Internet addiction and top issues

Recent research shows that some users of the Internet spend so much time logged on, that their personal and/or professional life suffers. This finding is corroborated by numerous anecdotal accounts of people becoming "hooked" on on-line interactivity, accounts that have circulated in on-line discussions as well as in real life settings. It is becoming common to know of someone, or have heard of someone, that has become enamored with on-line activity to the point that they ignore important personal responsibilities. This paper is an overview of current research findings, and an attempt to explore some of the possible explanations for this phenomena. Factors inherent in on-line interactivity that might be contributing to developing Internet Addiction Disorder (IAD) are distinguished from factors inherent in the people proposed to be most at risk for, or suffering from, IAD. Recommendations for treatment of affected individuals are offered.

Broken marriages, lost jobs, failing school grades and forgetting to eat are just some of the consequences being reported in media articles as the experience of people who feel they have become addicted to Internet interpersonal communicating (Jabs, 96; DeLoughry, 96; Suryaraman 96). It is the social aspect of computer assisted communication, the interpersonal exchange with others, that is so stimulating, rewarding and reinforcing that some people are finding it hard to know when to stop (Suler 96, Young 96). Cyberspace communications (email discussion groups, chat rooms, bulletin boards and MOO's) offer people an opportunity to experience a form of social contact, with no real social presence. The significant difference between cyberspace relationships and ones maintained by other existing technologies (telephones, mail, fax's) is that the new culture values of Internet virtual communities have as social norms ones that allow for, and even encourage, contact with relative strangers. "As Rheingold (94) notes, one might think the Net a cold place, and yet it need not be. In the impersonal isolation of our large cities, where people often live separated from kin or lonely amid the multitudes, the Net can become a surrogate social-life-a vital source of interpersonal contact despite its non-physical nature. " (North, 96).

Because cyberspace does not offer a means to monitor others non-verbal responses to one's communications, several unconscious, firmly held expectations about communications protocols are challenged (Huang, 96). A critical factor in understanding how text based interpersonal relationships can lead some people to experience pathological consequences is the dis-inhibiting effect inherent in on-line interactivity. The improbability of any local, real life repercussions for on-line social activity produces a new and poorly understood psychological phenomena; people feel free to express themselves in an unrestrained manner. "If all computer-mediated communication systems can be said to have one single unifying effect upon human behavior it is that usage tends to cause the user to become less inhibited." (Reid, 94). Judgments of others in this virtual social setting, made without the normal sensual clues, can consist of distorted, emotionally laden projections (King, 95), and can be communicated without the normal constraints imposed by the need to maintain social order. This is a naturally exciting, stimulating and reinforcing aspect of Internet communications, one that contributes to the occurrence of IAD.

"An on-line community is one of the easiest ways to meet new people. Certainly it is very low-risk. I think this is mainly due to the essential informality of on-line conversation. Rather than being required to sustain a single conversation with one or more people, relationships usually form out of numerous, often short exchanges. In a way, it reminds me of commuters who take the bus or ferry. They see each other frequently but each encounter is of a fairly short duration. In situations like this the pressure is minimal. If you'd rather read the paper than chat then you just do it and don't worry about it. But, over time, many people form enduring relationships this way. In the on-line environment, just like any other social situation, the basic currency is human attention. In the public forums, you communicate with groups that may have as many as several hundred people involved - even if they don't all make comments." (Coate, 92)

Internet communication increases the range of possible social networks that a person can connect to, and adds elements of diversity that are very appealing to some (Wellman, 96). There is a "hyperpersonal aspect" to Internet communications, a way to be more selective about how one presents ones self. The kinds of differences between people that might inhibit relationship formation are hidden. This promotes a sense of group membership, one that is solely depended on the perceptions of the receiver. Control over impression formation is enhanced in written mediums. "Another component of the model, feedback, suggests that these heightened self-presentations and idealized perceptions magnify each other to a superordinal level, as users reciprocate each other's partial and selective presentations." (Walther, 96). This magnification factor of the hyperpersonal model is a theoretical formulation that could help account for the high rates of flame wars (arguments) and love affairs that happen on the net. There is as yet no empirical evidence supporting the observation that flame wars and love affairs occure in open, interactive virtual communities at a rate higher than what one would expect, but there is a growing body of anecdotal reports of this and a widespread awareness of a high frequency of these extreme interpersonal cyberspace exchanges.

