When their parents drive them up to Paradigm Malibu’s bougainvillea-festooned treatment facility on Via Escondido Drive on the Pacific Coast, the kids sometimes refuse to get out of the car.

Nearly all of them become anxious and upset when they’re asked to surrender the thing that led them there: their smartphones. A few have even threatened to kill themselves at the prospect of having their internet cut off.

Paradigm Malibu, established in 2012, started out catering to clientele with classic drug and alcohol addictions. Now it has developed a program specifically for adolescents with device-use disorders. It’s not alone: Several rehabs have sprouted up across the U.S. to treat those whose lives have become unmanageable because of technology.

“Smartphone addiction” may seem like a cliché — an eye-roll-inducing first-world problem — but it can have devastating effects. Extreme use of digital devices and the internet can lead to behavioral disorders that are as debilitating or life-threatening as alcohol or drug abuse. And aside from those most severe cases, addictive technologies may be breeding an entire generation prone to depression and loneliness.

Recent studies indicate problematic internet and device use affects roughly 5%-8% of U.S. teenagers, according to Dr. David Hill, who chairs the American Academy of Pediatrics’ Council on Communications and Media. “If you look at the role that screen media is playing in our society — contributing perhaps to fearfulness and isolation — there are ways to say perhaps it’s a bigger crisis than opioids,” he says.

Now the problem has come to the boardrooms of technology giants. And it could alter the way companies like Apple, Facebook and Google design smartphones, apps and media, with some critics raising the specter of government regulation if the industry doesn’t get its house in order.

In January two large Apple shareholders, Jana Partners and the California State Teachers’ Retirement System, sent a letter to the company’s board urging Apple to develop solutions for the “unintentional negative consequences” of iPhone usage among kids. Meanwhile, one of Facebook’s investors has pressed it to create a committee to study the potential financial exposure to the social giant for the platform’s mental health consequences.

Apple CEO Tim Cook has acknowledged that he’s personally concerned about the dangers of overusing technology. “I don’t have a kid, but I have a nephew that I put some boundaries on,” he told a group of college students in the U.K. at an Apple coding event in January, per a Guardian report. “There are some things that I won’t allow. I don’t want them on a social network.”

Concerns over tech addiction have spawned a movement among people who used to work in Silicon Valley to advocate for their former employers to change their ways. (A recent Wired article labeled the employees “turncoats.”) The most prominent of these activists is Tristan Harris, a former design ethicist at Google. He’s now the executive director of the Center for Humane Technology, which he co-founded with venture-capital investor Roger McNamee, an early Facebook backer. Their aim is to push the industry toward “technology that protects our minds and replenishes society.”

From Harris’ standpoint, a profit-motivated corporation sees addicts hooked on its products or services as a boon to its bottom line. Technology companies whose business models hinge on maximizing attention “are not aligned with human well-being,” he says. “It’s not because they’re evil but because that’s their model. The key thing is, the addiction [to technology] is not happening by accident — it’s happening by design.” Harris believes the industry will respond to public pressure to create more ethical, less harmful products.

But the tech reformers aren’t just about picking fights. The investors who called on Apple to examine the issues related to phone usage by kids say they want to work with the company to use scientific research to create safeguards, according to Dr. Michael Rich, director of Harvard University’s Center on Media and Child Health in Boston, who helped draft the letter. That could include more fine-grained controls to time-limit device and app usage. Rich compares his ideas to the advocacy that resulted in the auto industry equipping its vehicles with seat belts and airbags.

Companies sometimes say they’re doing everything they can in order to shield themselves from liability, notes Rich. “What we’re hoping to do,” he says, “is bring key stakeholders and thought leaders to the table as equals and fix this as best we can.”

Tech giants have taken steps to respond, although critics say they’re not moving fast enough.

Apple, commenting on the investors’ letter, has said: “We think deeply about how our products are used and the impact they have on users and the people around them. We take this responsibility very seriously and we are committed to meeting and exceeding our customers’ expectations, especially when it comes to protecting kids.”

