Internet Addiction: Does It Exist Whats Important for Internetbased HIVSTI Prevention

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Internet Addiction Does It Exist?Whats
Important for Internet-based HIV/STI Prevention

• Tim Hunt, LCSW, CASAC
• Internet-based Health Solutions Conference
• November 14th, 2007

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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

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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/stormkin
  g/iad.html

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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/october
  18/med-internet-101806.html

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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

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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.

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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

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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)

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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)

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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/stormkin
  g/iad.html

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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/stormkin
  g/iad.html

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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

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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

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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

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Opportunities

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

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Opra??!
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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

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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

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Intervention Messages and Cyber Space

• Making Safer Connections an Option!

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Contact Information

• Tim Hunt, LCSW, CASAC
• Behavioral Health Consultation and Training
• 412 Sixth Avenue Suite 412New York, NY 10011
• [phone]
• timothy.l.hunt_at_gmail.com