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.  

Inpatient Care for Internet Addiction: Is it Necessary?

Is Internet Addiction real? That is the question I am often asked. Of course it is, I reply, but I can see how many people still question if we can truly become addicted to technology.

It is not technology itself that causes the problem but it is in how we have come to use technology in our lives. Look around any airport, school yard, or mall - everyone is staring at their screens.  We have become socially removed. What is the impact of this technology when it does become excessive or compulsive?

In my 20 years of researching Internet Addiction, I have become the world’s leading expert. I say this because it is humbling and not in any arrogant way. I see how my research and academic studies have been applied by researchers all over the globe. I have consulted with hundreds of clinics about Internet addiction recovery and given many workshops to therapists. I say with that authority, Internet addiction is a real problem.

We debate this in America while other countries such as China and Korea have established treatment centers to deal with the problem for years. We lag behind other countries who have established clinics and university-wide studies in an effort to combat a distressing new problem in our culture.

Internet Addiction is real. Treatment is often necessary. It does not stand alone, most often those who suffer from Internet addiction also suffer from other clinical problems such as depression, anxiety, substance abuse, or social anxiety or phobia.

In September of 2013, I opened the nation’s first inpatient treatment center at the Bradford Regional Medical Center in Bradford, Pa. It is part of Behavioral Health Services Dual Diagnosis Program and we have received calls from all over the world. It says to me how widespread the problem is and how many people are hiding their addiction to technology.

Based on the calls alone, it seems people have such a serious problem with their online use that they have struggled for years in outpatient counseling being seen by therapists who either dismissed the behavior as normal or weren’t sure how to address.

Inpatient counseling is intended for the serious cases of Internet addiction. Treatment focuses on daily individual therapy and 72-hour medically-supervised digital detox is required.

“Do I believe that inpatient care is necessary for Internet addiction?” “Yes,” I exclaim. “Inpatient care is necessary!”

Addiction is addiction. Americans have lagged behind other countries in treating people who may suffer from this problem. We are BRMC are proud to be the first inpatient program in the U.S. to offer such help. While the DSM-5 has only just included Internet Gaming Addiction in Section 3 for conditions that need further research in this last revision, my prediction is that in the years to come, more research will happen, and future DSM revisions will then include Internet Addiction as real condition.   

FAQs Answered on the New Inpatient Internet Addiction Recovery Program at BRMC

I have received several calls from people looking for referrals to the new inpatient program on Internet Addictioin recovery at the Bradford Regional Medical Center. Here are some answers:

What are your recovery principles?
At BRMC, we offer unique and specialized treatment methods for Internet addiction recovery. We view the Internet as a productive tool and unlike other addiction rehab that use traditional abstinence models, we focus on healthy choices that you can make about your own Internet use. We teach you how to go on a digital diet so that you can learn to use technology in responsible ways that add to your life. Family support and involvement is also strongly encouraged.

How can someone get help?
The first step is to determine if there is a problem. A licensed psychologist or social worker trained in identification and treatment of Internet addiction can effectively perform an assessment to determine what level of care is most appropriate. Please call 1-800-446-2583 to speak to a professional.

Who can refer someone to the program?
We welcome referrals from psychiatrists, psychologists, social workers, case managers, Employee Assistance Programs (EAPs), insurance companies, managed care organizations, MH/MRs, children & youth, probation, friends, family members, self-referrals, and clergy. Referrals are confidential and can be made by anyone. BRMC does not discriminate in accepting patients based on ethnic or national origin, race, religion, disability, age or gender. If you would like further information, please call 1-800-446-2583.

Will my insurance company pay for services?
Unfortunately, Internet addiction is not a recognized disorder covered by insurance. We do provide additional Payment Information on our program and details on methods of payment.

Who has to know about my hospitalization?Only the people you authorize will know about your hospitalization and these people will receive only the information that is necessary for them to continue your care or to give you support once you are discharged.

