Survey for Therapists treating cases of Internet Addiction

Section I: The purpose of this survey is to project the incidence and clinical intervention involved in cases of pathological Internet use. This survey is exploratory in nature and all practitioners who have dealt with cases of Internet addiction in their practice are strongly encouraged to complete the survey. This survey should take approximately 5 to 10 minutes to complete. Your participation is completely voluntary and your answers will be kept confidential. Completion of this survey means that you understood and consent to the above. Thank you in advance for your participation and time.

1. Have you seen a rise in the number of clients who spend an excessive amount of  time using the Internet?

= Yes
= No

2. Have you seen clients who appear "addicted" to the Internet?

= Yes
= No

If "yes," please state how many cases have you seen

3. Have you seen clients who present themselves as having relationship difficulties (e.g., breakups, withdrawn from others, few friends) and later discover it is related to addictive use of the Internet?

= Yes
= No

If "yes," how many cases have you seen

4. Have you seen clients who present themselves with clinically related issues (e.g., depression, bi-polar disorder, anxiety) and later discover it is related to addictive use of the Internet?

= Yes
= No

If "yes," how many cases have you seen

5. Have you seen clients who are addicted to the Internet who also suffer from a prior addiction history (alcoholism, over-eating, or sex addictions)?

= Yes
= No

If "yes," how many cases have you seen

6. Has your program considered a support group for those clients who suffer from an addiction to the Internet?

= Yes
= No

7. Do you feel the problem is more widespread than the number of cases indicates?

= Yes
= No

8. What type of intervention strategy do you mostly utilize to treat these cases?

= Cognitive-Behavioral
= Psychodynamic
= Humanistic
= 12 Step Recovery

Other =

9. Do you believe moderation is possible to treat addictive Internet use?

= Yes
= No

10. What types of activities do your clients mostly perform on-line? (Check all that apply)

= E-mail
= Chat Rooms
= Newsgroups
= Multi-User Dungeons (interactive games)
= World Wide Web
Other =

11. In the space below, please describe the types of problems that are caused by your clients excessive Internet use?

12. Do your clients form new relationships on-line?

= Yes
= No

13. Do your clients form a new persona on-line?

= Yes
= No

14. Briefly describe the nature of what makes the Internet addictive among clients
     you have treated.

Section II: Below are a list of statements about your attitudes as a mental health professional regarding addictive use of the Internet. For each of the following, please circle the best response using the key below which most represents how much you agree or disagree with each statement.

1 = strongly agree
2 = agree
3 = neutral
4 = disagree
5 = strongly disagree

1. I feel that addictive use of the Internet may become a significant problem in our society?
1 2 3 4 5

2. I feel that mental health practitioners need to pay more attention to the ramifications of addictive use of the Internet?
1 2 3 4 5

3. I feel that addictive use of the Internet can be as serious as other established addictions (e.g., alcoholism) in terms of psychological and family problems?
1 2 3 4 5

4. I feel that counselors do not take Internet addiction seriously as a legitimate disorder?
1 2 3 4 5

5. I feel that more research is needed to better understand the nature of addictive
Internet use and how it is related to other psychiatric illnesses and addictive behaviors?
1 2 3 4 5

6. Are there any other comments you wish to address on the subject of addictive use of the Internet which this survey did not mention? If so, please use this space to make comments. (Use back of this sheet if necessary)

Section III: Please answer the following information.

Your Gender:

= Male
= Female

Type of Clinical Practice:

= University Counseling Center
= Private Practice
= Drug and Alcohol Rehabilitation Center
= Community Mental Health
= Psychiatric Hospital

Other =

Number of years in practice:

As part of our on-going research may we contact you to follow up on this survey? If so, how can we reach you?

Your Name:

E-mail:

Address 1:

Address 2:

City:

State or Province:

Postal Code:

Telephone:

When you're ready to send the survey, press this button:

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