CyberPsychology & BehaviorVolume 2, Number 5, 1999Mary Ann Liebert, Inc.

Treatment of Computer Addicts with ComplexCo-Morbid Psychiatric Disorders

MARESSA HECHT ORZACK, Ph.D. and DEBORAH S. ORZACK, M.S.

ABSTRACT

Computer technology is expanding at an exponential rate, and its effect on society and indi-viduals is being observed in many locations and by many professionals. Computer-addictivebehavior is characterized by excessive and inappropriate use of the computer that has reper-cussions on an individual's real life obligations and relationships. Currently, these unantic-ipated consequences have been variously classified as computer addiction, Internet addictiondisorder, problematic internet use, pathological internet use, and as a new symptom to beadded to other psychiatric conditions. Mounting evidence indicates that those who are vul-nerable to these problems suffer from multiple co-morbid psychiatric disorders. The prob-lem is further complicated because computer usage is so pervasive in our society that the aimof treatment cannot be abstinence. It must be treated as an eating disorder where the goal isto normalize computer activities in order to survive. Assessment of each patient consists ofthe measurement of problematic computer behavior and definition of the expectations theyhave for the effects of these activities. Because of the complexity of these patients' problems,treatment needs to be multidisciplinary and include cognitive behavior therapy, psychotropicmedication, family therapy, and case managers. Teamwork is emphasized. Also, regular as-

sessments at 3-month intervals are important both for the patient and the team. The aim ofthe treatment is to help the patient manage the inappropriate behavior and still be able touse the technology.

INTRODUCTION For the present, not one of these classifica-tions is accepted as a psychiatric disorder in

Computer technology i has revolutionized the Diagnostic and Statistical Manual of Mentalour world and has provided untold ben- Disorders, (fourth .edition).9 Some very spe-

efits to millions of people; however, some cific studies have indicated that these prob-people have suffered strains to their mental lems are often co-morbid with other disor-and physical health as the result of this revo- ders.4'5,8,10"12 Shapira7 studied 14 self-selectedlution. Many authors have documented the Internet users with "Problematic Internetexistence of human problems related to com- Use"; each of them fit the DSM-IV criteria forputer use.1^8 These problems have been clas- between three and eight psychiatric disorderssified by several different names, including per patient. These included social phobias,the following: computer addiction, internet ADD/ADHD, paraphilias, insomnia, moodaddiction disorder, pathological Internet use, and anxiety disorders, pathological gambling,problematic Internet use, and cyberaddiction, and other addictions.

McLean Hospital, The Computer Addiction Service, Belmont, MA.

465

466 ORZACK AND ORZACK

Because men initially dominated this field oftechnology, the early literature concernedthem.2 However, as the technology has becomeeasily available, women have begun to use

computers as often as men and are now just as

likely to develop a problem. Morahan-Martinand Schumacher10 found that women were

lonely, bored, and depressed.The Computer Addiction Service (CAS) at

McLean Hospital (affiliated with HarvardMedical School) opened in 1996, when it be-came apparent that a growing problem existed.Because McLean is a world-renowned treat-ment facility, most of our patients have verycomplex histories. The entire patient popula-tion seen at the CAS clinic meets the DSM-IVcriteria for at least three co-morbid disordersper patient.13'14 Greenfield,15 in an onlinestudy, found that 6% of 900 respondents ad-mitted to using the computer compulsively. Ofthat 6%, all were identified as having atjeastone disorder, primarily depression.

An off-line study of 900 college students in-dicated that 9% qualified as dependent.12 Witha possible population of 92 million people inthe United States and Canada who are now re-

ported to be on the Internet, it is obvious thatdiagnostic tools and treatment methods mustbe developed. This article will present threecase histories of patients with complex diag-noses. The patients require multi-disciplinaryinterventions that are described below.

METHODS

Assessment

The following treatments were developed atthe CAS clinic in order to help devise bettertreatment interventions and learn more aboutthe stresses that drive this behavior. The signsand symptoms of computer addiction (CA) are

based on contact with my own patients, nu-

merous requests for referrals, consultationsfrom other therapists, and many online re-

quests for help (Table 1). Table 1 is based on an

impulse control disorder model that is verysimilar to one used for gambling. I make no

other claim for the validity of this diagnosticscale because it is based on a highly selectedpopulation.

