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Navigating the Mental Health Internet

 


Lesson 6.1 Internet Addiction

 

Description AssessmentTreatment
ControversiesAdditional Resources


Description

Internet addiction has been been the subject of increasing clinical interest, although it remains a controversial topic.  While some argue that the Internet is merely a communications medium and cannot be compared to addictive stimuli like drugs and alcohol, others point to the growing number of individual cases related to overuse of the Internet seen in psychotherapy practices.  Similar problems have been reported with overuse of video and computer gaming before the arrival of the Internet, so it not the Internet per se that created this type of problem.

One of the first articles documenting excessive dysfunctional Internet usage that merited clinical attention is case study of a 43 year old woman preoccupied with chat rooms which eventually destroyed her 17 year marriage.
Addictive Use of the Internet: A Case that Breaks the Stereotype by Kimberly Young, Ph.D.

Internet addiction includes not only excessive chat room participation, but several ways that people spend too much time online to the detriment of their social and financial well-being. Below are some examples where cases of problems related to Internet use have been documented:

online gambling
online shopping
day trading
cybersex affairs
adolescents and online gaming
children and violent computer games

 

cartoon about cyberaffairs





cartoon about online shopping (Copyright New Yorker)

Cases of people who get into deep financial trouble in online auctions have been reported.

Case of Online Auction Addiciton

Dysfunctional use of the Internet by children as well as adults can result in diminished participation in the family.

on time with children
David N. Greenfield, Ph.D of the The Center for Internet Studies conducted and published study with ABCNEWS

WebsiteThe Nature of Internet Addiction: Psychological Factors in Compulsive Internet Use

The results, presented at the American Psychological Association Meeting in 1999, showed that

Nearly 6% of the 17,251 persons surveyed meet criteria for compulsive Internet use.
Over 30% report using the Net to escape from negative feelings.
The vast majority admitted to feelings of time distortion, accelerated intimacy, and feeling uninhibited when on-line.

Quiz QUIZ EXERCISE 29:

According to David N. Greenfield, Ph.D in The Nature of Internet Addiction: Psychological Factors in Compulsive Internet Use the key areas that seem to be impacted by addictions including Internet addiction are ...


a) marriages and relationships
b) employment
c) legal/financial area
d) all of the above

Record your answers for later insertion into the Quiz.

The Internet appears to be a growing problem in the workplace. Psychologist Michael Fenichel,PhD described some clinical observations about persons who present for treatment with computer-related issues:

tend to have pervasive and characteristic cognitive styles which include a sort of "multi-tasking" with high-speed processing, and a loss of mid- and long-term goal directedness, diminished length of attention span, disrupted patterns of living (e.g., eating), and detached or disturbed social relationships, often using the computer as the focal point for all contact with the world.
"Internet Addiction": Addictive Behavior, Transference or More?

There is no official psychological or psychiatric diagnosis called Internet addiction. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not include such a category. To become an official diagnosis, "Internet Addiction Disorder" must be shown by research that it can be reliably diagnosed, and that the diagnosis correlates with outcome, treatment results, histories, and prognosis (to establish external validity). Many have argued that it is closer to pathological gambling which is an Impulse Disorder rather than a type of substance related disorder. Already studies are establishing a connection between problematic Internet use and DSM-IV Axis I Impulse Disorder. For example, a study of 20 individuals with problematic Internet use was conducted where problematic Internet use was defined as (1) uncontrollable, (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties and (3) not solely present during hypomanic or manic symptoms. The researchers found:

All (100%) subjects' problematic Internet use met DSM-IV criteria for an impulse control disorder (ICD) not otherwise specified (NOS). All 20 subjects had at least one lifetime DSM-IV Axis I diagnosis in addition to their problematic Internet use; 14 (70.0%) had a lifetime diagnosis of bipolar disorder (with 12 having bipolar I disorder).
Psychiatric features of individuals with problematic internet use. Shapira NA, Goldsmith TD, Keck PE, Khosla UM, McElroy SL. J Affect Disord. 2000 Jan-Mar;57(1-3):267-72

Quiz QUIZ EXERCISE 30:

In Psychiatric features of individuals with problematic internet use the authros define problematic internet use as ...


a) uncontrollable
b) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties
c) not solely present during hypomanic or manic symptoms
d) all of the above

Record your answers for later insertion into the Quiz.


Quiz QUIZ EXERCISE 31:

Go to the Pubmed search page and conduct a search for Internet addiction research articles. Just enter the keywords Internet addiction into the box that says Search PubMed for and then click on Go. You should get about 20 citations for articles on Internet addiction including several research articles. Record one article title in the box below.


[Short Answer Response]

Record your answers for later insertion into the Quiz.

Assessment

Researchers have worked to establish the first criterion--the constellation of symptoms that constitutes Internet addiction. Psychologist Kimberly S. Young conducted a three-year study of Internet abuse reported in Internet Addiction: The Emergence Of A New Clinical Disorder, which was presented at an APA Meeting. Based on her findings and her extensive clinical experience with this problem, she has proposed a definition which involves having four or more of the symptoms listed below during the past year.