How long will I stay?
Your time in the hospital depends on what your individual needs are. This is a 10-day program but additional time can be accommodated depending on your therapeutic need. Your individualized treatment plan focuses on what can be accomplished in the shortest periods of time. With this as a foundation for progress, you can continue treatment in an outpatient setting.

Call 24 Hours a Day – 1-800-446-2583

New Internet Addiction Inpatient Treatment and Recovery Program at BRMC

By now the news has been released that we have opened the new Internet Addiction Treatment and Recovery Program at the Bradford Regional Medical Center in Bradford, PA. We are excited to be part of this historic event, as the first program of its kind in the U.S. It is heart-felt for me to see my life's work become a reality and to hopefully build a program that will help many in need.

Internet Addiction

Contact us 1-800-446-2583 116 Interstate Parkway Bradford, PA 16701 Get Directions

The Internet Addiction Program is a part of the Behavioral Health Services Dual Diagnosis Unit at Bradford Regional Medical Center in Bradford, PA. The Internet Addiction Treatment and Recovery Program offers counseling and treatment for adults 18 years of age and older, the program is for those who have been unsuccessful overcoming the excessive use of the internet and electronic gaming on their own. The program involves a voluntary ten-day stay within a secure and dedicated patient unit. Internet addiction is any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. Internet Addiction has been called internet dependency and internet compulsiveness. By any name, it is a compulsive behavior that completely dominates the addicts’ life. Internet addicts make the internet a priority more important than family, friends, and work. The internet becomes the organizing principle of addicts’ lives. They are willing to sacrifice what they cherish most in order to preserve and continue their behavior.

We are committed to helping patients develop a healthier lifestyle free from addiction and abuse of electronic media.

The service is the first hospital based recovery program in the United States, and offers the first ever Digital Device Treatment Program in the nation.Our expert clinicians understand technology related behavioral addictions. They work with individuals, couples, and families to help them better understand and recover from an internet, video gaming or technology related behavioral addiction.

This inpatient program provides individual, group and family therapy through a unique, individualized treatment plan, of which aftercare planning, family and referral involvement are key components. Patients will be treated by a multidisciplinary team including psychiatrists, licensed psychologists, certified addiction counselors, psychiatric nurses, social workers, mental health therapists, case managers and support staff.

For seeking admissions to the program, please call the number above to receive our application.

History of my research on Internet Addiction since 1994

Here is an article from the Globe and Mail in Canada on how the Center for Internet Addiction Recovery started. It was a wild time for me. Personally, I was a young graduate fresh from graduate school and I had no idea what I was getting myself into and wow, did the publicity on my work really set a tone. I couldn't believe by age 30 I was doing so many interviews and I can't really say I knew what I was doing.

Professionally, I launched an entire field. I still look back in disbelief. I remember after my friend called me to tell me her and her husband had separated over his addiction to the Internet, I posted a small survey online. At the time (again, think 1994), I received maybe two email per month. The next morning, I awoke to over 40 emails responding to my survey. Most told me woes of how much they had lost because of the amount of time they spent on the Internet. People told me how they lost their jobs because they were online instead of working. People told me how they got separated or divorced because of their addiction to the Internet. Students across the country told me how they were addicted to the very tool that their universities were encouraging them to use. I quickly realized that I had hit a psychological nerve. This was a bigger issue than anyone had thought. I expanded my survey with more detailed questions. I wanted to know what it was like to be inside the mind of an Internet Addict.

I was drawn by the constant stories that followed. Some were amazing, simply amazing! I mean, I couldn't believe that people had lost a spouse or a loved one over the computer but it was true. At first, people told me how much they were addicted to chat rooms and pornography. Again, keep in mind this was 1994 before Facebook, Twitter, or eBay. The Internet was being touted as a revolutionary tool. And that it is. I don't take away any of the vast benefits of this technology. I did become the single voice that showed that there was also a dark side.

