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Joining game in progress.

You materialize at a sprawling ranch near a snowcapped mountain covered with freshly powdered pines. Three horses graze nearby behind a purplish wooden fence.

To open the gate, click the lock.

A jet-black mare wearing a striped blanket approaches, its hooves sinking into the slush and white puffs blooming from her nostrils.

Click horse.

Name: Lucky
Age: 20 years
Likes: Carrots
Dislikes: Apples

Checking your inventory, you select a carrot. Lucky nibbles it from your hand, increasing her health. Congratulations! You have earned a Good Deed. As Lucky nuzzles your parka, you see two buildings.

Check overhead map.

The smaller building is marked Stable, the larger one Main Ranch House.

You follow deep sets of bootprints to a two-story log cabin. Several pairs of hiking shoes drip on the porch alongside two rocking chairs. A sign on the door says THE RANCH. You walk inside to find five other gamers. One is a slight, bearded figure in a dark blue hoodie, jeans, and white socks.

Click gamer.

Nickname: CTL
Age: 22
Favorite game: Pokémon Showdown
Quit games: Two weeks ago

You approach with a nod. As you shake his hand, it turns from pixels into flesh.

The game I’m describing isn’t real, but it’s an accurate depiction of things that are happening at a real place. The bearded figure you just met is named Brian, and he’s undergoing therapy at , the country’s first residential treatment center for video-game addicts. Along with several other young adult residents, he’s been progressing through three stages of treatment, which ReStart offers for a hefty fee: more than $50,000 total. There’s a waiting list for admission. There is also another branch that helps those addicted to a different kind of game – online casino games – which currently is rolling out in a pilot program in Italy with the help of . We hope that it will become more available to the general public as they work to accommodate the increase in demand.

Stage one has two parts. In the first, ReStart participants spend about a month detoxing (or “de-teching”) at Rise-Up Ranch, a five-acre working spread in the hills outside Carnation, Washington, about 25 miles east of Seattle. When they’re not doing talk sessions, they’re outdoors—hiking, gardening, and tending to the ranch’s animals.

During part two of the detox, patients move to Heaven’s Field, in Fall City, where they settle into what ReStart calls “an intensive life-sharing community” of recovering gamers. After that comes Open World, a halfway house located at a treatment center in Bellevue, a stone’s throw from Microsoft. At this stage, patients share an apartment and participate in group counseling sessions. They also mentally prepare to go back into the workplace, live independently, and begin a radical new chapter of their lives. Because for many, the goal of all this isn’t just to moderate their gaming. It’s complete abstinence.

As long as there have been video games, critics have bemoaned their social and psychological consequences. Over the years, researchers have churned out studies showing that violent games can lead younger players to be more hostile and less empathetic. Not everybody buys this, and there’s research that says there is no connection.

Inarguably, too much gaming can lead to health problems. Last March, the Endocrine Society—an international organization of endocrinologists—released a , involving a group of 33,900 teenagers, which found that heavy screen time and snacking could increase risk of heart disease and diabetes. In another , scientists from the New York Institute of Technology found that gamers who played between three and ten hours per day reported a range of ailments, including eye fatigue and neck, back, wrist, and hand pain—yet only 2 percent were getting medical attention. The researchers also found that 40 of the people studied “did not participate in any form of physical activity,” though presumably the gamers at least walked to the bathroom and the fridge.

The concept that seriously overdoing video games counts as addiction is new, and it comes at a big moment in the evolution of the industry. If you haven’t worked a joystick since the days of Ms. Pac-Man, entering a modern gaming environment would be about as shocking as getting an iPhone in the 1880s. Today’s games are cinematic artworks. They enable players from around the world to share digital adventures that are so immersive, so full of surprise and delight and realistic living things, that they can fulfill the core human need to explore. So-called open-world games, which encourage players to travel through unrestricted landscapes as they live out cinematic narratives, have been around in less robust form for decades. Now, thanks to faster internet speeds and extraordinary graphics, thriving online communities have transformed franchises such as Fortnite, Minecraft, and League of Legends into multibillion-dollar businesses and, more profoundly, an entire way of life.

Last October, , the Manhattan-based juggernaut behind the long-running Grand Theft Auto series, released its latest blockbuster for PlayStation and Xbox, Red Dead Redemption 2, a prequel to its 2010 action-adventure fantasy set in a fictionalized American West. The new game, which took more than seven years and hundreds of millions to produce, casts players as a gang of outlaws who ride and rob and shoot their way across the frontier. The lush landscapes of flowing rivers and snowy mountaintops, inspired by painters like Rembrandt and Bierstadt, cover many square miles of territory. This imaginary world teems with wildlife: bison roaming the plains, geese flying overhead, sockeye salmon jumping upstream. Completing the various missions that propel you through the story often feels secondary to simply exploring.