There can be a voyeuristic aspect to cyberspace participation, which may be more salient to some that others. People that "lurk", participate in a read only mode, in chat rooms or email groups, are surreptitiously witnessing the ideas, feelings and interactions of the active participants. In the more academic discussion forums, where the social norm is the exchange of research ideas and the philosophic debate of social abstraction, this voyeuristic component is not a significant attraction. This is in contrast to some chat rooms where the suggested topics often invite flirtations, or the forums set up to provide emotional support for difficult personal problems. In these forums, lurking is a means of gaining access to very personal information in a manner that no real life forum can offer. This electronic eavesdropping is one possible source for the positive reinforcement that the nature of the Internet provides to those for whom it's use has become pathological. This emotional stimulation is on a schedule of reinforcement called variable-ratio, as one can never predict just when some "juicy tid-bit" of self-revelation will come across one's screen, and the actual exposure rate to this is dependent on the amount of time spent on-line.

The attributes of Internet communications that stand out as offering the potential for rewarding, stimulating emotional involvement's include; it's ease of access and 24 hour availability, the wide range of diverse personal connections possible, the hyperpersonal nature of interpersonal relationships, the ability to witness others interacting (with no risk) and the uninhibited nature of no risk relating. It is reasonable to assume that many people will find one or more of these factors reinforcing enough to become passionate about their Internet activities, at least for the initial period of time when they are still discovering the capabilities of new Internet social connections. These factors are necessary, but not sufficient, to explain true pathologic computer use. Some additional qualities inherent in the user must be present that differentiate those for whom Internet communications are a passionate past-time from those for whom this activity becomes a compulsion resulting in loss. The passion possible is understandable, as virtual community involvement's dissolve geographic boundaries and expand the ability of people with common interests to share ideas important to them. However, the nature of addiction is to continue to pursue the initial excitement one received, at the risk of other social involvement's and responsibilities.

A passion adds value to one's life, an addiction takes away value. When the line between these two is crossed, the addict is often the last to know, due to their denial. A family and social history will reveal that the subject is being evaluated by close friends as actually suffering a great loss from their activity.

Internet Addiction Disorder is the term first proposed by Dr. Ivan Goldberg for pathological, compulsive Internet usage. The criteria for this disorder are listed in appendix 1 and are based on similar criteria for substance abused disorders found in the DSM-IV. It is ironic that Dr. Goldberg was not serious about proposing this as an official diagnostic category, yet this term became used extensively. Dr. Goldberg recently revised his suggestion to change the term for this condition to Pathological Computer Use, and changed several of the criteria.

Pathological Computer Use Disorder was proposed by me as the name for a disorder in which people overuse computers to the extent that (A and/or B):

A. Such use causes them distress;
B. Such use has a detrimental effect on their physical, psychological, interpersonal, marital, economic, or social functioning.

A parallel unofficial disorder would be 'workaholism" and the parallel official DSM-IV diagnosis would be "Pathological Gambling."(Goldberg, 96)

In another note posted to the Internet, Dr. Goldberg refers to this condition as one that causes "Decreased occupational, academic, social, work-related, family-related, financial, psychological, or physiological functioning." For this study, the term Internet Addiction Disorder (IAD) will be used to designate a pathological use of computers, to engage in social interactivity. The term Pathological Computer Use (PCU) will be reserved for the broader category in which someone is pathological about any aspect of computers, and includes uses that are not social in their nature.

There is an increasing attention being paid to this problem in the US. The field has a long ways to go before a complete understanding of this phenomena is reached, but there are two forces that are motivating the effort. One is a business interests. Corporate executives are quickly learning that they risk loosing valuable worker productivity as they provide Internet access to their employees, if that employee becomes hooked on the interactivity available. The other force is coming from the area of social psychology, as more and more people report to each other stories of horror about friends that have lost jobs, students that have failed out of school, and others who end up with $500. American On-line bills.

Dr. Kimberly Young, a leading researcher of this disorder, used the following criteria for assessing IAD in a large initial study of this problem.

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 feel restless or irritable when attempting to cut down or stop your on-line use?
Do you go on line to escape problems or relieve feelings such as helplessness, guilt, anxiety or depression?
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, or irritability?
Do you stay on line longer than originally intended?

