Drug of Choice

Every addiction has its tools of the trade—the corkscrew, the ashtray, the needle, the tiny spoon.

This Lake Oswego condo also has the telltale gear of a junkie.

A bottle of Clear Eyes.

A half-dozen containers of Ice Breakers mints.

Shakers for salt, pepper and garlic salt, to spice up microwaveable dinners.

A 40-inch Samsung HDTV and an Xbox 360.

And, blindingly close to the TV's glare, a cushy recliner.

The resident of this den of iniquity is Chad Johnson, a 35-year-old unemployed abuser.

His vice is the Internet. He's been hooked for over a decade.

Most days, for up to eight hours, Johnson is plugged into a liquid-crystal display, checking his stocks, making a "concerted effort" not to look at porn, playing Halo 3, or losing himself in the digital version of crack cocaine—World of Warcraft,

Is he actually addicted? "I would definitely say yeah," says Johnson.

So are an estimated 9 million other people in this country—which, if true, means the Internet is more seductive to Americans than cocaine (with 6 million regular users).

The idea that Internet use can be addicting has been passed around like an email virus since the mid-1990s, when Americans started logging on in large numbers. The notion that it can be more menacing got attention this month after Steven Kazmierczak's shooting rampage at Northern Illinois University.

"COLLEGE KILLER CRAZY FOR VIOLENT VID GAME," screamed the New York Post. The tabloid noted Kazmierczak's ominous fondness for the shoot-'em-up game Counter-Strike.

The theory is expressed in more nuanced terms by Portland psychotherapist Jerald Block, one of the country's leading experts on Internet addiction. Block downplays the violent content of the games, but believes both Kazmierczak and Virginia Tech shooter Seung-Hui Cho showed signs of an unhealthy "computer-person relationship."

Block is a 43-year-old psychotherapist with a graying reddish beard and a paunch. He is no Luddite. He sold Apple II computers in high school and studied industrial engineering at Columbia University, after which he worked as a computer consultant. He first noticed signs of addiction in the mid- to late '90s among his colleagues. "I remember seeing people in this trancelike state," Block recalls.

A few years later, he went to medical school at Yeshiva University. While training, Block treated a female stalker in a psychiatric emergency ward. She had been interviewed by six other therapists, but Block was the first to realize her stalking had begun online.

After opening a practice in Portland in 1999, he started looking for signs of Net addiction among his patients, and developed his theory of "pathological computer use." As his writings on the subject got noticed, he began getting referrals.

Block, whose office is in the Pearl District's Irving Street Lofts, has become perhaps the leading medical expert on a condition that has no official diagnosis but is widely called Internet addiction. He testified before the U.S. Senate Judiciary Committee in 2005 and has been quoted often in the press. He has an article on the subject coming out next month in the prestigious American Journal of Psychiatry.

Currently, 10 percent of his practice in Portland consists of Internet addicts. Chad Johnson is one of his patients.

His treatment?

He's tried the Thoreau cure, prescribing outdoorsy vacations. "It does not work. They get enraged, and sometimes drop from treatment," Block says.

Block has also recommended naltrexone and acamprosate—drugs commonly used to treat alcoholism, which are thought to block certain kinds of cravings—but no patients have taken him up on it. "A lot of people don't want to get off the computer that much," he says.

Ultimately, Block treats his patients by talking it out. This isn't easy, he says, because "they have every reason not to talk about it."

"Adults have tremendous shame about their virtual lives. They also find it enormously valuable and stabilizing. So they don't want to put it at risk," says Block.

For addicts, the computer becomes "a heat sink for aggressive or sexual impulses," Block says.

He's developed a rule of thumb: If an addict says he spends four hours a day on the computer, he probably spends eight.

Block is hardly alone in his field.

At least a half-dozen other therapists in Portland offer treatment for Internet addiction. And up I-5 in Redmond, Wash., Hilarie Cash counsels Internet addicts through her practice at Internet/Computer Addiction Services.

