Addictive use of the Internet is a new clinical phenomenon that many practitioners are unaware of, and subsequently unprepared to treat. Some therapists are unfamiliar with the Internet itself, making its seduction difficult to understand. Other times, its impact on the individual’s life is minimized, since many practitioners fail to recognize the legitimacy of the disorder.
Given the popularity of the Internet, accurate diagnosis of Internet addiction is often difficult, because its legitimate business and home use often masks addictive behavior. Internet addiction is characterized as an impulse-control disorder that does not involve an intoxicant; of all the diagnoses referenced in the DSM-IV it is viewed as most akin to Pathological Gambling. By using Pathological Gambling as a model, symptoms of compulsive online use are outlined as follows:
- Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?
- Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
- Have you repeatedly made unsuccessful efforts to control, cut back or stop Internet use?
- Do you feel restless, moody, depressed or irritable when attempting to cut down or stop Internet use?
- Do you stay online longer than originally intended?
- Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
- Have you lied to family members, a therapist or others to conceal the extent of involvement with the Internet?
- Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?
Clients are considered dependent users when answering yes to five or more of the questions, and when their behavior cannot be better accounted for by a Manic Episode. Only non-essential computer/Internet usage (i.e., non-business or academically related use) should be assessed.
While time is not a direct function in diagnosing Internet addiction, addicts generally are excessive about their online usage, spending upward of 40 to 80 hours per week online. Sleep patterns are disrupted due to late-night log-ins, and addicts generally stay up surfing until two, three or four in the morning, with the reality of having to wake up early for work or school. In extreme cases, caffeine pills are used to facilitate longer Internet sessions. Such sleep deprivation causes excessive fatigue, which impairs academic or occupational performance and may decrease the immune system, leaving the addict vulnerable to disease. Furthermore, sitting at the computer for such prolonged periods also means that addicts aren’t getting the proper exercise, sometimes leaving addicts at increased risk for carpal tunnel syndrome.
Treating Internet Addiction
Treatment for Internet addiction is similar to those methods used for compulsive behaviors, such as pathological gambling or compulsive overeating. Traditionally, clinicians who specialized in the treatment of addictions integrate individual, group (treatment and support) and family counseling, with a heavy emphasis on abstinence. Abstinence is frequently included in the treatment plans for individuals suffering from alcoholism, drug addiction and compulsive gambling. However, individuals experiencing process addictions, such as compulsive overeating or compulsive spending, must learn moderation and not total abstinence.
Internet addiction falls into this same category if the computer is used as part of the client’s work or educational setting. In such cases, teaching clients how to set limits, balance activities and schedule time without complete abstinence can be successful. For example, like a compulsive overeater who sets limits by committing to abstinence from particular trigger foods (sweets, butter, potato chips), an Internet addict may decide to abstain from visiting particular chat rooms, Web sites or gaming sites.
To achieve this goal, cognitive-behavioral therapy (CBT) is the primary treatment. The goal of CBT is for clients to disrupt their problematic computer use and reconstruct their routines with other activities. The goal of treatment is not to put an end to Internet use, but to reduce it to moderate and sensible use. Some basic guidelines in applying CBT with Internet-addicted clients are to set clear time limits on Internet use, identify triggers for abuse, abstain from problematic online applications and reintegrate offline activities.
Set clear time limits. Structured sessions should be programmed for the client by setting reasonable goals, perhaps 20 hours instead of a current 40. Then, schedule those 20 hours in specific time slots and write them onto a calendar or weekly planner. The client should keep the Internet sessions brief but frequent. This will help avoid cravings and withdrawal. As an example of a 20-hour schedule, the client might plan to use the Internet from 8 to 10 p.m. on weeknights and 1 to 6 p.m. on the weekends. Incorporating a tangible schedule of Internet use will give the client a sense of being in control and help avoid the potential risk of relapse.
Identify triggers for abuse. It is important to determine the Internet activities, situations and emotions that are most likely to trigger online binges. A particular chat room, a certain time of day or a client’s mood just before logging online may all serve as triggers that can lead to abuse. Recovery means relearning how to use the Internet in order to make better choices about time spent online and abstinence from problematic online applications. To pinpoint these triggers, have clients maintain a Daily Activity Log to keep track of when and how they use the computer. Keeping a log serves as a baseline of present activities, identifies high-risk situations that can lead to excessive online use and serves as a guide in future treatment planning. Thoroughly go through the client’s responses and determine if any patterns emerge. What time of day does the client usually log online? How long does the client stay on during a typical session? What applications are most problematic for the client and why? (Be specific: which sites, chat rooms, games.) What types of feelings or situations precede online use for the client? Does stress trigger a client’s need to go online? How does the client feel when he or she logs off? Like a craving for a cigarette or a desire to have a drink, emotions such as stress, depression, loneliness, anxiety or burnout can lead to a client’s need to go online, which serves as a temporary distraction to fill an emotional void.
Abstinence from problematic online applications. Clients must develop more appropriate ways of coping with problems than turning to the Internet. Underlying problems contributing to the addictive behavior, such as relationship difficulties, job stress or untreated psychiatric conditions, must be addressed, along with helping clients achieve complete abstinence from problematic online applications. Filtering software, typically used by parents to block access to online sexual content from their children, can help clients to self-regulate Net use. The software can be programmed to automatically block a multitude of online applications, such as porn sites, chat rooms or gaming sites. For many, this stops the behavior immediately, and many describe the experience as a “cold shower” that breaks the trance associated with the addiction. With it, clients feel empowered to control the temptations that often lead to relapse.
Reintegration of offline activities. Simply being at the computer increases a client’s risk of falling back into old patterns. Therefore, to maintain a healthy balance of Internet use, work with the client to cultivate alternative activities that take them away from the computer and that help them rekindle their interest in old activities that have been replaced because of the Internet. It is helpful to take a personal inventory of what the client has cut down on, or cut out, because of time spent online. Perhaps the client spends less time hiking, golfing, fishing, camping or dating. Maybe the client has stopped going to ball games, visiting the zoo or volunteering. Perhaps it is an activity that the client has always put off trying, such as joining a fitness center. Encourage clients to find healthy ways to spend their time as they wean themselves from the computer. This also means that clients must take time out each day to avoid plugging into anything. Have clients avoid computers, laptops and any other technological device that habitually demands attention. At those moments, encourage a client to get up, walk around the office, stretch, do breathing exercises or meditate. At the very least, take a short break from the computer.
Finally, in serious cases, twelve-step support groups can be part of treatment planning. Support groups improve the Internet addict’s real-life social support system, while providing an opportunity to build offline relationships. Such peer support offers comfort that decreases the reliance upon the Internet for companionship and serves as a safe place to reality-test interpersonal behavior that leads to personal growth.