Tuesday, Nov. 14 at 2 p.m. ET

Internet Addiction

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Maressa Hecht Orzack
Computer Addiction Researcher
Tuesday, November 14, 2006; 2:00 PM

Maressa Hecht Orzack, director of the Computer Addiction Study Center at McLean Hospital in Massachusetts, will be online Tuesday, Nov. 14 at 2 p.m. to take questions about Internet addiction.

Submit your questions and comments before or during the discussion.

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Maressa Hecht Orzack: Here's how I got into computer addiction -- It's now been over 11 years that I discovered Internet addiction -- I was playing solitaire online, and I was also on a listserv, and I was trying to learn a new program. I got angry at the listserv, and I would go back to solitaire. I got frustrated with the program, and I went back to solitaire. I kept playing solitaire more and more -- my late husband would find me asleep at the computer. I was missing deadlines. I knew something had to be done -- I was actually treating addicts, gamblers, substance abusers. I quit the listserv, and I restructured how I played, so I was playing for time and not for scores.

I started to talk to my patients, I started to talk to people at McLean, and I started getting referrals, until it got to the point we started a computer addiction service and study center - we've seen an expansion from online sex, to gambling to video games. I look forward to taking your questions on the subject.

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Coatesville, Pa.: What are the signs of a person who has Internet addiction?

Maressa Hecht Orzack: The signs vary, but one of the things is that people have difficulty with relationships, they tend to do things that will keep them involved online, despite the consequence. They are in danger of losing their jobs, they have problems with sleep. What I hear now, very frequently, is that a lot of teenagers, who are involved in this, will flunk out of school. There's a problem that exists that they can't seem to manage in their lives -- that's characteristic of any addictive behavior.

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Pasadena, Calif.: Hi,

Thank you for doing this chat.

I'm fairly sure that I am addicted to the Internet. A quick e-mail check frequently turns into 8-10 hours wasted looking at entertainment sites. This has certainly had a detrimental effect on my work and personal life.

I've tried cutting back, but I find it difficult to do when my work requires me to use the Internet. Any suggestions?

Maressa Hecht Orzack: The first thing I do is to do a clinical interview and find out what else is going on. If there are people who continue to play despite the consequences, there's something else going on. There are people in California who can work with this and do understand it -- if you want to contact me directly through morzack@mclean.harvard.edu I can give you a referral.

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Arlington, Va.: Can you give some examples of some really bad cases you have seen?

Maressa Hecht Orzack: I have had people who are so disturbed when their families have taken their Internet away that they have been totally unable to function. Other times they have been to the point where they have run away from home. Or there is violence as a result. These people are out of control and they are really unable to manage. There is also the factor that many online games are meant to keep people there, and I think that's important for people to know.

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Belmar, N.J.: There seems to be an issue of cause or effect in overuse of the Internet. Are people being pulled in by the Internet (like a Venus fly trap) or are they "willingly" using the Internet to escape/avoid other problems? Or perhaps both are happening depending upon the person.

Also, what are three suggestions that can be used on a daily basis to assist the withdrawal process?

Maressa Hecht Orzack: Readiness to change is the first thing that's required -- if they can't control it, they need to look for some help around their other issues. Once someone is ready to change, then they'll start to come and see me and make attempts to change their behavior. Then, they can set themselves goals -- they need to set a daily goal of what they can accomplish that day, and what they won't do. Another thing is, many people who are involved in the Internet need to check it for work of school, and it's very important -- that makes it totally different than a substance abuser, who can be abstinent. However, it's very tricky because many people tell me -- "oh, I'll just check it for five minutes" and that's where they get into trouble.

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Cleveland: How much is too much?

Maressa Hecht Orzack: How much is too much? Does it affect your family relationships? Are you losing sleep? Are you unable to manage your time? Why are you doing this in the first place? Too much really depends on what your losses are. Do the losses exceed your gains? And if they do, that's too much.

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New York, N.Y.: I broke up with my ex because he absolutely could not get away from the computer. This Internet addiction fueled a sex addiction which just made everything worse. The funny thing is, I am in recovery (AA) so I know the chains of addiction and he saw firsthand my transformation after getting sober. So how in the world do you convince someone they have a problem?

Maressa Hecht Orzack: If they are at the point where other people, as you are saying, are finding that they are being neglected, that this is a problem -- it's hard to tell the person who is at fault, because they are in denial, and liable to blame you. I think certainly someone needs to find out what else is going on in this person's life -- again, I would define it in terms of losses. If they are in a position where they can't think or are out of control -- the fact that it's even being discussed means there is something happening. They may blame the other person, or the boss, or work, or school. There's no way you can make them get help unless it's legally required.

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Arlington, Va.: Are people with other addictions, such as alcohol or nicotine, more likely to become addicted to the Internet also? Could the three go together so that the use of one triggers the use of the others? See, I have this friend ...

Maressa Hecht Orzack: There are people who, having had other addictions, sometimes can lead to this. There are people who had alcohol or some other substance to enhance the feelings they get when playing games. Yes, that does happen.

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Washington, D.C.: Does IM count as an addiction? That is the way my 13-year-old son communicates with his friends; does homework, etc. I'm hoping it is a passing phase. When should we be worried? His grades are fine and he is quite popular.

Maressa Hecht Orzack: It depends -- a lot of people use instant messaging. It's not only the computer that's involved, it's all the other techniques people have of communicating with each other -- MySpace, Facebook, text messaging -- you can do anything from a cell phone now. Many of these electronic changes are fabulous, and it's only a percentage of people who use them inappropriately -- millions of people who use these techniques find them useful, but it's those who have a history of negative behavior that get in trouble.

