Intervention for Pathological and Deviant Behavior Within an On-Line Community - Techniques for the Treatment of Internet addiction

Written by Dr. Kimberly Young and Dr. John Suler

Setting Goals

Many attempts to limit Internet usage fail because the user relies on an ambiguous plan to trim the hours without determining when those remaining on-line slots will come (Young, 1998). In order to avoid relapse, structured sessions should be programmed for the subject by setting reasonable goals, perhaps 20 hours instead of a current 40. Then, schedule those twenty hours in specific time slots and write them onto a calendar or weekly planner. The subject should keep the Internet sessions brief but frequent. This will help avoid cravings and withdrawal. As an example of a 20-hour schedule, the subject might plan to use the Internet from 8 to 10 p.m. every weeknight, and 1 to 6 on Saturday and Sunday. Or a new 10-hour schedule might include two weeknight sessions from 8:00 - 11:00 p.m., and an 8:30 am - 12:30 p.m. treat on Saturday. Incorporating a tangible schedule of Internet usage will give the subject a sense of being in control, rather than allowing the Internet to take control (Young, 1998).

Bill was a busy corporate marketing executive who found himself spending every evening on-line, and ignoring his wife and two children. He belonged to over 50 newsgroups and read through over 250 E-mails per day. Bill had no significant clinical history, but found himself immersed with newsgroups. He lamented, "My wife complains constantly and my children are always angry with me because I prefer the computer to spending time with them." Bill was very receptive to goal setting and planned his on-line sessions every week. He limited the number of newsgroups from 50 to 25, choosing only the most salient ones. He implemented a specific, time-limited schedule coupled with external stoppers such as an alarm clock to control his on-line habit and make time for his family.

Abstinence

Young (1996a) suggested that a particular application such as chat rooms, interactive games, newsgroups, or the World Wide Web may be the most problematic for the subject. If a specific application has been identified and moderation of it has failed, then abstinence from that application may be the next appropriate intervention. The subject must stop all activity surrounding that application. This does not mean that subjects can not engage in other applications which they find to be less appealing or those with a legitimate use. A subject who finds chat rooms addictive, may need to abstain from them. However, this same subject may use e-mail or surf the World Wide Web to make airline reservations or shop for a new car. Another example may be a subject who finds the World Wide Web addictive and may need to abstain from it. However, this same subject may be able to scan newsgroups related to topics of interest about politics, religion, or current events.

Abstinence is most applicable for the subject who also has a history of a prior addiction such as alcoholism or drug use. Marcia is a 39 year old controller for a major corporation. She had a ten year problem with alcoholism before she entered a local AA support group. While in her first year of recovery, she began to use the Internet to help with her home finances. Initially, Marcia spent a total of 15 hours per week using electronic mail and finding potential stock information on the World-Wide-Web. Until she discovered chat rooms, then her on-line time jumped dramatically to an estimated 60 to 70 hours per week as she chatted and routinely engaged in cybersex. As soon as she came home from work, Marcia rushed to her computer and stayed there the rest of evening. Marcia often forgot to eat dinner, called in sick to work to spend the day on-line, and took caffeine bills to help keep her alert and awake to indulge in her Internet habit. Her on-line habit had impaired her sleep patterns, health, job performance, and familial relationships. Marcia explained, "I have an addictive personality and do everything to excess, but at least being addicted to the Internet is better than being an alcoholic. I fear if I gave up the Internet I would begin drinking again." In this case, chat rooms were the trigger for Marcia's compulsive behavior. The focus of treatment for Marcia included abstinence from chat rooms with the continuance of using the Internet for productive purposes.

Subjects with a premorbid history of alcohol or drug addiction often find the Internet a physically "safe" substitute addiction as Marcia's case illustrates. Therefore, the subject becomes obsessed with Internet use as a way to avoid relapse in drinking or drug use. However, while the subject justifies the Internet is a "safe" addiction, he or she still avoids dealing with the compulsive personality or the unpleasant situation triggering the addictive behavior. In these cases, subjects may feel more comfortable working towards an abstinence goal as their prior recovery involved this model. Incorporating past strategies that have been successful for these subjects will enable them to effectively manage the Internet so that they can concentrate on their underlying problems.

Reminder Cards

Often subjects feel overwhelmed because, through errors in their thinking, they exaggerate their difficulties and minimize the possibility of corrective action (Young, 1998). To help the subject stay focused on the goal of either reduced use or abstinence from a particular application, have the subject make a list of the, (a) five major problems caused by addiction to the Internet, and (b) five major benefits for cutting down Internet use or abstaining from a particular application. Some problems might be listed such as lost time with one's spouse, arguments at home, problems at work, or poor grades. Some benefits might be, spending more time with one's spouse, more time to see real life friends, no more arguments at home, improved productivity at work, or improved grades.