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Monday, December 02, 2013

How to assess Internet Addiction in the New Inpatient Treatment Center

We opened the first inpatient treatment center for Internet Addiction in September, 2013 at the Bradford Regional Medical Center in Bradford, Pa (http://www.brmc.com/internetaddiction). 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.  With so many practical uses of the Internet signs of addiction can easily be masked or justified.  Further, clinical assessments are often very comprehensive and cover relevant disorders for psychiatric conditions and addictive disorders. However, given its newness, symptoms of Internet addiction may not always be revealed in an initial clinical interview. While self-referrals for Internet addiction are becoming more common, often the client does not present with complaints of Internet or mobile addiction.  People may initially present with signs of clinical depression, bi-polar disorder, anxiety, or obsessive-compulsive tendencies, and hide signs of Internet addiction on clinical interview. 
When we assess clients for admissions to the inpatient unit, we follow a clear assessment tool as , diagnosing Internet addiction can be challenging.  Given the dependence we have on technology, detecting and diagnosing Internet addiction is difficult as its legitimate business and personal use often mask addictive behavior.  The best method to clinically detect compulsive use of the Internet is to compare it against criteria for other established addictions.  Early studies likened Internet addiction to addictive syndromes similar to impulse-control disorders on the Axis I Scale in the DSM (APA, 1994) and utilized various forms of DSM-IV based criteria to define the disorder. Of the all the references in the DSM, Pathological Gambling was viewed as most akin to this phenomenon. In my work trying to classify the problem, I develop the Internet Addiction Diagnostic Questionnaire (IADQ) as a screen tool (Young, 1998a). The questionnaire quickly gained significant popularity. It is now widely cited in the academic literature and used in a multitude of studies and clinics as a screening tool. The IADQ assesses clients with the following questions:
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 significant relationship, job, educational or career opportunity because of the Internet?
7.      Have you lied to family members, therapist, 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)?  
Answers should evaluate non-essential Internet usage such as for non-business or academically related use.  Endorsing five or more of the questions over a six-month period is considered addictive or dependent Internet use, although more recent studies that empirically tested the IADQ found that using 3 or 4 criteria where just as robust in diagnosing Internet addiction as using 5 or more and suggested that the cutoff score of 5 criteria might be overly stringent (Dowling & Quirk, 2009). I err on the side of caution and stick to the 5 criteria that I had originally developed. Associated features of the disorder may be present such as ordinarily excessive Internet use, neglect of routine duties or life responsibilities, social isolation, and being secretive about online activities or a sudden demand for privacy when online. While the IADQ provides a means to screen for Internet addiction, these warning signs can often be masked by cultural norms that encourage and reinforce technology use.  Even if a client meets all of the criteria, signs of abuse can be rationalized as, “I need this for my job” “I need this for school”. 
Using the IADQ (see http://www.netaddiction.com for details on the development of the test), we screen patients for Internet addiction. We are able to properly assess the presence of the disorder, and combined with a thorough psychiatric exam and medical history, we determine the basis for admissions criteria. If you are looking for more information on the inpatient unit or further details on how to apply to the program, please visit http://www.brmc.com/internetaddiction or http://netaddiction.com.