The Internet is not a benign tool. It has a life of its own. I was glad that I stuck to this earlier research. I remember that I was finishing up a fellowship at Strong Memorial Hospital in Rochester, NY. I had posted signs at all the colleges and libraries looking for people to participate in my research. I worked alone from my one bedroom apartment. I can't tell you why I kept going. The more I talked to others, the more I realized there was a problem with how much people consumed the Internet. It was the wild west of its day. I did not want to take away from any of the great potential that the Internet had to offer. Still, I knew there was this dark side, as people told me stories upon stories of how it damaged their lives.

I remember people crying on the phone with me or emailing me for help. I started the Center for Internet Addiction shortly thereafter. I knew I needed to a place to support my research and to offer counseling. It was often why people called. I started the center without a game plan. I had no idea what it would become.

I remember collecting all these case studies, still unsure what I was going to do with them. One day, walking through a K-mart in Rochester, I was struck by the idea of writing a book. I went to the local Borders (when they still existed) and bought several addiction recovery books. I am sure the clerk thought I had a problem. I studied each book looking at how it was set up, the ways the writer integrated theories with case studies, and I tried to teach myself how to write a book. The only thing I had ever written before that was my doctoral dissertation.

I completed my first draft in 1997 and went about trying to find an agent. Fifty rejections later -- an agent finally agreed to take me on. Another fifty editors rejected the book proposal until finally John Wiley and Sons agreed to take on the project. It was a thrilling time. My editor was a wonderful teacher. While my first draft needed considerable revision, she taught me and I learned. Eventually, my first book, Caught in the Net was published in 1998. It was met with criticism. I almost stopped studying Internet Addiction. It was hurtful and painful at the time. I was young and all I wanted to help others.

As I traveled across the country, I met people whose lives were changed because of my book. They would come up to me after my lectures thanking me for my work and for validating a problem that at that time no one else believed that they suffered from. I realized I was giving a voice to others who had nowhere else to turn.

I am glad that I stuck it out. Studying Internet Addiction changed my life forever. I am grateful that God gave me the courage and wisdom to do this -- and to hopefully help many who otherwise didn't have a voice.

New Internet Addiction Inpatient Treatment and Recovery Center Opening Soon!

It has been a while since I have had a chance to post on my blog. I apologize. Things have been hectic and crazy. I have been working with the Bradford Regional Medical Center to open the first inpatient hospital-based program on Internet Addiction Treatment and Recovery. I am very excited. The clinic is set to open September 1st, 2013. There is much to do to prepare. I will give you details as soon as I have them, for now, I can say it is the first inpatient treatment center for IA in the United States. We are excited to offer a program like this and I will serve as the Medical Director. I can hardly believe it.

As a refresher, I have been looking at several blog posts on Internet Addiction being included in the DSM-5. I think that there is much discussion still on what are the types of Internet addiction, what is healthy versus unhealthy signs of Internet use, what are the risk factors, and what are symptoms.

Since I have the new inpatient treatment center opening, I thought I would post a refresher that answers these frequent questions. Again, I will be sure to update you once the center is open!!

The first question, what are the type of Internet Addiction? 

Internet Addiction covers a variety of impulse-control problems, including: 

• Cybersex Addiction – compulsive use of Internet pornography, adult chat rooms, or adult fantasy role-play sites impacting negatively on real-life intimate relationships.
• Cyber-Relationship Addiction – addiction to social networking, chat rooms, and messaging to the point where virtual, online friends become more important than real-life relationships with family and friends.
• Net Compulsions – such as compulsive online gaming, gambling, stock trading, or compulsive use of online auction sites such as eBay, often resulting in financial and job-related problems. 
• Information Overload – compulsive web surfing or database searching, leading to lower work productivity and less social interaction with family and friends.
• Computer Addiction – obsessive playing of off-line computer games, such as Solitaire or Minesweeper, or obsessive computer programming.

The most common of these Internet addictions are Internet gaming and Internet sex addiction.

Healthy vs. unhealthy Internet use

The Internet provides a constant, ever-changing source of information and entertainment, and can be accessed from most smart phones as well as tablets, laptops, and computers. Email, blogs, social networks, and message boards allow for both public and anonymous communication about any topic. But how much is too much Internet usage?

