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Internet Addiction Back to Course Index

 

 

 

Internet Addiction

 

Int Add3

 

 

Introduction

 

Internet use is currently accepted as part of the social structure in the USA and in many other countries, as well.   Operation, oversight, and control of the Internet is difficult to administer as it is multi-national, relatively new, and broad-based in its applications; consequently, it is left to the user to determine his or her own boundaries and to decide what is enough or too much.  It should be noted that certain aspects of Internet use is “somewhat” controlled.  For example, legalized gambling has an age restriction and frequently posts warnings regarding the potential for addiction. 

 

Internet use is a controversial subject at the present time.  Some choose to define excessive use as an “addiction” whereas others strongly disagree.  I will not attempt to resolve this debate as I think excessive use of the Internet is a problem regardless of what we call it.   For example, a survey of 18,000 Internet users found that approximately 5.7 percent of this sample could be considered compulsive Internet users.  (Greenfield, 1998).  The results of this survey compare favorably with other surveys that indicate the range of compulsive users to be between 5 and 15 percent of those who regularly use the Internet.   Internet use is widespread today with usage estimates as high as 70 percent of the total US population.  It follows that over 20 million Americans are potentially impacted by excessive use of the Internet.

 

Problematic use of the Internet may consist of any or all of the following:

·                    Too much time online

·                    Excessive and anonymous socialization

·                    Pornography

·                    Excessive online shopping and e-mail

·                    Use to escape life circumstances

·                    Use to escape depression and boredom

              

The general problems associated with Internet use increase significantly when Internet gaming is considered.  The Internet is generally home-based and in most cases, gaming websites originate from a foreign country that is favorable toward gambling.  Consequently, it is more difficult to manage and control this application as other countries often have more liberal gaming laws than those found in the USA.  Gambling is a special case and social acceptance or rejection will eventually decide its fate…with a permissive/favorable attitude, it will increase, and when public opinion turns negative, it will decrease.  At the present time, it appears to be on an upswing, as evidenced by the successes in Nevada, NJ, media (TV programs that televise poker games), other gaming outlets (horse racing, dog racing, lotto, scratch cards, bingo and a multitude of others) and the Internet.  

 

If society attempts to limit Internet use or to stop Internet gaming, if history tells the future, the outcome would be similar to the attempt to prohibit of the use of alcohol.  In that case, Americans chose to consume alcohol, regardless of the legal ramifications.  Many have noted that more alcohol was consumed during prohibition (1920-1933) than either before or immediately after it was repealed.  In essence, Americans chose to drink,  Many choose to use the Internet to shop, socialize and gamble.  In essence, we have never been able to successfully legislate morality or to impose limits on social activities, and will probably fail again if we attempt that approach on the Internet.   Our best approach is to educate the general public, focus on control of the Internet and to develop effective treatment modalities for those who become compulsive users and need professional help.

 

 

INTERNET EXPOSURE

 

As in other types of addiction, compulsive Internet use is progressive (increases over time).  It is more challenging to detect, as many of the physical attributes associated with other addictions (such as alcoholism) are not present with Internet use.  However, the absence of physical symptoms does not infer that Internet addiction has a lesser impact on individuals and society than any other addiction.

 

As with alcoholism, there are phases associated with the progression of use.  The generalized phases along with a brief description of each are as follows:

q       Social Phase: Typically a new user is in awe of the amount of information on the Internet and the ease at which it may be accessed.  Most users are also pleased that it is home-based, available 24/7, and is relatively inexpensive (if one can limit their on-line shopping and stays away from gambling).

q       Use/Excessive Use Phase: The transition from social use to excessive use can be quick, exciting, and destructive.   The user experiences heightened emotional states such as joy, excitement, anxiety, aggression, depression, et al.  The user often undergoes personal/social/value/lifestyle changes and began to let the Internet control their lives.  For example, ending a social relationship that began in the chat room can be psychologically devastating (almost to the level of losing one of the family).   The user is generally aware of the problem (at this phase) but he or she has difficulty controlling the impulse to use; consequently, relationships with family and friends deteriorate.

q       Compulsive Phase:  The progression to the compulsive phase is slow and usually occurs over a few years (typically 3 to 5).  The behavioral patterns of people who have progressed to this phase is similar to people who get hooked on soap operas to the point they will forgo other social activities and family outings in order to use the internet.  In chat experiences, the individuals that become regulars become part of the extended family.  At times, the user can no longer maintain normal social or family relationships.  He or she may begin to recognize their problem and will often seek help from friends or other users.  The compulsive user generally feels remorse and hopelessness after concluding a long session.   Loss of former lifestyle and relationships may be accompanied by suicidal ideations.

