INTERNET ADDICTION DISORDER

INTRODUCTION

Netaholics Anonymous, a humorous parody of Alcoholics Anonymous, has poked fun at Internet Addiction Disorder, as have many others. Netaholics Anonymous says the "Top 10 Signs You,re Addicted to the Internet" are the following:

1. You wake up at 3 a.m. to go to the bathroom and stop and check your e-mail on the way back to bed.
2. You get a tattoo that reads "This body best viewed with Netscape Navigator 1.1 or higher."
3. You name your children Eudora, Mozilla and Dotcom.
4. You turn off your modem and get this awful empty feeling, like you just pulled the plug on a loved one.
5. You spend half of the plane trip with your laptop on your lap...and your child in the overhead compartment.
6. You decide to stay in college for an additional year or two, just for the free Internet access.
7. You laugh at people with 28.800-baud modems.
8. You start using smileys in your snail mail.
9. The last mate you picked up was a JPEG.
10. Your hard drive crashes. You haven't logged in for two hours. You start to twitch. You pick up the phone and manually dial your ISP's access number. You try to hum to communicate with the modem. YOU SUCEED! (Suler, par. 16)

We laugh at this because we can all connect with it since technology has brought us the personal computer and the Internet. And Dr. Ivan Goldberg, who originally invented the term Internet Addiction Disorder,, did it as a parody, modeling the disorder on other addictive behaviors (King, par. 9). He since, however, has become a believer in this addiction and is presently the facilitator of an Internet addiction support group (Suler, par. 10).

There are still those, however, who question whether Internet Addiction actually exists. Dr. John Grohol, in (1998) editor of the Mental Health Page on the Internet, points to the problem of trying to define excessive use in terms of hours spent online the following paragraph:

Leonard Holmes, PhD, writes. . .about studies presented at the last APA convention in August [1997], which have contradictory findings. One survey of online users found 19 hours per week of Internet use was the average (Brenner, 1997). Kathleen Scherer's 1997 study of college students at the University of Texas at Austin found that pre-defined "dependent" users of the Internet spent an average of 11 hours per week. Morahan-Martin and Schumaker found in a smaller survey that "pathological users" spent an average of 8.5 hours online per week. Keith Anderson,s preliminary results from a study of 1,000 students in multiple universities around the world found that for the total population of his subjects (includes users and non-users of the Internet), 9.5 hours per week is typical. Mental Health Net's own ongoing survey suggests that the majority of ...[its] readers spend anywhere from 7 to 14 hours per week online (par. 5).

Clearly, from these varied results, we can see that we cannot determine what is normal and what is not by merely looking at the amount of time spent online. Dr. John Grohol wants to dismiss the possibility of Internet Addiction's being a disorder by saying that it's no different from people spending "too much time at work, to the detriment of their relationships, family life, personal enjoyment, etc." (par. 9). But, as Goldberg says, "A parallel unofficial disorder would [my emphasis] be workaholism," and the parallel official DSM-IV (Diagnostic and Statistical Manual IV by the American Psychiatric Association) diagnosis would be "Pathological Gambling" (ctd. in King, par. 13).

Some, such as A'isha Ajayi, professor of Information Technology at Rochester Institute of Technology in New York, see what is happening with the Internet as a natural progression of technological advances. She says:

What we are seeing is merely the continuation of a decades-long trend of people spending increasingly more time with technology than with other humans. This shift away from the family and peers to mass media technology as the primary socialization agents can be traced to the radio in the 1930s, followed by television in the 1950s, and the computer networks today. For many people, going online is a way of dealing with a society where people are becoming increasingly more isolated from one another. (ctd. in Symptoms of Internet Addiction, par. 3)

But, is this isolation that Ajayi speaks of healthy? Jeffrey Goldsmith, professor of psychiatry at the University of Cincinnati, thinks not. Snell interviewed Goldsmith for his MA thesis at UC Berkeley Graduate School of Journalism and reports that Goldsmith believes that

In the future, we may see a growing part of our population become socially malnourished, replacing face-to-face, sight, sound and smell conversations with virtual reality. As we lose the stimulation that Goldsmith believes we can only get from direct personal contact, we may all begin to suffer from a technology caused social malaise. (par. 34)

Moreover, comparing the technological advances of the personal computer and the Internet to the technological advances seen in past decades, those of the TV and radio, may be a false comparison. Scherer, of the counseling and mental health center at the University of Texas-Austin, claims that "[a]lthough some educators argue that television or reading also cut into people's social lives,...the Internet is more addictive because it offers interaction with other people that ostensibly fills a social void" (Murray, par. 16).

