Recent research shows that some users of the Internetspend so much time logged on, that their personal and/or professional lifesuffers. This finding is corroborated by numerous anecdotal accounts ofpeople becoming "hooked" on on-line interactivity,
accounts that have circulated in on-line discussionsas well as in real life settings.

It is becoming common to know of someone, or haveheard of someone, that has become enamored with on-line activity to thepoint that they ignore important personal responsibilities. This paperis an overview of current research findings, and an attempt to exploresome of the possible explanations for this phenomena. Factors inherentin on-line interactivity that might be contributing to developing InternetAddiction Disorder (IAD) are distinguished from factors inherent in thepeople proposed to be most at risk for, or suffering from, IAD. Recommendationsfor treatment of affected individuals are offered. 

What makes the Internet attractive?

Broken marriages, lost jobs, failing school gradesand forgetting to eat are just some of the consequences being reportedin media articles as the experience of people who feel they have becomeaddicted 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, rewardingand 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 experiencea form of social contact, with no real social presence. The significantdifference between cyberspace relationships and ones maintained by otherexisting technologies (telephones, mail, fax's) is that the new culturevalues of Internet virtual communities have as social norms ones that allowfor, 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 interpersonalcontact despite its non-physical nature. " (North, 96). 

Because cyberspace does not offer a means to monitorothers 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 interpersonalrelationships can lead some people to experience pathological consequencesis the dis-inhibiting effect inherent in on-line interactivity. 

The improbability of any local, real life repercussionsfor on-line social activity produces a new and poorly understood psychologicalphenomena; people feel free to express themselves in an unrestrained manner."If all computer-mediated communication systems can be said to have onesingle unifying effect upon human behavior it is that usage tends to causethe 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, emotionallyladen projections (King, 95), and can be communicated without the normalconstraints imposed by the need to maintain social order. This is a naturallyexciting, stimulating and reinforcing aspect of Internet communications,one that contributes to the occurrence of IAD. 

"An on-line community is one of the easiest waysto meet new people. Certainly it is very low-risk. I think this is mainlydue to the essential informality of on-line conversation. Rather than beingrequired to sustain a single conversation with one or more people, relationshipsusually form out of numerous, often short exchanges. 

In a way, it reminds me of commuters who takethe bus or ferry. They see each other frequently but each encounter isof 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'tworry about it. But, over time, many people form enduring relationshipsthis way. 

In the on-line environment, just like any othersocial situation, the basic currency is human attention. In the publicforums, you communicate with groups that may have as many as several hundredpeople involved - even if they don't all make comments." (Coate, 92) 

Internet communication increases the range ofpossible social networks that a person can connect to, and adds elementsof diversity that are very appealing to some (Wellman, 96).

There is a "hyperpersonal aspect" to Internetcommunications, a way to be more selective about how one presents onesself. The kinds of differences between people that might inhibit relationshipformation are hidden. This promotes a sense of group membership, one thatis solely depended on the perceptions of the receiver. Control over impressionformation is enhanced in written mediums. "Another component of the model,feedback, suggests that these heightened self-presentations and idealizedperceptions magnify each other to a superordinal level, as users reciprocateeach other's partial and selective presentations." (Walther, 96). 

This magnification factor of the hyperpersonalmodel is a theoretical formulation that could help account for the highrates of flame wars (arguments) and love affairs that happen on the net. There is as yet no empirical evidence supporting the observation that flamewars and love affairs occure in open, interactive virtual communities ata rate higher than what one would expect, but there is a growing body ofanecdotal reports of this and a widespread awareness of a high frequencyof these extreme interpersonal cyberspace exchanges. 