The initial interview consisted of question-ing the patient to determine what signs andsymptoms were evident (Table 1). In order tomake a proper diagnosis, I administered theOrzack version of Anderson's Internet Addic-tion Scale.5'14 In this version the scale has beenaltered to include all kinds of computer activ-ity rather than just the Internet. The scale was

used diagnostically and not as a research tool.It was therefore possible to explore each of thequestions in depth rather than just checking offanswers. In addition, we found that it was ad-visable to add a new series of questions. Thesequestions started out with "What are your ex-

pectations when you turn on the computer?""Are they positive or negative?" is one exam-

ple. Such questions allowed people to makestatements with more freedom than when an-

swering the scale.Welsh12 did content analyses of answers and

found that those subjects classified as depen-dent had very different expectancies from thenondependent sample. The former turned to

computers for relief from anxiety and tension,whereas the latter were neutral about the effectof the computer.

Clinical guidelines require a treatment planwith a re-evaluation of the patient's progress at3-month intervals. Each treatment plan is pre-sented to the team and must be approved byeach member. The patient is included in plan-ning the treatment.

Treatment

Now that there is evidence that this technol-ogy is growing at an exponential rate, it is nec-

essary to be aware that there are unanticipatedconsequences to it: We must be ready to helpthose users who have difficulty managing it.As more people use computer technology,more problems will surface. It is, therefore,necessary to learn to help people recognize theexistence of problems and to find ways to mod-erate their behavior.

Computer Addiction appears similar to eat-

ing disorders in as much as the most appro-priate and effective treatment for each cannothave abstinence as the goal. One can choose notto gamble, smoke, or drink because the user'slife will only be better as a result. The majority

COMPUTER ADDICTS 467

Table 1. Computer /Internet Addiction Disorder

Persistent and recurrent misuse of the computer is indicated by at least five of the following:1. Experiences pleasure, gratification, or relief while engaged in computer activities.2. Preoccupation with computer activity, including thinking about the experience, making plans to return to

the computer, surfing the web, buying the newest and fastest hardware.3. Needing to spend more and more time or money on computer activities to change mood.4. Failure of repeated efforts to control these activities.5. Restlessness, irritability, or other dysphoric moods such as increase in tension when not engaged in

computer activities.6. Need to return to these activities to escape problems or relieve dysphoric mood.7. Neglect of social, familial, educational, or work obligations.8. Lying to family members, therapists, and others about the extent of time spent on the computer.9. Actual or threatened loss of significant relationship, job, financial stability, or educational opportunity

because of computer usage.10. Show physical signs, such as carpal tunnel syndrome, backaches, dry eyes, migraine headaches, neglect of

personal hygiene or earing irregularities.11. Changes in sleep patterns.

Computer misuse is not better accounted for by OCD or a manic episode.

of patients with CA cannot be expected to ab-stain from using the technology because mostof them must use computers either in school orto earn a living. Treatment, therefore, concen-trates on helping people to moderate inappro-priate behavior rather than to eliminate it.

Cognitive Behavior Therapy15 is based on thepremise that thoughts determine feelings. Thepatients are taught to recognize these thoughtsso that they can identify the trigger points forinappropriate computer behavior. On a case-

by-case basis, the therapist and patient deter-mine what activities can be substituted for theinappropriate one. This has to be a collabora-tive plan and often involves contracting foreach sub-goal step toward the major goal,which is being able to manage their time on thecomputer. Motivational Enhancement therapy8follows a less confrontational approach andtreatment styles can be more innovative. It al-lows the patient and therapist to collaborate onthe treatment plan and set attainable goals. Thepatient is informed from the very beginningthat relapses are always possible and that theyare not an indication of failure. Relapse pre-vention is the crux of the treatment. A combi-nation of both interventions seems to workbest.

A very important component of the teamtreatment is consultation with a psychophar-macologist about intervention with medica-tion. Most of these patients are on a combina-tion of SSRIs and anti-anxiety drugs, which arenot addictive. Some even need an occasional

anti-psychotic medication. This combinationhelps them to concentrate and enter into more

productive therapy.