 

Often professional counselors may suspect that one or more of their clients are overly involved with the Internet.  In such cases, the counselor may need diagnostic tools to help determine if a client has an Internet-related problem and if so, to what severity.   A twenty-question questionnaire (similar to Gamblers Anonymous (GA) 20-question questionnaire) has been developed to provide a counselor with some indication of the client’s disorder related to the Internet.  This questionnaire should be used for information purposes only as it does not relate to diagnostic criteria in the DSM-IV.   Problem Internet users generally answer “yes” to seven (7) or more of the questions.  Should this be the case, professional counseling related to impulse control is strongly recommended.

 

 Table 1 presents the twenty questions – the client should answer each one carefully and honestly as the earlier a problem is identified the earlier treatment can begin (early intervention increases the success rate of treatment). 

 

 

TABLE 1

Internet Questionnaire  – 20 Questions

 

 

NO

YES

1

Do you lose time from work due to Internet use?

Œ

Œ

2

Does Internet use make your home life unhappy?

Œ

Œ

3

Do you ever gamble on the Internet?

Œ

Œ

4

Do you ever feel remorse after a late night session in the chat room?

Œ

Œ

5

Do you escape from personal problems by retreating to the Internet?

Œ

Œ

6

Does Internet use cause a decrease in you ambition or efficiency?

Œ

Œ

7

After a session in the chat room, do you feel you must return as soon as possible to find out what happened to the other person(s)?

Œ

Œ

8

After a session, do you have a strong urge to return and continue the dialogue?

Œ

Œ

9

Do you often stay on the Internet until you are exhausted?

Œ

Œ

10

Are you ever tardy or miss work due to late night sessions on the Internet?

Œ

Œ

11

Do you ever miss family functions to spend time on the Internet?

Œ

Œ

12

Do you plan your daily activities to allow time for the Internet?

Œ

Œ

13

Does the Internet make you careless about the welfare of your family?

Œ

Œ

14

Do you ever stay on the Internet longer than you planned?

Œ

Œ

15

Do you ever stay on the Internet to escape worry or trouble?

Œ

Œ

16

Have you ever caused a family financial crisis by excessive on-line shopping or gambling?

Œ

Œ

17

Does Internet use cause you to have difficulty sleeping?

Œ

Œ

18

Do arguments, disappointments, or frustrations create within you an urge to use the Internet?

Œ

Œ

19

Do you have an urge to celebrate good fortune by a few hours on the Internet?

Œ

Œ

20

Do you ever consider self-destruction as a result of your Internet use?

Œ

Œ

 

TOTAL

Œ

Œ

 

 

Clinical Diagnosis


Internet addiction is not included in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by health professionals for diagnosis. The only behavioral addiction (as opposed to substance addiction) included in the latest DSMis gambling disorder.

Internet addiction appears to be a common disorder that very well might merit inclusion in DSM-V in the future. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and if in order with other criteria would consist of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging.


Any of the variants should include the four components 1) excessive use, often associated with a loss of sense of time or a neglect of basic drives, 2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible, 3) tolerance, including the need for better computer equipment, more software, or more hours of use, and 4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue.

In-kind, the International Classification of Diseases 11th Revision (ICD-11) also does not have a specific code for internet abuse, addiction, or disorder yet.  Reports by expert committee members show a discussion around the terms “addiction” and “abuse,” and the possibility of dropping the terms in favor of less pejorative and stigmatizing identifiers such as “dependence” and “harmful use,” according to the thirty-fifth report of the WHO committee.  There is speculation that Internet Use and Gaming Disorder will be included in the ICD-11 in future editions.  Currently, the code most frequently accepted for such criteria would be the Impulse Control Disorder.