Grohol and Ajayi seem to want to push the abuse of the Internet under the carpet; after all, it is a tool that is a boon to the society, isn't it? Education should benefit from such a tool that opens the information highway to students. Scherer says that we are facing a real paradox here. She says that the Internet's usefulness and social acceptability are what make it so very easy to abuse, and one might also add, make it so very easy for us to deny that anything so wonderful could have a negative side. "Students will log on to their computer to check e-mail from a professor or to write a paper for their biology class, and then with a simple push of a button, immerse themselves in Internet banter for hours" (Murray, par. 13) Scherer says that "[i]t becomes so easy for students to move between work time and play time that the line between the two gets blurred" (ctd. in Murray, par. 14).

Morahan-Martin and Schumaker, also think there is more to using the Internet than only the progression of technology. They report that there are other indicators of pathological use of the Internet than the time spent online. They say that pathological users:

reported significantly more loneliness (as measured by the UCLA Loneliness Scale). They used online games more than other users, and they also used more technologically sophisticated aspects of the net (such as FTP, virtual reality, and remote support communication software) more than other students. They did not use IRC (Internet Relay Chat) more than other students. (Holmes, par. 8)

Leonard Holmes, of the Mental Health Guide Online, poses the question: "When is Internet use pathological" (par. 10)? And he responds, "The simple answer: when it gets in the way of the rest of your life" (par. 10). Dr. Goldberg is more specific. He says that Internet use is pathological when it causes "[d]ecreased occupational, academic, social, work-related, family-related, financial, psychological, or physiological functioning" (ctd. in King, par. 14). Ordinary healthy activities can become addicting. "There is, however, usually some high involved, and we refer to this behavior as "mood altering" behavior. This means it changes your emotional state in some way. That's what behavioral addictions are about. The main way to determine if some activity is addictive is if it is having a negative impact on some other important area of your life" (Internet Addiction, par. 3).

Viktor Brenner, who is at Marquette University's Counseling Center, says that "if it [Internet Addiction Disorder] exists it can only be a psychological addiction, a behavioral failure to resist an impulse leading to other role functioning problems; conceptually, it would be most akin to Pathological Gambling" (par. 14). However, as researchers have tried to define a predictable pattern to excessive Internet use, it has become clear that "the Internet appeals to people with so many different interests that there may not be a single predictable pattern to excessive Internet usage" (par. 14).

Regarding college students, Storm King says that "[s]uch obsessive behavior has become quite a problem on some college campuses where computer facility administrators have had to literally pull the plug on some addicted students" (par. 22). He says that "[w]hen students move away to go to collage, they can suffer a loss of social support. The easy and unlimited access to the Internet that universities supply their students may appear as a safe and fast way to form new relationships, and become an obsessional form of activity if the student is having problems facing adult pressures" (par. 24). In 1996 Young, a clinical psychologist and psychology professor at the University of Pittsburgh at Bradford, reported that the value of the Internet as an educational tool must be questioned when "fifty-eight percent of students [in her study] reported a decline in study habits, a significant drop in grades, missed classes, or being placed on probation due to excessive Internet use" (ctd. in Young, 1998a, par. 14). Young, also, cites Brady who in 1996, stated that "Alfred University's Provost W. Richard Ott investigated why normally successful students with 1200 to 1300 SATs had recently been dismissed. To his surprise, his investigation found that forty-three percent of these students failed school due to extensive patterns of late night log-ons to the university computer system" (1998a, par. 15).

When considering the students that instructors of ESL (English as a Second Language) teach in the US, they not only have moved away to college and suffer a loss of social support, but they suffer a loss of cultural support, too. Many of the students in this researcher's classes talk of being able to chat with friends back home over the Internet to find out what is going on there. One morning a student arrived at class looking rather disheveled, and after the class was over, he admitted that he had been online all night, had laid down for a couple hours of sleep in the clothes from the previous day before coming to class, which were the same clothes that he was wearing then. In another class, a girl from India spoke about a relationship that she was having with a boy from France over the Internet. She confided that it was very romantic and that they spent hours at night just "chatting."

THE RESEARCH QUESTION

The question arose: "How widespread the problem of "internet addiction" was among the college freshmen and foreign students in the United States, many away from home for the first time?" Seeking an answer for this question in the spring semester of 1998, I conducted a survey of foreign students in freshman composition classes on the Bentley College campus in Waltham, Massachusetts, and the results of this research follow.

