. Brain researchers might argue that Curtis, for instance, plays WoW eight to ten hours a day because he suffers from a brain reward pathway overhaul that makes this epic synthetic world too difficult to resist. But as I consider how much time young men like Curtis spend online, I also realize that they play from a particular place in their life.

As our conversations with Curtis evolved, it was clear that he was going through a period of personal turbulence that, in all likelihood, made WoW an especially important place for him socially and emotionally. It is quite plausible that Curtis plays WoW because the game enables him to experience things online—achievement, excitement, and pleasure—that he has yet to adequately experience off-line. In other words, he plays as much for social and personal reasons as he does for neurobiological reasons.

For all of its promise and potential, the fact that some people, a few million perhaps, go to virtual worlds to feel things—power, love, status, self-worth, and acceptance—that they cannot feel in the physical world is distressing. In the end, this suggests that the reasons people use computer-generated worlds may have as much to do with what they encounter in their first lives and physical world as it does in their second lives and virtual world. Even as we learn more about the biological aspects of the compulsion to go online, we must never overlook the social aspects. Life in the online world is intricately connected to life in the off-line world. It always has been and it always will be.