In several months of having a survey posted to a Web site, Dr. Young received over 400 respondents that self reported meeting 4 or more of the 10 criteria, and were thus diagnosed with IAD. Dr. Young states, in an interview, that many respondents reported what she termed a "centralization of use of the Internet at the expense of other activities" and "putting priority on maintaining electronic relationships." When asked about the prevalence rates for this condition, Dr. Young replied that, in the absence of any hard data, she would guess that the rates were similar to the rates for Pathological Gambling, or between 1 to 5 percent of all Internet users. Dr. Young felt that the ability to assume different roles, to develop intimate relationships and to be unconcerned about any possible repercussions were the most important factors of Internet interconnectivity that were most likely to contribute to the potential for IAD. The contrast between these new, exciting and projection filled relationships and ones real life ones may make existing associations seem dull in comparison (Young, 96).

Role playing is done mostly in the forums that are MOO's and MUD's. These are virtual environments were participants exert some level of control over how the environment is viewed by others. A new form of these forums provides a graphical interface, where participants can create personal avatars (small cartoon like characters) that interact with other avatars in both a visual and text enhanced manner. Dr. John Suler has studied one such environment, Time-Warner's Palace . He discusses the process of why some people might become addicted to such an environment in terms of how this activity fulfills all of Maslow's hierarchy of needs. At the bottom of the hierarchy are the basic needs, such as the need for procreation. Dr. Suler reports a high level of flirting in the Palace, with the added abilities of gender swapping and complete anonymity not found in real life. The second level of Maslow's hierarchy is about the need for interpersonal contact, social recognition, and a sense of belonging. Dr. Suler points to the common participation in an interesting virtual environment as a basic means by which people using the Place feel connected. Like any bar scene, some people will come and go rather quickly, but there usually exists a core of regulars that all know each other by name. It is this call to hang out with friends that can become, for some, so reinforcing that they start to ignore real life opportunities to fill this need. Continuing along the line of Dr. Suler's analysis of possible addiction to the Palace, the next level of Maslow's hierarchy is the need for learning, and the self-esteem that arises from one's achievements. Computer interactivity in role playing environments, once one has learned how to participate, are conducted in real time. They offer instant feedback and acknowledgment. One can get see the results of ones efforts to influence others and the environment very quickly. Building a personality, from scratch, and having it become known, and then being rewarded with the gain in status one has earned can be a very gratifying way to fulfill this level of need. Extra status can be earned by becoming a "wizard", one who has extra power over other participants. The highest level of Maslow's hierarchy is the need for self-actualization. This involves the effort one puts into evolving as a unique individual as well as an attempt to come to terms with one's mortality. It may seem difficult to imagine how possessing such a lofty goal could contribute to a pathology. As Dr. Suler explains in his account of this, the Internet offers users unique opportunities to work out questions of identity and "perhaps even realize inner interests, attitudes, and aspects of their personality that were previously hidden." (Suler, 96). The implication of this insightful analysis of how the Internet can satisfy basic and advanced human needs is that many people experience being thwarted in their attempts to gain satisfaction at a specific level of need in real life, and may find the Internet is the first interpersonal medium that satisfies these drives. This would be strongly reinforcing, to the point that such an individual might not look to real life interactions for need fulfillment for some time. Additionally, a close reading of Dr. Suler's essay leads one to conclude that an analysis of how modern culture and societal structures fail to provide adequate, comprehensive means of basic and advanced need fulfillment would be instrumental in defining more precisely what kind of personal deficits in this area are likely to be an antecedents to Internet addiction (Suler, 96).

Additional documentation of the intensity with which some people involve themselves in cyberspace role-playing is provided by this quote from James Sempsey;

MU* Addiction. Another related topic, also explored by Bruckman, is that of MUD addiction wherein people so prefer their on-line lives that they actually begin to abandon their "real" lives, spending up to 18 hours per day living in virtual reality (Kelly & Rheingold, 1993; Bruckman, 1994). There have even been reports of Internet related deaths, such as cardiac arrests resulting from sleep deprivation and lack of personal maintenance or suicides due to Net related stress lmer-Dewitt,1993; Rheingold, 1994). Such obsessive behavior has become quite a problem on some college campuses where computer facility administrators have had to literally "pull the plug" on some addicted students (Cassidy, 1995). Little is known about this new form of addiction, but as mentioned previously a preliminary draft of the DSM-V includes a section delineating some of these types of "Cyber Disorders" (Zenhausen, 1995). (Sempsey, 95)