THE STUDY

SUBJECTS The subjects, 28 ESL expository writing students, ranged in age from 18 to 25, the largest number in the 18 and 19 year-old category. Eighteen different nationalities were represented, with 15 different native languages. There were 16 males and 12 females. Twenty-two of the students were actually freshmen, while six were sophomores or juniors. Twenty-one of the students lived on campus, and the other seven lived off campus. Twenty-one of the students were not employed, six had part-time jobs, and one was working full-time. Twenty- three of the students had access to a computer all of the time, and five students had access most of the time. All of the students were single, and all of them were full-time students.

METHOD Kimberly Young has done a large share of the empirical research on Internet Addiction Disorder. Her research has identified problem areas that mental health professionals, educators, and human resource managers have determined exist due to individuals becoming addicted to the Internet. Dr. Young has devised a questionnaire to measure the severity of Internet Addiction disorder (Young, 1998b, p.31-33). Accompanying Dr. Young's questionnaire, subjects were also asked to fill out a background data sheet (See Appendix). Five different ESL expository writing classes were given the questionnaires and background data sheets. Students were asked to fill out the questionnaire and the data sheet at home and bring them back to be collected. Twenty-eight students returned with their questionnaires and data sheets completed.

(Not in REFERENCES) Young (1998c) has three categories in her Internet-Addiction Disorder severity range: average (scores 20-39), frequent problems (scores 40-69), and severe problems (scores 70-100).

Multiple regressions were run on the scores with the background data information as predictor variables.

RESULTS AND DISCUSSION The scores from the questionnaires gathered from the students ranged from 22 to 64. No student scored in the severe problems range. However, 17 students scored in the frequent problems range, and 10 in the average range. No one scored below average.

Only one variable proved to have a significant t-test value; females were more likely than males to have a higher score (p<.05) and, therefore, more problems related to their Internet use. This finding was surprising since many of the research studies done on Americans, who were not necessarily students, showed that males tended to have more problems with their use of the Internet than females did (Brenner, Thompson, Egger, (cited in King)). The fact that only one predictor variable seemed to correlate strongly with the scores, and that it itself is in contradiction to what other researchers have found with other populations, seems to support the problem area that other researchers have noted, that it is difficult to determine a predictable pattern for those who have problems with excessive Internet use.

When one considers the myriad of applications available on the Internet, however, it should not surprise anyone that profiling what constitutes an Internet abuser is very difficult. An application that may be addictive for one, may not be for another; yet, that is not to say that the other person is not addicted to a different application. There is something for everyone on the Internet. Murray, of the American Psychological Association Monitor, contends that with the wide variety of services available on the net, the only thing that seems to be a constant in whether or not someone will abuse the Internet is that the person has access to the Internet (par. 4).

IMPLICATIONS FOR EDUCATION It appears that the ESL students in this study are having some problems with their use of the Internet, just as American students reported in other studies seem to be. We can not just sit back and do nothing, but that seems to be what is happening; people are doing nothing. Snell says that

[t]hough even the most ardent supporters [of] interactive computer communications, like Pavel Curtis, admit that those programs [like IRC ((Internet Relay Chat), MUD (Multiple-User Dimensions), MOO (A type of MUD)] produce a steady trickle of addicts, nobody seems to be rushing to stop them from spreading. Some news stories have reported a movement to ban chat programs like IRC from college campuses, but the truth is that the campuses that have banned such programs have done it because of overloaded hardware, not due to a fear of the programs' addictive powers. (par. 71)

Snell notes that John Manly, a systems administrator at Amherst College in Amherst, Massachusetts says, "'Once we upgrade our system, I'm planning to re- enable MUD access here'" (par. 72).

Even though we may not be able to profile those that have the addiction, researchers are in the first steps of identifying criteria to be used to determine whether or not someone is addicted to the Internet. Dr. Suler, of Rider University, says that any proposed diagnosis must withstand the weight of extensive research. "It must meet two basic criteria. Is there a consistent, reliably diagnosed set of symptoms [i.e., criteria] that constitutes this disorder? [and] Does the diagnosis correlate prognosis of people who are so diagnosed" (par. 7). Suler reports that "so far, researchers have only been able to focus on . . . trying to define the constellation of symptoms that constitutes a computer or Internet addiction" (par. 8).

