Internet Addiction: Does It Exist?What’s Important for Internet-based HIV/STI Prevention: Internet Addiction: Does It Exist? What’s Important for Internet-based HIV/STI Prevention Tim Hunt, LCSW, CASAC Internet-based Health Solutions Conference November 14th, 2007


Objectives: Objectives Define terms and proposed DSM-V criteria of Internet Addictive Disorder (IAD) Identify potential risk factors for compulsive problematic internet usage Explore implications for internet-based HIV/STI prevention interventions


Internet Addictive Disorder (IAD) or Pathological Computer Use: Internet Addictive Disorder (IAD) or Pathological Computer Use Passion versus addiction IAD: Pathological use of computers to engage in social interactivity (Goldberg, 1997) Computer versus Internet DSM-V Standards for a disorders inclusion Consistent and reliable diagnostic set of symptoms Correlations: similar histories, personalities, prognosis Multiple theories regarding addiction Psychodynamic Sociocultural Behavioral Biomedical King, S.A. (1996). Is the Internet Addictive, or Are Addicts Using the Internet? Retrieved 7/6/2006 from http://webpages.charter.net/stormking/iad.html


Some Findings: Some Findings Out of 18,000 Internet users surveyed 5.7% met suggested criteria for compulsive use (1999 Center for Internet studies) 60% of companies surveyed had disciplined employees (2002, Cyber Psychology) Out of Stanford study 2,513 surveyed: 13.7% “hard to stay away” 8.7% concealed use 8.2% used internet to relieve negative moods 5.9% felt relationships suffered due to excessive internet use 12.3% had seen a need to cut back http://news-service.stanford.edu/news/2006/october18/med-internet-101806.html


Other Findings: Other Findings Women are now on-line more than men 50% of people on-line lie about their age, weight, job, marital status and gender Use of the internet is a contributing factor in family, relationship and family problems Conner, M.G. (2004) Internet Addiction and Internet Sex Retrieved 7/12/2006 from http://www. Crisiscounseling.com/Articles.htm


In pairs:: In pairs: What might be some potentially harmful effects of “compulsive” use of the internet? Where does HIV/STI risk fit? Give an example from clients with whom you work.


Potential Problems: Potential Problems Personal neglect Compulsive checking and “clicking” Isolation and avoidance of people Lost productivity Depression Dissociative states Marital or Relationship Problems Sexual Addiction and increased sexual risk behaviors Gambling Internet Abuse in the workplace Academic failure Disability Conner, M.G. (2004) Internet Addiction and Internet Sex Retrieved 7/12/2006 from http://www. Crisiscounseling.com/Articles.htm


Internet Addictive Disorder (IAD) Proposed Diagnostic Criteria: Internet Addictive Disorder (IAD) Proposed Diagnostic Criteria I Tolerance, as defined by either of the following: (A) A need for markedly increased amounts of time on Internet to achieve satisfaction (B) Markedly diminished effect with continued use of the same amount of time on the Internet II Withdrawal, as manifested by either A or B below: (A) the characteristic withdrawal syndrome, 1, 2 and 3 below (1) Cessation of (or reduction) in Internet use that has been heavy and prolonged (2) Two (or more) of the following, developing within several days to a month after Criterion 1: (a) psychomotor agitation (b) anxiety (c) obsessive thinking about what is happening on the Internet (d) fantasies or dreams about the Internet (e) voluntary or involuntary typing movements of the fingers (3) The symptoms in Criterion 2 cause distress or impairment in social, occupational or another important area of functioning (B) Use of the Internet or a similar on-line service is engaged in to relieve or avoid withdrawal symptoms Diagnostic Criteria for IAD (http://www.psycom.net/iadcriteria.html)


Addictive Disorder (IAD) Proposed Diagnostic Criteria (cont.): Addictive Disorder (IAD) Proposed Diagnostic Criteria (cont.) III Internet is often accessed more often or for longer periods of time than was intended IV There is a persistent desire or unsuccessful efforts to cut down or control Internet use V Important family, social, occupational or recreational activities are given up or reduced in duration and/or frequency because of Internet use VII Internet use is continued despite knowledge of having a persistent or recurrent physical, family, social, occupational or psychological problem that is likely to have been caused or exacerbated by Internet us (e.g., Sleep deprivation, marital difficulties, lateness for early morning appointments, neglect of occupational duties or feelings of abandonment in significant others) Diagnostic Criteria for IAD (http://www.psycom.net/iadcriteria.html)