Immersion in a collaborative fantasy world, where ones role and character can be very flexible, self determined, and different from ones real life presentation has the potential to produce a pathological absorption, if someone is predisposed to that state. A recent study of college students found a statistically significant difference in the amount of past or present psychopathology between students that were most prone to fantasize and those who's levels of fantasy engagement was measured in the normal range. In particular, depression and symptoms of dissociation were highly correlated with the high fantasy group. The researchers concluded that "a history of fantasy proneness can place certain persons at risk for significant psychopathology." (Rauschenberger, 95). If a persons fantasy life is being generated by an unconscious perception of a lack of access to social status, relating to others on the Internet, where outward symbols of status have no meaning, could predispose one up for compulsive Internet use.

The extent that frustrations in real life might contribute to a tendency for IAD is poorly understood. It is known that status and power in virtual communities is gained in a very different manner than real life. The lack of visual clues, and the relative anonymity of participants, fosters a sense of equality. One is judged on the strength of ones ideas, regardless of ones status in their real life community. This status equalization increases access to new people and provides access to information, relationships and communications that one could not expect to receive when operating in the confines of real life organizational and community structures (Garton, 95). If a person is motivated to participate in a social network, and be perceived as a respected member, the Internet offers a tremendous variety of "invite yourself in, open to anyone" communities. There is a very real sense of having achieved status when others in that form quote ones messages or acknowledge ones contribution. The degree that this serves as a reinforcement for continuing this behavior is dependent upon the degree with which someone is lacking other traditional sources social status. When students move away to go to collage, they can suffer a loss of social support. The easy and unlimited access to the Internet that universities supply their students may appear as a safe and fast way to form new relationships, and become an obsessional form of activity if the student is having problems facing adult pressures (Sanchez, 96).

There is no one cause for addiction. Addiction is a process that has distinct stages and responds to treatment best when the individual factors of each case are taken into account. There are many theories as to the etiology of additive behaviors, and very little integration of theory and research into the clinical treatment of addictions (Thombs, 94). Some researchers operate under theories that depict an addiction as a primary disorder, not caused by other personality factors. Others view addiction as secondary, and look for factors pre-existing that might account for, or moderate the addiction. It has been suggested that IAD has similar features as gambling addiction (Young, 96; Goldberg, 96).

One study of pathological gambling found a high correlation between this addiction and a history of trauma. As a sub-category of gambling addicts, the prevalence of those that had suffered trauma, leading to post traumatic stress symptomology, was found to be significantly higher than in the general population. The authors theorized that a form of learned helplessness lead to a negative affect as a general response to life, and that the immediate gratification of gambling offered a "temporary respite in the insatiable quest for self-affirmation." (Taber, 87). If someone is suffering from IAD, they may have the additional quality of being defensive about this, and exaggerate the positive aspects of their life to compensate. This was found to be the case with drug addicts (Gibson, 87).

Dr. Nancy Wesson, a clinical psychologist who specializes in the treatment of shyness and behavioral addictions, who's practice is in the Silicone Valley, sees a lot of patients with IAD. In a recent telephone interview, she stated that clients almost never present with this problem, they present with some other symptomology, and IAD is discovered to be a comorbid or primary condition. Approximately 30% of her case load has experienced serious disruption and loss due to excessive on-line interactivity. Her understanding of the extent of this problem, in consultations with peers, is that the rate of this is increasing, and it occurs in 25% to 35% of the clients seen by her fellow therapists. Dr. Wesson ascribes to the theory of behavioral addiction that postulates that "the addiction lies within the person, and they are engaging in some activity that has mood altering potential" for that person. In Dr. Wesson's treatment of clients with shyness, she is increasingly finding that some have obsessively developed on-line relations, and those relationships constitute the only relations these clients have. (Wesson, N. personal communication, Dec. 2, 1996).

