Results

The sample included 23 females and 12 males with an average of 14 years of clinical practice. Their affiliations ranged as follows: 65% worked in private practice, 20% were employed by a community mental health clinic, 10% worked in a university counseling center, and 5% were employed in a drug and alcohol rehabilitation center. Approximately 87% of survey respondents were from the United States, and 13% were from United Kingdom and Canada.

Table 1 suggests that clients are most likely to present with direct complaints of compulsive Internet use, relationship difficulties, or a prior addiction problem and are less likely to present with a psychiatric illness. Respondents noted that 80% of their clients used email, 70% chat rooms, 10% newsgroups, 30% interactive online games, and 65% used the World-Wide-Web (primarily to view pornography or to utilize online trading or auction house services). Respondents reported an average caseload of nine clients who they classified as Internet-addicted, with a range of two to fifty clients treated within the past year. It should be noted that 95% of the respondents reported that the problem was more widespread than these numbers indicate.

Internet Addiction is a broad term covering a wide-variety of behaviors and impulse-control problems.¹³ Qualitative results gleaned from this study suggest that five specific sub-types of Internet addiction could be categorized:

1. Cybersexual Addiction - compulsive use of adult web sites for cybersex and cyberporn.
2. Cyber-relationship Addiction – over-involvement in online relationships.
3. Net Compulsions - obsessive online gambling, shopping, or online trading.
4. Information Overload - compulsive web surfing or database searches.
5. Computer Addiction - obsessive computer game playing (e.g., Doom, Myst, or Solitaire).

Qualitative analysis indicated that a leading factor underlying pathological or compulsive use of the Internet was the anonymity of electronic transactions. Specifically, anonymity was associated with four general areas of dysfunction:

1. Encouraged deviant, deceptive, and even criminal acts such as viewing and downloading obscene images (e.g., pedophilia, urination, or bondage fantasies) or illegal images (e.g., child pornography) widely available on adult web sites. It should be noted that the evidence indicates that clients who entertained deviant sexual fantasies involving children and adolescents did not attempt to contact children or adolescents beyond the Internet. Commentary suggested that the existence of deviant fantasies did not necessarily equate with or reliably predict that the sexual molestation of children will occur or has occurred. The behavior began out of curiosity and soon became an obsession. In cases of Cybersexual addiction, sex offender psychotherapy was offered to reduce potential risk.
2. Provided a virtual context that allowed overly shy or self-conscious individuals to interact in a socially safe and secure environment. Over-reliance upon on-line relationships resulted in significant problems with real life interpersonal and occupational functioning. In such cases, cognitive-behavioral and interpersonal psychotherapy techniques were applied in to reduce avoidant behavior and to enhance social skills.
3. Interactive components of the Internet facilitated cyberaffairs or extramarital relationships formed on-line that negatively impacted marital or family stability, primarily leading to separation and divorce. Individual and marital therapy and family therapy were used when couples’ worked towards reconciliation after the online infidelity.
4. The ability to develop alternative online personas, dependent upon a user’s mood or desires, that provided a subjective escape from emotional difficulties (e.g., stress, depression, anxiety) or problematic situations or personal hardships (e.g., job burnout, academic troubles, sudden unemployment, marital discord). The immediate psychological escape found within the "fantasy" on-line environment served as a primary reinforcement for the compulsive behavior. Underlying mood disorders and psychosocial issues were treated with psychotherapy and pharmacological interventions as appropriate.

Table 2 shows a summary of attitudes maintained among therapists who have treated compulsive use of the Internet. Not surprisingly, respondents strongly agreed that addictive use of the Internet is a serious problem akin to other established addictions, felt that the problem was underestimated and that more attention and research in this area was necessary. Respondents considered the implementation of an Internet addiction support group at their agency to provide intervention and believed that moderation of compulsive use was possible.

Discussion

Approximately 83 million Americans are currently online with that number expected to grow by 12 million in the next year alone.¹¹ As the popularity of the Internet rapidly continues to grow, cyber-disorders may pose a serious clinical threat, as little is understood about the treatment implications of this relatively new and often unrecognized phenomenon. Due to the Internet’s encouraged use for retail and business applications, it is highly likely that the nature and scope of the familial, social, and occupational consequences may be underestimated. Therefore, public policy matters concerning the marketing and promotion of the Internet should be considered from a mental health perspective. As a profession, prevention programs, recovery centers, support groups, and the integration of training workshops specializing in Internet addiction should be encouraged to address the emergence of such cyber-related problems.

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