ARTICLE SUMMARY:- INTERNET ADDICTION: SYMPTOMS, EVALUATION AND TREATMENT

This article tell us about internet addiction is a new mental health disease and the clinicians still unaware about it. Thus, this article is going to facilitate the clinicians to understand thoroughly about the internet addiction. The article will first focus on the complications of diagnosis of Internet addiction. Second, the negative consequences of such Internet abuse are explored. Third, how to properly assess and identify triggers causing the onset of pathological Internet use are discussed. Fourth, a number of recovery strategies are presented. Lastly, since Internet addiction is an emergent disorder, implications for future practice are presented.

COMPLICATIONS IN DIAGNOSING INTERNET ADDICTIONFirst and foremost, the concept of internet addiction was introduced by Young in 1996 and this concept has triggered a great debate among the scholars especially the academicians and clinicians. One of the issues that has been debated among them was about the term addictive and addiction. Some of the scholars said that the term addictive can only be applied if there are physical substances being consumed in ones body. However, many believed that the term addiction can only be applied if it is related to the consumption of drugs. Yet, the term addiction has been used widely to describe a number of behaviours (e.g. gambling, overeating and playing games) that did not involve any consumption of drugs. Thus, the term of addiction can be applied to describe any behaviour or condition and not only confined to the consumption of drugs.Furthermore, the complication to prove internet addiction arose when the internet itself gives a lot of benefits to the people. In fact, it facilitates and eases our daily activities. For example, internet helps us to do research, to access any international libraries and etc. On top of that, there are many books that promote internet because it gives benefits to us. Hence, it is difficult to recognise one who is having internet addiction and it needs the skilled clinicians to comprehend first the features of internet addiction to differentiate normal and internet addicts.Proper diagnosis is hard to do when there are no specific features of internet addiction that listed in Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). Therefore, Young has established eight questions based on the criteria of pathological gambling because they are quite similar to the pathological user Internet. The eight questions are:-

1. Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate next on-line 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 on-line 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)?

Patient will be considered as addicted if he answered yes five times and onwards. From these questions the clinicians can differentiate between normal and pathological user Internet addiction. However, the author has highlighted that the propensity of patients denial is high because the need for him to carry out employment tasks or academics purposes. Thus, even though the patient has fulfilled all eight features, he can easily cover with "I need this as part of my job," "Its just a machine," or "Everyone is using it". Therefore, the clinicians really need to comprehend all the features of internet addiction in order to identify the pathological user Internet addiction.NEGATIVE CONSEQUENCES OF ADDICTIVE USE OF THE INTERNET

There are many negative consequences of addictive use of the internet. However, in this article only several negative impacts were highlighted in the aspects of familial, academics and occupational. Familial Problems

Young discovered about fifty-three percent of Internet addicts were involved in serious relationship problems. The Internet addicts will spend more time in front of the computer to stay online rather than spending time with the family. In fact, marriage relationships seem to be the most affected by the excessive use of the Internet. This is because the Internet addicts have the propensity to neglect all their obligations such as feeding their children and doing the house chores. Apart from that, they will become grumpy when their partner question their consumption of time in front the computer. Moreover, the matrimonial lawyers found out that many cases of divorce are due to the cyber affairs. The addictive users will spend more time with their virtual partner and gradually their love towards their real life spouse will dissipate and consequently, they withdraw from the marriage in order to maintain the virtual relationship.

Academic Problems

The Internet has been promoted as a tool that can facilitate students in their learning. However, one survey revealed that eighty-six percent of responding teachers, librarians, and computer coordinators believe that Internet usage by children does not improve performance. They argued that the materials in the Internet were disorganized and unrelated to the school curriculum. Therefore, the Internet usage in the school did not help the student to improve their grades at all. Furthermore, Young found that fifty-eight percent of students reported a decline in study habits, a significant drop in grades, missed classes, or being placed on probation due to excessive Internet use. The students were misuse the Internet by joining chat rooms, playing games and etc. On top of that, Alfred Universitys Provost W. Richard Ott investigated why normally successful students with 1200 to 1300 SATs had recently been dismissed. His investigation found that forty-three percent of these students failed school due to extensive patterns of late night log-on to the university computer system. This is due to the inability of students to manage their usage of the Internet. In fact, a survey initiated by counselors at the University of Texas at Austin found that of the 531 valid responses, 14% met criteria for Internet addiction. As a result, there are many programmes that being organized to increase the awareness among students about the Internet addiction.Occupational Problems