This anonymous quote summarizes some of these qualities of the people that may be prone to IAD;
Additionally, the utility of the activity has be called into question when you are looking at an intensely repeated behavior. In the case of frequent and continual use of the Internet what I see most frequently in my practice (I am a psychiatrist in general private practice) is that the Internet becomes a way of avoiding intimate social contact. The hook however is that it looks like contact given the freedom that people take to communicate their most intimate thoughts and so it has the appearance of intimacy while in fact the communication is just with a computer screen and words on a line. There is a self-delusion of real depth and emotion here when it allows for the most complete masquerade (I will only show what I want) and the most complete control (I will only interact when I want) and no one truly knows who I am (Anonymous email post)

In Dr. Kimberly Young's interview with a radio talk show host (available on the Web as a Real Audio clip), Dr. Young stated that in about 50% of the 400 cases of IAD she reviewed, the person reported a prior history of another addiction. The rate at which this study population reported other pathology was mixed, with no pattern to, or significance in, the self reports of the co-occurrence depression, introversion or general personality disorders (Young, 96).

Three studies have now reported results of survey data that attempt to define the scope of IAD. These articles are available on the Web, and are all self report data from surveys. Each used a different strategy for recruiting subjects. The studies used definitions for Internet Addiction that were similar, but each used different means to analyze their results.

Viktor Brenner posted a survey called the Internet Usage Survey to the web, and then advertised it's existence by listing it with search engines. The survey asked about on-line usage in terms of time spent on-line, and if on-line interactivity had negatively impacted one's work or professional life. Brenner received 185 valid responses, of which two thirds were from males. Thirty-two of the questions made up what the author calls an "Internet-Related Addictive Behavior Checklist" or IRABC. Thirty percent of respondents reported a failed attempt to cut back on their Internet usage, but only 7% endorsed the item that related to "getting in to hot water" at work due to this. The fact that 58% reported that others in their life had told them they were spending too much time on-line is significant and congruent with a well know aspect of addictive behaviors is that one's friends and family members are often aware of the problem long before the individual involved is able to admit any troubles. Brenner notes that there appeared to be an over-representation of researchers and reporters interested in this topic that also answered the survey question. In addition, the study population contained a large number of users that were new to the Internet. The average time on-line was 24 months, but with a standard deviation of 22 months, 24% reported being on-line less then 6 months. Most DSM-IV diagnostic criteria have a time requirement that the condition must have persisted before it can be diagnosed. The lack, in this study and others reviewed here, of differentiating the newcomers from the users with a longer history of net use, is a confound. The possibility exists that a percentage of people self-reporting as Internet addicts are actually just currently very passionate about their on-line use, and will be able to moderate it if the problems it creates for them persists. Brenner addresses some of the pros and cons of the methodology involved in Web based surveys, with the ease of subject access being the major advantage. Among the drawbacks mentioned is the need for researcher to understand the nuances of web page design (Brenner, 96).

Steve Thompson posted a survey called the "McSurvey", composed of questions designed to determine the kinds of disruptions experienced by people that self-identified as Internet Addicts. This is a two-tiered study, and only the first part was available for review. Additional quantitative data will be forthcoming. Thompson embarked on a search for these subjects, in what he terms a "total immersion into the studied environment". He queried various cyberspace forums where a high rate of this phenomena could be expected, in various modalities, and got 104 valid responses. Of those, 72% reported an addiction or dependency to the Internet, and 33% stated their Internet use had negative effect on their lives. In testing to see if a perceived deficit in real life personal relations was correlated to the reporting of Internet Addiction, Thompson reports mixed results. Twenty-nine respondents in this subject pool reported that their communication skills had been "crippled", but 36 reported an enhancement in this. Forty-seven percent reported some level of physical distress such as blurred vision or sleep disorders, or a similar somatic complaint. Thompson did not report what percent of respondents were new to the Internet, and in this initial qualitative report the data on on-line usage rates is unclear, so a complete review of this study is not possible at this time. Of notable interest are the results relating to the question about what this group thought was their primary reason for engaging in on-line activity. This was a pursuit of knowledge. It is not clear if this represents knowledge of facts or of others. Thompson concludes that Internet Addiction is a real phenomena, one deserving of study, but cautions that many people currently reporting this condition may in fact only be responding to the newness of this source of knowledge in their lives, and are so involved in learning all the benefits they can receive that they are "interpreting it all as being out of moderation when it comes to the perception of their usage." (Thompson, 96). (Note: Additional data that was not reviewed here has now been posted to http://www.personal.psu.edu/sjt112/iads/thesis.html)