Even though developing criteria to identify potential Internet addicts is proving problematic at this point, there are many researchers now working on the development of criteria needed to diagnose the disorder itself. Criteria have been borrowed from DSM-IV's criteria for pathological gambling and adapted to Internet Addiction Disorder, since the gambling addiction is viewed as most akin to Internet addiction, and Young states that "[b]y using Pathological Gambling as a model, Internet addiction can be defined as an impulse-control disorder which does not involve an intoxicant" (1998a, par. 5).

Researchers are also having problems determining how many of the criteria need to be met in order to ascertain whether the disorder actually exists in a particular individual. Different researchers suggest different numbers. It would, however, appear that this does not mean that we should sit back and wait until researchers have come to terms with the exact set of criteria or the appropriate number of criteria needed to indicate that the disorder is actually present, while students continue to fail academically. We need to take a conservative approach at this time and alert students who match the minimal number of criteria established to date which are thought to be needed to define the existence of the disorder. The American Psychiatric Association says that if a person answers yes to three or more of the following criteria, than he or she is defined as addicted or dependent upon the Internet.

1. Does the person need increased amounts of time on the Internet to achieve satisfaction? Or is there a diminished effect with continued use of the same time spent on the Internet?
2. Does the person experience signs of psychological withdrawal (i.e., increased depression, agitation, or moodiness) when they are off-line?
3. Does the person spend longer periods of time on the Internet than originally intended?
4. Does the person spend a great deal of time engaged in activities to stay on-line longer?
5. Does the person continue to use the Internet despite knowledge of having a persistent or recurrent problem that is likely to have been caused or exacerbated by use of the Internet? (e.g., work related problems, academic problems, family problems)?
6. Has the person made unsuccessful attempts to cut down how much time s/he spends on-line OR does s/he lack the desire to cut down how much time s/he spends on-line?
7. Has the person given up any social, occupational, or recreational activities because of the Internet? (adapted from Workshop training for Mental Health professionals)

An Internet Addiction Support Group (IASG) has been established, and they have adopted the APA's criteria for Internet Addiction Disorder, but have added a few details. Regarding question 2, dealing with psychological withdrawal, the IASG says that the withdrawal may be manifested by either

1. "the characteristic withdrawal syndrome" or
2. "Use of the Internet or a similar on line service to relieve or avoid withdrawal symptoms" (Internet addiction disorder, sec. II)

With reference to the characteristic withdrawal syndrome, the person ceases or reduces use of the Internet that has been heavy and prolonged. Within several days of cessation

two (or more) of the following...develop . . : Psychomotor agitation, anxiety, obsessive thinking about what is happening on the Internet, fantasies or dreams about the Internet, and voluntary or involuntary typing movements of the fingers.... The{se} symptoms . . . cause distress or impairment in social, occupational or another important area of functioning. (Internet addiction disorder, sec. II)

The IASG has noted that people that suffer from this disorder often have "a persistent desire or [make] unsuccessful efforts to cut down or control Internet use" (sec IV). They also tend to spend a lot of time on activities related to the Internet, for example, "buying Internet books, trying out new WWW browsers, researching Internet vendors, [or] organizing files of downloaded materials" (sec. V).

The APA also lists other common characteristics of Internet Addiction:

1. Internet Addicts socially isolate themselves from others.
2. Internet Addicts become defensive and argue with others about how much time they spend on-line.
3. Internet Addicts suffer from sleep deprivation
4. Internet Addicts continue to use the Internet despite recurrent problems in their real life caused or exhaserbated by use of the Internet. (Workshop training for Mental Health professionals)

Internet Addicts suffer from often several of the following problems because of their Internet use:

• Social Problems (loss of interest in social activities, friendships, and community events.
• Family Problems (increase marital problems, separation, and possibly divorce)
• Financial Problems (increase credit card debt, long distance toll charges for phone calls to net friends)
• Occupational Problems (reduced work productivity, receiving a poor employee evaluation)
• Physical Problems (increased eyestrain, headaches, carpel tunnel syndrome) (Workshop for Mental Health professionals)

A Home page on the Internet asks educators to look for signs in their students. "Consultation to Educational Institutions" say to look for the following things in your students:

1. Academic failure
2. Academic probation or expulsion
3. Loss of interest in attending classes
4. Lack of motivation to study
5. Less time devoted to studying
6. Loss of interest in extracurricular activities
7. Dating problems
8. Relationship problems and break-ups
9. Less interest in going out with friends on campus
10. Increased time spent in front of computer
11. Closer to on-line friends than real life friends
12. Continued use of the Internet despite these negative consequences

The students that we find to be at risk need to be referred to University and College Counseling Centers. Moreover, this means that our counseling centers on campus need to be prepared for dealing with students that have Internet Addiction problems. Young (1998a) says that

[a]mong university settings and corporations, it would be prudent to recognize that students and employees, respectively, can become addicted to a tool provided directly by the institution. Thus, college counseling centers should invest energy in the development of seminars designed to increase awareness among faculty, staff, administrators, and students on the ramifications of Internet abuse on campus. (par. 54)

Most certainly, this would be preferable to students, being put on probation or being forced to terminate their education.