THREE CASES

I chose the following cases because they are

.

representative of the type that are treated at ourclinic. The names and many of the facts are al-tered to protect the privacy of the patients.Case 1

Harry, a 30-year-old man, was referred to me

after he was hospitalized because of a suicidalgesture. He said this attempt was a cry for helpbecause he was having difficulty relating to hisWeb-mates in the virtual community where hespent most of his time. He was living in a

halfway house and also having trouble relatingto his roommates.

Harry has a long history of severe depres-sion, post-traumatic stress, and has multiplehospitalizations. Some of his problems are theresult of his mixed ethnic background. Harrystill feels the lack of an ethnic identity. Hiswhite mother divorced his African Americanfather when she realized he had come homefrom Vietnam with an alcohol and drug prob-lem. The substance abuse worsened when hecould not get a job, and he became abusive, es-

pecially to his son Harry.Harry always felt out of place in either cul-

ture. His mother did the best she could as a

468 ORZACK AND ORZACK

poor, single woman. An advocate of Zen Bud-dhism and naturopathy, she tried to help him.But he still ended up needing professional helpby the time he was a teenager.

He had few friends and remembers thinkingto himself that he often felt that the worldwould never miss him if he disappeared. Whenhe was in high school, his life changed whenhe first encountered the school's old, discardedApple II computers. Without any instruction hefigured out how to run it. He was entrancedwith the technology and spent all his free timeon the computer. Harry discovered other com-

puter users who welcomed him.After graduation from high school, he went

to a community college to study computer de-sign. He wanted to learn how to apply his artto computers. Unfortunately, he was not ableto endure the rigors of the college life. He rarelyfinished any of his art assignments. He felt thedrawing classes were unnecessary.

When the MAC came out he wanted one,but he could not afford it. Somehow he man-

aged to get into a university computer labwhere he again found companionship. Hespent so much time at the lab that other stu-dents began to resent him. He felt more athome in the lab than in the halfway house. Heabused his privileges and was denied permis-sion to enter the lab.

By the time this happened, he had made a

mark for himself and people knew he could de-sign and draw cartoons. He decided to buy a

computer for the first time using a credit card.He saved money by not subscribing to an In-ternet Service Provider. He was a resourcefulperson and managed to tap into free Internetservers in libraries and computer labs on col-lege campuses. In that way, he was able to fur-ther his career as a web artist.

For fun he joined a virtual community wherethe participants were mythical characters. Hisparticular avatar was predatory and consid-ered a bad actor in the virtual community. Hismost recent suicidal gesture was the result of a

particular avatar getting angry and rejectinghis advances. He entered this virtual commu-

nity each night and kept getting the same treat-ment. Finally, he became so distraught that heoverdosed.

As an indication of his somewhat divided

life, he is also a Web Master for a political cause.He juggles these activities almost daily.

When Harry started to attend the clinic, hesaid he was ready to change his behavior andleave the virtual community. His team from hishalfway house, his psychiatrist, and his case

manager all encouraged him to come. The lo-gistics of transportation to the clinic were a

problem, but he finally persuaded his motherto drive him to the clinic. He has also come bypublic transportation. Either way, considerablemotivation is required for him to keep ap-pointments.

One of the complaints of the team was hisfailure to keep appointments because he stayedup all night on the computer. Other complaintscentered on his poor personal hygiene. Wesoon found out that he never returned phonecalls or answered his pager. It was also evidentthat he and his roommates did not give eachother messages. We agreed that the best wayto reach him was to leave a message online.This reminds him that he has an appointmentthe next day and needs to get to sleep.

Once he actually started coming to the clinic,Harry needed to determine what his next pri-ority would be. He thought he could contractto leave the virtual community where he was

so badly abused each day. He finally was enti-tled to spare himself this abuse.

Asking a patient like Harry to give up thecomputer is pointless. Instead, the therapymust concentrate on what jobs the patientcould do with his with computer skills. Harrybegan to think of ways he could use the com-

puter to make money. Rather than followthrough with ideas for temp computer jobs, hedecided to make money on an online auction.He liked marbles because of their bright colorsand thought he could buy marbles cheaply andsell them on an online auction. He was con-

vinced he would get rich quick. He got so

caught up in staying up on the auction that he"gambled" away his gains and kept buyingmore. He used up his credit card allowance. Fi-nally he lost out because he owed a great dealof money to a seller and could not pay it. Hewas blacklisted by the website.