Oliver Egger posted a questionnaire to the Web designed to determine Internet behavior and addiction. Most of the replies came from Switzerland, 450 valid responses were received, and a throughout statistical analysis of this data was available for review. As opposed to the two previous studies reviewed here, Egger did not advertise for Internet Addicts to take his survey, but instead asked all respondents to self-identify as addicted or dependent. There were 10.6% of the respondents who endorsed this item. Egger analyzed responses based on these two groups to see what differences were significant. To a statistically significant degree, those identified as addicts reported (among other things) a greater tendency to:

Report negative consequences for their Internet use.
Participate more often in on-line self help groups.
Feel an urge to use the net when off line.
Anticipate their next Internet usage.
Feel guilty over their Internet usage.
Lie to their friends about how much time they spend on-line.
Report that colleagues complained about their excessive Internet use.

There were no significant differences in the data on age, gender or living situation, or in how long the person had been using the Internet. Since newcomers were just as likely to endorse being addicted to or dependent on the Internet as others, it is not clear if the level of distress reported by this group is a pervasive condition or a passing phase. This data set represents a strong case for the occurrence of negative consequences for Internet addicts. Egger offers very little besides the data to indicate how one should interpret it, but this study is rich in it's quantitative content. Questions were asked on a 6 or 7 point Likard scale, and published results include histograms as well as the raw data. The 450 responses were generated in only 6 weeks, as the study was announced to Internet forums such as www.news.announce, alt.irc.misc and alt.mud.misc. Links to the survey site were established and an inducement for participation was offered. Egger sates that " Since their is no particular interest group for a questionnaire like this, a competition was added to induce more people to take part in the survey." (Egger, 96)

It was possible in this review to locate several areas where the results of these studies can be directly compared.

*1 Brenner's question here involved failed attempts to cut back on Internet usage.
*2 Thompson's question here involved decreased communications skills, as subjects thought others would report about them.

Note: Egger's results were dichotomized here. For example, 60% reported never having anyone complain of their excessive Internet use, so the 40% reported above is the total of the categories of respondents that choose rarely, sometimes, or often for this choice.

It is clear from this review that the time period specified in Dr. Goldbergs original IAD official criteria were not used in these studies to distinguish true cases of this disorder from people that may be experiencing a temporary, passionate Internet involvement. Dr. Goldberg suggested that IAD existed only if the criteria were evaluated across a 12 month interval. Newcomers to the Internet have not had time to demonstrate the strength of their resolve to prioritize their on-line time, with respect to any real and continued losses, with regard to the very real value and knowledge they may be gaining, and the often extraordinary amount of time needed to learn all that the Internet can offer.

Dr. Young's original study of 400 people with IAD clearly did include this time period in the criteria for that diagnosis, but that actual data from that study was not reviewed here. The author failed the get the full text of that widely publicized study in time for this review. That study was designed to recruit people suffering from their Internet use, to see if Dr. Young's criteria for evaluating this condition were valid. Dr. Young is currently involved in a larger study that is expected to reveal more about the prevalence rates for this condition.

Treatment of any behavioral addiction is facilitated by a thorough assessment of the unique behavioral reinforcement patterns contained in any individual case. This process is complicated for IAD due to the newness of this phenomena. Anyone seeking help for themselves, or concerned about a loved one, faces several real obstacles. One is finding a psychologist or mental health professional that will acknowledge the existence of this problem, and not just attribute it to other pathology that may or may not be present. Secondly, there is a serious lack of psychologists that are familiar enough with the specific types of Internet social interactions to be qualified to formulate a treatment plan to address IAD (Young, 96).

Following the general caveat that what causes a problem is a problem, it might seem that total abstinence is a reasonable "cure". Most cases will not be amenable to that solution, because so many of the reported cases are from student and worker populations where use of the Internet to accomplish research or business goals is a requirement, not an option. It is prudent then to offer the client with IAD a program of recovery resembles going on a diet (Orzack, 96). Overeaters Anonymous, a twelve step group that addresses eating disorders, is a valid model from which examples of dealing with the reduction of a behavior can be drawn.

