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Most recently, studies have documented Internet addiction in a growing number of countries, such
as Italy (Ferraro et al., 2007); Pakistan (Suhail & Bargees, 2006); and the Czech Republic
(Simkova & Cincera, 2004).

Reports also indicate that Internet addiction has become a serious public health concern in China
(BBC News, 2005), Korea (Hur, 2006), and Taiwan (Lee, 2007).

About 10 percent of China’s more than 30 million Internet gamers were said to be addicted. To
battle what has been called an epidemic by some reports, Chinese authorities regularly shut down
Internet cafes, many illegally operated, in crackdowns that also include huge fines for their
operators.
INTERNET ADDICTION was first researched in 1996, and findings were presented at the American
Psychological Association. The study reviewed over 600 cases of heavy Internet users who
exhibited clinical signs of addiction as measured through an adapted version of the DSM-IV
criteria for pathological gambling (Young, 1996)

Addictions are defined as the habitual compulsion to engage in a certain activity or utilize a
substance, notwithstanding the devastating consequences on the individual’s physical, social,
spiritual, mental, and financial well-being. Instead of addressing life’s obstacles, tackling daily
stress, and/or confronting past or present trauma, the addict responds maladaptively by resorting
to a pseudo coping mechanism
Typically, addiction manifests both psychological and physical characteristics.

Physical dependence occurs when an individual’s body develops a dependence on a certain

substance and experiences withdrawal symptoms upon discontinuing the consumption, such as
drugs or alcohol. While initially an addictive substance induces pleasure to the user, his or her
continued consumption is driven more by a need to eliminate the anxiety brought about by its
absence, thus leading the individual to compulsive behavior.

Psychological dependency becomes evident when the addict experiences withdrawal symptoms
such as depression, cravings, insomnia, and irritability. Both behavioral addiction and substance
addiction usually give rise to psychological dependence.
students are the most at-risk population to develop an addiction to the Internet because of the
encouraged use of computers, wired dorms, and mobile Internet devices (Young, 2004).
Away from home and their parents’ watchful eyes, college students long have exercised their new
freedom by engaging in pranks, talking to friends at all hours of the night, sleeping with their
boyfriends and girlfriends, and eating and drinking things parents would not approve of. They
utilize that freedom by hanging out in chat rooms or sending messages to friends on Facebook or
MySpace with no parent to complain about their refusal to get off the computer.
For companies, Internet addiction has been shown to be both a legal liability as well as a
productivity problem. As corporations rely on management information systems to run almost
every facet of their business, employee Internet abuse and its potential for addiction has become
a possible business epidemic
DIAGNOSIS
DIAGNOSIS OF Internet addiction is often complex. Unlike chemical dependency, the Internet
offers several direct benefits as a technological advancement in our society and not a device to be
criticized as addictive. Individuals can conduct research, perform business transactions, access
libraries, communicate, and make vacation plans. Books have been written outlining the
psychological as well as functional benefits of the Internet in our lives. By comparison, alcohol or
drugs are not an integral or necessary part of our personal and professional lives, nor do they
offer any direct benefit.

People may initially present with signs of clinical depression, bipolar disorder, anxiety, or
obsessive-compulsive tendencies, only for the treating professional to later discover signs of
Internet abuse upon further examination (Shapiro, Goldsmith, Keck, Khosla, & McElroy, 2000).
Therefore, diagnosing Internet addiction upon clinical interview can be challenging
According to Dr. Maressa Hecht Orzack, the director of Computer Addiction Services at McLean
Hospital, a Harvard Medical School affiliate, and a pioneer in the study of Internet addiction,
Internet addicts demonstrate a loss of impulse control where life has become unmanageable for
the online user, yet despite these problems, the addict cannot give up the Internet. The computer
becomes the primary relationship in the addict’s life (Orzack, 1999).
classified as dependent online users were generally excessive about their online usage, spending
anywhere from 40 to 80 hours per week, with sessions that could last up to 20 hours (Greenfield,
1999; Young, 1998a). Sleep patterns were disrupted due to late-night log-ins, and addicts
generally stayed up surfing despite the reality of having to wake up early the next morning for work
or school. In extreme cases, caffeine pills are used to facilitate longer Internet sessions. Such
sleep deprivation caused excessive fatigue, impairing academic or occupational performance and
increasing the risk of poor diet and exercise.
ASESMEN
The Internet Addiction Diagnostic Questionnaire (IADQ) was the first screening measure developed for diagnosis (Young, 1998b). The following
questionnaire conceptualized the eight criteria for the disorder:

1. Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?

