Internet addiction treatment programs on the rise

Whether every clinician believes it is a “real” addiction or not, internet addiction has been around for many years and the programs to treat this behavioral addiction are quickly sprouting up as well.

Hilarie Cash, PhD, LMHC, has been doing private practice work for over 30 years. When she decided to move her private practice to Seattle 19 years ago, she says this is when she began to see clients who were experiencing internet addiction.

When Cash met Cosette Dawna Rae, MSW, LICSW, LMP, who was a 20-year IT professional who had made the career move into the addiction treatment field, the two agreed on the need for a residential program.  Soon after, reSTART: Internet Addiction Recovery Program (Fall City, Wa.) was born.

Program literature for reSTART describes the program as a “retreat.” Cash says it’s a voluntary therapeutic retreat away from the world so individuals can focus on the therapy they need. The program, which accepts men 18 and over (although Cash says most of them are between 18 and 28), focuses on a structured healthy lifestyle. This includes things such as eating healthy, meditating, exercising five days a week, participating in wilderness adventures and other recreational activities and learning many basic life skills.

Since the diagnosis is not yet official (although it is mentioned in the DSM-5 as requiring further research), it is currently a self-pay treatment.

The first three weeks, “the detox phase,” helps clients’ brains restore the dopamine receptors and Cash says the men start feeling much better after this period. “All of the depression, anxiety and irritability starts clearing up and their thinking gets better,” she explains.

Throughout their 45-90 days at the retreat, the individuals work on a life balance plan –their plan for moving forward, going back out into the world and having to deal with digital technology and other possible co-occurring addictions. 

After their plan is set and through participation in the program the staff can tell that they’re ready to graduate from that first phase, individuals can then choose to move to the “Transitions” program. Here the individuals live in apartments with an on-site office, a therapist who does individual and group therapy and a computer lab that is supervised. During this time, they can work on their long-term plan (getting jobs, going back to school, etc.) but remain in a structured and protected living situation in case they need ongoing help. Living in the apartments can last 6 months or longer, depending on how long the individual needs it.

A man’s addiction?

The reSTART program started out as a co-ed program, but leaders made the decision to be a male-only program after only seeing a few women come in for treatment over the years. Cash believes that while it is very possible for women to get addicted to the Internet, the effect on their lives is usually milder, so they are still able to manage their lives well enough.

“Speaking stereotypically, my experience is that women are much more interested in interpersonal relationships, and from an early stage, women tend to be more involved and interested in developing their social skills. I think that really helps inoculate them against the addiction to a considerable extent,” Cash explains. “There definitely are some women who get completely lost in this world. I’m not suggesting that they don’t get addicted, but because they are continuing to function better, they don’t end up on our doorstep. Whereas when the guys get lost in that world, they tend to just jump off the cliff and really go down.”

The male population may be more susceptible to this type of addiction because many times they have failed to develop good social skills, or because they are socially anxious. The internet and/or video games may become the reinforcing of the escapist cycle, Cash says.

“The technology offers this escape from the challenges of the real world and particularly from the social world that you’re anxious about,” Cash says.

Co-morbid conditions

Cash says all individuals arrive with some co-occurring mental health condition. At the very least when they arrive they are anxious and depressed, she says.

For many of the internet addicts, the anxiety and depression lifts after they detox. Some take medications that can be stopped, and some need to continue the medication in order to function.

Other co-morbid conditions Cash has seen in internet addicts include:

• Asperger’s syndrome- About 30% have high-functioning Aspergers. These individuals have usually never been diagnosed but staff at reSTART recognizes Aspergers traits (that’s why they’re so socially anxious).
• Attention Deficit Disorder (ADD)- A very high percentage have ADD and have already been diagnosed. However, Cash says it’s interesting because sometimes it’s hard to know which came first. She explains, “For example, are they truly ADD or do they just look like they have ADD because their attention span is so short and they’re so used to being hyper because of all the video games they play?”
• Some have bipolar disorder.
• Some have post traumatic stress disorder (PTSD) and while reSTART will not address this right away, it does acknowledge it and gives the client some education around the topic.
• As far as substances go, reSTART screens for abuse up front and if that is their primary problem, they are screened out of our program and sent elsewhere. But if it’s fairly a minor problem and they’re not going to go into a heavy drug or alcohol withdrawal, reSTART lets them go through their detox from the marijuana or alcohol along with their detox from the internet.

‘An addiction is an addiction’

At the Illinois Institute for Addiction Recovery, the staff has been treating clients with internet addiction since 1996. The inpatient treatment varies in length, says Coleen Moore, marketing and admissions manager at the Illinois Institute, and can range anywhere from 30 to 90 days. There is no separate “program” at the Illinois Institute, but rather “in the majority of the programs clients are commingled with others who are suffering from a multitude of addictions and other mental health issues,” she explains. “We believe an addiction is an addiction.”

However, there are specific groups twice per week that work specifically with those suffering from Internet addiction and their treatment plans are tailored to fit their individual needs. There is a request for a period of abstinence from the computer and internet.

“We ask for that period of abstinence so the person can begin to understand who they are what they are about without the use of the Internet,” Moore explains. “Eventually Internet use will be reintegrating, but with having structure and accountability.”  

Achieving a ‘first’ in the field

Bradford Regional Medical Center (BRMC; Bradford, Pa.) recently announced the launch of the first hospital-based Internet addiction treatment and recovery program in the United States. The program, which is part of BRMC’s Behavioral Health Services division, is led by Kimberly Young, PsyD. The unit is dual-diagnosis, meaning that individuals must also have a psychiatric illness for admission. Unlike the reSTART program, this is a 10-day treatment plan that helps both men and women ages 18 and up.

At the Bradford program, Young’s team utilizes cognitive-behavioral therapy-Internet addiction (CBT-IA), a model designed for treating Internet addiction by applying CBT with harm reduction therapy (HRT). The three-phase approach begins with behavioral modification to gradually decrease the amount of time the individual is spending with the technology. In the second phase, cognitive therapy is used to address the denial that is often present among this population and also to challenge the rationalizations that the person is using to justify the excessive use. Finally, the third phase “applies the HRT to identify and treat coexisting issues involved in the development of compulsive internet use,” according to Young’s article on CBT:IA published in the Journal of Cognitive Psychotherapy.

Resources for internet addiction treatment

Because internet addicts and internet addiction treatment is on the rise, it’s important to recognize the resources that are available. reSTART has created a template for internet addicts—called ITAA (internet and technology addicts anonymous) and encourages any clinician to download that template from the organization’s website. Another 12-Step template and other resources are provided by OLG-Anon (On-Line Gamers Anonymous).

Books:

• ‘Video Games and Your Kids: How Parents Stay in Control’ by Hilarie Cash and Kim Mcdaniel (both clinicians). This book addresses child development and what is appropriate video game and internet use given a child’s age and stage of development.
• ‘iDisorder: Understanding Our Obsession with Technology and Overcoming Its Hold on Us’ by Larry Rosen. Rosen sets out to describe the personality disorder that can develop in people who have grown up with video games and digital media.
• ‘Hooked on Games: The Lure and Cost of Video Game and Internet Addiction’ by Andrew Doan, MD, PhD. This is Doan’s personal account of being a gamer and going through addiction and recovery. He’s a neurobiologist and offers a great deal of resource material.
•  ‘Out of the Shadows’ and ‘In the Shadows of the Net’ by Patrick Carnes, PhD. These two books deal with pornography and sex addiction.