Each person’s Internet use is different. You might need to use the Internet extensively for your work, for example, or you might rely heavily on social networking sites to keep in touch with faraway family and friends. Spending a lot of time online only becomes a problem when it absorbs too much of your time, causing you to neglect your relationships, your work, school, or other important things in your life. If you keep repeating compulsive Internet behavior despite the negative consequences in your offline life, then it’s time to strike a new balance.

To relieve unpleasant and overwhelming feelings

Many people turn to the Internet in order to manage unpleasant feelings such as stress, loneliness, depression, and anxiety. When you have a bad day and are looking for a way to escape your problems or to quickly relieve stress or self-soothe, the Internet can be an easily accessible outlet. Losing yourself online can temporarily make feelings such as loneliness, stress, anxiety, depression, and boredom evaporate into thin air. As much comfort as the Internet can provide, though, it’s important to remember that there are healthier (and more effective) ways to keep difficult feelings in check. These may include exercising, meditating, using sensory relaxation strategies, and practicing simple breathing exercises.

For many people, an important aspect of overcoming Internet and computer addiction is to find alternate ways to handle these difficult feelings. Even when your Internet use is back to healthy levels, the painful and unpleasant feelings that may have prompted you to engage in unhealthy Internet use in the past will remain. So, it’s worth spending some time thinking about the different ways you intend to deal with stressful situations and the daily irritations that would normally have you logging on.

Risk factors for Internet addiction and computer addiction

You are at greater risk of Internet addiction if:

• You suffer from anxiety. You may use the Internet to distract yourself from your worries and fears. An anxiety disorder like obsessive-compulsive disorder may also contribute to excessive email checking and compulsive Internet use.
• You are depressed. The Internet can be an escape from feelings of depression, but too much time online can make things worse. Internet addiction further contributes to stress, isolation and loneliness.
• You have any other addictions. Many Internet addicts suffer from other addictions, such as drugs, alcohol, gambling, and sex.
• You lack social support. Internet addicts often use social networking sites, instant messaging, or online gaming as a safe way of establishing new relationships and more confidently relating to others.
• You’re an unhappy teenager. You might be wondering where you fit in and the Internet could feel more comfortable than real-life friends.
• You are less mobile or socially active than you once were. For example, you may be coping with a new disability that limits your ability to drive. Or you may be parenting very young children, which can make it hard to leave the house or connect with old friends.
• You are stressed. While some people use the Internet to relieve stress, it can have a counterproductive effect. The longer you spend online, the higher your stress levels will be.

Signs and symptoms of Internet addiction vary from person to person. For example, there are no set hours per day or number of messages sent that indicate Internet addiction. But here are some general warning signs that your Internet use may have become a problem:

• Losing track of time online. Do you frequently find yourself on the Internet longer than you intended? Does a few minutes turn in to a few hours? Do you get irritated or cranky if your online time is interrupted?
• Having trouble completing tasks at work or home. Do you find laundry piling up and little food in the house for dinner because you’ve been busy online? Perhaps you find yourself working late more often because you can’t complete your work on time — then staying even longer when everyone else has gone home so you can use the Internet freely.
• Isolation from family and friends. Is your social life suffering because of all the time you spend online? Are you neglecting your family and friends? Do you feel like no one in your “real” life — even your spouse — understands you like your online friends?
• Feeling guilty or defensive about your Internet use. Are you sick of your spouse nagging you to get off the computer and spend time together? Do you hide your Internet use or lie to your boss and family about the amount of time you spend on the computer and what you do while you're online?
• Feeling a sense of euphoria while involved in Internet activities. Do you use the Internet as an outlet when stressed, sad, or for sexual gratification or excitement? Have you tried to limit your Internet time but failed?

Physical symptoms of Internet addiction

Internet or computer addiction can also cause physical discomfort such as:

• Carpal Tunnel Syndrome (pain and numbness in hands and wrists)
• Dry eyes or strained vision
• Back aches and neck aches; severe headaches
• Sleep disturbances
• Pronounced weight gain or weight loss