"There's a huge number at folks at Microsoft who are on computers all day. They play games. They go home and they play games some more. They can tolerate work because it fits right into the whole lifestyle," says Cash.

She has run support groups for gamers, an addiction-prone group. But most clients seek help because they've gotten into trouble with their spouses over porn or sex chat rooms. Young men are the worst cases.

"These are usually guys who've flunked out of high school. They're living at home. Their parents don't know what to do with them. Most of them don't date. They take care of their sexual needs with porn, and spend all their time gaming. They're just a mess," says Cash.

Both Block and Cash say the extreme consequence of Internet dependence is not the gun rage of a Kazmierczak or a Cho, but something far more mundane and predictable: lost jobs, failed classes, divorce. Among addicts, the "computer-human relationship" becomes more compelling than money or sex.

While both Block and Cash say addicts are almost always male, they apparently come in all ages. One example is Michael Strickland, a 58-year-old retired graphic designer in Portland. He beat alcoholism years ago, before online games even existed. But for Strickland, the computer proved just as habit-forming. He says chronic pain from a spinal birth defect exacerbated his growing dependence on World of Warcraft, perhaps the most addictive game ever designed. "It's a monster, man. It's got tentacles you can't even see," says Strickland.

WoW, as players call it, is the world's most popular online game, with 10 million subscribers who pay $15 a month to play. The premise is basically a rip-off of Lord of the Rings. Players adopt an alter ego, like a knight or a magician, explore a fantasy world, dress up in magic armor and band together to slay beasts.

WoW is unwinnable. There is no end. Players join guilds with dozens of members, who become like bar buddies hassling you to stay for another round. Going "afk" (away from keyboard) for a "bio break" (the toilet) can bring reprimands from a player's team leaders.

There is also the undeniable appeal of becoming a character that's more powerful and successful than your real self. "Virtually everyone who spends a lot of time in WoW has something in their life they are hiding from," says Strickland.

"Literally, I lived in a recliner and I crawled to the toilet," he says of the days when his pain—and his WoW habit—was at its worst. The game is not only addictive, Strickland says, but "a replacement for life."

Despite his pain, in the game Strickland "can walk, run, jump, even fly—I can go, go, go without stopping, and there is no pain associated with it!"

Strickland, who is divorced, even developed an online romance with another WoW player. "I've met many people who say they're females—and I believe they are—who are married, and they want to have a relationship with me. They're putting out these vibes, constantly," Strickland says.

Vibes?

"She was talking about names of characters that had different sexual connotations in different languages. Stuff like that," Strickland says. "I feel like an idiot. I hate to admit this, but I did get sucked in, because I was hurting. I caught myself in the middle of it and thought, 'What the fuck am I doing?'"

After 2 1/2 years of playing—sometimes for up to a week straight—Strickland recently burned out, as many addicts eventually do.

"Right now, the last thing I want to do is play WoW," Strickland says. "It just becomes a grind and a real drag."

Still, he admits, "I might get sucked back into it."

Luke is a fresh-faced 16-year-old private-school student in Portland. He doesn't have a girlfriend. He has a cell phone, but not surprisingly, he's more reachable by instant message. His MySpace page lists dozens of friends. It contains no mention of his jones.

Luke has put over 4,200 hours into WoW since middle school. He'd try to set time limits for his gaming, only to watch one hour turn into five, again and again. He found himself sleep-deprived, rushing to finish assignments between classes, and spending less time with friends. But he managed to keep his mom in the dark about his nightly habit. "I was a pretty sneaky player," he says. If Mom came to his room, he'd quickly make his homework appear on the screen.

"The game...is like a drug," Luke writes. "The moment i know i was totally addicted was when i had a completely wow dream it was a circle of me, and like 4 other players, all were talking like my friends but in wow bodies and we ran around and killed stuff now, looking at people who are addicted, i feel bad...sort of compelled to make them stop."

How does one distinguish between a bona fide addict and an office worker who for eight hours a day uses email and Microsoft Word and sneaks in a game or three of solitaire?

