This story appears in the August 2015 issue of 425 Business.

Online gaming was ruining Callum Morrison’s life, so he checked into an Eastside retreat to detox. Was the game to blame?

Callum Morrison, a 20-year-old Southern Methodist University student, was at his mother’s San Antonio home on Jan. 4. That morning, he left for the law firm he worked at during breaks in school. He arrived at 9 a.m., but he wasn’t there to organize case files or prepare briefs. Instead, he was there to play World of Warcraft.

His gaming at the office wasn’t unusual; Morrison often played WoW at the firm to shield his gaming from others. But Morrison’s family was on to the ruse. They knew his 12-hour holiday-break “workdays” weren’t spent solely on clerical tasks.

Morrison played that Sunday until 2 p.m., when Chris Amberson, his boss and his mother’s boyfriend, popped in and told Morrison he needed to come home. Amberson drove Morrison there, where his mom, Carla, was sitting in the den waiting for him. Other family members silently queued in the adjacent room, waiting to begin an intervention.

Once Morrison sat down, they filed out: first came Amberson, then two of Morrison’s sisters, his dad, and his stepmother. Then came someone Morrison didn’t know. The guy introduced himself as Scott Graham and told Morrison his relatives had some letters they’d like to read to him.

One by one, Morrison’s family knelt before him and detailed the son and brother they once knew. The one that exuded kindness. The one who would respond to angry sisters by slipping a note under their door that read, “I love you.” The one who would burst into song, often coaxing others to sing with him. The basketball player who took pride in his physical fitness. The promising student. The former debate team member. The young man with an interest in law.

That Morrison, his family explained, had vanished. Basketball and socializing had been replaced by consistent 10-hour gaming sessions. Friends would call asking for favors, only to be back-shelved an extra couple hours so Morrison could continue to play WoW. Morrison was lethargic during mornings that followed three hours of sleep, and energy drinks were a primary form of sustenance. He skipped family gatherings and pulled away from friends.

“In keeping with what is a developing pattern, I don’t see you participating in family time. … I don’t see you interacting socially at all,” his mom read to him. “I see you becoming more and more isolated, as you continue to lie to others, as well as yourself, about what you are becoming and what you are doing. … I see you being very alone and, at a certain point, I see that you could pass a point of no return. The hole could be too deep to escape. I picture you being written off by family and friends. When I think about all of this, I feel completely heartbroken and incomplete. A part of me would die with you, never to be replaced.”

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WoW screenshot courtesy Josh Gingell

Morrison had felt during previous exchanges that his family exaggerated the magnitude and harm of his gaming. The intervention began to change his mind. “The picture that everyone was painting as to what they thought would happen if I continued what I was doing, hearing them describe what they thought might happen — that was one of the big blows that shattered my denial,” Morrison would remember six months later.

When everyone was finished speaking, Graham asked Morrison if he would accept help. Morrison said yes, and Graham told him to finish packing his bags — his mom and his sisters already had done most of the packing — and get in the car. Morrison and the interventionist were going to Washington state, and their flight to Sea-Tac left in an hour.

At the airport, Morrison inquired a bit about his destination, but he wasn’t overly curious — he was starting to understand he needed help and he didn’t care where it came from. A few hours later, Morrison and Graham skirted the epicenter of Washington’s $600 million gaming industry as they drove from Sea-Tac to Fall City. Mere minutes away from the high-rise offices where nearly 3,000 developers crafted the Halo, Dota, and Guild Wars game franchises, Morrison checked into Restart Life, the retreat where he would try to quell his video game addiction.

MORRISON FIRST VISITED Azeroth, the world in which WoW is set, in seventh grade. He strung together free trials for a few years, then started the $15-a-month subscription when he was a high school sophomore. Early on, Morrison would play only casually during breaks in the school year. But by the summer of his freshman year of college, when friends were out of town and family members were at work, Morrison’s gaming had entered the compulsory realm.