Apple notes that it offers an array of controls to restrict apps and features, in-app purchases, and types of content. With iOS 11, released in autumn, the company added a Do Not Disturb While Driving feature that turns off notifications if the device senses the user is in a car. That only came, however, years after research demonstrated that distracted driving was a significant contributor to accidents.

Samsung, another large smartphone maker, in January announced a partnership with Arianna Huffington’s Thrive Global wellness start-up to launch a kind of “Do not disturb” app for Galaxy Note devices that automatically replies to incoming messages for a set period to let senders know their owners are out of pocket.

Facebook, for its part, has acknowledged research on the ill effects of social media and says it’s trying to do better. The company is changing algorithms to improve the quality — over quantity — of the time its 1.4 billion users spend on the service. That includes showing fewer viral videos on Facebook starting in the fourth quarter. Company CEO Mark Zuckerberg wrote in a Jan. 31 post: “By focusing on meaningful connections, our community and business will be stronger over the long term.”

The medical world is still trying to get a handle on the long-range impact of smartphones and social media on childhood development and adult mental health. Studies have linked excessive tech usage to depression and anxiety. To be sure, it’s a stretch to call internet devices, say, the “new heroin.” Unlike addictive substances, there’s no chance of physical dependency.

But many smartphone apps, especially those that are ad-supported, are engineered to hit the same pleasure centers of the brain that alcohol and opiates do. What some in the field refer to as “problematic internet use” can have real consequences. Broadly speaking, it can make an individual’s day-to-day life unmanageable, with symptoms that also include severe insomnia, impulsivity and worse.

Technology addiction is “a progressive disease that could potentially lead to death. That’s the reality of it,” says Dr. Hilarie Cash, chief clinical officer of reStart, a Seattle-area rehabilitation center that specializes in such disorders. “Most of us don’t get that far. But most people don’t die of alcohol poisoning, either.”

What sets off alarm bells for healthcare professionals is the nearly ubiquitous reach of smartphones. About 95% of U.S. adults now own a mobile phone of some kind, and effectively 100% of Americans ages 18-29 do, according to the latest data from Pew Research Center.

Marc Benioff, CEO of Salesforce.com, is distrustful of both device makers and social media. “I think that for sure, technology has addictive qualities that we have to address, and that product designers are working to make those products more addictive, and we need to rein that back,” Benioff said in a recent CNBC interview in which he opined that governments should regulate social media like tobacco companies or junk-food producers.

Even binge-watching has come under fire for its potential health risks. Last year, the American Academy of Sleep Medicine issued a warning about the need for adequate shut-eye — after Netflix CEO Reed Hastings told analysts the company’s No. 1 competitor was sleep. “When you watch a show from Netflix and you get addicted to it, you stay up late at night,” Hastings had said on an earnings call.

The threat of legislation alone could jolt tech firms into action. “Companies are not going to self-regulate, and most people don’t recognize that it’s potentially a serious problem,” says mobile-industry analyst Jeff Kagan. “The question is whether the industry will come up with a solution.”

Of course, new media and technologies frequently blossom amid fears that they’ll corrupt people’s minds. Edward R. Murrow, in a 1957 interview, warned that television entertainment was fast becoming “the real opiate of the people.”

Some believe the hand-wringing over device addiction is just so much hysteria. “We’re not injecting Instagram or freebasing Facebook,” says Nir Eyal, author of “Hooked: How to Build Habit-Forming Products.” “This is on a different scale from heroin or cigarettes. There’s nothing hacking through the brain barrier. It’s kind of loony what’s going on right now.”

Eyal is the organizer of the Habit Summit conference in San Francisco, now in its fifth year. Among other things, attendees to the event (tickets start at $900) are promised tips on “the stages of habit formation and how to optimize for user retention.” The former software engineer — who insists he’s not an apologist for the industry — argues that the human-psychology techniques that Facebook and others use to make their products habit-forming can be employed in apps that are healthy and productive, like learning a new language or exercising.