He started working at a local fast food chainbut was fired for poor hygiene and failing toshow up on time. His team tried to help him

COMPUTER ADDICTS 469

and even found him an ideal job, but he ap-plied for one that was even less accessible thanthe clinic. He dreamed that he would makeenough money to buy a car and that wouldsolve the problem. They did not hire him. Bythe time he went for the perfect job for him,teaching computer skills to minority students,they had filled it.

Because Harry was on disability and livingin a halfway house, his rent, food, and a smallallowance for daily expenses were paid for bya social service agency. None of his other ex-

penses were covered and he had to pay hisdebts. He now had no transportation becausehis mother had moved 2,000 miles away for thewinter. He was desperate to make money.

He turned to a criminal act in order to payoff his debt. He became so excited that he ac-

tually said he felt a rush as he paid all the bills.As soon as he had completed the task he feltdown and empty. In order to dispel that feel-ing, he turned to the auction again and startedbidding. At a team meeting, he disclosed thefact that he had no money left at all. It was verydifficult for him to admit what he had done.But the team decided that he was in enoughtrouble and he did not need to be chastised.Without this kind of support, this personwould be destitute on the street.

His contract was then amended to include no

use of credit cards unless he had the money tocover them. During all this turmoil, his recordfor showing up for appointments was poor. Heneglected to get his prescriptions filled, failedto meet with the caseworker, and neglected tak-ing care of himself physically.

Just as he was giving up; Harry met a manwho needed someone to help him enter his col-lection of collectibles into a database. He lifeagain changed because this man was indepen-dently wealthy. Here Harry had access not onlyto a brand new computer, but a modem andfree food. He had actually never used a PC be-fore and, thus, had to learn a new skill.

The lure was too much for him and he startedplaying games instead of working for this man.What started out as a friendship soon becamea power struggle. Money talked and Harry didwhat he was told. He scanned objects for the"boss" to use on the online auction.

Luckily he earned enough money to buy

himself a vacation. This was triumph for him.While away, he kept us up to date on hisprogress and activities by E-mail. Life againseemed good for him upon his return. He didnot want to return to the "boss." He resumedtherapy and met with the team again. Heseemed OK, but still did not have a job. He re-turned to the one sure source of money, a bor-ing slave job. Therapy again was neglected andcommunication was minimal. The one thingthat he has now gained in his life is proficiencyin Windows programs. Harry is now moremarketable in the workforce.

Such a patient would not be able to survivein this world if not for a team approach.

Case 2

Her therapist referred Vicky to me becauseshe was staying up all night in a chat room on

her newly purchased computer. She was ne-

glecting her son. She had been seeing that ther-apist with her ex-husband in couples' therapyto deal with custody issues. Later she contin-ued to see the therapist without the ex-hus-band.

Vicky is a 40-year-old professional woman

who had a long history of ADD, depression,sleep walking, and social phobia. She is shy,has poor self-esteem, and is overweight. Shesuffers from insomnia, chronic back problems,and knee problems. She is divorced and has a

teenage son who lives with her. He has ADHDwith symptoms of Oppositional Defiance.There are constant custody fights with her ex-

husband.Eight months ago, Vicky acquired a com-

puter and became totally dependent on it; of-ten spending 10-12 hours a night on the com-

puter. Regardless of her work schedule, as soon

as she gets home she logs on. She keeps hercomputer by her bed and the keyboard on herlap. Whenever her son or boarder wanted tocheck their E-mail, she would stand over themuntil they were done.

Her weight is also a problem, but she refusesto exercise because of the difficulty she has inwalking. Because her computer is by her bed,she often falls asleep online and has even

logged on in her sleep. Also she eats constantlywhile she is on the chat. This led to a major

470 ORZACK AND ORZACK

problem. She spilled water on her keyboardand ruined it. She raced to the store for a re-

placement but was told they were sold out. Sheblew up and demanded they find one. Even-tually they did, but not before she had atantrum in the store.

Vicki stays on Online for these reasons: shefeels wanted and respected and has a sense ofidentity. She does not fake anything in her on-line persona. She says she is shy, has poor self-esteem, and is overweight. Yet she has metmany people, had many IMs, and relies on thechat for companionship. People online accepther as she is.