Downtime was an instigator, but it certainly wasn’t the lone cause for Morrison’s gaming frequency. Each time he logged in to WoW, he entered a universe sculpted by skilled designers with deep knowledge of psychological motivation. Games such as WoW, categorized as massively multiplayer online role-playing games, or MMOs, combine immense virtual worlds with storylines and online socialization that coax players into hourslong sessions. According to Jamie Madigan, a psychologist and author of Getting Gamers: The Psychology of Video Games and Their Impact on the People Who Play Them, MMOs rely on the three prongs of the self-determination theory of motivation: autonomy, competence, and relatedness.

“Real life is not very good at satisfying those three needs,” Madigan said. “So games are designed to provide shortcuts to satisfying each one of those needs, MMOs especially. Everything is in the numbers. It’s what level you are, what equipment you’ve got, what stat bonuses you have, and so forth. And seeing friends pop up with their online status and invite you to a group — it’s all very satisfying.”

Players describe MMO gameplay as an accelerated version of real-life growth. As they progress through the game, players acquire more goods and skills and partake in adventures of their choosing. This virtual maturation doesn’t occur in a vacuum. Just as one would show off a new boat to friends or wear a new jacket to work, MMO players get to work toward and share accomplishments with others in the game. Thanks to online play, chats, and guilds — social communities that meet within games — MMOs foster virtual communities that to many players are as significant as those outside the game.

“A lot of my thoughts when I was playing the game were based on progression — trying to get farther and be better, and sharing those successes with the people I met in the game,” Morrison said.

Self-determination motivators can foster long-term commitment to a game, but more basic tactics are used to keep a gamer from logging off once they’re playing. The operant conditioning model psychologist B.F. Skinner used in the 1930s to make rats compulsively press a lever in the hopes of food are employed in MMOs, largely in the form of loot acquisition. Loot — rewards in the form of objects or currency hidden throughout a game — is randomized; players can’t be certain whether a drop will be a significant acquisition or a common item they likely already possess. Thus, players keep roaming virtual worlds in search of loot, just as casino hounds mindlessly push the buttons of a slot machine. They know the payoff lights will flash; they just don’t know when.

“This basically is the equivalent of a whole generation of children growing up in a Skinner box and allowing the makers of games to manipulate them in ways that will draw them in and make them addicted,” said Dr. Dimitri Christakis, a University of Washington pediatrician who studies the effects of media on children.

These design elements aren’t coincidences, and MMO developers have devised financial systems built around the various hooks. WoW’s 10 million subscribers in 2014 generated $857 million in revenue for publisher Activision Blizzard, and that money is directly tied to keeping players coming back month after month. (Activision Blizzard did not respond to requests for comment.)

Games that don’t use a subscription model still rely heavily on in-game purchases called microtransactions. Through intricate economies built into the game, players can purchase items both practical — say, a shield for your avatar or an ability that would otherwise take hours of quests to attain — and superfluous. Blizzard even has a WoW pet shop.

MMO structure rewards players for longevity and the corresponding financial commitment. “You get rewards, special currency, prestige, achievements,” said Richard Rowan, an instructor at Redmond’s DigiPen Institute of Technology who has worked on nine MMOs. “Asking somebody to quit an MMO they’ve been playing for 10 years is sort of like asking somebody to move to Europe and leave all their stuff behind. Everything that they’ve spent 10 years building is right there … all of these trophies of their accomplishments. Acquisition is addictive; it’s the same thing with gambling. At the same time, that’s just basic human motivation.”

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photo by Jake Bullinger

MORRISON’S FIRST WEEKS at Restart dripped with boredom. After spending his waking hours in a virtual environment defined by action, social fulfillment, and measurable growth, he now found himself in a rural Eastside area being ordered to do comparatively mundane tasks every day. Clients have a rotating list of chores — cooking one week, gardening the next. Many have poor physical fitness levels and hygiene, so staff must normalize exercise and cleanliness.

“I miss how easy and instant the reward system was,” Morrison said. “When you’re at Restart, it’s really easy to surround yourself with knowledge and reasoning on why it was toxic and how false the rewards are, but that doesn’t change how real it felt at the time, how much it felt like I was progressing and getting through ranks.”

