01/09/2015 12:47 BST | Updated 02/09/2015 06:59 BST

Inside Britain's First Technology Addiction Clinic: When Playing Candy Crush Is No Longer A Game

[Picture: ADAM HESTER VIA GETTY IMAGES]

Standing in the reception of Nightingale Hospital, there is one thing that sets it apart from any NHS waiting room I have ever been in: the sense of stillness.

There are no screens buzzing to tell patients when it’s time for their appointment and there is no one tapping away on their phone while they wait to be seen by a doctor.

Nightingale exudes a feeling of calm, which I suppose shouldn’t be all that surprising, considering the fact that it hosts the UK’s first technology addiction clinic.

Dr Richard Graham approached Nightingale's director Martin Thomas about setting up the clinic in 2009. At the time, Dr Graham was working at an NHS practice and had identified technology addiction as a growing problem.

“Particularly with young men I was seeing for depression, I started to see that their use of video games such as World of Warcraft was a very prominent part of what was concerning parents, friends and teachers,” he tells me, as we sit in one of hospital’s vast conference rooms.

“When anyone tried to stop these young men from playing on such games, their reactions would range from intense distress where they would often threaten self-harm, or aggression. These certainly seemed like signs of addiction to me.”

The designated technology addiction service became available at Nightingale a year later in 2010. Within nine months of the clinic opening, Dr Graham - who up to that point had focussed on treating gamers - received a request from an all girls school where the pupils wanted help managing their usage of Facebook.

Today, anyone can seek help at the clinic, although many of Nightingale's tech addiction patients are teenagers whose insecurities during adolescence have led them to seek solace in the virtual world, or young professionals struggling to switch off after a pressured day working in the City.

A typical Nightingale patient may be addicted to gaming, using certain apps or visiting specific websites.

Their technology addiction may sometimes focus on the device itself.

“Have you seen the people queuing in Regents Street or Covent Garden for the latest iPhone or tablet, or flying to the US to get the latest iPad?” Dr Graham asks.

dr graham

Dr Richard Graham in one of Nightingale's therapy rooms

There is no set method of treatment at Nightingale, as doctors tailor addiction recovery plans to the individual.

However, all patients will have an initial consultation where they talk to a doctor - and at £350 for the 1.5 hour assessment, the service certainly doesn’t come cheap. Most patients will then have a series of therapy sessions, but some will require hospitalisation.

“On the whole, it’s about preparing the patient and their family for when they can’t access their device or game and establishing where that’s going to be kept - it may be that the device needs to be locked away. Then we figure out what they are going to do with their time instead,” Dr Graham says.

“Hospital is one extreme, but for some, it may be planning holidays on the weekends, seeing relatives or going somewhere where there is no signal.”

In today’s world where technology is part of almost every day life - we use Tinder to find a date, ASOS to buy clothes and Uber to book a taxi - I wonder how on earth you decide that a person is addicted to technology.

I can easily lose half an hour scrolling through Instagram and I’m not the only one who finds it difficult to switch off - the average Brit checks their phone every six and a half minutes.

So what's the deciding factor between an addict and an average urbanite?

According to Dr Graham, there is a difference between using technology a lot and being dependent on it, although this difference isn’t always easy to see.

“If you’re thinking about an app or game a lot and craving it, then that could be a sign that you have a problem,” he says.

“I encourage individuals to think about how they feel when they use technology and why they are using it.

“Does using the device give them a buzz? Perhaps it makes them feel relaxed? If they don’t use the device, what effect does that have on their behaviour?”

Withdrawal responses can be a key indicator when diagnosing technology addiction, he adds.

Conflicts with family and becoming less open about use are both symptoms we associate with alcohol or drug addiction, but they are also major warning signs for tech addiction.

Missing out on things in the real world, because you are so absorbed in the virtual world, should also raise a red flag.

If you have been late for work on multiple occasions because you were distracted by Twitter, or you’ve turned down an opportunity - be that a night out with friends or a job interview - because the latest game was coming out that day, you may be addicted.

nightingale communal room

A community area in Nightingale Hospital

Dr Graham tells me of a 17-year-old young man he recently treated who would spend time on Reddit, instant message game friends through Skype on his mobile, watch e-Sports on Twitch and also spend 6-8 hours gaming most days.