1. Do you feel preoccupied with the Internet or on-line services and think about it while off line?
2. Do you feel a need to spend more and more time on line to achieve satisfaction?
3. Are you unable to control your on-line use?
4. Do you feel restless or irritable when attempting to cut down or stop your online use?
5. Do you go online to escape problems or relieve feelings such as helplessness, guilt, anxiety or depression?
6. Do you lie to family members or friends to conceal how often and how long you stay online?
7. Do you risk the loss of a significant relationship, job, or educational or career opportunity?
8. Do you keep returning even after spending too much money on online fees?
9. Do you go through withdrawal when off line, such as increased depression, moodiness, or irritability?
10. Do you stay online longer than originally intended?

Dr. Young has created an interactive online test for Internet Addiction based on the above criteria , although reliability and validity data are not reported.
WebsiteInteractive Online Internet Addiction Test
Exercise: Take this test to see what are the major behaviors involved in Internet use-related problems

Dr. Young also has tests on her site for other Internet-releated problems including:

Cybersexual Addiction
Obsessive Online Traders
Compulsive Online Gambling
Online Auction Addiction
A Partner's Addiction
A Paren's Assessment of Child's Internet Addiction

Treatment

John Suler,PhD has proposed a treatment approach that is based on the observation that,

People become "addicted" to the Internet, or act out pathologically in cyberspace, when they have dissociated it from their f2f (face-to-face) life. Their cyberspace activity becomes a world unto itself. They don't talk about it with the people in their f2f life. It becomes a walled-off substitute or escape from their life.

Bringing Online and Offline Living Together: The Integration Principle

Internet addiction, like all others types, entails isolation from others and prioritizing of the compulsive activity over all other aspects of life. Dr. Suler goes on to propose some interventions that integrate online and off-line worlds.

Telling online companions about one's offline life
Telling offline companions about one's online life
Meeting online companions in-person
Meeting offline companions online
Bringing online behavior offline
Bringing offline behavior online

Dr. Young, who founded the Center for Online Addiction, leads an online self-help group for Internet Addictions. Although some would compare this to holding an AA meeting in a bar, she has been able to engage people in re-evaluating and altering their patterns of Internet usage using this approach. She believes that, as with other addictions, it is first necessary for the person to break through their denial. However, she reports that Internet addiction does not require abstinence for a healthy and life-enhancing recovery. The Internet can be a personal and professional resource when used appropriately. Her treatment approach focuses on

finding a balance between Internet use and other life activities. The treatment model is similar for eating disorders or controlled drinking programs.  The focus being to identify triggers which onset binge-behavior and re-learning how to use it in moderation.
How do You Treat Internet Addiction?

Dr. Young's book, Caught in the Net, describes therapeutic interventions and provides practical self-help tools.
online support group for Internet addicts

Controversies

There are no accepted guidelines as to how to distinguish "normal" enthusiasm from "pathological" preoccupation. Storm King asked a crucial question: We don't know whether the Internet can actually make someone addicted or alternatively if those who are overusing the Internet already have a vulnerability to such behavior. 
Is the Internet Addictive or are Addicts Using the Internet?

Stanton Peele,PhD has also raised questions about the validity of the concept of addiction. He argues that the disease model does not explain the dysfunctional aspects of such behaviors and is not scientifically based, even when applied to substances such as alcohol and cocaine. Why aren't people who spend a lot of time reading called "book addicts" instead of people affectionately calling them bookworms?

Quiz QUIZ EXERCISE 32:

On the Stanton Peele Addiction Web Site Stanton Peele MD


a) introduces the term Internet Addiction into the clinical literature
b) criticizes the disease model of addiction for drug and alcohol abuse
c) argues that the term Internet Addiction should only be applied to persons working in the computer field
d) none of the above

Record your answers for later insertion into the Quiz.

As mentioned previously, not all researchers and clinicians support the idea of Internet addiction.  They question the necessity for a unique diagnosis, pointing to the lack of such diagnoses for television addiction, telephone addiction, etc.  One such researcher is John Grohol,PsyD who has been a vocal skeptic of Internet addiction as a distinct disorder. 
Internet Addiction Guide

But is clear that people have lost their jobs, flunked out of school, and gotten divorced because their Internet use consumed all their time. Such extreme cases demonstrate the need for therapists to pay attention to Internet use in their assessment.

Quiz QUIZ EXERCISE 33:

Internet addiction ...


a) is a new diagnostic category in the DSM-IV
b) is a media-created term that has no clinical validity
c) only applies to individuals who work in the computer field
d) is a new clinical problem documented in case studies and other research

Record your answers for later insertion into the Quiz.

Cartoon about family life and the Internet

Additional Resources

John Suler, Ph.D.'s site on the Psychology of Cyberspace contains a good overview and links to other websites on Internet addiction
Computer and Cyberspace Addiction
by John Suler, Ph.D.

The APA Monitor recently published a special issue on Psychology and the Internet
with an article entitled Is Internet addiction real? as well as articles on Rural Telepractice, the Internet as a tool for self-exploration, and the Digital Divide.

Reformulating the Internet Paradox: Social Cognitive Explanations of Internet Use and Depression by Robert LaRose, Matthew Eastin, and Jennifer Gregg. Journal of Online Behavior
This online article presents a new study indicating that the previously-found relationships between online activity and depression is limited to novice users. As users become more experienced with the Internet and their competence improves, the hassles that the Internet itself presents recede. Moreover, users become more skilled at getting social support from others online. These factors lead to improved, not reduced, mental health.

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