Types of Internet Users

 

As in substance abuse, with its three types or levels of users (recreational/social, abuse, and dependency/addiction) there are also different types or levels of Internet use.  The following paragraphs identify the generalized types and present a brief description of the individuals who fit into each type:

 

q       Social Internet user: Individuals who use the Internet socially; generally used for business and entertainment.  They typically use with control (limit how frequently they use and how much time is involved) and usually use infrequently except for business use.   The social user will often conceal infrequent late-night sessions from family or friends.  A social user may remain at this level throughout a lifetime and ‘enjoy’ the Internet without the detrimental impacts that are common with more advanced types.

q       Serious Social Internet User: Internet use is a major source of entertainment and most of his daily activities are planned around use.  He/she typically has a daily routine with planned sessions.  His or her intensity and absorption increase over time and the user may experience strong emotional swings with an attendant attitude of, “I’m okay” after a positive experience and/or “I’m not okay” after a negative session.  However, for this classification, Internet use is still under control and he/she could stop but they would miss it.   This type is often disassociated from family activities.

q       Relief or Escape User:  Internet use is a significant element in this individual’s life.  Emotionally, the user equates use as being as important as family, career, and/or education.  However, there is generally little impaired functioning with regards to family, job, and/or education.  Internet use is typically more than a pastime; however, the user can stop but experiences some difficulty.   Also, emotional swings are heightened during this level over that of previous levels.  Progression to the next level may occur and can be associated with a traumatic experience such as the loss of a job.  The most important criterion for this classification is that the user does not generally compromise life areas (family, career, financial status, etc.)

q       Antisocial Personality: Users often avoid interaction with family or friends with an attendant strong urge to use much like a cocaine addict who forsakes all others or commits criminal acts to continue his/her addiction (this is a psychological comparison only and is not intended to equate Internet use to Cocaine use).  The individual with an antisocial personality disorder may use the Internet as an escape mechanism. 

q       Problem Use: The Internet is increasing in importance in individual life and it has begun to cause impairment in family, job, school, and other normal social functioning.   Consequently, it is no longer just a form of fun or entertainment.  

q       Compulsive User: A compulsive user has characteristics similar to the following criteria.  This criterion is NOT defined in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (commonly referred to as the DSM-IV) and should be used as information and not for clinical diagnosis.  A compulsive Internet user may be characterized by a persistence and recurrence behavior, indicated by the presence of at least five (5) of the following items:

 

1.      Is preoccupied with Internet use (e.g., preoccupied with reliving past episodes or ways to gain additional access to the Internet.

 

2.      Needs to use with increasing amounts of time to achieve the desired excitement

 

3.      Has repeated unsuccessful efforts to control, cut back or stop using the Internet

 

4.      Is restless or irritable when attempting to cut down, or stop using the Internet

 

5.      Uses as a way of escaping from problems or from relieving a desperate mood (e.g., feelings of hopelessness, guilt, anxiety, depression)

 

6.      Strong urge to return another day to find out what happened in the chat room or to specific individuals

 

7.      Lies to family members or others to conceal the amount of time or level of involvement with the Internet

 

8.      Has neglected family or job obligations due to use of the Internet

 

9.      Has jeopardized or lost a significant relationship, or educational or career opportunity because Internet use

 

10. Relies on others to provide money to relieve a desperate financial situation caused by excessive shopping or gambling on the Internet.

 

An individual who suspects they have impulse control problems should be exposed to these criteria carefully and openly (under the guidance of a professional counselor).  As with any  “excess situation”, it is common for an individual to deny their exposure and to blame everything and everyone except themselves.  It also makes treatment more difficult (if an individual is in denial), as it’s hard to help someone who doesn’t think they have a problem.  Again, a compulsive Internet user may need professional help if he/she wants to overcome his/her condition and resume normal social functioning.

 

Warning Signs / Diagnostic Tools

 

I doubt if anyone ever starts using the Internet with the intent of becoming a compulsive user. For example, early users typically begin with a low level of involvement that increases gradually over time.  Many individuals never progress beyond this phase; however, for some who progress to the compulsive use phase, it can be totally devastating.

 

Compulsive use is not easy to detect, as most individuals will attempt to hide their problem from themselves (self-denial) as well as from family and friends.   However, there are warning signs that if properly interpreted and acted upon can help the individual to accept his/her problem and also help to accurately diagnose the problem.    Some of the indicators that an individual may have a problem include:

q       High absenteeism from family functions

q       Inability to stop or control the use

q       Going into debt due to excessive online shopping or gambling

q       Using the Internet as an escape from stressful situations, worry, or trouble

q       Neglecting self or family

q       Providing false information regarding the amount o time spent on the Internet

q       Abnormal emotional swings.  Feelings of guilt, shame, hopelessness, and depression, as a result of excessive use (in some severe cases suicidal ideations may occur).

q       Financial crisis – indebtedness.

q        Refusing to discuss the time and money involved with Internet use

q       Secrecy and avoidance – only interested in Internet activities.