The excessive usage of Internet was affected the employees. One survey from the nations top 1,000 companies revealed that fifty-five percent of executives believed that time surfing the Internet for non-business purposes is undermining their employees effectiveness on the job. In fact, by using the tracking devices, one firm has tracked all traffic going across its Internet connection and discovered that only twenty-three percent of the usage was business related. These results have surprised all the managers due to the massive abuse of Internet. Hence, the Internet has been the worst distraction by many employees.ASSESSMENT OF PATHOLOGICAL INTERNET USE

Normally, the symptoms of Internet addiction were rarely prevailed when the clinical interview was being carried out. Therefore, the clinicians need to understand the features of Internet addiction and asses the pathological Internet use. To properly assess the Internet pathological use, the author believed that there are certain cues that make the user to be addictive and the cues need to be traced back through the assessment. In fact, there are four types of cue that need to be assessed. Applications

The first factor that might be influenced one to stay longer on the Internet is its application. On the Internet, there are many applications such as chat rooms and games. In addition, the Internet addicts might obsessed with one of applications that available on the Internet and spend his excessive amount of time on it. Therefore, the clinicians need to identify which application that influenced the user and how many hours he spends on it. A deep assessment can be done with several questions like (a) What are the applications you use on the Internet? (b) How many hours per week do you spend using each application? (c) How would you rank order each application from best to least important? and (d) What do you like best about each application?. By using these questions, the clinicians can easily determine the pattern of applications of Internet addicts.Emotions

The second factor that triggered the addictive use of the Internet is emotion. The Internet can be an instrument for one to escape from the real problem. It gives one a pleasant, security or calm feeling when he is online. Hence, one has the tendency to keep coming back to stay on the Internet. Therefore, the clinicians should ask "How do you feel when off-line?" to the Internet users and reviewed their answer whether they feel unpleasant feeling like unsatisfied, worried, and troubled. Then, the clinicians should ask them "How do you feel when using the Internet?" and if they give positive response like excited, happy and thrilled, then it indicates that the user has indulged in Internet addiction. Furthermore, if the clinicians faced with the introvert user, then the clinicians can ask the user to keep a diary in order to know his true feeling when he is online. These ways of assessment can help clinicians to determine the normal from the pathological Internet use.Cognitions

The third factor that triggered the excessive use of internet is cognition. The Internet addicts have more tendency to think negatively or paranoia about something. In fact, they also have maladaptive cognition such as low self-esteem or insecurity about their physical appearance. Consequently, they chose the Internet a mechanism to escape from their real problem. Moreover, some of Internet addicts will hide their addictive towards the Internet while being treated. Thus, clinicians have to concentrate on the patients if they have deep core beliefs like I am no good or I am a failure. This is because these patients have higher tendency to be the Internet addicts.Life Events

One that has less connections to other people or deprived of love from his loved one has the higher propensity to involve in Internet addiction. This is because he makes the Internet as his security blanket to escape temporarily from his problems. Likewise, the alcoholic will continuously drink alcohol if he faced a problem but when he is sober the problem is not changed. Yet, he keeps drinking because that habit is his escape instrument from reality.

TREATMENT STRATEGIES FOR PATHOLOGICAL INTERNET USE

The treatment for the pathological Internet use should be simple or moderate practices. It cannot be in the term of forcing or aggressive because the patients will reject it immediately and it is hard for them to change their habits instantly. There are several techniques to treat the patients. The techniques are (a) practice the opposite time in Internet use, (b) use external stoppers, (c) set goals, (d) abstain from a particular application, (e) use reminder cards, (f) develop a personal inventory, (g) enter a support group, and (h) family therapy. The first three techniques of treatment are including time management and the remains will be enforced later because of having a good time management only is inadequate to stop the Internet addiction. Practice the Opposite

Practice the opposite time in using the Internet is like changing the whole schedule of the Internet addicts. The clinicians should take their time to know the patients routine in using the Internet by asking a set of questions such as (a) What days of the week do you typically log on-line? (b) What time of day do you usually begin? (c) How long do you stay on during a typical session? and (d) Where do you usually use the computer?. Once the clinicians get the answers and reviewed them, ask the patients to do the opposite routine. For example, if the patients usually log-in as soon as they wake up, then ask them to do anything else first like taking the breakfast or shower. By doing other activities, their time will be occupied and their Internet activities became lesser than usual. The author called this treatment as practice the opposite.External StoppersExternal stopper is another simple technique to treat the internet addicts by using their obligations like going to the school or work as the stopper of using the internet. For example, set a time for the patients to log-in the internet one hour before they are going to work. They will naturally stop themselves and log-off from the internet. However, the risk by using this treatment is the patients might be ignored their obligations and continue to stay online. Therefore, the clinicians can suggest to the patients to put the alarm clock beside the computer so that they alert and know when they are supposed to stop their internet activities.Setting Goals