Even visitors who don’t pathologically game likely would find Restart’s grounds comforting. The house, property of cofounder Cosette Rae and her husband, Gary Simmons, is on a beautiful forested plot with a lofted cabin, a garden, and chicken coops. It’s closer to organic farms than to skyscrapers. Jazz music in the house coupled with birdsong outside is impossibly tranquil. Owls sometimes perch outside the windows.

But for video game addicts used to the sights and sounds of worlds custom-made to flood the brain’s pleasure centers with dopamine, tranquility can be torture. Most clients experience withdrawal symptoms that include lucid dreams, sleepless nights, mood swings, and severe fatigue.

Restart’s goal is to condition clients to appreciate, or at least accept, delayed gratification and self-sustenance. “Typically they are smart guys, they are nice guys, but they have gotten way off track from their potential,” said Hilarie Cash, Restart’s cofounder. “When they were at home at high school, their parents provided enough structure that … even though they were gaming, they still got their homework done. Then they go off to college, and they don’t have a structure, and they don’t have self discipline.” Cash said the increased social and academic demands in college cause anxiety among Restart clients, which in turn leads to gaming.

When the gaming becomes problematic, affluent parents can send their kids to Fall City for the minimum 45-day retreat, which costs $25,750. “We’re often the lesser of two evil choices,” Cash said. “The parents are saying, ‘We either kick you out and you go find your own way, or you go to Restart.’”

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Wow screenshot courtesy Josh Gingell

Restart isn’t just an abstinence-and-hard-work center, though. Group therapy sessions are a daily occurrence, and each client meets individually with a licensed counselor. Clients partake in a 12-step program. The goal is not only to help prepare clients to manage their conditions despite ample opportunities to game or ply the Web, but also to help them understand their condition and repair relationships.

For Morrison, that meant counteracting deceitful behavior. His debate-team skills helped him lie to friends and family members; many of his friends didn’t even know he played WoW.

“I was really afraid of failure and rejection, and you don’t have to encounter any of that in the video game,” he said. “I had this image I was trying to convince myself of, which was this perfectionist not getting denied, not being vulnerable. Filling the social gap with video games became easier.”

With the video games gone at Restart, Morrison had to address his offline shortcomings. “We call our folks at home once a week, and it’s so alien being honest with them,” Morrison said. “There’s a week between (calls), and I almost feel like I need the full week to work up the courage every time to talk about a few more things that I want to.”

Morrison spent a month at Restart before he told a friend about his condition. He was met with support, but his friend treated the condition as an oddity.

“His first reaction was, ‘Oh, thank God — I thought it would be drugs,’” Morrison said. “From the culture I came from, it’s (pathological gaming) so not a thing. Although he accepted it, it’s going to be a while before the gravity of it, of how much I have to avoid it and how much of a problem it is, gets communicated.”

THE LATEST EDITION of the Diagnostic and Statistical Manual of Mental Disorders (DSM) calls what Morrison suffers from Internet gaming disorder. Conditions listed in the DSM have met the American Psychiatric Association’s criteria that warrant clinical intervention, meaning drugs can be prescribed, treatment can be sought, and insurance companies can help foot the bill. Internet gaming disorder made the text, but it was slated for further research. The APA is certain that pathological gaming exists; what it’s not sure of is whether Internet gaming disorder is a standalone condition.

Pathological gaming in its various monikers — gaming addiction, problematic gaming, compulsive gaming — is well documented. Deaths and suicides that followed Internet gaming sessions in the U.S. and Southeast Asia have received international media attention, and the hardcore gaming communities in Southeast Asian Internet cafes have generated shock in Western media. Singapore, for example, takes the condition seriously: Government-led studies have found that 9 percent of Singaporean youth are “pathological gamers” who play at least 37.5 hours per week, and the government offers treatment resources.

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Data provided by Entertainment Software Association and Gartner

International studies, which primarily focus on youth, say 7.5 percent to 12 percent of gamers are addicted, but using terms like “addiction” or “pathological” is problematic when those issuing the labels are using different criteria.