 

From a behavioral viewpoint and overall characteristics are that an individual with an Internet problem may begin to make high-risk time decisions that could lead to disruption of normal family relations and may also lead to anti-social behavior.   Also, an Internet abuser may continue to believe that they can handle the situation, keep the family happy and still use the Internet.  However, if/when things improve, he or she generally continues to use it until they are again in another family or financial crisis.  In essence, the using cycle continues until the compulsive user enters treatment.

 

The Cycle of Internet Use (Overview)

 

The  “Cycle of Use” is presented to help the Internet user or a professional counselor working with an Internet user to better understand problematic use of the Internet and also to help the therapist structure an effective treatment program (help the addicted individual break the cycle of use).  The objectives are for the individual and the professional involved with treatment to recognize the special needs of this sub-population and design treatment modalities aimed at their specific needs.  For example, as it is beneficial for an insulin-dependent diabetic to be educated on all aspects of diabetes, it is equally important for the problematic Internet user to be educated on impulse control, distortive cognitive ability, and the consequences of poor decision-making.

  

Figure 1 depicts the cycle of use and identifies the major functional elements associated with the cycle.  The following paragraphs describe each element and how it impacts the user’s life.

 

Int Add 1

 

 Figure 1

 

 

VALUE/BELIEF SYSTEM

 

An individual’s value/belief system reflects his/her perception of self and represents values, judgments, and myths that he/she believes to be true.  A person’s value/belief system is fairly well established by an early age and is refined and honed as life’s experiences make us into the person we are at any given time in our lives.   It is a major control and decision-making guide and helps us to choose between right and wrong and things we do versus don’t do.  Our value/belief system influences our thinking and decision-making throughout our lives.  Most individuals have a value/belief system about:

q       Religion

q       Alcohol and other drugs

q       Sexuality

q       Race

q       Careers

q       Age

q       Personal activates

q       Time management

q       Social issues

q       Community involvement

q       Family roles

 

A therapist should explore a client’s values/beliefs to understand what they believe about various topics including topics related to impulse control.   Questions might include:

o       Were you exposed to limits or restrictions as a youth

o       Did your parents have a permissive attitude toward social activities? 

o       Did you have a detailed schedule as a youth?

 

Obviously, exposure to a permissive attitude/environment will enable a young person to form a positive image of most activities and/or to establish a distorted mental picture of specific activities (such as games of chance).   To give an example of how our beliefs/values work in the life of an Internet user, let’s suppose a person forms a concept of a problem user as one who is stays on the Internet all night.  Now, let’s suppose this individual is a compulsive user but does not meet this pre-programmed characteristic.  In this case, the individual would test his situation against his value/belief system and would conclude he does not have an Internet problem.  The cycle is repeated until there is a match between his/her behavior and his/her pre-programmed belief/value system.  The cycle may also be disrupted by other factors (generally a crisis) in the user’s life.

 

DISTORTED COGNITIVE ABILITY

 

The overall concept is that distorted cognitive ability results in illogical and impaired thinking.  Consequently, an individual is unable to comprehend the reality, consequences, or truth about events/actions/activities.  When an individual cannot see the reality or truth about things, the distorted cognitive activity is generally referred to as denial.  The most common forms of denial are:

q       Rationalizing:       Making excuses for Internet use.  For example, “I’m restless and it helps me relax”.

q       Minimizing:           Indicating his/her use is less serious than it really is.  Example: “Sure I surf the net, but not that much”; “I only go online during the day, real users play all night”.

q       Blaming:   I use the Internet because;  “everyone else does”.  The user admits involvement but the responsibility for it lies with someone else.  Example.