In a separate category, Eyal says, are predatory gambling and gaming apps, which he agrees should be curbed. He also thinks parents should be able to have more tools to monitor or restrict their kids’ smartphone usage. But in general, he says, device-usage problems are akin to binge-eating, not popping painkillers. “If you are a food addict, you need help. But it’s not about the food,” he says. “There’s something else that’s going on.”

The problem, though, really can result in life-or-death situations. One teen patient treated by Harvard’s Rich was so severely addicted to social media and online gaming that he began skipping school and holing up in his bedroom, awake all night. When the boy’s parents, frantically looking for a solution, removed the family’s internet router, he grew despondent and tried to kill himself.

“His virtual world became more real than the real world,” Rich says.

Such cases are rare. But Rich is concerned that the pervasiveness of personal technology is breeding a range of behavioral problems, particularly in children. “You go by any playground at recess, and the kids are all staring at their smartphones,” he says. “Is that pathology or is it just the way the world is evolving?”

To Dr. Jean Twenge, a professor of psychology at San Diego State University, it’s very clear that overuse of digital media is linked to mental health issues and unhappiness. Her research has found that U.S. teenagers who spend three hours a day or more using electronic devices are 35% more likely to have a risk factor for suicide than those who spend less than an hour with them — while those who spend five or more hours are 71% more likely to have a suicide risk factor.

The hard part is determining cause and effect. Do depressed kids use social media and devices more? Or do smartphones lead to depression and anxiety? What we know for sure is that the largest change by far in teens’ lives over the past five years was that more of them owned smartphones and were spending more time on social media, says Twenge, author of “iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood.”

“It doesn’t matter whether you call it an ‘addiction’ or ‘overuse,’” she says. “I’m just interested in the consequences.”

For actor Kirk Cameron, the best answer is more-assertive parenting. He’s produced documentary film “Connect,” which recently premiered with two limited theatrical screenings and will soon be released on home video. The movie looks at young people struggling with technology-overuse problems and strategies for dealing with them. His biggest takeaway from the project: Parents have to enforce ground rules for their children’s device usage.

“We cannot outsource parenting to a piece of technology that blocks content,” says Cameron, an evangelical Christian who’s had to wrestle with overseeing the device usage of his six kids.

For those truly in need of a tech detox, there are programs like those at Paradigm Malibu. The kids coming to Paradigm with problematic device-usage behaviors are spending upwards of nine hours per day on their phones, checking them hundreds of times daily, says Dr. Jeff Nalin, the company’s co-founder and chief clinical officer.

“When somebody doesn’t want to give up their phone, they feel like their whole world is imploding,” he says. “These kids use devices as a coping mechanism because they’re feeling crappy about themselves. But you’re sticking a cork in a volcano. At some point it’s going to blow.”

Paradigm Malibu is a high-end facility. The company charges $49,000 for a 30-day in-patient program (though it says health insurance on average covers 60%-80% of the cost). The three-story residential center is nestled against the Santa Monica Mountains, a block away from the Pacific Ocean.

Nalin says the focus of the treatment is to help afflicted teens find a healthy balance of screen time. “There’s really no way to be ‘device-free’ anymore,” he says. “You can’t just stick your head in the sand and say, ‘Don’t use the device.’”

Daniel Sieberg is a former technology and science journalist who — while he wasn’t on the brink of suicide — says he felt addicted to devices to a degree that was unhealthy.

“I was in denial about how badly I was managing my own life,” says the 46-year-old. He says his health and well-being were suffering, as were his relationships in the real world. “I look back and think, ‘Wow, how did I let that happen?’”

Ultimately, Sieberg says he turned his life around after an intervention from his wife, who had nicknamed him “Glow Worm” because he would almost always be staring at a screen while in bed. The four-step program he created for himself to curtail tech usage began with him quitting social media for several months, and he wrote a book based on the experience: “The Digital Diet.”

“There’s a growing movement to be mindful about technology,” Sieberg says. “The message is, you can love your technology — just not unconditionally.”