The scope of Red Dead Redemption 2 rivals the biggest Hollywood films: 300,000 animations, half a million lines of dialogue, 1,200 actors (700 with speaking parts), 2,200 days of motion-capture scene work, and a 2,000-page script. As Rockstar Games cofounder Dan Houser New York magazine last year, the result is an experience “in which the world unfolds around you, dependent on what you do.” Red Dead Redemption 2 was released on October 26, 2018, and brought in during its first weekend, beating the strongest film opening of 2018, Avengers: Infinity War, by almost $100 million. Seventeen million copies shipped in just two weeks.

For developers, the goal of this new generation of open-world games is stimulating a player’s sense of adventure in ways that emulate the real thing. Jean-Sebastien Decant, creative director for the latest Far Cry installment, New Dawn—which puts players in a carefully rendered postapocalyptic Montana—says, “The key is to provide as much agency and as many surprises as possible.” Worlds are designed to make players expect the unexpected—say, a hermit living in a wilderness cave—just as one might stumble upon a bear in Yellowstone. Maura Reagan, a former ReStart therapist, suggests that the simulations satisfy something primal in her clients, similar to what they might feel if they were climbing Mount Everest or descending the Amazon: a sense of purpose, accomplishment, and empowerment. “These guys are getting the hero’s journey,” she says, “but digitally.”

New science indicates that digital adventure may be just as thrilling as the real thing. An emerging body of research suggests that these virtual worlds can stimulate the same brain activity and physiological response as offline exploration. But taking epic journeys without leaving your basement can come at a price. In the most extreme cases—for people like Brian and the other patients at ReStart—the gaming world became so alluring that they left the real one behind.

“This is Microsoft country,” Cosette Rae, the cofounder of ReStart and also its CEO, tells me as we plod down a snowy path to a large gray-sided lodge with sweeping views of the Cascades. We’re visiting Serenity Mountain, a ReStart rehab facility, similar to the ranch, that’s devoted exclusively to teenagers. Serenity sits on 32 rolling acres of winding trails and towering trees. There’s an indoor pool, three koi ponds, and a barn that’s been converted into a gym and art room. A sign on the front door reads Live the Good Life; another says No Smoking or Vaping. A few scruffy gamers in puffy jackets and hoodies hurl snowballs with one of the psychologists, a middle-aged guy in worn boots and a plaid shirt.

The proximity to Bellevue—home to Microsoft, Nintendo, and other giants in technology and gaming—is intentional. “If you’re going to treat heroin addicts, you’re not going to find them in the workforce,” Rae tells me. “You’re going to find them out on the streets.” And if you’re going to treat people with “technology problems,” as she puts it, there’s no better place than here. “One of the things that we believe creates health and wholeness in people is a connection with the outdoors and nature,” Rae says.

Rae and cofounder Hilarie Cash got the inspiration for ReStart from watching tech-addiction struggles firsthand. After spending the nineties as a contract developer and IT worker for Seattle tech companies, Rae became a clinical social worker. One case involved a 15-year-old boy who was skipping school to play World of Warcraft, the hugely popular online role-playing game, 17 hours a day. Cash had seen people with similar problems, and she had a personal stake, too—a young son who was developing a taste for gaming. “I was looking at the future,” she says, “and I was thinking, I want to understand this so I can protect him, so he doesn’t become one of these clients.”

Video-game addiction is not yet listed as an official mental-health condition in the Diagnostic and Statistical Manual of Mental Disorders, the compendium of recognized forms of mental illness published by the American Psychiatric Association. That may eventually change—last June, the World Health Organization included “” in its International Classification of Diseases, a web-based diagnostic tool that helps doctors identify and treat afflictions. But there’s still plenty of resistance from health experts. In 2017, two dozen scholars around the world cowrote a for the Journal of Behavioral Addictions arguing against the use of the diagnosis, saying that there isn’t enough evidence to support it yet.

At ReStart, the issue seems settled: staff and clients talk about gaming like they would any other addiction. Rae tells me about a 13-year-old boy who was “using” World of Warcraft a dozen hours a day. Stories about game addicts run the gamut—lost jobs, dashed hopes, broken marriages. Rae mentions a man who fell asleep at the wheel and crashed his car after a gaming marathon at a convention. Another man developed deep vein thrombosis in part from sitting in his game chair too long. He eventually lost a leg to amputation.