 

Distorted cognitive activity or impaired thoughts mask the reality of most situations, and truth (in many cases) ceases to exist.  An Internet user who finds them selves in a quagmire can gain insight as to their preconception (thinking) regarding excessive Internet use by answering and analyzing the following questions:

1.      Most frequently used form of denial (with respect to Internet use) is: __________ (rationalizing, minimizing, blaming or others)

 

2.      Most frequently processed impaired thought:__________________________________________

 

3.      I’m not a problem user because: ____________________________________________________

 

If an individual becomes emotionally stressed when asked the aforementioned questions, it is a strong indication that the individual is in denial regarding their involvement with the Internet and they are in need of professional help. The key to any cognitive change is that the individual is open and honest and willing to accept that change is needed.  If they have a good attitude, it is easier for them to accept the perils associated with compulsive use.  The net is that people can change but in most cases, the change must be initiated at the cognitive level.  If one is in denial regarding a problem there is very little that anyone else can do to help that individual.

 

CONTINUED INTERNET USE

 

It is self-evident that distorted cognitive ability enables an individual to continue using the Internet, which leads to behavioral problems or unmanageability of one’s life.

 

 

IMPULSE CONTROL PROBLEMS

 

As the use continues, the individual begins to encounter the negative consequences of his/her behavior.  In general, the consequences cause pain (psychological or physiological) that, when severe enough, may increase our willingness to seek help.  The hypothesis is that deeply embedded in human nature is the tendency to resist all change until we finally experience pain and then we may stop to look at the cause of the pain.  This process may manifest itself in any of the following:

q       Physical (health problems, increased risk-taking)

q       Emotional (feelings of guilt, shame, or depression)

q       Spiritual (low self-esteem, feeling empty, isolated)

q       Financial (heavy debt load; inability to manage)

 

Another self-analysis assignment is for an individual to identify the main consequences as a result of his/her Internet use.  This exercise is generally done over several counseling sessions and ultimately will lead the individual to accept responsibility for their decisions (related to the Internet). 

 

 

Individual Addiction Cycle

 

Figure 2 depicts an individual addiction cycle and identifies the major elements associated with the cycle.  Most counselors believe that all addictions fit into a cycle and that it starts with a cognitive process related to the event (thinking about or being preoccupied with the activity).  This could be viewed as a ‘locked in’ mental state, where the main focus could be on obtaining access to the Internet.  Some individuals are so focused that they appear to be in a trance state.  Most trance states vary in intensity, duration, and frequency.  The initial onset may be mild but generally get more intense as time passes without satisfying the impulse.   The trance state also varies depending on how long the individual has been a compulsive Internet user as all individuals are creatures of habit and we program ourselves to expect resolution within a predetermined timeframe or the mind will increase the desire to satisfy the impulse.

Int Add 2

 

 

 

 

 

                                                    Figure 2:  Individual Addiction Cycle

 

COGNITIVE ACTIVITY

 

The best method for an individual to understand this phase of use

is to ask a series of questions and for the individual to “be honest” when answering.  The questions are:

q       What thoughts did you focus on when you initially began using the Internet?

q       How did the focus items change as the compulsion to use increased?

q       What are your thoughts like at present?

q       What do you think regarding using again?

q       How often do you think about using it?

 

Remember that it takes time to break old habits and to reprogram our minds to want different things.   Also, remember the urge to continue or resume problematic use will be very strong when an individual initially attempts to stop.  It’s also safe to say that “everyone thinks about resuming again”, and individuals must be resilient in their efforts to break the cycle.  This exercise is intended as a tool that will help the individual to become familiar with how his/her mind works and the thought processes prior to previous relapses.   Again, the mind wants to continue to do those things that bring pleasure.  Consequently, a “big shopping spree” or  “visiting a friend on the net” are positive events in our minds.  Consequently, there is a strong drive to repeat those activities.  Unfortunately, we all know the negative side of compulsive use of any kind, but our mind is quick to “set aside” those thoughts when the other (positive) thoughts are being processed. As healthy, normal humans, it is always a good idea to keep the rewards versus consequences balanced in our minds.  I often use the phrase, ‘when one makes the decision (for example, to stay up all night and surf the net) they also accept the consequences”.  Sometimes good happens, but most of the time bad and sometimes catastrophic events can occur.

 

HABITS

 

The second part of the individualized addiction cycle is a set of habits that generally lead to Internet use.  Some counselors may refer to this as ritualistic or as a person being on autopilot where the behavior is almost fully automatic and, once initiated, the activities are generally done without thinking.  The preceding cycle (Figure 1) discusses preoccupation, which is thought without action (it may lead to action), whereas this cycle addresses a set of habits (ritual) that are typically completed without thought.

