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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.

Next, have the subject transfer the two lists onto a 3x5 index card and have the subject keep it in a pants or coat pocket, purse, or wallet. Instruct subjects to take out the index card as a reminder of what they want to avoid and what they want to do for themselves when they hit a choice point when they would be tempted to use the Internet instead of doing something more productive or healthy. Have subjects take the index card out several times a week to reflect on the problems caused by their Internet overuse and the benefits obtained by controlling their use as a means to increase their motivation at moments of decision compelling on-line use. Reassure subjects that it is well worth it to make their decision list as broad and all-encompassing as possible, and to be as honest as possible. This kind of clear-minded assessment of consequences is a valuable skill to learn, one that subjects will need later, after they have cut down or quite the Internet, for relapse prevention.

Marcia, who we discussed earlier, utilized a reminder card to help abstain from chat rooms. She attached the card to her computer to help fight her cravings. Her list of problems included: risked loss of job, hurting her mother and children who hardly spoke with, lost sleep, and an increase in catching viral infections. Her list of benefits included: improved work performance, better relationships with her family, increased sleep, and enhanced health.

Personal Inventory

Whether the subject is trying to cut down or abstain from a particular application, it is a good time to help the subject cultivate an alternative activity. The clinician should have the subject take a personal inventory of what he or she has cut down on, or cut out, because of the time spent on the Internet. Perhaps the subject is spending less time hiking, golfing, fishing, camping, or dating. Maybe they have stopped going to ball games or visiting the zoo, or volunteering at church. Perhaps it is an activity that the subject has always put off trying, like joining a fitness center or put off calling an old friend to arrange to have lunch. The clinician should instruct the subject to make a list of every activity or practice that has been neglected or curtailed since the on-line habit emerged. Now have the subject rank each one on the following scale: 1 - Very Important, 2 - Important, or 3 - Not Very Important. In rating this lost activity, have the subject genuinely reflect how life was before the Internet. In particular, examine the "Very Important" ranked activities. Ask the subject how these activities improved the quality of his or her life. This exercise will help the subject become more aware of the choices he or she has made regarding the Internet and rekindle lost activities once enjoyed. This technique was utilized with most of the on-line subjects and appeared particularly helpful for those who felt euphoric when engaged in on-line activity by cultivating pleasant feelings about real life activities and reduced their need to find emotional fulfillment on-line.

Individual Therapy and Support Groups

Obviously, the limited availability of support groups or specialists in Internet addiction recovery is the major impetus for seeking on-line consultation. It is important to also keep in mind that in many cases, on-line consultation is not intended to face-to-face therapy and further treatment is recommended. Therefore, a large part of the on-line service is to assist subjects in locating drug and alcohol rehabilitation centers, 12 Step recovery programs, or therapists who offer recovery support groups that will include those addicted to the Internet. This outlet will be especially useful for the Internet addict who has turned to the Internet in order to overcome feelings of inadequacy and low self-esteem. Further treatment, especially recovery groups, will address the maladaptive cognitions leading to such feelings and provide an opportunity to build real life relationships that will release their social inhibitions and need for Internet companionship. Lastly, these groups may help the Internet addict to find real life support to cope with difficult transitions during recovery akin to AA sponsors.

Some subjects may be driven towards addictive use of the Internet due to a lack of real life social support. Young (1997b) found that on-line social support greatly contributed to addictive behaviors among those who lived lonely lifestyles such as homemakers, singles, the disabled, or the retired. This study found that these individuals spent long periods of time home alone turning to interactive on-line applications such as chat rooms as a substitute for the lack of real life social support. Furthermore, subjects who recently experienced situations such as a death of a loved one, a divorce, or a job loss may respond to the Internet as a mental distraction from their real life problems (Young, 1997b). Their absorption in the on-line world temporarily makes such problems fade into the background. If the on-line assessment uncovers the presence of such maladaptive or unpleasant situations, treatment should focus on improving the subject’s real life social support network.

The clinician should help the client find an appropriate support group that best addresses his or her situation. Support groups tailored to the subject’s particular life situation will enhance the subject’s ability to make friends who are in a similar situation and decrease their dependence upon on-line cohorts. If a subject leads one of the above mentioned "lonely lifestyles" then perhaps the subject may join a local interpersonal growth group, a singles group, ceramics class, a bowling league, or church group to help meet new people. If another subject is recently widowed, then a bereavement support group may be best. If another subject is recently divorced, then a divorcees support group may be best. Once these individuals have found real life relationships they may rely less upon the Internet for the comfort and understanding missing in their real lives.

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