One of her cyber-friends lives nearby, andthey now have a face to face relationship. Heis close enough to drop by each day. Theyspend much of their time together chatting on-line with others.

When I first checked her use of the computer,her dependency level was very high. She_wasonline for more than 10 hours a day, and ad-mitted to being irritable if she had to log off.She often missed meals, failed to keep ap-pointments, and, most of all, was highly sleepdeprived. The only way she could stay awakeat work was to take her prescribed Ritalin.

The first time she came to see me a friendbrought her because she was afraid. After shetold me her story, I asked her to tell me the one

thing she felt she really needed to do immedi-ately. "Pay my bills" was her answer. Specifi-cally, she contracted to let her boarder log onfor an hour while she worked on her bills. Atthe end of the hour she could return to her chatif she wished.

The next time she came] alone and reportedshe had paid some of her bills. She was pleased.The next week she decided to get off the com-

puter and cook dinner for her son. She still hasnot seen her psychiatrist for medication thatshe stopped using several months ago. Theseare very simple accomplishments. I keep cau-

tioning her not to contract for too much. Hercase is interesting because she has absolutelyno other computer skills and never strays fromthe chat groups.

After 3 months she had improved aboutfeeding her son, had paid her bills, and wasable to tolerate having someone else on thecomputer. She did go to see her psychiatrist

who re-emphasized the importance of her tak-ing her fluoxetine on a regular basis. She haddecreased her time online to 8-10 hours. Shewas regularly working double shifts to getmore money to pay her bills.

She still uses the chat after work. Conse-quently, she would be up for 36 hours at atime. She often didn't fall asleep until earlymorning and then often overslept and got towork late.

Her son is now 14, an age where he canchoose which parent to live with. As of thiswriting, he has chosen to move to his father'shome in a nearby state. This means that she willbe alone much more often, and it will be moredifficult for her to stay off the chat room. Sheis worried about her son because she knowsthat his father is verbally abusive and highlydemanding. He made the choice, however, andshe has to learn to live with it now.

She states that she feels better on the com-

puter. She feels safer when first meeting men

online. Only when she is comfortable withthem online will she agree to an offline meet-ing.

Prognosis for this case is mixed. The patientis unable to see that staying in a virtual envi-ronment for many hours is avoiding reality.She sacrifices her health for online connec-tions. She misses her son, although they docorrespond regularly by E-mail. She has mod-ified some of her behavior and is still in ther-apy with her original therapist and still at-

tending the clinic. However, she is stilloverwhelmingly connected to the computer.This case illustrates the enormous reinforce-ment for some patients who need to have an

identity, a sense of belonging, and sexual grat-ification.

Case 3

Steve is a 44-year-old man who was referredto me from our inpatient unit because of his ex-cessive computer use on the inpatient unit. Hewas hospitalized as the result of a friend'sphone call to the police saying he had a gun. Itwas decided that he was a danger to himselfand others. The police confiscated the guns heowned and brought him to McLean Hospital,where his therapist was located. While on the

COMPUTER ADDICTS 471

unit, he spent most of his time on a laptop com-

puter, isolated from other patients.At the time of admission, Steve was ex-

tremely distraught and appeared to have para-noid delusions. His memory was impaired andhe was highly distractible. He said that his com-

pany and the government were involved in a

conspiracy to suppress one of his inventions.He claimed they stole it and destroyed all therelevant documents. He tried to blow the whis-tle and was not only ignored, but also shunned.He and his family lived in constant fear of re-taliation from the people he had accused. Thefinal straw came when his father not only re-fused to help him, but also told him never tobother him again.

His past history includes a diagnosis ofADHD, depression, and periodic binge drink-ing. He turns to alcohol whenever he experi-ences an emotional high or low. He has had arecent car accident and conviction for a DUI.His current therapist was treating him withDexedrine and anti-depressants for severalyears. Recently, his psychiatrist took him offmedication because he was abusing it.

He is married with two children. He lives inan affluent neighborhood and has an upper-class lifestyle. He comes from a dysfunctionalfamily with a maternal and paternal history ofalcoholism. In addition, his mother-in-law hasa similar history.

