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Dr. Maressa Hecht-Orzack of McLean Hospital founded the Computer/Internet Addiction Service in the Spring of 1996. She indicated that the referrals she received were from various clinics throughout the hospital instead of direct self-referrals for Internet addiction. She reported that primarily depression and bi-polar disorder in its depressive swing were co-morbid features of pathological Internet use. Hecht-Orzack noted that patients typically hide or minimize their addictive Internet use while being treated for the referred disorder. Since it is likely that a patient will self-refer more readily for a psychiatric illness than for pathological Internet use, the clinician should screen for maladaptive cognitions which may contribute to the patient’s addictive use of the Internet. Clinicians should evaluate if patients maintain deep core beliefs about themselves such as "I am no good" or "I am a failure" in order to determine if these may contribute to their pathological Internet use. It is important to note that intervention should focus on effective management of the patient’s primary psychiatric illness and note whether this treatment ameliorates the symptoms of pathological Internet use.
Life Events
A person is vulnerable to addiction when that person feels a lack of satisfaction in one’s life, an absence of intimacy or strong connections to others people, a lack of self-confidence or compelling interests, or a loss of hope (Peele, 1991, pg. 42). In a similar manner, individuals who are dissatisfied or upset by a particular area or multiple areas of their lives have an increased likelihood of developing Internet addiction because they don’t understand another way of coping (Young 1997a, Young 1997b). For example, instead of making positive choices that will seek out fulfillment, alcoholics typically drink which dulls the pain, avoids the problem, and keeps them in a status quo. However, as they become sober, they realize that their difficulties have not changed. Nothing is altered by drinking, yet it appears easier to drink than to deal with the issues head on. Paralleling the alcoholics’ behaviors, patients use the Internet to dull the pain, avoid the real problem, and keep things in status quo. However, once off-line, they realize that nothing has changed. Such substitution for missing needs often allows the addict to temporarily escape the problem but the substitute behaviors are not the means to solve any problems. Therefore, it is important for the clinician to assess the patient’s current situation in order to determine if he or she is using the Internet as a "security blanket" to avoid an unhappy situation such as marital or job dissatisfaction, medical illness, unemployment, or academic instability.
For example, Mary is a discontented wife who views her marriage as empty, full of discord, and sexual dissatisfaction. Mary discovers Cybersex as a disease free outlet to express desires both fantasized about or neglected within her marriage. She also meets new on-line friends in a chat room, or in a virtual area which allows multiples users to speak to one another in real time. These new on-line friends are the ones to whom she turns in order to obtain the intimacy and understanding missing with her husband.
TREATMENT STRATEGIES FOR PATHOLOGICAL INTERNET USE
Use of the Internet is legitimate in business and home practice such as in electronic correspondence to venders or electronic banking. Therefore, traditional abstinence models are not practical interventions when they prescribe banned Internet use. The focus of treatment should consist of moderation and controlled use. In this relatively new field, outcome studies are not yet available. However, based upon individual practitioners who have seen Internet addicted patients and prior research findings with other addictions, several techniques to treat Internet addiction are: (a) practice the opposite time in Internet use, (b) use external stoppers, (c) set goals, (d) abstain from a particular application, (e) use reminder cards, (f) develop a personal inventory, (g) enter a support group, and (h) family therapy.
The first three interventions presented are simple time management techniques. However, more aggressive intervention is required when time management alone will not correct pathological Internet use. In these cases, the focus of treatment should be to assist the patient in developing effective coping strategies in order to change the addictive behavior through personal empowerment and proper support systems. If the patient finds positive ways of coping, then reliance upon the Internet to weather frustrations should no longer be necessary. However, keep in mind that in the early days of recovery, the patient will most likely experience a loss and miss being on-line for frequent periods of time. This is normal and should be expected. After all, for most patients who derive a great source of pleasure from the Internet, living without it being a central part of one’s life can be a very difficult adjustment.
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