One sign is that addicts come to think their computers have human emotions. They intuitively understand the meaning of each click, tap and beep. They sense when it takes too long to start up a program. "They know when it's sick," says Block. "It's like knowing your wife's favorite rose."

But, as with drugs, use doesn't become addiction until the computer use causes real-life problems. It's not what you're doing on the computer that makes you an addict, but everything else you're not doing.

Take WW's Checklist

There is no agreed-upon diagnosis for Internet addiction. There may be by 2012, when the American Psychiatric Association publishes the next edition of its

In the meantime, here's

's own checklist. If you answer "C" to more than one of these questions, you might have a problem. —

Block spots Internet addicts with a checklist of his own devising, built around the acronym SIGNS:

Sleep-pattern disturbance

Irritability before and after computer use

Guilt and attempts to hide or purge computer use

Nightmares and dreams about computer use

Social avoidance

Block says shutting off an addict's computer can be a dangerous move.

In a 2007 article in the American Journal of Forensic Psychiatry, Block noted that Columbine High School shooter Eric Harris began plotting to blow up his school only after his parents kicked him off the computer. Block did not blame the violent content of the games but the abrupt severance from the shooter's "virtual life."

Block personally treated a young man who had been a heavy gamer for much of his life. At age 17, the patient developed a heroin addiction and dropped the computer. By 20 he was in rehab for the heroin but was developing a seven-hour-a-day online gaming habit.

"Take away the computer, and I don't have a doubt he'd be back on heroin," Block says.

("Wow…I'm not gonna say it couldn't happen," says Ed Blackburn, who runs the opiate detox programs for Portland's Central City Concern. But "none of our counselors have come to us and said, 'Boy, we're seeing a lot of people developing Internet addiction.")

Relapse rates are high, Block says. There is no cure. Yet.

There are good reasons to be skeptical about Internet addiction.

For starters, everyday use does not pose a problem. "Honestly, nobody ever calls and says, 'I need treatment and my life has fallen apart because I'm on email too much," says Cash, the therapist in Redmond.

Second, psychiatric theories change with the times. For instance, in the 19th century, novels were thought to cause hysteria in women. There was a plague of books.

Third, Internet addiction is not yet recognized as a mental disorder in the United States.

There is also the fact that most Internet addicts have some other disorder. Chad Johnson, for instance, is schizophrenic. (Interestingly, he says he almost never has a delusion while his mind is focused on a video game.)

This is why some psychiatrists argue that Internet addiction is best treated by attacking a person's deeper problems. "It's not the computer itself, it's particular behaviors on the computer—compulsively checking your email, or checking the value of your house. It's a way of dealing with loneliness or depression," says Portland therapist Melissa Owens.

Then again, other countries are already treating Internet addiction as a public health crisis.

In South Korea, among the most wired countries in the world, Koreans treat online gaming as a national pastime. Driven by press reports of people dropping dead of heart failure after days-long gaming sessions, the government there has trained more than 1,000 counselors to treat Internet addiction and set up nearly 200 treatment centers, including a boot camp-style clinic in the countryside. (The camp didn't work, Block says. Too many patients relapsed.)

The government estimates more than 210,000 children need help.

In China, too, thousands of Internet "addicts" have been hospitalized. The Chinese government, which estimates 10 million young people may be afflicted, regulates the amount of time people can spend online by limiting licenses for new Internet cafes, requiring online gamers to use their real names when logging on, and mandating software that makes the games harder to play after users exceed a three-hour-a-day limit. Addicts can be confined to military hospitals for up to 10 weeks, and subjected to martial drills, antipsychotic medication and "comprehensive education," according to an email to Block from Ran Tao, a doctor with the Center for Addiction Medicine at Beijing Military General Hospital.

"At least in those Asian countries, they are clear about it being an addiction. They don't have their heads in the sand about it," says Cash.

Every addiction has pushers. Often, they're former users.

Marcus Eikenberry is 37, big, bearded and tattooed. He started gaming with Ultima Online in 1997.