In a small, quiet library at Serenity I meet Nate, an 18-year-old in a hoodie and jeans who’s been here several months. He spent his early years in Colorado, where he says he was “outside all the time,” roaming the woods with his buddies, looking for fun and adventure. Starting at age 13, Nate began filling the same exploratory need with World of Warcraft. Playing as a character named Bothar the Paladin, he fell in with a group of gamers who would venture together into the supernatural lands of Warcraft.

Before long, gaming had completely replaced the outdoors. Instead of goofing around in the woods, he searched for hidden jewels in Warcraft. “It’s similar in the sense that you don’t know what’s going to happen,” he explains, shifting in his chair. “I guess that’s like how, in the wilderness, you go and find something and you’re like, man, that’s just so beautiful.”

By Nate’s junior year in high school, he was skipping nutritious meals for junk food or eating nothing at all. His 3.5 GPA plummeted into the twos, and he finally stopped going to school.

All this came to a halt one night around 3 A.M. Nate was in his bedroom watching a Japanese anime series called My Hero Academia when he got “gooned”—slang for being bagged by handlers from a wilderness-therapy program. As his father explained to him that his problem with gaming had gone too far, Nate nervously eyed the three men who were there to escort him away.

“There’s no talking around it,” Nate recalls. “They were just like really big guys, very muscular, and there’s three of them.” After undergoing three months of treatment in a woodsy locale outside Bend, Oregon, he was taken to Serenity to start the rehab process.

There’s plenty of natural beauty to be had at Serenity. Cash takes me out for a hike on one of the trails nearby. It’s lovely and peaceful, the quiet stillness made more so by a thick blanket of snow. As we move through the trees, Cash talks about the psychological and physical benefits of being outdoors: lower stress, elevated mood, increased focus. When I ask her if she can imagine a day when virtual worlds become as compelling as this, she gasps and says, “The real world cannot be substituted by a virtual one.”

But, actually, it can.

While it seems strange to think that the virtual outdoors could substitute for the real thing, science is beginning to suggest that it often does. Recent have shown that the same parts of your brain that get stimulated during a hike can get fired up by screen time in a digital wilderness. Colin Ellard, a neuroscientist at the University of Waterloo in Ontario, has studied the phenomenon, and he says that “when we engage in game play, certainly with immersive virtual environments, we’re probably reproducing a lot of the same patterns of activity in the brain that are produced by real environments.”

To understand this, consider the science on why being outside is good for your brain in the first place. Using fMRI scans, studies have shown that when we’re outside taking in a majestic view, we stimulate the parahippocampal gyrus, a region of the brain that’s a central component of the limbic system. The euphoric feeling you get in the outdoors likely comes from opiate receptors inside the parahippocampal gyrus that flood you with physiological goodness that’s similar to what you get from a slice of pizza or a romantic relationship.

There’s an evolutionary reason for this: the more stimulated we are by our environment, the more inclined we are to explore it. In a 2006 for American Scientist, neuroscientists Irving Biederman and Edward A. Vessel wrote that the brain has “information-acquisition mechanisms that reward us for learning about the environment” and that “such mechanisms would have an evolutionary advantage.”

Ellard and his colleagues wondered whether a simulated outdoor environment might also elicit rewards. To test this, they put participants through a stressful ten-minute simulation, asking them to write about a recent challenging experience while the sounds of jackhammers and honking cars played in their headphones. They then donned virtual-reality headsets and explored a photorealistic forest, with shrubs, trees, flowers, and streams. For added immersion, the scientists misted the testing area with Forest Breeze air freshener. (Nothing like the whiff of chemical pine to get you feeling outdoorsy.) They found that the stress reduction delivered by the virtual outdoors was similar to being outside. Though there’s debate about whether this response happens mainly because of the novelty of being in virtual reality, Ellard thinks the effects are real.

To get a taste of what VR feels like, I strap on an Oculus headset to play a rock-climbing called The Climb, which can make you feel weak in the knees. I’m looking out on a sun-dappled rock wall overlooking a vast and gorgeous simulation inspired by Halong Bay in Vietnam. I gaze at distant gray limestone pillars jutting up from turquoise blue waters. Wispy white clouds drift overhead; waves lap sandy beaches. Using touch controllers, I move my hands along the rock wall, squeezing the trigger to grip and release.

When I make the mistake of looking down at hundreds of feet of air below me, my brain tells my body to freak out, and it responds accordingly—sweat flows from my palms, my stomach flops.