Another thing that needs to be done is the addition of a segment during freshman orientation that makes students aware of the dangers of excessive Internet use and that also makes them aware that if they notice they are having problems, which means they need to be aware of symptoms, they know where they can go for help. Young (1998a, pars. 39-50) gives eight techniques for treating Internet Addiction, the description of which is outside the scope of this paper, but counseling centers at university and college campuses should be educated in these intervention techniques. Researchers, such as Scherer and Bost, are continuing their studies. Murray reports that Scherer and Bost "are conducting a study of 1,000 students, some who use the Internet and some who don't. They want to determine the forms the disorder takes and how best they can help afflicted students" (par. 22). Even though there are still many unanswered questions regarding this disorder, we can not wait for all of the information to be tallied. Murray says that

Internet addiction can affect anyone who has easy access to the plethora of online services, but students seem especially prone to it. As universities increasingly give students their own free Internet accounts, psychologists like Kandell and Kimberly Young...have noticed them spending larger amounts of time online, sometimes to the detriment of their social lives and studies. (par. 4)

If we are going to give the students free access to the Internet, we must take responsibility for the negative effects, as well as the positive.

ENDNOTES 1 In the original, the word "client" was used, instead of "person," since the article was directed at Mental Health professionals.

REFERENCES

ONLINE RESOURCES

Brenner, V. (1997). An initial report on the online assessment of Internet addiction: The first 30 days of the Internet usage survey. America Online: www.ccsnet.com: Article: An initial report on the online assessment of Internet addiction: The first 30 days of the Internet usage survey, pp. 1-6. (Feb. 1998)

Consultation to educational institutions. America Online: Article: Consultation to educational institutions, pp. 1-2. (Feb. 1998)

Grohol, J. What is normal? How much is too much when spending time online? America Online: Psych Central: Mental Health Page: Article: What is normal? How much is too much when spending time online?, pp. 1-3. (Feb 1998)

Holmes, L. What is "normal" Internet use? America Online: mentalhealth.miningco.com: mental health resources: Article: What is "normal" Internet use?, pp. 1-4. (Feb 1998)

Internet addiction. America Online: Article: Internet addiction, p. 1. (Feb. 1998)

Internet addiction disorder. America Online: Article: Internet addiction disorder, pp. 1- 2. (Feb 1998)

King, S. (1996). Is the Internet addictive, or are addicts using the Internet? America Online: Article: Is the Internet addictive, or are addicts using the Internet?, pp. 1- 16. (Feb 1998)

Murray, B. (1998). Computer addictions entangle students. American Psychological Association Monitor. Available: America Online: Article: Computer addictions entangle students, pp. 1-3. (Feb. 1998)

Snell, J. (1998). Turn on, log in, drop out. Masters Thesis: UC Berkeley Graduate School of Journalism. America Online: Article: Turn on, log in, drop out, pp. 1- 11. (Feb. 1998)

Suler, J. (1996). Computer and cyberspace addiction. America Online: Article: Computer and cyberspace addiction, pp. 1-5.

Symptoms of Internet addiction. America Online: Article: Symptoms of Internet addiction, pp. 1-2.

Workshop training for mental health professionals. America Online: Article: Workshop training for mental health professionals, pp. 1 2.

Young, K. S. (1998a). Internet addiction: Symptoms, evaluation, and treatment. Book chapter appearing in Innovations in Clinical Practice: A Source Book, Volume 17. America Online: Article: Internet addiction: Symptoms, evaluation, and treatment, pp. 1-17.

PUBLISHED RESOURCES

Young, K. S. (1998b). Caught in the Net. New York: John Wiley & Sons Inc.

Barbara Kennedy-Souza teaches at Bentley College in Waltham, MA. She is on the editorial board of an online journal, TESL-EJ (Teaching English as a Second Language-Electronic Journal). She is an active member of TESOL (Teachers of English to Students of Other Languages), NAFSA (National Association of Foreign Student Affairs), and AAAL (American Associan of Applied Linguistics).