Risk Factors: Risk Factors Factors related to On-line interactivity vs. personal characteristics Interpersonal Communication: Rewards Social contact with no real social presence Social norms encourage contact with relative strangers Dis-inhibiting effects Social setting without sensual clues, lacking in social order and open to distorted projection Hypersonal aspect with selectivity Voyeurism and “lurkers” Availability: 24 hours, diverse connections, instant gratification King, S.A. (1996). Is the Internet Addictive, or Are Addicts Using the Internet? Retrieved 7/6/2006 from http://webpages.charter.net/stormking/iad.html


Potential Co-Occurring Challenges: Potential Co-Occurring Challenges Co-Occurring Disorders Study of 400 cases found 50% prior addiction history (Young, 1996) Obsessive Compulsive Depression Introversion Personality Disorders Personality Traits that increase vulnerability Fantasy proneness Shyness Social phobias Perceived lack of social status, narcissistic injury Environmental factors Homophobia, stigma, prejudices and other social constraints Isolation King, S.A. (1996). Is the Internet Addictive, or Are Addicts Using the Internet? Retrieved 7/6/2006 from http://webpages.charter.net/stormking/iad.html


Intervention: Intervention Assessment and staging Challenge of finding providers familiar with the issue Assess specific pattern of usage (e.g., . Chat, email, real time, games, sexual encounters, Persona used, work, research) Cybersexual Addiction Cyber-Relational Addiction Net Compulsions Information Overload Computer Addiction Cognitive Behavioral Treatment Approaches Most Effective Applying other recovery models Abstinence versus harm reduction Utilizing computer aided treatment recovery plans Addressing triggers (anticedents) 12-step Individual versus group Psychopharmacology


Assessing Internet Addictive Disorder (IAD): Assessing Internet Addictive Disorder (IAD) Do you feel preoccupied with the Internet or on-line services and think about it while off line? Do you feel a need to spend more and more time on-line to achieve satisfaction? Are you unable to control your on-line use? Do you go on-line to escape problems or re-live feelings such as helplessness, guilt, anxiety or depression? Do you feel restless or irritable when attempting to cut down or stop your on-line use? Do you lie to family members or friends to conceal how often and how long you stay on-line? Do you risk the loss of a significant relationship, job or educational or career opportunity because of your on-line use? Do you keep returning even after spending too much money on on-line fees? Do you go through withdrawal when off-line, such as increased depression, moodiness, irritability? Do you stay on-line longer than originally intended? Young, K. (1996) Internet Can be as Addicting as Alcohol, Drugs and Gambling, AN APA news release available www. Apa.org/releases/internet.html


Opportunity for more study: Neurotransmitter Functions: Opportunity for more study: Neurotransmitter Functions Dopamine: “reward pathway” “addiction pathway” Serotonin: mood, sleep, sex, appetite Norepinephrine: increases blood pressure, gives energy, related to adrenalin American Psychiatric Association Textbook of Substance Abuse Treatment, 2002


Opportunities: Opportunities Research of effective and enhanced models of treatment Self help availability Education Combating secrecy Providers Community Developing effective HIV/STI risk messages


Opra??!: Opra??!


Internet-based Interventions: Defining the Boundaries: Internet-based Interventions: Defining the Boundaries Staff wellness Education and self care Protocols and policies Supervision “Client” wellness Recognizing the red flags Engaging and motivating Tailoring the internet-based message Developing and maintaining referral resources


Activity: Activity In your small group discuss one of the following: 1) What has your agency done or is thinking about doing to promote wellness of staff using the internet as a tool? How did you set the priorities? How is it working? 2) What do you think are the key red flags to notice when working with a client via the internet who may be using it compulsively? 3) How might you tailor your HIV/STI prevention intervention to address those that are compulsively using the internet? Report Back to the large group…


Intervention Messages and Cyber Space: Intervention Messages and Cyber Space Making Safer Connections an Option!


Contact Information: Contact Information Tim Hunt, LCSW, CASAC Behavioral Health Consultation and Training 412 Sixth Avenue Suite #412 New York, NY 10011 (212) 982-7436 timothy.l.hunt@gmail.com