There can be a voyeuristic aspect to cyberspaceparticipation, which may be more salient to some than 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 themore academic discussion forums, where the social norm is the exchangeof research ideas and the philosophic debate of social abstraction, thisvoyeuristic component is not a significant attraction. This is in contrastto some chat rooms where the suggested topics often invite flirtations,or the forums set up to provide emotional support for difficult personalproblems. In these forums, lurking is a means of gaining access to verypersonal information in a manner that no real life forum can offer. Thiselectronic eavesdropping is one possible source for the positive reinforcementthat
the nature of the Internet provides to thosefor whom it's use has become pathological. This emotional stimulation ison a schedule of reinforcement called variable-ratio, as one can neverpredict just when some "juicy tid-bit" of self-revelation will come acrossone's screen, and the actual exposure rate to this is dependent on theamount of time spent on-line. 

The attributes of Internet communications thatstand out as offering the potential for rewarding, stimulating emotionalinvolvement's include; it's ease of access and 24 hour availability, thewide range of diverse personal connections possible, the hyperpersonalnature of interpersonal relationships, the ability to witness others interacting(with no risk) and the uninhibited nature of no risk relating. It is reasonableto assume that many people will find one or more of these factors reinforcingenough to become passionate about their Internet activities, at least forthe initial period of time when they are still discovering the capabilitiesof new Internet social connections. These factors are necessary, but notsufficient, to explain true pathologic computer use. 

Some additional qualities inherent in the usermust be present that differentiate those for whom Internet
communications are a passionate past-time fromthose for whom this activity becomes a compulsion resulting in loss. Thepassion possible is understandable, as virtual community involvement'sdissolve geographic boundaries and expand the ability of people with commoninterests to share ideas important to them. However, the nature of addictionis to continue to pursue the initial excitement one received, at the riskof other social involvement's and responsibilities. 

What is Internet Addiction? 

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

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

Pathological Computer Use Disorder was proposedby 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 theirphysical, 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. Goldbergrefers to this condition as one that causes "Decreased occupational, academic,social, work-related, family-related, financial, psychological, or physiologicalfunctioning." For this study, the term Internet Addiction Disorder (IAD)will be used to designate a pathological use of computers, to engage insocial interactivity.
The term Pathological Computer Use (PCU) willbe reserved for the broader category in which someone is pathological aboutany aspect of computers, and includes uses that are not social in theirnature. 

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

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

   Do youfeel preoccupied with the Internet or on-line services and think aboutit while off line? 

    Do you feel a need to spendmore and more time on line to achieve satisfaction? 

    Are you unable to control youron-line use? 

    Do you feel restless or irritablewhen attempting to cut down or stop your on-line use? 

    Do you go on line to escapeproblems or relieve feelings such as helplessness, guilt, anxiety or depression? 

    Do you lie to family membersor friends to conceal how often and how long you stay on-line? 

    Do you risk the loss of a significantrelationship, job, or educational or career opportunity because of youron-line use? 

    Do you keep returning evenafter spending too much money on on-line fees? 

    Do you go through withdrawalwhen off line, such as increased depression, moodiness, or irritability? 

    Do you stay on line longerthan originally intended?

In several months of having a survey posted toa Web site, Dr. Young received over 400 respondents that self reportedmeeting 4 or more of the 10 criteria, and were thus diagnosed with IAD.Dr. Young states, in an interview, that many respondents reported whatshe termed a "centralization of use of the Internet at the expense of otheractivities" 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 wouldguess 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 theability to assume different roles, to develop intimate relationships andto be unconcerned about any possible repercussions were the most importantfactors of Internet interconnectivity that were most likely to contributeto the potential for IAD. The contrast between these new, exciting andprojection filled relationships and ones real life ones may make existingassociations seem dull in comparison (Young, 96). 

Role playing is done mostly in the forums thatare MOO's and MUD's. These are virtual environments were participants exertsome level of control over how the environment is viewed by others. A newform of these forums provides a graphical interface, where participantscan create personal avatars (small cartoon like characters) that interactwith 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 mightbecome addicted to such an environment in terms of how this activity fulfillsall of Maslow's hierarchy of needs. At the bottom of the hierarchy arethe basic needs, such as the need for procreation. Dr. Suler reports ahigh level of flirting in the Palace, with the added abilities of genderswapping and complete anonymity not found in real life.

