Internet Addiction: College Student Case Study Using Best Practices in Cognitive Behavior Therapy.

Internet Behavior Dependence, a form of Internet addiction, is an new disorder requiring informed response from addictions clinicians such as mental health counselors. We present a working definition for Internet Behavior Dependence (IBD), overview the prevalence rates and demographic profiles of dependent users, then review assessment criteria and treatment for IBD. In addition, we provide an example of Cognitive Therapy using the Case Management Summary recommended by Beck (1995). ********** As access to Internet technologies has increased, so too have behavioral disorders related to Internet use. Despite limited scientific research and competing or poorly defined constructs (Armstrong, Phillips, & Saling, 2000), mental health counselors nevertheless must assess and treat cases of Internet Behavior Dependence (IBD). We offer a framework for working with individuals who present with symptoms associated with Internet Behavior Dependence. In this article, we introduce a working definition for IBD, overview IBD prevalence rates and demographic profiles, then review IBD assessment criteria and treatment considerations. Following this, we introduce the use of Cognitive Therapy for treating IBD, then we offer a case example along with a demonstration of the use of a Case Summary Worksheet. INTERNET BEHAVIOR DEPENDENCE DEFINED A review of counseling literature reveals two basic definitions for Internet related disorders, both adapted from existing DSM-IV criteria for pathological gambling and substance dependence. We review these and propose a third, which we base on cognitive-behavioral criteria consistent with a developmental approach. Goldberg presented the first definition for Internet-related disorders, Internet Addiction Disorder (IAD), as a behavioral addiction that serves as a coping mechanism and borrows from substance-dependence criteria from the DSM-IV (Garrison & Long, 1995, p. 20; Goldberg, 1996). Expanding the definition to include six core components of Internet addiction (salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), Griffiths (1998) hypothesized that the source of this addiction could stem from one or more aspects of Internet use such as the process of typing, the medium of communication, the lack of face-to-face contact, Internet content (e.g., pornography), or online social activities (chat rooms, MUDs, bulletin boards, computer games). Complementing this definition is Kandell's (1998) definition of Internet addiction as including any type of activity once logged on to the Internet. In short, most people agree that Internet addiction could have several sources. Young presented a second definition for Internet related disorders, Problematic Internet Use (PIU), another diagnostic term based on DSM-IV criteria associated with pathological gambling (Young, 1996; Young & Rogers, 1998a). This definition requires that individuals meet five of eight criteria for Internet addiction in order to qualify as an addict. Criteria for Problematic Internet Use include (Young, 1999): 1. Preoccupation with Internet 2. Need for longer amounts of time online 3. Repeated attempts to reduce Internet use 4. Withdrawal when reducing Internet use 5. Time management issues 6. Environmental distress (family, school, work, friends) 7. Deception around time spent online 8. Mood modification through Internet use By using criteria similar to that of pathological gambling, Young implies that PIU bears more similarity to an impulse control disorder than to substance dependency. A problem with the use of these two definitions and their associated criteria is that they neither rule out co-morbidity as a causal factor (Mitchell, 2000; Shapira, Goldsmith, Keck, Khosla, & McElroy, 2000), nor separate the medium from the message (Griffiths, 1998; Pratarelli, Browne, & Johnson, 1999), nor determine whether time on the Internet is related to normal work or to pathological addiction (Kiernan, 1998). …