After his parents divorced, his mothergained sole custody of him and his brother un-til their teen years. He then had the option ofchoosing where to live and both he and hisbrother moved to his father's home. His step-mother became an important influence in hislife. Later he was quite disturbed when his fa-ther divorced her, even more than when hismother died. He followed another a typicalfamily pattern by attending a prep school, an

ivy league college, and obtaining a graduatedegree at a prestigious university. There, he be-came very involved in computer software andprogramming in a specialized field of statistics.He had binge drinking episodes in college andused other substances as well.

Steve founded his own company after hegraduated and seemed destined for success. Hedeveloped an intellectual product and was try-ing to sell it; however, it was stolen by some

other organization in order to prevent the prod-uct from being marketed.

This happened over 5 years ago. He contin-ued to struggle with his business but becameaware that his life was getting more and moreout of control. He lost friends and job oppor-tunities. In order to prove his law case, Stevespent hours and hours on the computer search-ing out facts and filing complaints. He ne-

glected his family. His condition deterioratedas he became so obsessed with his task that heceased to be able to function.

His friends deserted him, he could not getwork anywhere, and his wife argued with himconstantly about his compulsive computer use.He stayed in his office almost all day and wellinto the night in order to escape his wife's nev-

erending criticisms. He even ended up joininga romantic chat group. In addition, he had a car

accident and was convicted of driving underthe influence of alcohol. He was very angrywith his psychiatrist because he took him offDexedrine. All of this resulted in his being hos-pitalized.

After Steve was discharged from the hospi-tal, he decided to change therapists. He electedto shift to me for therapy. Steve was referredfor two evaluations after discharge, one formedication changes and the other for psycho-logical testing to see if he was paranoid. He was

judged not to have thought disorder and was

put on a new drug regimen.His computer dependency was very high,

but much of it was time spent trying to provehis case. He began to see me on a regular ba-sis. It was clear that he was so distressed thathe needed to be anchored and helped to focuson how to change his life. He was still very de-pressed and needed reassurance about almostevery decision he made. For several weeks, hejust sat at home and did nothing. Slowly he be-gan to resume some activities. One of his goalswas to start taking care of himself physically.He agreed to start exercising in order to losesome of the weight he had gained during thelast few months.

He tried to help take care of his children. Hewas unable to concentrate for long enough pe-riods to watch his 12-month-old son, who felldown the stairs as a result. Luckily his son wasnot hurt. The daughter, 4 years of age, was old

472 ORZACK AND ORZACK

enough to know that something awful hap-pened to her father. She clung to him.

Another goal was to reestablish his relation-ship with his wife, who also needed help. Shedid get some counseling and met with me once.

The primary focus of all our therapy was to

help him to focus'on specific goals. He con-

tracted to do certain tasks and reported duti-fully at each session what he had actually donesince our last meeting. These are standard CBTtreatments. We talked about relapse preven-tion. He was in a 12-step group, but that didnot effect his chatting.

He did return to his office after several weeksand was tempted to resume his chatting again.We discussed the problem, and he said felt thathe needed the anonymity to be relaxed. Heknew that this was one place where he wouldnot be recognized because he was anyone hewanted to be. He decided to change his namein the chat and be someone else. He playedgames this way and actually enjoyed the free-dom he thought he had.

He agreed to start scheduling his activities inthe office. He worked 2 hours and, instead ofturning to the chat, he started running. In or-

der to help him leave his office at night, whenhe used to turn to chat room, he set up a golfgame or another kind of appointment. Heagreed to follow that rule.

He set aside family time and began to enjoyit. He and his wife hired babysitters so that theycould get out for dinner with friends. Hestarted playing racket ball, which is his favoritegame. That activity took place in a country clubwhere he knew many people.

However, Steve still spends hours trying toprove his case. A friend arranged for him tomeet with some special attorneys who gave himan extremely hard time. For weeks after that, hefailed to meet his contract and he was extremelydepressed again. His begged his psychiatrist toput him back on Dexedrine, but she refused. Hiswife also cautioned us not to put him back onit because he always abused it. He is now onfluoxitine and adderal (a mild stimulant).