Internet gaming disorder would be categorized as a behavioral addiction, and the only behavioral addiction in the DSM is pathological gambling. “There were no other behavioral addictions listed specifically because there’s just not good evidence about how they can and should be defined, and if they even constitute a unique mental disorder,” said Dr. Nancy Petry, a University of Connecticut psychiatrist who was on the workgroup that considered addictions for the DSM. To guide future studies, her team formulated diagnostic criteria based on nine factors, including withdrawal symptoms, covering up the gaming, a preoccupation with the game, and sacrificing relationships or career opportunities.

From the research that has taken place, a primary question about Internet gaming disorder remains unanswered: Is it a condition all its own, or is it a symptom of other psychological disorders?

Multiple studies suggest the latter to be the case, but the longest-running longitudinal study of gamers to date argues otherwise. The study, led by Iowa State University child psychologist Dr. Douglas Gentile, a member of the DSM workgroup with Petry, followed 3,000 Singaporean youth over two years and used diagnostic criteria similar to those the workgroup formulated.

Nearly 10 percent of students surveyed met the criteria for pathological gaming when the study began, and 7.2 percent of them met the criteria two years later. As for causation? “Gaming seems to be comorbid, or to truly lead, some of those problems,” Gentile said. “Once you start gaming that way, your depression gets worse, or your anxiety gets worse.”

AS KNOWLEDGE OF compulsive gaming grows, so too does the mainstream’s embrace of video games. Smartphone proliferation means nearly every person has a gaming device, and games are used as tools in many industries. Bellevue’s DreamBox Learning designs educational games to help overburdened teachers. The U.S. military uses games to train soldiers before tours of duty and to help them with post-traumatic stress disorder when they return home. Companies are using game-design principles to motivate employees, and competitive video gaming, known as e-sports, is a nearly $200 million industry that is projected to grow to $465 million by 2017. This month, fans of Valve’s Dota 2 will fill Key Arena to watch the world’s top teams compete in The International tournament, which drew nearly 20 million online viewers last year.

Like all games, MMOs can function as stress relief, and players can create a virtual existence that balances offline life. Researcher Nick Yee surveyed 35,000 MMO players from 1999 to 2004, and wrote a book about the results called The Proteus Paradox: How Online Games and Virtual Worlds Change Us — And How They Don’t, which details how virtual life mimics real life despite the lack of constraints in MMOs.

“There is this assumption that virtual worlds are entirely detached from the real world … A lot of my research says exactly the opposite,” Yee said. “How people behave in games like World of Warcraft is a reflection of their personality. People don’t think of these worlds as being escapes, and they’re used to developing relationships in this world.” Indeed, half of gamers Yee surveyed play with offline friends.

Yee’s survey debunks other stereotypes of MMO gamers, too. The notion of an obese, energy drink-swilling introvert, which has been popularized by exaggerated renderings in media such as a 2006 episode of South Park, is far from the norm. Fifty percent of Yee’s respondents worked full-time. Thirty-six percent were married, and 22 percent had children. There was no correlation between age and play time.

But Yee’s findings were consistent with some views of compulsive gaming. Half of respondents considered themselves addicted to MMOs, and 60 percent had played for 10 hours consecutively at least once in the past month.

There are caveats to these claims. First, the people identifying themselves as addicts likely weren’t using criteria similar to Gentile’s or Petry’s for diagnosis, nor are average folks skilled at self-diagnosing psychiatric conditions. Furthermore, a 10-hour gaming stretch may sound shocking to some, but there’s an inherent value judgment there. A person who reads or watches TV for a 10-hour stretch likely wouldn’t be considered an addict, yet those activities aren’t as collaborative as MMO play.

At Colorado State University, anthropologist Jeffrey Snodgrass has conducted classes and studies in WoW and Guild Wars 2, which was developed by Bellevue-based ArenaNet (ArenaNet declined to speak on the record for this story). His work has detailed how the MMOs function as productive online cultures that are as much a part of daily life and interaction as their offline lives. To him, long periods of gaming aren’t necessarily compulsive behavior; they’re stress relief or social activities akin to any other hobby.

“Our interview (subjects) … use the terms like ‘real life’ and ‘life online,’ but when they talk about (the game), they say, ‘This is real life,’” Snodgrass said. “Gaming is the most important thing in their life. It’s the center of their life; they identify as gamers.”