2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?

4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?

5. Do you stay online longer than originally intended?

6. Have you jeopardized or risked the loss of a significant relationship, job, or educational or career opportunity because of the Internet?

7. Have you lied to family members, therapists, or others to conceal the extent of involvement with the Internet?

8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety,
depression)
The diagnosis of pathological computer use in the upcoming revision of the DSM-5 (Block, 2008). Conceptually, the
diagnosis is a compulsive impulsive spectrum disorder that involves online and/or offline computer usage
(Dell’Osso, Altamura, Allen, Marazziti, & Hollander, 2006) and consists of at least three subtypes: excessive gaming,
sexual preoccupations, and e-mail/text messaging (Block, 2007).

All of the variants share the following four components:

(1) excessive use, often associated with a loss of sense of time or a neglect of basic drives;

(2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible;

(3) tolerance, including the need for better computer equipment, more software, or more hours of use; and

(4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue (Beard & Wolf,
2001; Block, 2008).
THE INTERNET ADDICTION TEST
(IAT)
The Internet Addiction Test (IAT) is the first validated instrument to assess Internet addiction
(Widyanto & McMurren, 2004). Studies have found that the IAT is a reliable measure that covers
the key characteristics of pathological online use. The test measures the extent of a client’s
involvement with the computer and classifies the addictive behavior in terms of mild, moderate,
and severe impairment.
Treatment
Use of the Internet is legitimate in business and home practice such as in electronic correspondence to
vendors or electronic banking.
The focus of treatment should consist of moderated Internet use overall. It is essential to help the client
target and abstain from the problematic application(s) while retaining controlled use over legitimate
Internet usage.
Treatment includes a variety of inventions and a mix of psychotherapy theories to treat the behavior and
address underlying psychosocial issues that often coexist with this addiction (e.g., social phobia, mood
disorders, sleep disorders, marital dissatisfaction, or job burnout).
To help clients abstain from problematic online applications, recovery interventions apply structured,
measurable, and systematic techniques. Using outcome data, cognitive-behavioral therapy (CBT) has
been found to be an effective approach with this population (Young, 2007)
In the early stages of recovery, clients will typically deny or minimize their habitual use of the
Internet and the consequences their behavior may have. Often, a loved one, a friend, a spouse, or
a parent has pushed the individual into seeking help. after diagnosis, the therapist should use
motivational interviewing techniques that encourage the client to commit to treatment as an
integral aspect of recovery. The concept of motivational interviewing evolved from experience in
the treatment of problem drinkers, and was first described by Miller
Motivational interviewing is a goal-directed style of counseling for eliciting behavior change by
helping clients to explore and resolve ambivalence. Motivational interviewing involves asking
open-ended questions, giving affirmations, and reflective listening. Motivational interviewing is
intended to confront the client in a constructive manner to evoke change, or to use external
contingencies such as the potential loss of a job or relationship to mobilize a client’s values and
goals to stimulate behavior change.

Clients dealing with addiction or substance abuse problems often feel ambivalent about quitting,
even after they admit they have a problem. They fear the loss of the Internet; they fear what life
might be like if they were unable to chat with online friends, engage in online activities, and use
the Internet as a form of psychological escape. Motivational interview helps clients confront their
ambivalence
Motivational interview
When did you first begin to use the Internet?

How many hours per week do you currently spend online (for nonessential use)?

What applications do you use on the Internet (specific sites/groups/ games visited)?

How many hours per week do you spend using each application?