The second level of Maslow's hierarchy is aboutthe need for interpersonal contact, social recognition, and a sense ofbelonging. Dr. Suler points to the common participation in an interestingvirtual environment as a basic means by which people using the Place feelconnected. 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 byname. 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 fillthis need. 

Continuing along the line of Dr. Suler's analysisof possible addiction to the Palace, the next level of Maslow's hierarchyis the need for learning, and the self-esteem that arises from one's achievements.Computer interactivity in role playing environments, once one has learnedhow to participate, are conducted in real time. They offer instant feedbackand acknowledgment. One can see the results of ones efforts to influenceothers and the environment very quickly. Building a personality, from scratch,and having it become known, and then being rewarded with the gain in statusone 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 powerover other participants. 

The highest level of Maslow's hierarchy is theneed for self-actualization. This involves the effort one puts into evolvingas a unique individual as well as an attempt to
come to terms with one's mortality. It may seemdifficult to imagine how possessing such a lofty goal could contributeto a pathology. As Dr. Suler explains in his account of this, the Internetoffers users unique opportunities to work out questions of identity and"perhaps even realize inner interests, attitudes, and aspects of theirpersonality that were previously hidden." (Suler, 96).

The implication of this insightful analysis ofhow the Internet can satisfy basic and advanced human needs is that manypeople experience being thwarted in their attempts to gain satisfactionat a specific level of need in real life, and may find the Internet isthe first interpersonal medium that satisfies these drives. This wouldbe strongly reinforcing, to the point that such an
individual might not look to real life interactionsfor need fulfillment for some time. Additionally, a close reading of Dr.Suler's essay leads one to conclude that an analysis of how modern cultureand societal structures fail to provide adequate, comprehensive means ofbasic and advanced need fulfillment would be instrumental in defining moreprecisely what kind of
personal deficits in this area are likely tobe an antecedents to Internet addiction (Suler, 96). 

Additional documentation of the intensity withwhich some people involve themselves in cyberspace role-playing is providedby this quote from James Sempsey; 

MU* Addiction.  Another related topic, alsoexplored by Bruckman, is that of MUD addiction wherein people so
prefer their on-line lives that they actuallybegin to abandon their "real" lives, spending up to 18 hours per day livingin virtual reality (Kelly & Rheingold, 1993; Bruckman, 1994). 

There have even been reports of Internet relateddeaths,
such as cardiac arrests resulting from sleepdeprivation and lack of personal maintenance or suicides due to Net
related stress lmer-Dewitt,1993; Rheingold, 1994). 

Such obsessive behavior has become quite a problemon some college campuses where computer facility administrators have hadto literally "pull the plug" on some addicted students (Cassidy, 1995).Little is known about this new form of addiction, but as mentioned previouslya preliminary draft of the DSM-V includes a section delineating some ofthese types of "Cyber Disorders" (Zenhausen, 1995). (Sempsey, 95) 

Immersion in a collaborative fantasy world, whereones role and character can be very flexible, self determined, and differentfrom ones real life presentation has the potential to produce a pathologicalabsorption, if someone is predisposed to that state.

A recent study of college students found a statisticallysignificant difference in the amount of past or present psychopathologybetween students that were most prone to fantasize and those who's levelsof fantasy engagement was measured in the normal range. In particular,depression and symptoms of dissociation were highly correlated with thehigh fantasy group. The
researchers concluded that "a history of fantasyproneness can place certain persons at risk for significant psychopathology."(Rauschenberger, 95). 

If a persons fantasy life is being generated byan unconscious perception of a lack of access to social
status, relating to others on the Internet, whereoutward symbols of status have no meaning, could predispose one up forcompulsive Internet use. 