Views regarding the ethics of MMOs and addictive gaming are dichotomous. On one end is the camp that says people like Callum Morrison are duped by game designers intent on engineering compulsive play. “I think if the American public ever saw what happened behind the scenes … at some of these game manufacturers, they might rightly be appalled,” Christakis, the UW pediatrician, said. “Can you imagine what it would feel like as a parent to know that there is someone there who is truly experimenting with ways to make their child addicted to their product?”

Game developers acknowledge that the best games can be addictive, but they don’t use the word in a clinical sense like Christakis. Developers who spoke for this story said addiction isn’t discussed much in gaming circles, and that’s because they feel they aren’t engineering the virtual equivalent of nicotine.

“If you make something fun, that means endorphins are going off in (the player’s) head. We’re in the business of fun. There are going to be people who are going to get addicted to that because of the way they work,” DigiPen’s Rowan said. “The nature of the product is to make it as entertaining as possible. Why wouldn’t you?”

Caught in the middle are families like the Morrisons, who experience addiction-like behavior that is sparsely understood and ubiquitously facilitated.

“The World of Warcraft game, I’d heard how addictive it was, and when I saw it on (Callum’s) screen, I just panicked,” Carla Morrison said. “I came down on it real hard. I said, ‘You are not allowed to do that; you are absolutely forbidden.’ But in this day and age, where all of kids’ assignments are given online and everything is turned in online, they can pull up a window and be playing and then (close) out of it when (parents) walk in the room.”

TODAY, CALLUM MORRISON lives in a Restart-leased Redmond apartment with two fellow clients. He’s in phase two of the program, the monthly cost of which starts at $7,500 and gradually drops to $2,500 over six months. (The Morrisons, as of press time, had paid Restart more than $58,000, a sum that does not include therapist fees or Morrison’s rent at the Redmond apartment.) He began working at a local hardware store and is exercising at 7:30 a.m. every weekday; since arriving in Washington in January, he has lost 34 pounds. Unshackled from video games, he is experiencing true autonomy in the offline world.

“It’s the little things — being able to say I’m going to get up early in the morning, and then actually do it, is so different,” Morrison said in May. “At the end of high school, when I was sleeping for three hours a night, it didn’t seem physically possible that I would ever listen to an alarm or ever get up. And now, every day that I can actually get up and actually be on time, it’s so cool.”

The end of Morrison’s onsite phase took place Feb. 19 in Restart’s Redmond office, a drab locale compared to the lush Fall City facility. Seventeen chairs surrounded Morrison in a conference room with stained gray carpet. The chairs were filled with casually dressed Restart staff, professionally suited parents and their significant others, and pajama-clad clients. Morrison, wearing black pajama bottoms, a plaid shirt, a fir-green vest, and the stoic expression seen 46 days prior during his intervention, shared his life-balance plan, the document Restart clients use to guide their recovery.

Callum told friends, family, and counselors that he would fill his days with work, basketball, and maybe a swing-dance class. When WoW came up in conversation, he would say he wasn’t in the loop and quickly divert the conversation. He would return to school and drink alcohol only in moderation.

Carla watched him with red, welling eyes. She continuously wrung her hands. His father, who wished Morrison had attended a more broad-based addiction clinic, looked on skeptically, smiling when his son mentioned athletics. After Morrison finished, his fellow clients critiqued his plan, saying college should wait — there are a lot of screens on campus, and pretty much every class has an online element — and alcohol could become a substitute addiction. They said he needed a plan for relapse, an event Restart treats as inevitable.

Morrison’s family was optimistic but skeptical; he stared blankly at his stepmother while she expressed shock over his unemotional presentation. The counselors debated the merits of his life-balance plan. They, too, said Morrison’s relapse plan was lacking — he needed an established network of people he could call. Their numbers needed to be on a sheet of paper in his wallet lest he forgets them or his cellphone dies.

As of press time, Morrison hadn’t relapsed. One of his main initiatives was returning to school, and in May, he was readmitted to SMU. Classes begin Aug. 24, and Morrison plans to be there, screens be damned.

Editor’s note: The price of a World of Warcraft subscription was corrected.