Striving for a ‘healthy digital diet’

Though Internet addiction may seem like a new concept to some, Kimberly Young, PsyD, began studying the topic in 1995 and has been deeply immersed in it ever since. After spending years doing private practice work and research, Young recognized that there was a demand for inpatient care for Internet addiction and founded the first inpatient clinic for Internet addiction recovery at Bradford Regional Medical Center (BRMC; Bradford, Pa.) in September 2013.

The program, which is part of BRMC’s Behavioral Health Services division, treats adult men and women. Because the hospital has a dual-diagnosis license, those who enter the program must also have a psychiatric illness to qualify for admission.

The 10-day treatment plan is strictly private pay ($14,000) and 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 (2011).

Outcomes

When an individual leaves treatment, the goal isn’t for him or her to be abstinent, as it would be with alcoholism or drug addiction. However, it would be similar to the outcomes of food addiction treatment where the goal is to have a “healthy digital diet,” in Young’s words.

Young says much of the work focuses around finding digital health and wellness and a balance in the individuals’ lives. There are many different outcomes and individualized plans. “What might work for one person doesn’t work for another person,” she explains.

The three most common forms of Internet addiction that have been seen in the inpatient program at BRMC are gaming, pornography, and gambling.

Room for improvement

Young, who is also a professor at St. Bonaventure University, says that while there isn’t much inpatient care for this population available in the United States, there is much more overseas. She also says that the United States is looked at by other countries as being significantly behind in the treatment and support of Internet addiction. For example, Korea has more than 500 inpatient clinics, China has dozens of clinics, and major cities in Italy, such as Milan and Rome, also have clinics.  

Many of the calls coming in to the center are from parents who are worried about their children’s behavior. Young says there is a definite need for an adolescent inpatient component to be developed.

The treatment course for adults and adolescents differs in the obvious way that adults are more independent, while adolescents are in school and living under their parents’ supervision. The adolescent group requires family counseling and parent training. Young, in her private practice, spends a great amount of time working with parents and helping them to establish guidelines for computer use at home.

Another area where she believes the United States is lacking involves intervention. “I’d say 99 percent of the calls are from a parent or spouse of the addict. We’re not getting people calling and saying, ‘Hi, I think I’m addicted to the Internet,’” she explains.

Diagnosing Internet addiction

Young developed a questionnaire for clinicians to use to determine whether an individual has an Internet addiction diagnosis – the Internet Addiction Diagnostic Questionnaire (IADQ). Eight questions are asked, and if five or more are answered with a “yes,” the person can be diagnosed. The questions, many of which resemble typical screening questions for substance use disorders, are as follows:

1.     Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?

2.     Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

3.     Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?

4.     Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?

5.     Do you stay online longer than originally intended?

6.     Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?

7.     Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?

8.     Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

The most prevalent co-occurring issues that Young sees with Internet addiction are depression and anxiety. And she says Asperger’s and autism are also common for this population, although her program doesn’t treat disorders.

In March, Young served as the keynote speaker at the first International Congress on Internet Addiction that was held in Milan. There, she learned that other countries have more advanced techniques and concepts in this area than the United States. She believes that if more professionals would devote time to understanding Internet addiction, major benefits could ensue.