The extent that frustrations in real life mightcontribute to a tendency for IAD is poorly understood. It is known thatstatus and power in virtual communities is gained in a very different mannerthan real life. The lack of visual clues, and the relative anonymity ofparticipants, fosters a sense of equality. One is judged on the strengthof ones ideas, regardless of ones status in
their real life community. This status equalizationincreases access to new people and provides access to information, relationshipsand communications that one could not expect to receive when operatingin the confines of real life organizational and community structures (Garton,95).

If a person is motivated to participate in a socialnetwork, and be perceived as a respected member, the Internet offers atremendous variety of "invite yourself in, open to anyone" communities.There is a very
real sense of having achieved status when othersin that form quote ones messages or acknowledge ones contribution. Thedegree that this serves as a reinforcement for continuing this behavioris dependent upon the degree with which someone is lacking other traditionalsources social status. When students move away to go to collage, they cansuffer a loss of social
support. The easy and unlimited access to theInternet that universities supply their students may appear as a safe andfast way to form new relationships, and become an obsessional form of activityif the student is having problems facing adult pressures (Sanchez, 96). 

There is no one cause for addiction. Addictionis a process that has distinct stages and responds to treatment best whenthe individual factors of each case are taken into account. There are manytheories as to the etiology of additive behaviors, and very little integrationof 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 thatmight account for, or moderate the addiction. It has been suggested thatIAD has similar features as gambling addiction (Young, 96; Goldberg, 96). 

One study of pathological gambling found a highcorrelation between this addiction and a history of trauma. As a sub-categoryof gambling addicts, the prevalence of those that had suffered trauma,leading to post traumatic stress symptomology, was found to be significantlyhigher than in the general population. The authors theorized that a formof learned helplessness lead to a negative affect as a general responseto life, and that the immediate gratification of gambling offered a "temporaryrespite in the insatiable quest for self-affirmation." (Taber, 87). 

If someone is suffering from IAD, they may havethe additional quality of being defensive about this, and exaggerate thepositive aspects of their life to compensate. This was found to be thecase with
drug addicts (Gibson, 87). 

Dr. Nancy Wesson, a clinical psychologist whospecializes in the treatment of shyness and behavioral addictions, who'spractice is in the Silicone Valley, sees a lot of patients with IAD. Ina recent telephone interview, she stated that clients almost never presentwith this problem, they present with some other symptomology, and IAD isdiscovered to be a comorbid or primary condition. Approximately 30% ofher case load has experienced serious disruption and loss due to excessiveon-line interactivity. Her understanding of the extent of this problem,in consultations with peers, is that the rate of this is increasing, andit 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 activitythat has mood altering potential" for that person. In Dr. Wesson's treatmentof clients with shyness, she is increasingly finding that some have obsessivelydeveloped on-line relations, and those relationships constitute the onlyrelations these clients have. (Wesson, N.
personal communication, Dec. 2, 1996). 

This anonymous quote summarizes some of thesequalities of the people that may be prone to IAD; 
Additionally, the utility of the activity hasbe called into question when you are looking at an intensely repeated
behavior. In the case of frequent and continualuse of the Internet what I see most frequently in my practice (I am a psychiatristin general private practice) is that the Internet becomes a way of avoidingintimate social contact. The hook however is that it looks like contactgiven the freedom that people take to communicate their most intimate thoughtsand so it has the appearance of intimacy while in fact the communicationis just with a computer screen and words on a line. There is a self-delusionof 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 onlyinteract when I want) and no one truly knows who I am (Anonymous emailpost) 

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

Review of recent studies 

Three studies have now reported results of surveydata that attempt to define the scope of IAD. These articles are availableon the Web, and are all self report data from surveys. Each used a differentstrategy for recruiting subjects. The studies used definitions for InternetAddiction that were similar, but each used different means to analyze theirresults. 

Viktor Brenner posted a survey called the InternetUsage Survey to the web, and then advertised it's existence by listingit with search engines. The survey asked about on-line usage in terms oftime spent on-line, and if on-line interactivity had negatively
impacted one's work or professional life. Brennerreceived 185 valid responses, of which two thirds were from males.

