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Winter 2009/10 | Vol 13 No 2

The last word

Does treatment for Internet addiction miss the mark?

By Hilarie Cash and Cosette Dawna Rae

According to the National Institute on Drug Addiction, the most effective way to treat addiction is to treat comorbid psychological problems concurrently. This is certainly the case at reStart: Internet Addiction Recovery Program in Washington. Some argue that programs designed for Internet addiction are too narrowly focused and that pathological use of computers is only a symptom of other problems. We argue that Internet addiction may reflect other issues, but that is a legitimate, specific disorder in itself that requires targeted treatment.

It is not uncommon for people with a technology-related behavioral addiction to report depression and anxiety, but it is not always clear whether these co-morbid conditions are the cause or the result of an impulse control disorder. Other co-morbid conditions that we commonly find as we work with people on an in-patient or out-patient basis are Asperger’s syndrome, social anxiety disorder, attention deficit disorder and attention-deficit/hyperactivity disorder.

The first phase of treatment involves an in-depth assessment and evaluation. By taking a thorough individual and family history we can begin to formulate ideas about co-morbid conditions. Our clinical experience has been that after several weeks away from video games and the Internet, our clients generally begin to improve. Depression and anxiety begin to lift.

Many of our clients come to us after having seen other mental health professionals who did not deal directly with the addiction, choosing, instead, to see the addiction as a manifestation of other problems that needed to be addressed first. We also hear from clients and their caregivers that many therapists have dismissed the possibility of a behavioural addiction, and in some cases, have actually encouraged individuals with excessive use patterns to continue their problematic behaviour. This failure to treat the process (behavioural) addiction directly, as one would deal with a chemical addiction, is, in our opinion, reminiscent of the early days of chemical dependency treatment when co-morbid conditions went untreated until someone was “clean and sober.” Perhaps it is because so many professionals in the mental health field are not trained to recognize, assess or treat technology-related behavioural addictions that this situation persists, despite growing evidence that Internet addiction disorder (IAD) is a new and fast-growing disorder.

The following case study illustrates our approach.

Bill (not his real name) was a 17-year-old client whose family had been living on the East Coast. He appeared to have been a well-rounded kid who played the cello, participated in sports, socialized with friends and did well in school. Bill’s world turned upside-down when his father left the family and maintained little contact with his children. Bill’s mother moved with her children to a new state to be closer to relatives. It was at this point that Bill began playing video games. The games were clearly an escape from the pain of losing his father, friends and all that was stable and familiar to him. His mother tried, ineffectively, to control his excessive gaming. Prior counselling proved ineffective as Bill’s video game use, depression and anxiety intensified. When his mother sought our help, Bill, who was about to turn 18, was flunking out of high school and refused to participate in any meaningful family activities, including meals and chores. He was unwilling to communicate with his mother. The only time he left the house was to visit friends with whom he could game.

Bill only agreed to come to reStart after a family intervention, where he was given the choice to either come to reStart or leave the house. He decided to join our program. His assessment identified him as depressed and anxious. The treatment plan we developed for him involved, among other things, teaching him about the nature of addiction and preparing him to re-enter a life that would involve moderate use of computers, helping him understand and express his feelings about what had happened with his parents and helping him develop real-world social skills and constructive skills for managing his emotions.

Over the course of the program, Bill made progress in all areas. When he left, he was much more socially confident and engaged, he was not depressed, and he had a relapse-prevention plan in place. He reported that the mindfulness training he had received had been the single most useful tool he had acquired.

It seems that the underlying problem is not whether Internet addiction treatment centres are too narrowly focused, but whether individual providers are skilled in assessing, evaluating and treating technology-related behavioural addictions along with other co-morbid conditions.

Hilarie Cash, Ph.D, and Cosette Dawna Rae, MSW, LSWAIC, are co-founders of reSTART: Internet Addiction Recovery Program in Washington.

Do you think programs designed for Internet addiction are too narrowly focused? Is pathological use of computers only a symptom of other problems, such as depression and social anxiety disorder?

Share your thoughts on our Last Word blog.

Editorials do not necessarily reflect the views of CAMH.