 

A using ritual is a behavior that leads to Internet use.  For example, it may be as simple as an urge to get the latest information about a friend or an urge to“try my luck” due to viewing a poker program on television.  In any case, once the ritual is initiated, it is very difficult to stop the process.  For a compulsive Internet user, it is virtually impossible without professional help.

 

Another assignment for the addicted individual is to describe what keys their Internet use. List and analyze the activities and behaviors leading to use.  The objective is that the better we understand what motivates an individual; the easier it is to interrupt the cycle.  The second part of the exercise is to identify what could be done to disrupt the process.   This may be as simple as planning outdoor activities that reduce the Internet or renting a movie for an evening of entertainment at home with the family.  Whatever the case may be, the better one understands themselves, the easier it is to manage their lives and to make better decisions.

 

COMPULSIVE USE                                              

 

The third element of Figure 2 is compulsive use and represents the actual use of the Internet.  Generally, the individual expects to experience an emotional high when they resume use.  Unfortunately, the opposite emotions, of fear, hopelessness, helplessness, shame, guilt, depression, and despair are often encountered.  One must remember that our minds retain the positive memories and have a tendency to set aside the negative ones.   Consequently, the individual ‘thinks’ he/she will experience a super high, when, in fact, he/she has been deceived by his/her own mind.  I think one of the root causes of severe depression is when the individual is expecting an unrealistic outcome and finally realizes he/she has to deal with a set of negative consequences.

 

CONSEQUENCES/FEELINGS OF HOPELESSNESS

 

The final element of the cycle is “consequences/feeling of hopelessness” Generally, the feelings of shame and guilt are experienced following a resumption of use.   However, the addicted individual’s mind attempts to soften his/her despair by processing thoughts such as “I will never use it again”; “things will be different in the future”.  The effect of this mental defense mechanism is to alleviate the bad feeling as quickly as possible by processing the neutralizing thoughts.  So, instead of facing the addiction, the individual’s mind has found another way to deny the addiction.  Consequently, the cycle continues.

 

PREVENTION/TREATMENT

 

Marlatt and Gordon described a comprehensive relapse prevention technique for alcohol and other drug addicts in 1995.  This treatment application will also work for problematic use of the Internet.   They suggested an approach where high-risk situations were assessed and then coping strategies were developed for each situation.  The following factors were analyzed for each situation:

q       Self-Efficacy: The individual’s perception of his/her ability to cope with situations.

q       Expectations:  What is the consequence to the user of a specific behavior?

q       Attribute:  Why an individual exhibits a specific behavior. 

q       Decision-Making:  Methodology used when the individual chooses a specific action.

 

Once this analysis is complete, Marlatt and Gordon (1995) suggest the following intervention strategies:

 

Self-monitoring:     Maintaining a log of urges/needs to use the Internet.  Additional information such as intensity of urge and coping strategy employed may also be documented.

 

Direct observation:            The individual rates the degree of temptation due to various situations.  The individual may respond to an imaginary past episode or a fantasy about a past episode and then describe what he/she may have done differently to avoid future encounters.

 

Coping Skills:         This analytical tool is used to document the client’s ability to cope once a high-risk behavior is encountered.  This helps the individual to identify strengths and weaknesses and helps the client focus on areas that need improvement.

 

Decision Matrix:     The matrix is used to document the consequences of a specific decision or action.  It may be used to gather immediate, as well as delayed consequences and can document both positive and negative outcomes.

 

Behavior Commitment:    This tool is intended to establish limits on Internet use.  It is also a commitment to seek help at the first episode of use, to prevent a full-scale return to use.

 

Reminder Questions:        They are used to key specific avoidance actions in the event of a strong urge.

 

It follows that a primary goal of any prevention program is to enable the individual to cope with future, inevitable urges to use the Internet inappropriately.  The initial step is to identify the coping strategies that can be used in high-risk situations.  It is also important to discuss an implementation plan for how these skills will be used.  Some have referred to this process as setting up a self-management program.  According to Ricky George (1990), “ The goals of self-management programs are to teach the individual how to anticipate and cope with the problem of relapse.”  This approach generally combines behavioral skills training, cognitive interventions, and lifestyle changes to help the individual modify their behavior.

The most frequently applied prevention method is the cognitive-behavioral approach.  The primary feature of this approach is that it acknowledges the individual may have had little or no control over becoming a compulsive user but has total responsibility for the management of his/her recovery.