There may be ways to engage the very activity itself as a deterrent. Since someone suffering IAD is already computer literate, and oriented towards computers as a resource, it makes sense to incorporate a computer assisted recovery. Many people already have calendar schedules they keep current and check often, on their computer. Using such a program to log one's on-line time, and what that time was specifically spent on, would be a means of both establishing a base line for the behavior and tracking recovery progress. Also, a client could set such a program to flash a message at regular intervals, reminding the user to stop momentarily and evaluate if their current Internet interactivity is warranted or not.

Dr. Maressa Orzack is currently treating IAD, and other pathological computer use, with cognitive behavioral therapy at the psychiatric outpatient clinic of McLean Hospital in Boston, MA. Presently, only individual treatment is offered, but plans exist for group treatment. Dr. Orzack states that this disorder should not be treated on-line, and a psychopharmacological consultation is recommended in some cases (Orzack, 96).

Effective treatment programs can be developed for IAD, but they must incorporate an understanding of the specific aspects on on-line use that is at the core of any individuals problem. If someone is "hooked" on hanging out in a chat channel with their close net friends, the reinforcement pattern will be different from someone involved in maintaining an alternate persona in a role playing MOO. Assessing someone with IAD for the exact nature of their on-line social activity is crucial, because the available range is so large. Each modality (email, real time chat, MOO's) has a different pattern of reinforcements it supplies. One approach that might work across such sub-types of IAD is an effort by the client to limit their Internet use to a regular set time each day. This would help counter the highly reinforcing variable ratio aspect, where one is never sure when something exciting is going to appear, but the total amount of excitation is dependent upon the amount of time on-line. For example, if someone knew that the were only going to check their email at 9 am, this would put the reinforcement back on a variable fixed schedule, where the reinforcement value is less. The desire to log on to see what might have transpired will be confronted, as a first step in a recovery program.

Technological advancements in communication tools have opened a new domain in social interactivity. It is now possible, from the privacy and sanctity of one's own home, to publish one's ideas to hundreds or thousands of other people, and receive instant and delayed feedback from across vast distances. This in a new development, and is now supplementing the traditional mass media, with it's 'from one to many" format, with a "from many to many" format, for millions of Internet users world wide. This is a categorically different form of human interaction, one that is too recent, and still changing too fast, for it's implications to be fully cognizant to even the oldest members of on-line virtual communities. IAD is not like other forms of behavioral addiction, because it involves interaction with others in the context of this new, scarcely researched medium.

Using the Internet is no more inherently addicting than any other human activity that someone might find pleasure producing, valuable or productive, be it social in nature or not. A full understanding of IAD is only possible if a complete understanding of the aspects of Internet personal behavior, that are unique to the Internet, is arrived at. This paper has been an attempt to distinguish the actual kinds of interactions that are only available on the Internet that have a highly stimulating value. The uninhibited and hyperpersonal nature of social contact in a virtual realm combine with the selectivity, anonymity and availability possible as unique characteristics of on-line social interactivety.

Research in this area is just now turning to look at the characteristics of Internet users that might predispose them to IAD. This paper is an initial attempt to match the unique qualities of the Internet to some inherent personality predisposition, the combination of which might help account for the occurrence of IAD at the levels it is now being reported. Fantasy proneness, shyness, social phobia, perceived lack of social status or attention are all characteristics that, when exposed to the instant acceptance and projection filled nature of virtual interpersonal relations, might constitute a vulnerability to IAD.

Future research will overcome the methodological handicap of self report data. One area that clearly has not been addressed at the level it deserves is the use of, and addiction to, on-line pornography and interpersonal cybersex. Anything that can safely, quickly, and completely satisfy such a basic human desire is bound to be addictive to some. How to induce subjects to self disclose about this activity is another methodological problem, and base rates for this activity are going to be difficult to determine.

Virtual relationships are mobile, can be very supportive (Wellman, 96), and have minimal risk compared to potential gains (Walther, 96). People using the Internet to form new relations are engaged in a new, stimulating and reinforcing activity. It is reasonable to expect a high percentage of new users to become more or less passionate for some period of time when first exposed to the possibilities of long distance friendships and the status equality inherent in virtual forums. It is clear from this review of research efforts that the time determinate in the diagnostic criteria for IAD is a very important, and it is only the continued focus on on-line involvement's, across a significant period of time in which real life losses occur, that marks IAD as a pathological condition, as opposed to a freely chosen passion.