There are many users that tried to limit their time in using internet but failed severely. This is because they had vague plan pertaining to when exactly they are going to continue back their internet sessions and they let the internet controls them. Therefore, the clinicians should limit the patients time in using the internet. For example, allow the patients to log-in about twenty hours rather than forty hours according to their current habits. However, their internet sessions should be arranged short but frequent in order to prevent them from withdrawal. Then, the clinicians should write their schedule on the calendar or their planner so that the patients aware with their new schedule and have a sense of being control instead of letting the internet control them.Abstinence

The abstinence here referred to the abstinence of application. As the author stated above, the clinicians need to know what kind of application that being preferred by the patients so that they can ask the patients to stop using their favourite application. Yet, the patients can still use other application that not related to their application. For instance, the patients are addicted to the chat room application. Thus, they must abstain from it. However, they can still use e-mail as a mechanism to communicate with others. By using this technique, the patients will reduce their time in front of the computer due to the less appealing application.Reminder Cards

Reminder cards are one of the techniques to ensure the patients to stay focus to eradicate their addictive use of the internet. The clinicians may ask the patients to list down five major problem of internet addiction and five benefits if they are free from the internet addiction. Then, ask the patients to write down on the card that they can bring it anywhere. This technique will remind them if they are trying to go back to their old habits and remain them on the path to strive their goals.

Personal Inventory

Personal inventory is one of the important ways to reduce the internet addiction. The clinicians should ask the patients to fill their personal inventory with activities that they neglect during their solitary time with the internet. For example, gathering with the family, hiking and etc. This will lead the patients to feel the real happiness by doing the real activities that they left behind because of the virtual world. Moreover, the clinicians should instruct the patient to put scale on their activities such as 1 - Very Important, 2 - Important, or 3 - Not Very Important. This way will make the patients to reflect their life before they are involved in addiction and make they realize that their decision to change are correct. Thus, they will more appreciate their life and people around them.Support Groups

Some of the normal users may turn into the internet addicts due to the lack of social life. They have less connections with the real people in the reality. Therefore, they may find online friends which always available to communicate. This make their attachment towards the internet became strong. Apart from that, there were some people who have lack of self-esteem or self-confidence that lured them into the virtual world because they feel more comfortable due to absence of direct contact with people. Moreover, patients that experienced the death of the loved one may involve in the internet to escape from the sadness and the lonely life. They need a group that has experienced the same problems like them so that they can share their problems or feelings. Thus, the clinicians need to find the suitable group for the patients in order for them to make new friends. The group may give support to the patients to go through their lives. Hence, the patients really need to join a group that can support them.Family Therapy

The internet addicts really need the family therapy because family are the closest contact and have a huge influenced in ones live. Family therapy need to include several important contents that gradually change the internet addicts. The contents are (a) educate the family on how addictive the Internet can be, (b) reduce blame on the addict for behaviors, (c) improve open communication about the pre-morbid problems in the family which drove the addict to seek out psychological fulfillment of emotional needs on-line, and (d) encourage the family to assist with the addicts recovery such as finding new hobbies. Hence, the family therapy has a good influence that may recover the addicts to normal.

FUTURE IMPLICATIONS OF PATHOLOGICAL INTERNET USE

A few years back, the study of pathological Internet use has grown. There are many research and theories examining the effects of on-line behaviour patterns. The emergence of a new psychological journal is being developed that will focus upon aspects of Internet use and addiction. However, the actual result not yet being specified and definite. Thus, the scholars need to study about the Internet addiction thoroughly before it can be recognized by the Diagnostic and Statistical Manual of Mental Disorders and be a reference in the future.

Surveys have found that about 47 million have ventured on-line and analysts estimate that massive of number will join online. With the increasing number of user, the clinicians should take note that there will be many possibilities the users became addictive and they should prepare the treatments for the patients.

This type of the addiction is new and the addicts may have the difficulties to express their problems regarding to the addiction. Therefore, the advertisements should be published to encourage the addicts to get their treatments. Moreover, at the university, the seminars or the programme to increase the awareness level regarding to the Internet addiction and the misuse the Internet should be held.

Last but not least, further research needs to be carried out in order to have deep understanding about the Internet addiction and the recovery programme to succeed.8