Adam set his alarm for 3 a.m., when he knew his parents would be fast asleep. He crept downstairs to the family's unfinished basement, and there, undetected in the early morning darkness, the Barrington teen fed his habit -- a furtive ritual he repeated several times a day.
It wasn't drugs, gambling or pornography that dominated his thoughts and dreams, sapped his academic ambitions and turned him into a deceitful recluse.
It was video games.
"It was almost a full-time job," recalled Adam, now 27 and living in Chicago. "You just wished you could freeze time in the real world and cruise on this until you were super tired, then go to sleep and come back later."
Uncontrollable video game playing is a 21st century affliction in search of an identity. Is it an addiction on its own terms, as many researchers believe? Or is it just a symptom of deeper problems such as depression or anxiety, as other experts insist?
Dozens of scientific papers have yet to produce clear answers, and the medical establishment has been equally indecisive, calling it a condition that requires further study before it can be classified as a full-blown psychiatric disorder.
That has put the small portion of American gamers whose play experts classify as "pathological" in a tough spot: Even when they believe they have a problem, there's no defined path to recovery.
Treatment specialists are uncommon, their methods are unproven and their care is rarely reimbursed by insurance. A few support groups have formed, but they've struggled to achieve visibility and attract members.
Many gamers thus have to figure out recovery for themselves, coming up with their own techniques to wrestle their habits into submission. For them, there's no final boss to defeat, no level up that will free them for good -- only constant temptation lurking behind a sea of screens.
Adam, who requested that his last name be omitted for fear of being stigmatized, began gaming innocuously enough. When he was 3, his parents bought him a Disney computer game, and a few years later gave him a Nintendo Game Boy and a Sega Genesis as Christmas gifts.
"He really loved anything that interacted on the screen," his mother said. "We got him educational games, but during that time it was becoming very popular to have a gaming system. To be honest, the whole concept of video game addiction was very foreign. All we cared about was that the games would not be violent."
Adam's gaming intensified once he had his own devices, partly because the rest of his childhood was unsatisfying. School was a drag ("I just didn't see the point"), and every sports team he joined was abysmal ("Once you know you're going to lose all the time, you really stop trying").
Video games saved him from all that. The point of each game was crystal clear, and with every level he conquered, his skill improved. The games provided a structure the rest of life seemed to lack and rewarded his effort with prompt recognition, from cascades of virtual coins to chirpy musical salutes.
And on top of everything, gaming was a blast: "There was a rush of adrenaline, a rush of endorphins," he said.
Researchers have studied the psychological rewards of video games for more than two decades, comparing their effects on the brain's pleasure-producing dopamine pathway with those of gambling and drug use. The results, while far from definitive, are intriguing.
Aviv Weinstein, a psychologist at Israel's Ariel University, recently reviewed dozens of studies into gaming and found that the structure and function of some brain regions change when people play games excessively, just as they do when people use drugs. He said that strengthens the argument that compulsive gaming could be a distinct mental disorder.
Critics such as Christopher Ferguson, a psychologist at Florida's Stetson University, are unconvinced. He said any pleasurable activity creates changes in the brain, and that the magnitude of the change differs greatly.
"Playing a video game increases the dopamine level by 100 to 200 percent," he said. "Methamphetamine increases it by 1,400 percent."
Ferguson was also skeptical of the link some researchers make between obsessive video gaming and problem gambling.
He said what keeps a slot machine player bolted to his chair is "intermittent reinforcement" -- the sense that a jackpot could come at any moment.
By contrast, Ferguson said, most video games are based on "continuous reinforcement" -- rewards that come at predictable intervals, such as when a player defeats an enemy and advances to the next level. That gives players more control than they have in gambling, he said.
On top of all that, Ferguson said, research has found that people who play video games compulsively often have a mental illness such as anxiety or depression. The games could just be a sign of that underlying problem, he said.
"It's like people who stay in bed all day when they're depressed," Ferguson said. "They're depressed -- they don't have a bed addiction."
Hooked on 'Warcraft'
Not every video game is the same, however, and the one that mesmerized Adam when he entered high school has a particular reputation for ensnaring players.
"World of Warcraft" is a massively multiplayer online role-playing game, or MMO, presenting a nearly endless landscape over which thousands of players roam freely. Small packs band together in the guise of warriors, druids and other characters to perform quests and battle other teams.
Adam was already committing much of his day to gaming, having learned to outwit the prohibitions imposed by his increasingly worried parents. When they stopped buying him games, he found pirate versions online. When they took away his access to the family computer, he used a modified PlayStation to keep going.
But "Warcraft" grabbed him as no other game had. It was a way to socialize with friends and strangers, explore an ever-changing, surprise-filled environment and develop feelings of mastery as his skills grew.
Soon, gaming was consuming an even bigger chunk of his life.
"I would joke with friends about sleep being the first to go, then schoolwork, then family and friends," he said. "It would just cut into those things as you needed more time."
Some researchers have found that MMOs are significantly more likely than other video game genres to lead to excessive play. One experiment, which assigned young people to play four types of games, concluded that those in the MMO group played more, slept less and suffered worse health effects than other players.
In 2004, video game researcher Nick Yee asked more than 2,000 MMO players if they considered themselves to be addicted. About 40 percent said yes.
That figure has been widely publicized, but Yee said it has been misinterpreted: Gamers often use "addicted" in a nonclinical sense, meaning only that they're really enjoying a game, he said.
"Psychiatrists never ask golfers this question because they don't perceive golf to be pathological to begin with," he said. "There are a lot of people asking it of gamers, but we don't have any other activities to compare it against."
