(CNN) -- Think of online video game addiction and what probably comes to mind is a socially awkward adolescent. But teens are not the only ones who get addicted.
A young man is treated for Internet addiction in Beijing, at China's first government-approved Web addiction facility.
Consider Zach Elliott, who lives in the U.S. state of Wisconsin, is in his mid-40s, and plays Final Fantasy XI, an online role-playing game. About three years ago, he says, "there were people in my real life that sort of vanished into this game, and I followed them into it."
Now he spends three hours a day playing the game on a computer in his basement. "I could have never anticipated the sort of draw the game has had for me, and how involved I would get," he says. "It still surprises me."
Relationships formed within the game are a key part of that draw. While parts of the game require intense focus, less hectic periods allow him to text-chat with other players from around the world about politics, religion and other topics. Some friendships form, as do some animosities.
He uses a blacklist feature to block out anyone who gets on his nerves too much. "It's something I wish I had in real life," he says. "There are people in this game who irritate me unbelievably."
On the other hand, some of the better relationships have crossed over into real life, or "RL." Chief among them is a couple in Canada with whom he exchanges Christmas presents, though he's never met them face to face.
But what about the other relationships in his life? It's a question increasingly being addressed by therapists who focus on online gaming addiction.
"We are seeing more and more adults and adolescents struggling with real world relationships because of virtual world relationships they have created," says Eric Zehr, vice president of addiction and behavioral services at the Illinois Institute for Addiction Recovery at Proctor Hospital. Members of his team have consulted therapists in South Korea, where "boot camps" have been set up to break online gaming addictions.
Elliott is a stay-at-home father with kids in school and a successful spouse generating income. That leaves him with enough spare time for not only Final Fantasy, but other activities as well, like participating in a local writing club that meets regularly at a café.
Other gamers live more precariously. Libby Smith, a trainer at the institute, is helping a World of Warcraft addict in his mid-20s who's dropped out of college, lost numerous jobs, lost his girlfriend, and is on the verge of homelessness. "He maintains he has no problem," says Smith. His family finally intervened and brought him to the institute.
According to Smith, compulsive gaming may be masking other underlying problems such as anxiety, depression or low self-esteem.
One of the symptoms of pathological gaming, says Smith, is an inability or unwillingness to examine one's behavior openly and honestly.
"It is important to remember this addiction is real, and as such, it has become the single most important relationship -- bar none -- in this person's life. As such, the addiction will resist any attempts to control it."
She suggests family or friends communicate their concerns with specific examples, rather than say things like "You spend all your time on the computer," which is likely to increase defensiveness. Words like "always" and "never" should be avoided.
Assuming the gamer doesn't live alone, she also suggests that the computer be placed in a centralized location within the home. That way it's harder to stay isolated, play the game in secret or hide their ongoing struggle.
"Regaining control over one's life means learning new skills and a new way of existing in this technologically based society," Smith says. "It is not easy, it is not quick, but it is possible."
For Elliott, an occasional reminder of how absorbed he is in the game comes when his Internet service is disrupted. "I get pretty upset," he says. Were he to be permanently cut off from the game, "I think I would feel that very acutely."
At the same time, though, he knows that the game has to end eventually.
"It's funny because when I think of not playing anymore ... I think about it as almost kind of a death," he says. "I know that sounds very dramatic, but I mean it is a sort of a life, and so it is a sort of a death to have it end." E-mail to a friend