Earlier this year, neurobiologists at the University of California at Irvine a group of gamers who played Minecraft, the popular open-world multiplayer title. Though the game isn’t photorealistic, it’s immersive and compelling, and it allows players to explore and build their own domains—jungles, deserts, forests, and so on—using Lego-like blocks. The participants in the study played approximately 45 minutes a day for two weeks. The researchers concluded that the game improved their hippocampal functions, specifically memory performance. “Video games can act as a form of environmental enrichment in humans,” they said in a paper that appeared in Frontiers in Behavioral Neuroscience.

Gregory D. Clemenson, one of the authors, cautions that this does not mean video games are as nourishing to the mind as a walk in the park, but they may do more good than people think. “There’s evidence that when we explore virtual worlds, we are using the same processes as when we explore a real one,” he says.

At the Ranch, gamers care for three goats—Tatiana, Rose, and Dammit the Fainting Goat—among other animals. Tending to critters is one method for helping them reengage with the world. In case the gamers need how-to advice, animal-care binders line the shelves inside the main building.

Brian, the 22-year-old who used to go by the handle CTL, sits cross-legged in a cushy reclining chair, relaxing after a daily group session. Like most people here, he’s wearing a hoodie that hides his face inside a soft, shadowy cave. He was addicted to the fighting games Pokémon Showdown and Super Smash Bros., which he played so much that he dropped out of school. He’s been here only two weeks, and he’s still adjusting.

“I’d be flat-out lying if I said I didn’t miss gaming,” he tells me, staring into space. “I think almost everyone here would be.”

At ReStart, one goal is to get people moving. The rehab begins with about a month of de-teching. This means, among other things, abstaining from screens for the sake of getting back in touch with themselves and the environment. “We’re focused very much on their health,” Cash says. “Eating well, exercising, and catching up on sleep. Because they’re all sleep-deprived.”

De-teching doesn’t cause the same symptoms of withdrawal suffered by alcoholics and drug addicts, but there are distinct challenges. Rae says that when clients detach from their dependence on reward cycles, their bodies go into some kind of crisis. Newcomers at ReStart can find themselves fighting depression, anxiety, and stress. Brian says that after years of barely eating and sleeping, just being back on a schedule has been mind-altering. “You have to get used to going to bed at the same time and waking up at the same time,” he says. Nate describes a kind of lucid dreaming he’s experienced during his de-teching, in which he’s able to visualize himself in the game world, despite the fact that he’s in a bunk bed deep in the woods.

After the initial phase, patients settle into a regular regimen of chores, counseling, and physical fitness. Residents tend to tomatoes, kale, and other vegetables in a greenhouse. One of the therapists is a wilderness first responder who takes the patients out on trails where they can learn about wildlife and ecology.

Maura Reagan used to run weekly movement-therapy classes at ReStart, focusing on rebuilding residents’ mind-body connection and facilitating the flow between their inner and outer worlds.

“Being able to show that their physical growth is parallel to their emotional growth really comes to life tangibly when we take them into the mountains,” she says. “They can actually see that they’re engaging in their bodies again.”

While some gamers are required to put down their controllers to get back outside, there’s a flip side to all this: augmented-reality games, in which a new generation of smartphone gamers are treating the real world like a playground. Players use their camera as a viewfinder, and it overlays computer graphics and information on the settings around you.

The first AR blockbuster arrived in 2016 in the form of Pokémon Go, which places tiny animated creatures into natural settings that players explore in a sort of scavenger hunt. The novelty of seeing a red-horned, flame-tailed Charmeleon scurry across your backyard spawned a global phenomenon, as phone-wielding humans with outstretched arms chased imaginary Pokémon into trees, oceans, and oncoming traffic. The game, owned by a San Francisco company called , cracked the top five in app-store revenue in 46 countries, bringing in more than $2 billion since its release.

Such experiences are all part of the plan for John Hanke, 52, Niantic’s game-­developing founder. An earlier company he owned, Keyhole, was devoted to scanning the globe; he sold it to Google as the basis for Google Earth. With Niantic, the goal was more personal: he wanted to get his kids outside. “I like to wander around to weird and interesting places,” he says. “With young kids, I’m dragging my family along. The agenda was to make it more fun and more likely that I could get my kids to agree.”

With his other popular title, Ingress, the idea is to appeal to older gamers, getting them to lean more heavily into the exploratory nature of the experience.

On a crisp Sunday afternoon in March, I head to Valley Forge National Historical Park in King of Prussia, Pennsylvania, to meet with a dozen avid Ingress players. As with Pokémon Go, you play it on your phone.

The conceit is the usual sci-fi fare: two factions—the alien-friendly Enlightened and the humans fighting against them, called the Resistance—are vying for control of landmarks around the world. To play, you have to visit the designated points of interest—say, the Temple of the Emerald Buddha in Bangkok, or a snowshoe trail in Fairbanks, Alaska. Once there, you “capture” a portal for your faction by triangulating it with the help of other phone-wielding teammates.