"I was working a 40-hour job and playing 40 hours a week," Eikenberry says. Naturally, he says, his wife complained. Rather than quit, "I decided to make the game my job."

His wife, a "casual gamer," was skeptical, but Eikenberry's online gaming business took off, and the marriage survived. His two sons, also gamers, help out at the office, and his younger brother is a full-time employee.

Today, Eikenberry owns what he believes is the largest company of its kind, catering to online gamers from all over the world. Markee Dragon Inc. is housed in a boxy commercial complex near Portland International Airport.

His company is like a combination of Citibank and Wal-Mart. He sells virtual items—like gold, magic swords and real estate in the form of castles, or even entire characters—for real money.

The business involves complex spreadsheets tracking supply and demand in different areas of the virtual world, as well as constant monitoring of competitors' prices. He even benefits from globalization. Often he buys from Chinese "gold farmers"—who spend their days killing monsters for virtual treasure, often earning a real-world commission (in yuan) on the fake gold pieces that they gather. The farmers' employers make their money by selling the virtual loot to dealers like Eikenberry.

His employees connect buyers with sellers and run what are essentially credit checks, because of the high fraud rate in the secondary market for virtual goods.

Eikenberry says he facilitates over $1 million a month in sales.

Eikenberry has no moral qualms about how he makes his living. "The people that are buying [this stuff] already know what the game is about. You can't say that they're naive," Eikenberry says. "I've never thought about it as the game that's the problem. It's the person that's the problem."

At the same time, he freely admits: "If you're not addicted, we don't make money off of you."

IS IT A SCAM

Every addiction, these days, has a chemical fix.

Because Internet addiction is not yet a recognized mental disorder in the United States, there is no ready prescription. No worries: Big Pharma is on the job.

Forest Laboratories, a $3.4 billion pharmaceutical company, partly funded a 2006 Stanford study on the prevalence of Internet addiction. The study found one in eight Americans showed at least one sign of "problematic computer use."

And a preliminary study, also funded by Forest Labs, shows some promising results treating Internet addiction with an antidepressant the company markets under the brand name Lexapro.

"Some people have suggested this is just an evil pharmaceutical empire that's just trying go sell more drugs," says the study's author, Eric Hollander, who chairs the psychiatry department at the Mount Sinai School of Medicine in New York City. "What I would say in response to that is that there is a subgroup of individuals who are biologically vulnerable" to Internet addiction.

"On balance I think that it's essential to be able to do studies," he says. "And nobody else is funding this kind of work."

Because insurance companies don't recognize the condition of Internet addiction or reimburse for its treatment, Block bills his patients' insurers for secondary diagnoses, whether it's anxiety or depression or obsessive-compulsive disorder.

Lee Siegel, in his new book, Against the Machine: Being Human in the Age of the Electronic Mob, argues that the Internet is making us less creative and more isolated. Siegel was suspended by The New Republic in 2006 after responding under a false name to critical bloggers.

Psychiatrist Eric Hollander has compared gambling addicts to cocaine addicts, and found that their brains' "reward circuitry" responds in the same way. He suspects the same may be true of Internet addicts.

World of Warcraft has over 10 million subscribers worldwide, 2.5 million of them in North America. By comparison, nearly 30 million people watch American Idol every week.

Chad Johnson's favorite movie is The Matrix. He says he's seen it 40 to 50 times.

Blizzard Entertainment, which makes WoW, was valued at $1.2 billion in 2007.

Block has noticed adults will cop to porn use but not computer gaming. "How are you going to talk about how you're a level 70 wizard in World of Warcraft with a straight face?" Block says.

Sites like On-Line Gamers Anonymous and gamerwidow.com function as support groups for Internet addicts. The following comment is from wowdetox.com: "My wife left me because of my WoW addiction. She said enough was enough and it was time she moved in with a real man instead of a geek. She left me for one of our old guildmates who quit two months prior and sent me pictures of them and posted them on our guild website."

WWeek 2015