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Syracuse, N.Y.: What in your experience is the most prevalent form of Internet addiction. Is it people wasting time or is it more to do with pornography/chatting/etc?

Maressa Hecht Orzack: Wasting time depends on what they are wasting time doing -- is it bothering them, is it keeping them from doing things, are they having problems doing things? Gambling, gaming, pornography are all pretty much represented. A lot of these people, again, are a minority of people who really get into trouble; but those who do do seem to get into real trouble.

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Atlanta: Don't you think its a little ironic that you are doing a chat about Internet addiction....on the Internet!?

Maressa Hecht Orzack: That's modern technology -- it is ironic, but I can accept that. I know that some people who are on a chat are different than those who call me -- and I get lots of phone calls -- or e-mail me. My rule, really is, in terms of treatment, I'm much more interested in actually seeing people in person.

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Washington, D.C.: Hi! My question is whether there is a correlation between addictive TV watching and Internet? Is it just procrastination? I think that I am addicted to watching TV, and then when I get to work I substitute the Internet for TV. Have you done any studies on this? Thanks!

Maressa Hecht Orzack: I haven't done any research on it, but there's a difference usually. TV is a passive procrastination, and being on the Internet is an active one, and I'm not sure if there's a correlation or not. To some extent it depends on the person, but the Internet is active, and some people may find that is more rewarding. But I do know that procrastination is a major component to much of this.

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Buenos Aires, Argentina: Which is your advice for introducing kids to the Internet?

Maressa Hecht Orzack: That's a good question. First of all, there must be a connection with the family. I suggest children not use it unless there is family present, they shouldn't use it as babysitting, they shouldn't do it alone. There are certainly children's programs that are perfectly delightful, but younger children can be exposed to games by older children, and that's something to avoid. There are all kinds of blocks and parental controls though that parents can use -- there's a group called Common Sense Media that rates games and Internet sites and controls, and I think that's an important group.

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Reston, Va.: You talk about "consequences." To me, even an hour online a day, only, has consequences -- you could be doing something more productive with your time.

What if the consequences are not dire -- you're just missing out on meeting new people or maybe are a little more isolated than you should be, but functioning fine -- what then?

Maressa Hecht Orzack: Well, the consequences are only if you think there is something going on that's keeping you from doing things. If you're avoiding meeting people, if you're avoiding responsibility, those are the kinds of consequences that are a problem.

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Washington, D.C.: Hi! Interesting article.

As a mental health professional in training, I am a little skeptical of a diagnostic category of "Internet Addiction." It seems clear to me that it is more of a symptom or a way of managing experience that is otherwise hard to tolerate -- that is, to manage depressive or anxious experience. Hence, I think treating it as a distinct phenomenon runs the risk of obscuring the underlying experience, which may go on untreated.

That said, I do think it has become clear that Internet use can be a very seductive way of managing these intolerable emotional experiences; it is effective for people in the short run but nevertheless often produces, eventually, the destructive effects that the article noted.

Maressa Hecht Orzack: I think some people do object to it being called an addiction -- I'm hoping it will come out in the next DSM as Internet Usage Disorder. I think that the most important thing though is, what is really going on? I find that similar to an addictive behavior, there are changes in someone's mood, and when that happens, something is going on in the brain, and it's similar to what goes on in other addictions, and I've been saying this for many, many years.

The reward system of the brain is affected, just like any other addiction, and it needs to be treated the same.

When I talk to people, I ask them what they are expecting to find online, and they say "escape" or sometimes "relief." They want a new identity or a sense of community -- especially with online games.

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Northwest D.C.: Isn't Internet addiction a way of avoiding other things in life, like working, school, relationships, contributing to society? These people are using the Internet to avoid something else? Just like most addictions, right? Maybe we'd be healthier physically if we didn't sit in front of a monitor and were outside exercising instead.

Maressa Hecht Orzack: It certainly is an avoidance method, it definitely would qualify for that. But people don't avoid things unless they are afraid of them, and I think that's what they have to look at. They're anxious, they're fearful, they are uncomfortable, they can't manage. I think people need to find out what else is going on. They're escaping from something. They're uncomfortable.

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Washington, D.C.: I think I am addicted to the Internet. I am trying to move to New York and am looking for an apartment and a job concurrently. I almost fear leaving the computer and missing a job posting, apartment listing, or both! I know this is irrational.

And I spend ALL DAY at work on the Internet.

It's not controlling my life -- I only use it during down time -- and while I don't think its bad to be connected to the world (because I do often check the news, that sort of thing), how can I decrease dependence?

THANKS!

Maressa Hecht Orzack: Treatment is very, very specific. There are two things that can happen, if a person is extremely disturbed or depressed, I will see if they need something prescribed. I do what is called cognitive therapy, which is that their emotions are determined by their thoughts, and this is somebody who is really anxious or afraid that something is going to happen.

It might be somebody who is anxious, or a perfectionist, or they're afraid they can't get their work done, so they jump to something else. We talk about what is really going on in your head -- what are your thoughts? What is really going on? I've heard this from many people -- it's called "all or nothing" thinking, that no matter what they do, they won't get ahead. It's something that's very unfortunate. They may insist that everything is going to be bad.

So we try to figure out how they can change those thoughts. I say, how far have you gotten in school? How can you be a a failure if you're in grad school? People tend to disqualify the positive, and we try to turn that around. And then we do something called motivational interviewing, talking about alternatives, things that will help them. We create contracts that will give them specific things to do, read a chapter in a book that relates to their problems, for instance. We try to get them to confront what they are trying to avoid and come to terms with their expectations. People often feel hopeless, and there are things that are upsetting to them, and they need techniques to help them. These are not short-term things.

Thanks for all of your questions today.

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