Thirty-two of the questions made up what the authorcalls an "Internet-Related Addictive Behavior Checklist" 
or IRABC.

Thirty percent of respondents reported a failedattempt to cut back on their Internet usage, but only 7% endorsed the itemthat related to "getting in to hot water" at work due to this. 

The fact that 58% reported that others in theirlife had told them they were spending too much time on-line is significantand congruent with a well know aspect of addictive behaviors is that one'sfriends and family members are often aware of the problem long before theindividual involved is able to admit any troubles.

Brenner notes that there appeared to be an over-representationof researchers and reporters interested in this topic that also answeredthe survey question. In addition, the study population contained a largenumber of users that were new to the Internet. The average time on-linewas 24 months, but with a standard deviation of 22 months, 24% reportedbeing on-line less then 6 months. 

Most DSM-IV diagnostic criteria have a time requirementthat the condition must have persisted before it can be diagnosed. Thelack, in this study and others reviewed here, of differentiating the newcomersfrom the users with a longer history of net use, is a confound. The possibilityexists that a percentage of people self-reporting as Internet addicts areactually just currently very passionate about their on-line use, and willbe able to moderate it if the problems it creates for them persists. Brenneraddresses some of the pros and cons of the methodology involved in Webbased surveys, with the ease of subject access being the major advantage.Among the drawbacks mentioned is the need for researcher to understandthe
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 experiencedby people that self-identified as Internet Addicts. This is a two-tieredstudy, and only the first part was available for review. Additional quantitativedata will be forthcoming. Thompson embarked on a search for these subjects,in
what he terms a "total immersion into the studiedenvironment". He queried various cyberspace forums where a high rate ofthis phenomena could be expected, in various modalities, and got 104 validresponses. Of those, 72% reported an addiction or dependency to the Internet,and 33% stated their Internet use had negative effect on their lives. Intesting to see if a perceived deficit in real life personal relations wascorrelated to the reporting of Internet Addiction, Thompson reports mixedresults.

Twenty-nine respondents in this subject pool reportedthat their communication skills had been "crippled", but 36 reported anenhancement in this. Forty-seven percent reported some level of physicaldistress such as blurred vision or sleep disorders, or a similar somaticcomplaint. Thompson did not report what percent of respondents were newto the Internet, and in this initial
qualitative report the data on on-line usagerates is unclear, so a complete review of this study is not possible atthis time. Of notable interest are the results relating to the questionabout what this group thought was their primary reason for engaging inon-line activity. This was a pursuit of knowledge. It is not clear if thisrepresents 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 reportingthis condition may in fact only be responding to the newness of this sourceof knowledge in their lives, and are so involved in learning all the benefitsthey can receive that they are "interpreting it all as being out of moderationwhen it comes to the perception of their usage." (Thompson, 96). 

(Note: Additional data that was not reviewed herehas now been posted to
http://www.personal.psu.edu/sjt112/iads/thesis.html) 

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

There were no significant differences in the dataon age, gender or living situation, or in how long the person had beenusing the Internet. Since newcomers were just as likely to endorse beingaddicted to or dependent on the Internet as others, it is not clear ifthe level of distress reported by this group is a pervasive condition ora passing phase. This data set represents a strong
case for the occurrence of negative consequencesfor Internet addicts. Egger offers very little besides the data to indicatehow one should interpret it, but this study is rich in it's quantitativecontent. Questions were asked on a 6 or 7 point Likard scale, and publishedresults include histograms as well as the raw data. The 450 responses weregenerated in only 6 weeks, as the
study was announced to Internet forums such aswww.news.announce, alt.irc.misc and alt.mud.misc. Links to the survey sitewere established and an inducement for participation was offered. Eggersates that " Since their is no particular interest group
for a questionnaire like this, a competitionwas added to induce more people to take part in the survey." 
(Egger, 96) 

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

*1 Brenner's question here involved failed attemptsto cut back on Internet usage. 
*2 Thompson's question here involved decreasedcommunications 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 thetotal of the categories of respondents that choose rarely, sometimes, oroften
for this choice. 