“Entering the sixth form, his time in school dwindled over the autumn term, finally to nothing by the end of the spring term. He didn’t seem to mind initially that his increasingly inverted day, filled with online activities, was blocking offline developments.

“When friends from his previous school sat their AS exams, he started to think the anxieties of his parents were worth listening to and agreed to an assessment.”

Dr Graham was able to trace the boy’s increasing use of technology back to when his parents separated in his mid-teens, which meant moving home and going to a new school, leaving behind a small group of good friends. He began to use community games such as ‘League of Legends’ and ‘Counter-Strike’ to forge new relationships, but his use soon escalated.

Luckily the young man hadn’t fallen too far behind with his school work when he first visited Nightingale and was able to get back on track.

The 17-year-old’s case isn’t all that unusual - another of Dr Graham’s young patients became addicted to gaming when he broke his leg one summer and wasn’t able to play football with his friends.

It might sound like a perfectly harmless scenario but Dr Graham believes that FOMO - the fear of missing out - is at the root of tech addiction for many young people.

“A lot of social media is about being liked, so having a strong desire to get retweets, likes and blog views can be a sign of anxiety,” he says.

“When I ask young people ‘why are you playing Fifa?’, they might say something like ‘because all my friends are’.

“Feeling a need to be part of a conversation that’s happening on Whatsapp or a need to have seen the latest viral video on Facebook is a big driver for a lot of people.”

For others, reliance on tech can develop as a symptom of a more complex mental illness or addiction.

For example, a person with an eating disorder may access pro-ana (pro-anorexia) sites online, or develop an addiction to looking at pictures of other people’s bodies on Instagram. A person inclined to gamble may find themselves shifting from recreational gambling, to addiction, due to the lure of gambling websites.

The multitude of games, apps and sites available in 2015 and the ever-growing crossover between tech and our day-to-day lives is making addiction increasingly difficult for specialists like Dr Graham to diagnose and treat.

“In 2010 when we started the clinic, Twitter was around but it was still developing,” he says. “You tended to have people on one site - Myspace or Beebo etc - and it was much easier then to think about that interface and what the person was using it for.

“But now people are using multiple apps and games, perhaps even playing two games simultaneously, and discovering the source of their usage is far more complex.”

Despite these challenges, Dr Graham is determined to find a way to help those with tech addiction as he knows all too well that leaving the condition untreated can have a negative long-term impact on health.

“If you’ve got desktop activities that are becoming abusive, then there are health implications related to being stationary for long periods of time,” he says.

“You’re probably not eating or drinking enough, or consuming the right things that take time to prepare. Sometimes, it’s quite remarkable the impact it can have telling someone in ‘the pattern’ that they should be drinking two litres of water per day and three meals,” he says.

Sleep deficit from hours of gaming can also be a serious health problem. Some gamers appear to others to be depressed, but it might actually be closer to having physical exhaustion.”

At the most extreme level, addiction in the form of SMS abuse may lead to death. Texting while driving has now overtaken drink-driving as a cause of teenage death in the US.

Considering the ever-growing issues when it comes to successfully treating technology addiction, isn’t the most obvious solution is to educate the population so that they do not develop such harmful behaviors in the first place?

Or better yet, why don’t we ban teenagers from using smartphones until they have the emotional maturity to handle them?

Dr Graham agrees that education is key, but convinces me that withholding technology from Generation Instagram is not the answer.

Instead, he recommends introducing technology as early as possible in the home, but managing it properly.

“Giving a baby of less than one year a special chair with an iPad stand built into it and leaving them alone is not going to be good for their development. But designating time, maybe five or 10 minutes, where using the iPad is a pleasurable or rewarding experience where they can learn, have a nice time and play with you is better than waiting till later down the line,” he says.

“It’s such a problem that the child who goes to secondary school will often suddenly be given a smartphone, at a time when they're already facing enormous anxiety as they take a step on the road to independence.

“They’re likely to become more impulsive at this time because of the brain changes that occur during puberty anyway, then we give them sophisticated smartphones with all sorts of connectivity, but we’re not teaching them how to manage this transition.”