Yee said new technologies are often blamed for compulsive behavior when depression and social anxiety are the true culprits. Adam said those were part of his own struggle.
"Some of it is maybe more tricky than other things," he said. "An issue I had, that a couple of my friends had, is that we were teenagers. We were socially awkward, we were horny and lonely and we felt something was missing, but we didn't know how to fix that.
"When you don't know how to fix that and create opportunities for yourself, you feel helpless. Why not play video games?"
Help hard to find
Adam's incessant gaming hurt his high school grades, he said, but he did well enough to get into the University of Illinois at Urbana-Champaign. There, his habit continued.
"When I was a freshman, the RA walked into my room and said, 'I don't see how you can get any work done with so many distractions,'" he said. "I'd forgotten what life was like without video games. To me they weren't distractions. They were just part of how everything works."
By his sophomore year, though, his mood and mental state had deteriorated. He went to the campus counseling center but gave up after a single session because he didn't feel a connection with his counselor. It was the last time he sought professional help.
Treatment centers for video game addiction are common in Asia, sometimes taking the form of isolating "boot camps," but they are still a rarity here. One exception is the Illinois Institute for Addiction Recovery, which has centers in Harvey, Peoria and Bloomington.
Brittany Ott, who does outreach work for the institute, said it has treated problem gamers for more than 20 years, employing methods similar to those used for drug and alcohol addictions: three or four weeks of group and individual therapy, lessons on coping skills and the creation of an abstinence plan for when addicts return home.
"The initial plan is at least 30 days with no use of any technology, then try to re-evaluate healthy steps on how to bring technology back into their lives," Ott said.
She said the institute has no data on the effectiveness of the approach, though it is trying to collect that information. The industry as a whole is short on vetted results: One review by Mark Griffiths of England's Nottingham Trent University found little research to support any gaming treatment program.
He believes video games can become a bona fide addiction, but that it is rare. While some researchers believe roughly 1 in 10 gamers are addicted, Griffiths thinks it's more like 1 in 1,000.
"They're assessing people who are preoccupied rather than addicted," he said, the difference being that addiction diminishes a person's life instead of adding enjoyment. "They might have some problems, but they're not addicted."
Some evidence suggests that time itself can cure problem gamers. Psychologist Joel Billieux of the University of Luxembourg and co-founder of the Internet and Gambling Disorders Clinic in Belgium said long-term studies of "excessive behaviors" such as gaming, shopping and exercise show they are usually transient phenomena.
"(The studies) support the view that these behaviors are often displayed to cope with real-life problems or psychological difficulties (such as depression or anxiety), and that in such cases they should not necessarily be considered and treated as genuine addictive disorders," he said.
By the end of college, Adam was trying to manage his gaming but still fell into a pattern of bingeing, abstinence and relapse. He would uninstall his favorite games from his computer, hoping the urge would go away, but when he was bored or upset or angry, he went right back.
Then, about three years ago, Adam started going out with a woman who knew nothing about his issues. Their first date took place at an arcade.
Though he eventually told her about his problem, she didn't think it was a big deal compared with people she knew who struggled with drugs. But that was before Adam showed flashes of addictlike behavior.
"We were supposed to go to dinner and he had made up the excuse that he had to see a family member," she said. "The next time I saw him I said, 'How was the meeting?' He looked bashful and said, 'I actually spent the whole day playing video games.'
"That was the first time he had lied to me. That was a really big deal."
It was a big deal to Adam too. Deceiving someone he cared about to spend more time gaming was his moment of clarity -- a realization that his habit was leading him into dark places.
At last, he plotted his escape.
Kicking the habit
Adam figured he needed to avoid temptation, so he limited his contact with friends who were hardcore gamers. He used filters on the popular Reddit website to avoid any discussion of gaming topics.
And in the most radical step, he rendered his online gaming account unusable by resetting his username and password to strings of randomly generated numbers and letters. He then burned the paper on which he had written them, ensuring they were lost forever.
"Once I removed all stimulation that was game-related, not playing became very easy," he said.
As Adam's obsession cooled, he grew interested in meeting others who had endured similar experiences. He formed a Chicago chapter of Computer Gaming Addicts Anonymous, a support group that loosely follows the 12-step approach to recovery (it recently began holding weekly meetings at the Hazelden Betty Ford Foundation on the Near North Side).
Through the group, Adam met a 55-year-old Chicago woman with a very different gaming problem. She didn't get sucked into elaborate fantasy worlds or high-adrenaline shooters -- her issue was smartphone games like "Burger Shop" and "Words with Friends."
"I lost a good job six years ago, and maybe a contributing factor was being tired from being up until 3 a.m. playing games on my phone," she said.
Therapy, prayer and traditional 12-step meetings didn't provide much help. But when she met Adam, talking things over in a Chicago coffee shop, she found someone who understood her issues and kept her accountable when she tried to stop.
The woman said she played her last video game in 2015, though she still finds herself pulled toward text-based trivia games.
"It's not that fun, but I think there's still some dopamine in it," she said. "Things are moving on my phone."
As for Adam, he works as a computer programmer, a situation he jokes is similar to a recovering alcoholic working in a liquor store. Constant proximity to a screen has not led him back into uncontrollable play, he said, though he still fools around with simple computer games for a few minutes a week.
In the end, he sees himself as a recovering addict, but he says the label isn't important. Video games were his deliverance from depression, loneliness and social anxiety. When he finally dealt with those problems, he said, he didn't need the games anymore.
That's not to say he wouldn't love to go back.
"They were awesome," Adam said. "A lot of people look back at video games with a certain amount of bitterness and disdain after they stop playing, but I loved them. I hope one day I can play video games responsibly."
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