To many video game enthusiasts, popular titles such as "World of Warcraft" and "Call of Duty" offer a chance to escape ordinary life for a more glamorous, heroic existence.
The trouble starts when these virtual worlds crowd out the real one, said psychiatrist Hilarie Cash.
"The people who are developing video games are very sophisticated now about behavioral principles," Dr. Cash said. "... For them, it's good business to create a highly addictive game."
Dr. Cash has been treating video game addiction for 15 years, working mostly with people hooked on massively popular multiplayer online role playing games such as "Everquest" and "World of Warcraft."
In August, she co-founded reStart, a 45-day in-patient program for treating video-game addicts. The Fall City, Wash.-based program is the first of its kind in the country and has so far graduated eight enrollees, Dr. Cash said.
Most Chattanooga-area gaming enthusiasts interviewed for this report said gaming provides them an outlet for social interaction. While they acknowledged that it could be addictive, they suggested that excessive gaming was a symptom of other issues.
"I think that people with addictive personalities and escapist tendencies are more likely to fall into a game, but they're just as likely to fall into something like alcohol or drugs," said Becca Palmer, 22, who spends 12-15 hours a week playing "World of Warcraft."
As of now, the American Psychiatric Association maintains a similar position. Video game addiction is not officially recognized by the APA, which publishes the Diagnostic Statistical Manual used to classify mental disorders. Dr. Cash said she and others in her field hope to present the APA with a convincing body of research to encourage video game addiction's inclusion in the next revision of the DSM, to be released in 2013.
Despite a lack of official recognition, the issue of gaming addiction is one that's increasing as the Internet becomes a part of people's lives at a younger age, Dr. Cash said.
According to a 2007 online poll of 8- to 18-year-olds conducted by the Harris market research company, about one in 10 participants (8.5 percent) reported at least six of 11 addictive symptoms of gaming. Almost a quarter (25 percent) said they felt "addicted to video games," according to the study.
Even with parental limits on a child's gaming habits, the lack of external restraints often results in young people slipping into unhealthy habits when they leave home, Dr. Cash said.
"What we're seeing is a problem that is growing through childhood but doesn't come to real fruition for a certain number of young adults until they leave to go to college," Dr. Cash said.
As a relatively new condition, gaming addiction lacks the widespread support infrastructure available to those with more traditional addictions such as alcoholism or gambling, Dr. Cash said.
Gaming addiction manifests itself in similar ways to substance addictions. As a result, quitting without help is not easy, Dr. Cash said.
"Can people quit? Absolutely -- maybe," she said. "But it's tough. That's the nature of addiction. It's very hard to stop."
SECOND LIVES
* Name (real/game): Becca Palmer / Shilar, Athiest and Athilar.
* Age: 22.
* Current playing: "World of Warcraft," "Kingdom of Loathing," "Resident Evil 5" and "Tomb Raider: Underworld."
* Profession (real/game): Student majoring in chemical engineering / Mage, druid and death knight.
* Average daily game time: 3-4 hours.
* The appeal: "My friends who moved away still play, so I get to connect with them and talk (through 'World of Warcraft'). I love solving problems. Going through a dungeon or raid, each boss has its own set of difficulties you have to overcome together. I never played team sports, but this is my version of a team sport, I guess."
* Name (real/game): Jake Redis / Narfalator and Tempart.
* Age: 21.
* Current playing: "World of Warcraft," "Call of Duty: Modern Warfare 2" and "Bioshock 2."
* Profession (real/game): Student majoring in geology / Shock trooper and mage.
* Average daily game time: 5 hours.
* The appeal: "It's the escapism aspect of ('World of Warcraft'). When you are playing the game, you're not yourself. You're the character or the avatar doing all this cool stuff, and you get away from your life of boring stuff like going to classes or a job. You're a hero. I see how that can be addicting."
* Name: Avery Krouse (aka Coruscus).
* Age: 25.
* Currently playing: "World of Warcraft."
* Gaming addiction, fact or fiction?: "You get addicted to the feeling of that 'ding' that happens whenever you achieve any of the mini-goals or progress to the next level. I'm sure there are chemicals that pop in your brain every time it happens, and once you get used to them, you want them more and more, just like any drug."
* Name: Patrick Winecoff (aka KnifeCakes).
* Age: 40.
* Currently playing: "Call of Duty: Modern Warfare 2."
* Gaming addiction, fact or fiction?: "I definitely see people playing and getting lost in a game for hours on end and ignoring everything else they have to take care of at the house or at work, but we do that with a lot of other thing as well. People do that with TV."
* Name: Ben Levy (aka TheOneJew)
* Age: 25.
* Currently playing: "Call of Duty: Modern Warfare 2" and "Darksiders."
* Gaming addiction, fact or fiction?: "It's like a mini job. When ('World of Warcraft') became that to me, I had to stop. I realized I was doing a routine every day of doing the same thing over and over, and after a while, it was very boring, so I went to a different medium."
RESOURCES
Think you or someone you know might have a problem with excessive gaming? Here are some resources experts recommend consulting:
Web
* reStart Internet Addiction Recovery Program (www.netaddictionrecovery.com)
* Online Gamers Anonymous (www.olganon.org)
Books
* "Video Games & Your Kids: How Parents Stay in Control" by Hilarie Cash and Kim McDaniel.
* "PlayStation Nation: Protect Your Child from Video Game Addiction" by Olivia and Kurt Bruner.
* "Game Addiction: The Experience and the Effects" by Neils Clark and P. Shavaun Scott.
SELF-DIAGNOSIS
Hilarie Cash, co-founder of the reStart internet and gaming addiction recovery program, developed a list of 12 potential signs or symptoms of addiction. The list is available on the reStart Web site at www.netaddictionrecovery.com.