Dr Graham even wants antenatal classes to include discussion on how to best use technology in the home, because “the baby will see you on your phone way before they have access to one”.

nightingale bedroom

A bedroom for patients at Nightingale

For parents who already have older children, he has a few ideas for how you can ensure your child has a healthy relationship with technology.

“Have what I call ‘clean’ times and zones for the whole family, where it is expected that all members - including parents - will not use their devices and do something together,” he says.

This group approach can be particularly useful when one child is perhaps more inclined to abuse technology than his or her siblings - they aren’t made to feel singled out.

“Mealtimes are often a good moment to ban technology and I would recommend also setting a curfew for devices, often an hour before bedtime is a good tactic,” he adds.

One simple but effective tactic Dr Graham learned from a parent, was that putting all phones in a shoebox at the bottom of the stairs at bedtime can help children who are struggling.

I ask whether this idea may also help adults. After all, Arianna Huffington, founder of The Huffington Post, also recommends banning technology from the bedroom and using a good, old fashioned alarm clock to get you up in the morning.

“Yes, my recommendations for adults and children are fairly similar - it’s all about setting yourself some goals around times when you’re not going to be on your device - and really trying to stick to them,” he says.

One thing Dr Graham is passionate about it that a digital detox for adults does not necessarily mean going cold turkey.

He suggests that as a journalist, it wouldn’t be advisable for me to stop using the internet altogether, as I need to access news sites in order to do my job. But what might be more helpful, is writing a list of the sites that I need to use, and a list of the sites I use for recreation, then cutting down time on those that aren’t essential.

This slimlining process is what helps many of Nightingale’s patients manage their addiction in a time when technology is unavoidable.

Towards the end of my Nightingale visit, we take a walk around the rest of the hospital to look at the facilities available.

The pristine corridor leads to bedrooms for patients staying overnight that look more like hotel rooms than any hospital cubicles I’ve ever seen. While Dr Graham’s passion for helping those in need seems genuine, I'm reminded again that Nightingale is a private service aiming to make a profit.

The hospital currently sees around 50 patients for tech addiction per year, but Dr Graham admits that this relatively low number is perhaps more likely down to the accessibility of the service, rather than there being a lack of people suffering from tech addiction.

“When I set up the clinic, I was aware that some NHS addiction services had just about started to take gamers into their programmes, but it was mainly alcohol treatment programmes and drug treatment programmes that were available,” he says.

“For the young men I was seeing at the time, the thought of them receiving treatment alongside crack cocaine addicts was a very worrying prospect for them.”

Dr Graham tells me that not much has changed since 2010 in terms of the way the NHS treats technology addiction, and after my visit to Nightingale, I decide to find out if this is true.

The NHS website’s page on addiction includes just a short paragraph about internet addiction. Although people can speak to their GP if they are concerned about their use of the internet or their devices, there are a lack of specialist services available free of charge.

The Central and North West London Foundation Trust does run a clinic for tech addiction - the Centre for Compulsive and Addictive Behaviours (CCAB) - but it is only a pilot service.

“The CCAB has been running since 2012 and has received around 100 referrals for a variety of difficulties including compulsive gaming, internet addiction and compulsive pornography use,” consultant clinical psychologist Dr Neil Smith from CCAB tells me via email.

“The numbers are small as we have not advertised our presence due to this being a small pilot with no funding - referrals have largely come through word of mouth or internet searches.

"There are no immediate plans to expand this service within the NHS, due to a lack of obvious funding sources, and to our knowledge there are no other such dedicated services in the UK.”

But I wonder why this is the case.

Technology addiction is far more serious than reaching for your phone to play Candy Crush every time you get on the tube. It has the potential to ruin, and even cost sufferers their lives.

With the rise of wearables and the constant introduction of new apps, games and devices, the buzz around technology doesn’t look set to die down anytime soon. Unfortunately, that also probably means technology addiction is here to stay and it seems like those who are in socially challenging situations are the most susceptible.

The work of doctors at Nightingale Hospital is clearly helping some people to manage their relationship with technology. But is a private service in an affluent area of London really the best way to help those who are most vulnerable?

I’m not convinced.

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