The waiting room for Hilarie Cash’s practice has the look and feel of many a therapist’s office, with soothing classical music, paintings of gentle swans and colorful flowers and on the bookshelves stacks of brochures on how to get help.
But along with her patients, Dr. Cash, who runs Internet/Computer Addiction Services here in the city that is home to Microsoft, is a pioneer in a growing niche in mental health care and addiction recovery.
The patients, including Mike, 34, are what Dr. Cash and other mental health professionals call onlineaholics. They even have a diagnosis: Internet addiction disorder.
These specialists estimate that 6 percent to 10 percent of the approximately 189 million Internet users in this country have a dependency that can be as destructive as alcoholism and drug addiction, and they are rushing to treat it. Yet some in the field remain skeptical that heavy use of the Internet qualifies as a legitimate addiction, and one academic expert called it a fad illness.
Skeptics argue that even obsessive Internet use does not exact the same toll on health or family life as conventionally recognized addictions. But, mental health professionals who support the diagnosis of Internet addiction say, a majority of obsessive users are online to further addictions to gambling or pornography or have become much more dependent on those vices because of their prevalence on the Internet.
But other users have a broader dependency and spend hours online each day, surfing the Web, trading stocks, instant messaging or blogging, and a fast-rising number are becoming addicted to Internet video games.
Dr. Cash and other professionals say that people who abuse the Internet are typically struggling with other problems, like depression and anxiety. But, they say, the Internet’s omnipresent offer of escape from reality, affordability, accessibility and opportunity for anonymity can also lure otherwise healthy people into an addiction.
Dr. Cash’s patient Mike, who was granted anonymity to protect his privacy, was at high risk for an Internet addiction, having battled alcohol and drug abuse and depression. On a list of 15 symptoms of Internet addiction used for diagnosis by Internet/Computer Addiction Services, Mike, who is unemployed and living with his mother, checked off 13, including intense cravings for the computer, lying about how much time he spends online, withdrawing from hobbies and social interactions, back pain and weight gain.
A growing number of therapists and inpatient rehabilitation centers are often treating Web addicts with the same approaches, including 12-step programs, used to treat chemical addictions.
Because the condition is not recognized in psychiatry as a disorder, insurance companies do not reimburse for treatment. So patients either pay out of pocket, or therapists and treatment centers bill for other afflictions, including the nonspecific impulse control disorder.
There is at least one inpatient program, at Proctor Hospital in Peoria, Ill., which admits patients to recover from obsessive computer use. Experts there said they see similar signs of withdrawal in those patients as in alcoholics or drug addicts, including profuse sweating, severe anxiety and paranoid symptoms.
And the prevalence of other technologies – like BlackBerry wireless e-mail devices, sometimes called CrackBerries because they are considered so addictive; the Treo cellphone-organizer ; and text messaging – has created a more generalized technology addiction, said Rick Zehr, the vice president of addiction and behavioral services at Proctor Hospital.
The hospital’s treatment program places all its clients together for group therapy and other recovery work, whether the addiction is to cocaine or the computer, Mr. Zehr said.
"I can’t imagine it’s going to go away," he said of technology and Internet addiction. "I can only imagine it’s going to continue to become more and more prevalent."
