Applications

The Internet is a term which denotes a variety of functions accessible on-line such as the World Wide Web (WWW), chat rooms, interactive games, news groups, or database search engines. Young (1996) noted that addicts typically become addicted to a particular application which acts as a trigger for excessive Internet use. Therefore, the clinician needs to determine which applications are most problematic for the addicted user. A thorough assessment should include an examination of the extent of use among particular applications. The clinician should ask the patient several relevant questions, (a) What are the applications you use on the Internet? (b) How many hours per week do you spend using each application? (c) How would you rank order each application from best to least important? and (d) What do you like best about each application? If this is difficult to note, the patient may keep a log near the computer in order to document such behaviors for the next week’s session.

The clinician should review the answers to the above questions in order to determine if a pattern emerges, such as reviewing those applications ranked one or two in terms of importance and how many hours the patient spends on each. For example, the patient may rank chat rooms as number one in terms of importance and use them 35 hours per week compared to lower ranked newsgroups which are only used 2 hours per week. Another patient may rank newsgroups as number one and use them 28 hours per week compared to the lower ranked World Wide Web which is only used 5 hours per week.

Emotions

Peele (1991, pg. 43) explained the psychological hook of addiction as "it gives you feelings and gratifying sensations that you are not able to get in other ways. It may block out sensations of pain, uncertainly, or discomfort. It may create powerfully distracting sensations that focus and absorb attention. It may enable a person to forget or feel "okay" about some insurmountable problems. It may provide an artificial, temporary feeling of security or calm, of self-worth or accomplishment, of power and control, or intimacy or belonging." It is these perceived benefits which explain why a person keeps coming back to the addictive experience.

Addictions accomplish something for the person, however illusory or momentary these benefits may actually be. Because of the mental pleasure that people find in their addictions, they begin to behave more intensely about them. Feelings of excitement, euphoria, and exhilaration typically reinforce addictive patterns of Internet use. Addicts find pleasant feelings when on-line in contrast to how they feel when off-line. The longer a patient is away from the Internet, the more intense such unpleasant feelings become. The driving force for many patients is the relief gained by engaging in the Internet. When they are forced to go without it, they feel a sense of withdrawal with racing thoughts "I must have it,’ "I can’t go without it," or "I need it." Because addictions serve a useful purpose to the addict, the attachment or sensation may grow to such proportions that it damages a person’s life. These feelings translate into cues which cultivate a psychological longing for the euphoria associated with the Internet.

To best focus on emotional triggers, the clinician should ask the patient "How do you feel when off-line?" The clinician should then review the responses and determine if they range on a continuum of unpleasant feelings such as lonely, unsatisfied, inhibited, worried, frustrated, or troubled.

The clinician would then ask the patient "How do you feel when using the Internet?" Responses such as excited, happy, thrilled, uninhibited, attractive, supported, or desirable indicate that use of the Internet has altered the patient’s mood state. If it is difficult for the patient to determine such emotions, ask the patient to keep a "feelings diary." Have the patient carry a notebook or card in order to write down feelings that are associated with being both off-line and on-line.

Cognitions

Addictive thinkers, for no logical reason, will feel apprehensive, when anticipating disaster (Twerski, 1990). While addicts are not the only people who worry and anticipate negative happenings, they tend to do this more often than other people. Young (1996) suggested that this type of catastrophic thinking may contribute to addictive Internet use in providing a psychological escape mechanism to avoid real or perceived problems. In subsequent studies, she found that maladaptive cognitions such as low self-esteem and worth, and clinical depression triggered pathological Internet use (Young, 1997a, Young 1997b). Young (1997a) hypothesized that those who suffer from deeper psychological problems may be the ones who are drawn the most to the anonymous interactive capabilities of the Internet in order to overcome these perceived inadequacies.