For avid players, Ingress is the best of both worlds, virtual and real. Michael “Qwerkus” Gerchufsky, a 50-year-old medical editor from Phoenixville, Pennsylvania, describes the appeal as we hike around the towering National Memorial Arch: “I was like, wait, there’s a video game that gets me outdoors?”

For nonplayers, the game can seem pretty geeky—a bunch of adults running around old cabins and forts, clicking their phones and yelping about the portals they successfully wrangle for their teams. But hey, a bunch of adults whacking little balls with wooden sticks probably looked pretty odd when golf first came around.

Ingress players stress both the sociability and active lifestyle of the game. Elizabeth Brunt, a software engineer, tells me how she broke her ankle in a fall and had to do rehab. “I needed to get out of the house,” she says. “With this I could play a video game but also get outside. It’s a good reason to keep moving.” Mike “Baron” Eisenstein, a science writer, says he regularly plays when he travels—for fun and as a way of meeting people. “I tried to play on Kilimanjaro,” he says, “but I had crappy cell service.”

Mary “MysticalGnu” O’Rourke, a manager for Choice Entertainment Technologies in Boulder, Colorado, is also obsessed. “It ­really appeals to people who are adventurous,” she says. “It’s like the old days of glory, gold, God. You have to establish new territories. This is taking that aspect and encouraging people to reexplore the world in the context of a game.” She devotes much of her spare time to exploring the country through Ingress. Connecticut, Florida, New Mexico, Nevada, mountains, parks, beaches, hiking, flying, driving. To access more remote areas in Colorado, she bought an ATV and a satellite phone. She recently took a jeep up Horseshoe Mountain to lay claim to a portal, continuing on foot when the trail narrowed too much for her vehicle.

Niantic’s AR world expanded this year with a Harry Potter game. One of Hanke’s design imperatives is to use more audio, so that players can gather clues and communicate as much as possible without having to stare at a screen. They also work hard to pace the game for daily life, designing microadventures that can be completed in five to ten minutes. Hanke sees more nongaming manifestations in the future, too. “Augmented reality is bleeding out from games into physical fitness,” he says.

In other words, AR points to a future in which we can have the best of both worlds. We can experience the outdoors in a new way, with a new lens, exploring places with people who might not be inclined to go outside and meeting new friends along the way. As the technology becomes more seamless, it will fade, like everything else, into the background of our lives. The true sign of this integration will be when we stop talking about this stuff at all. It’ll just be a part of the experience, another tool for the road, like a compass.

It’s midafternoon at the Bellevue Technology Center, a collection of bland office buildings in the heart of Microsoft country. This is the kind of place where ­coders and designers are creating the next great software and hardware that will capture our eyeballs.

One suite of offices here is the unlikely home to an outpatient service for people in one of the final phases of ReStart. Opened at this locale in October 2018, this is Open World, named for the genre of exploratory games that bedazzled so many patients in the first place. The participants have completed eight to twelve weeks of therapy in the mountain retreats of Washington and are in the home stretch of recovery. They share an apartment nearby while attending frequent counseling sessions focused on how they’ll balance their lives, including their technology use, in the years to come.

“To be ready for the transition program,” Cash tells me, “they really have to have a good life-balance plan and be in a recovery mindset.”

Near the kitchen, I meet a 21-year-old named Chris. As he sits on a stool picking at the last of a sandwich, he tells me about the vicious circle he experienced as a kid growing up in Texas.

“My dad was very neglectful. He didn’t spend much time with me,” he says. “But the time that we did spend together was playing video games. So that kind of increased my desire to play, especially when trying to escape anything I didn’t want to deal with.”

After several months in ReStart, Chris says he’s finding his way in the world again, and he’s taken up disc golf and nature walks. “I love spending time in nature,” he says. “It’s one of my favorite things to do these days.”There’s a tendency to think that being outdoors is inherently better than time spent in a virtual space. The truth, however, is increasingly complex. We have become cyborgs, toggling between the world around us and the world on our screens. With new technologies like AR, those worlds will continue to blur until, at some point, they overlap. It won’t be so easy to differentiate, as we do now, lamenting that we’re spending too much time staring at our phones when we should be staring at the sky. And it will be our increased immersion in virtual worlds that may heighten something more crucial: our need for the outdoors. In this sense, the gamers in ReStart are like visitors from the future, people who have returned from the other side of the pixelated glass, blinking back from their reverie to soak in the life around them.