How would you rank order each application from most to least important? (1 = first, 2 = second, 3 = third, etc.)?

What do you like most about each application? What do you like least?

How has the Internet changed your life?

How do you feel when you log offline?

What problems or consequences have stemmed from your Internet use? (If these are difficult for the client to describe, have the client keep a log near the computer in order to document
such behaviors for the next week’s session.)

Have others complained about how much time you spend online?

Have you sought treatment for this condition before? If so, when? Have you had any success?
The answers to these questions create a clearer clinical profile of the client. The therapist can
determine the types of applications that are problematic for the client (chat rooms, online gaming,
online pornography, etc.).

The length of Internet use, the consequences of the behavior, a history of prior treatment
attempts, and outcomes for any treatment attempts are also assessed. This helps clients begin
the process of examining how the Internet impacts their lives. It is helpful for the client to gain a
sense of responsibility for his or her behavior. Allowing clients to resolve their ambivalence in a
manner that gently pushes them helps them to be more inclined to acknowledge the
consequences of their excessive online use and engage in treatment.
Helping the client explore how he or she feels just before going online will help pinpoint the types
of emotions being covered by the behavior (or how the client is using the Internet to cope or
escape from problems).
Answers may include issues such as a fight with a spouse, depressed mood, stress at a job, or a
poor grade in school.
Motivational interviewing should explore how these feelings diminish when online, looking for how
the client rationalizes or justifies using the Internet (e.g., “Chatting makes me forget about the
fight with my husband”; “Looking at online porn makes me feel less depressed”; “Gambling online
makes me feel less stressed at work”; “Killing other players in an online game makes me feel
better about my poor grade at school”). Motivational interviewing is also meant to help the client
recognize consequences stemming from excessive or compulsive use.
Clients who become addicted to the Internet may suffer from a number of emotional and personal problems.
They see the Internet as a safe place to absorb themselves mentally to reduce their tension, sadness, or stress
(Young, 2007).
Individuals who may feel overwhelmed or may be experiencing job burnout or money problems or life-changing
events such as a recent divorce, relocation, or death in the family can absorb themselves in a virtual world inside the
computer.
They can lose themselves in anything from online pornography to Internet gambling and online gaming. Once online,
the difficulties in their lives fade into the background as their attention becomes completely focused on the
computer. Addressing all unhealthy or compulsive behaviors early on the evaluation process will aid the client.
Working within the motivational interviewing context, clients can see how they use the computer as a new way of
escaping without really dealing with the underlying problems in their lives. They will also learn that an addiction to
the Internet can be as harmful as other addictions they may have by continuing to avoid problems without ever
resolving them.
Excessive or problematic Internet use often stems from interpersonal difficulties such as
introversion or social problems (Ferris, 2001). Many Internet addicts fail to communicate well in
face-to-face situations (Leung, 2007). This is part of why they use the Internet in the first place.
Communicating online seems safer and easier for them. Poor communication skills can also
cause poor self-esteem and feelings of isolation, and can create additional problems in life, such
as trouble working in groups, making presentations, or going to social engagements.
Therapy needs to address how they communicate offline. Encouraging affect, communication
analysis, modeling, and role-playing are helpful interventions to apply to establish new ways of
interacting and social functioning (Hall & Parsons, 2001). Others may have limited social support
systems in place, which is in part why they turn to virtual relationships as a substitute for the
missing social connection in their lives. They turn to others on the Internet when feeling lonely or
in need of someone to talk to
Due to their addiction, clients often damage or lose significant real-life relationships, such as with
a spouse, a parent, or a close friend (Young, 2007). Often, these were individuals who provided
the addict with support, love, and acceptance before the Internet, and their absence only makes
the addict feel worthless and reinforces past notions of being unlovable.

Involving loved ones in recovery can be a rich source of nurturing and sponsorship to help a client
maintain sobriety and abstinence. Couples or family therapy may be necessary to help educate
loved ones about the addiction process and engage them more fully in helping the client maintain
boundaries established with the computer.