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

Dr. Young's original study of 400 people withIAD clearly did include this time period in the criteria for that diagnosis,but that
actual data from that study was not reviewedhere. The author failed the get the full text of that widely publicizedstudy in time
for this review. That study was designed to recruitpeople suffering from their Internet use, to see if Dr. Young's criteriafor
evaluating this condition were valid. Dr. Youngis currently involved in a larger study that is expected to reveal moreabout the
prevalence rates for this condition. 

Treatment suggestions 

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

Following the general caveat that what causesa 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 accomplishresearch or business goals is a requirement, not an option. It is prudent
then to offer the client with IAD a program ofrecovery 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 activityitself as a deterrent. Since someone suffering IAD is already computerliterate,
and oriented towards computers as a resource,it makes sense to incorporate a computer assisted recovery. Many people
already have calendar schedules they keep currentand check often, on their computer. Using such a program to log one's
on-line time, and what that time was specificallyspent on, would be a means of both establishing a base line for the behavior
and tracking recovery progress. Also, a clientcould set such a program to flash a message at regular intervals, remindingthe
user to stop momentarily and evaluate if theircurrent Internet interactivity is warranted or not. 

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

Effective treatment programs can be developedfor IAD, but they must incorporate an understanding of the specific aspectson on-line use that is at the core of any individuals problem. If someoneis "hooked" on hanging out in a chat channel with their close net friends,the reinforcement pattern will be different from someone involved in maintainingan alternate persona in a role
playing MOO. Assessing someone with IAD for theexact nature of their on-line social activity is crucial, because the availablerange is so large.  Each modality (email, real time chat, MOO's) hasa different pattern of reinforcements it supplies. 

One approach that might work across such sub-typesof IAD is an effort by the client to limit their Internet use to a regularset time each day. This would help counter the highly reinforcing variableratio aspect, where one is never sure when something exciting is goingto appear, but the total amount of excitation is dependent upon the amountof time on-line. For example, if someone
knew that the were only going to check theiremail at 9 am, this would put the reinforcement back on a variable fixedschedule, where the reinforcement value is less. The desire to log on tosee what might have transpired will be confronted, as a first step in arecovery program. 

Conclusion 

Technological advancements in communication toolshave opened a new domain in social interactivity. It is now possible, fromthe privacy and sanctity of one's own home, to publish one's ideas to hundredsor thousands of other people, and receive instant and delayed feedbackfrom across vast distances. This in a new development, and is now supplementingthe traditional
mass media, with it's 'from one to many" format,with a "from many to many" format, for millions of Internet users worldwide.

This is a categorically different form of humaninteraction, one that is too recent, and still changing too fast, for it'simplications to be fully cognizant to even the oldest members of on-linevirtual 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 addictingthan any other human activity that someone might find pleasure producing,valuable or productive, be it social in nature or not. A full understandingof IAD is only possible if a complete understanding of the aspects of Internetpersonal behavior, that are unique to the Internet, is arrived at. Thispaper has been an attempt to distinguish the actual kinds of interactionsthat are only available on the Internet that have a highly stimulatingvalue. The uninhibited and hyperpersonal nature of social contact in a virtual realm combine with the selectivity, anonymity and availabilitypossible as unique characteristics of on-line social interactivety. 

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

Future research will overcome the methodologicalhandicap of self report data. One area that clearly has not been addressedat the level it deserves is the use of, and addiction to, on-line pornographyand interpersonal cybersex. Anything that can safely, quickly, and completelysatisfy such a basic human desire is bound to be addictive to some. Howto induce subjects to
self disclose about this activity is anothermethodological problem, and base rates for this activity are going to bedifficult to determine. 

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