The hardest thing for him to do is to look forjobs. He is still a pariah to many corporations.Even though he has had setbacks, he has at-tained many of his goals. He is in good physi-cal shape, and he is interacting with his chil-

dren. He and his wife are very close, and sheis very supportive.

In order to save money, he closed up his of-fice and moved his business home. Althoughhe still is focussed on the conspiracy, he is ableto make realistic plans. He is working hard at

finding a job without any success. No onewants to hire a whistle blower. He has never

resolved his relationship with his father. He re-

lapses when he is faced with rejection. He goesback to binge drinking and romantic chatswhen he experiences strong emotions, eithernegative or positive.

Recently, a major win at a racket ball tour-nament sent him back to the bar and the com-

puter. But the episodes with alcohol or the com-

puter are much shorter than they used to be.Currently, he has money to survive without a

job, but he can't go on forever. He is beginningto face the possibility that he may have to

change his career. He is still in treatment, dili-gent about keeping his appointments, and de-termined to get better.

CONCLUSION

We have tried to demonstrate the validity ofthe team approach in dealing with these com-

plex computer addiction cases. A variety ofteam members were used for .this purpose.These included a psychiatrist, a caseworker, a

behavioral psychologist, social workers, andhalfway house resident counselors.

We also found that it was helpful to havetreatment reviews every 3 months in order tofollow the progress of these patients on a reg-ular basis. The diagnostic scales and the ex-

pectancy questionnaire that we used gave us

further information about the patients'progress. It is our hope that these measure-ments will help others to treat these very com-

plex cases.

REFERENCES

1. Murray, J.B. (1996). Computer addictions entanglestudents. APA Monitor, 27:38-39.

2. Shotton, M.A. (1989). Computer addiction? A study ofcomputer dependency. New York: Taylor and Francis.

3. Goldberg, I. (1996, July 5). Internet addiction. Elec-

COMPUTER ADDICTS 473

tronic message posted to research discussion list. Re-search@cmhc.com.

4. Young, K.S. (1998). Caught in the net. How to recognizethe signs of Internet addiction and a winning strategy forrecovery. New York: John Wiley & Sons, Inc.

5. Anderson, K. (1999). Internet use among College Stu-dents: Should we be concerned? Presented at the 107thmeeting of the American Psychological Association,Boston, MA.

6. Scherer, K. (1997). College life online: Healthy and un-

healthy internet use. / College Student Development,38:655-664.

7. Shapira, N.A. (1998). Problematic internet use. Paperpresented at American Psychiatric Association, Toronto.

8. Brenner, V. (1995). Psychology of computer use:

XLVII. Parameters of Internet use, abuse, and addic-tion. Psychological Reports, 80:879-882.

9. American Psychiatric Association. (1994). DSM-IV:Diagnostic and statistical manual of mental disorders.Washington, DC: Author.

10. Morahan-Martin, ]., and Schumacher, P. (1997). Inci-dence and correlates of pathological Internet use. Paperpresented at the 106 annual convention of the Amer-ican Psychological Association, Chicago, IL.

11. Kandell, J.J. (1998). Internet addiction on a collegecampus: The vulnerability of college students. Cyber-Pyschology and Behavior, 1:11-17.

12. Welsh, L.M. (1999). Internet use: An exploratory study

of coping style, locus of control, and expectancies. Un-published Doctoral Dissertation, Northeastern Uni-versity.

13. Orzack, M.H. (19XX). Computer Addiction: What isit? Psychiatric Times. Online document: http://www.mhosource.com/edu/psytimes/p980852.html

14. Orzack, M.H. (1999). How to recognize and treat com-

puter.com addiction. In: Clinical and counseling psy-cholgy, (Vol. 9, lesson 2). New York: Hatherleigh Pub-lications.

15. Greenfield, D.N. (1999). Nature of Internet addiction:Psychological factors in compulsive Internet use. Pre-sented at 107th Meeting of American PsychologicalAssociation, Boston, MA.

16. Shaffer, H.J. (1996). Understanding the means and ob-jects of addiction, technology, the Internet and gam-bling. / Gambling Studies, 12:461-469.

Address reprint requests to:Maressa Hecht Orzack, Ph.D.

The Computer Addiction ServiceMcLean Hospital

115 Mill StreetBelmont, MA 02478

E-mail: orzack@computeraddiction.com