 

Recovery Model

 

This model is based on the concept that recovery is a process that requires the mastery of emotional, psychological, social, and recovery-related tasks.  These tasks, which become increasingly more challenging, are the foundation for recovery.  Recovery is defined as the ongoing process of improving one’s level of functioning while striving to maintain a non-problematic use of the Internet.  A brief overview of a recovery process follows:

 

1        Pre-treatment phase:   The individual experiences or becomes aware of:

q       Unpleasant consequences associated with his or her Internet use (family, friends, loss of freedom, etc.)

q       Loss of control of their life

q       Emotional pain (may motivate an individual to decide to enter treatment).

 

2        Initial stabilization:

q       Stop problematic use of the Internet

q       Professionally managed coping and emotional strategies (to ease the discontent associated with urges to resume using)

q       Help with controlling impulsive behavior (counseling)

 

Phase 1:        Recovery (Getting Started)

q       Helps individuals to accept and comprehend the addiction process

q       Identify use triggers:  Develop a plan to avoid and control impulses.

q       Learn problem-solving, stress management, and anger management skills.

q       Accept personal responsibility for self (choices, decisions, behaviors, and consequences)

q       Express feelings

 

 

Phase 2:        Recovery (Early)

q       Accepts the need for recovery

q       Accepts responsibility for the management of Internet use

q       Begins to develop an Internet-free self-image

q       Acknowledges the need for lifestyle changes

q       Adjusts to non-use behavior – apply new problem-solving skills as needed

q       May struggle with peer and family issues as an Internet-free lifestyle is demonstrated

q       Improved self-image.

 

Phase 3 (Middle)

q       Changed behavior and cognitive awareness aligned with new self-concept.

q       Accepts responsibility for own recovery.

q       Recognizes and embraces the success of recovery.

q       Incorporates problem-solving skills into a new lifestyle.

q       Comfortable with lifestyle changes.

q       Continues to struggle with peer and family issues.

q       Learns to balance and control life.

 

Phase 4 (Advanced)

q       Focus on learning coping skills to help deal with peers and family

q       Increases the scope of life; starts to fulfill potential.

q       Develops balance and takes control of life.

q       Develops independence from the treatment program – develops self-initiative.

q       Accepts identity as a recovering individual.

 

After Care

q       Positive experiences fuel personal growth.

q       Focus on the total person (activities, spiritual growth, and independence).

 

Keys to Avoid A Return to Problematic Internet Use

q       High Activity Level: An idle mind often wanders in the wrong direction.

q       “To Do” lists to guide daily  activities

q       Goal setting to acknowledge and reward success

q       Individual reward system:     Work toward a specific individualized reward.  For example, new car, trip, clothes

q       Plan pleasurable activities:  Hobbies, travel, reading, etc.

q       Plan self-improvement activities: Items that will help the individuals feel good about themselves.

o       Exercise/ active lifestyle

o       Nutrition program

o       Rest/relaxation time

o       Manage stress

o       Think positive

q       Avoidance of high-risk situations and activities

o       Events that previously led to use

o       Avoid people/functions whose focus in on Internet use

o       Avoid ‘things’ that have triggered previous ‘return to problematic use’

q       Develop mind-management techniques:   Block negative thought processes.  The mind always leads the physical act (i.e., an individual thinks positively regarding an activity before they do the activity).  Consequently, if we could train our minds to detect ‘wrong’ thinking (about Internet use), then we could alter or disrupt those thoughts and focus on different things or thought processes to avoid actually using it.

q       Avoid overconfident feelings, such as, “I am in control and I have this problem licked”.  Generally, overconfidence leads to high-risk behavior and poor decision-making.

q       Avoid out-of-balance emotional states.  Either feeling too good (overconfident) or too bad (depression) can lead to a resumption of use.

q       Forgetting or rationalizing away the pain and anguish of the former lifestyle.  Our minds will sometimes focus only on the pleasurable aspects of a former activity and completely mask (or forget) the negative consequences.  At times, individuals are convinced that returning to a former lifestyle would be wonderful (feeling, emotions, etc.)  Also, when they actually return to that lifestyle, they become deeply depressed as the reality of their actual use is realized.  The mind is a wonderful thing, but it too must be monitored and trained and one must realize that the mind can be misleading in some cases.

q       Think positive; act positive, and surround yourself with positive people.   Remember the little engine that said, “I can”.