Intervention for pathological and deviant behavior within an on-line community.

by Dr. Kimberly Young (University of Pittsburgh, Bradford) and Dr. John Suler (Rider University)

Abstract

Treatment for Internet addiction is limited as this is a relatively new and often unrecognized affliction. Individuals complain that they have been unsuccessful in finding knowledgeable professionals or support groups specializing in Internet addiction recovery. Given these limitations, an experimental on-line consultation service was developed for pathological and deviant behavior among Internet users. The primary goals of the service were to serve as an informational resource, to provide immediate access to knowledgeable professionals, to administer brief, focused interventions designed to control and moderate Internet use, and to assist in seeking further treatment when required. This paper will review various on-line interventions and discuss the efficacy and limitations of an on-line consultation for this client population.

Introduction

The Internet has been touted as a revolutionary technology among politicians, academicians, and businessmen. However, among a small but growing body of research, the term addiction has extended into the psychiatric lexicon that identifies problematic Internet use associated with significant social, psychological, and occupational impairment (Brenner, 1996; Egger, 1996; Griffiths, 1997; Loytsker & Aiello, 1997; Morahan-Martin, 1997; Thompson, 1996; Scherer, 1997; Young, 1996a; 1996b; 1997a; 1997b;1998).

This research has primarily focused on assessment and evaluation of the extent of the addictive use of the Internet. Of all the diagnoses referenced in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV; American Psychiatric Association, 1995), Young (1996a) viewed Pathological Gambling as most akin to the pathological nature of Internet use and defined this as an impulse-control disorder which does not involve an intoxicant. An eight-item questionnaire which modified criteria for pathological gambling was developed to serve as a screening instrument to classify subjects as "dependent" or "non-dependent" users (See Appendix 1). It should be noted that while this scale provides a workable measure of Internet addiction, further study is needed to determine its construct validity and clinical utility. Survey results documented 396 case studies who experienced significant job, family, academic and financial problems subsequent to heavy patterns of chat room, newsgroup, and Multi-User Dungeon (i.e., on-line games) use.

Subsequent research on compulsive Internet use which used on-line survey methods showed that self proclaimed "addicted" users often looked forward their next net session, felt nervous when off-line, lied about their on-line use, easily lost track of time, and felt the Internet caused problems in their jobs, finances, and socially (e.g., Brenner, 1996; Egger, 1996; Thompson, 1996). Two campus-wide surveys conducted at the University of Texas at Austin (Scherer, 1997) and Bryant College (Morahan-Martin, 1997) have further documented that pathological Internet use is problematic for academic performance and relationship functioning using independent criteria for assessment.

Despite the increased awareness that pathological Internet use is a legitimate concern, treatment programs that address Internet addiction are only slowly beginning to emerge. Individuals who suffer from this have frequently complained that they have been unsuccessful in finding knowledgeable professionals or support groups specializing in Internet addiction recovery as this is still a relatively new and often unrecognized affliction. Therefore, an experimental on-line consultation service was developed in order to address pathological and deviant behavior among Internet users. The primary goals of the service were to serve as an informational resource, to provide immediate access to knowledgeable professionals, to administer brief, focused interventions designed to control and moderate Internet use, and to assist in seeking further treatment when required.

Methods

Serving as subjects were individuals who responded to an experimental on-line consultation service established at the web site for The Center for On-Line Addiction. Participants seeking on-line consultation initially completed a general assessment instrument designed to evaluate information related to pathological Internet use. This assessment form existed on a secured server in an effort to protect confidential information electronically transmitted. The assessment form included questions related to the presenting problem, level of Internet usage, prior clinical history, and demographic information. The main issue or specific nature of the presenting problem such as onset, frequency, and severity was initially assessed. Level of Internet usage was determined by examining the number of hours spent on-line per week (for non-academic or job-related purposes), the length of time using the Internet, and types of applications utilized. Prior clinical history was evaluated by asking relevant questions about prior addiction or psychiatric illness (e.g., depression, bipolar disorder, attention deficit disorder, obsessive-compulsive disorder). Completed forms were submitted directly to the principle investigator’s electronic mailbox for a consult that were answered within 48 hours.

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