Mariah is a thirteen-year-old girl who lives with her mother and sees her father every other weekend. She’s an outgoing, social girl who sometimes gets gently reprimanded by her teachers for talking too much during class. However, overall her teachers like her a lot, and she’s always done well in school. She’s been on an after-school soccer team for several years. Recently, however, she’s getting into more trouble at school, her grades are slipping, and she doesn’t want to go to soccer practice. Her parents agree that there’s a problem, and they’re on the same page about social media and technology being a big part of that problem.
Her parents report that Mariah got her first cell phone when she was ten years old. She also has an iPad and uses the family computer regularly. At first, her parents strictly limited her cell phone use to texting her family members and the close friends that her parents already knew. However, as time went on, she asked for more privileges. Her parents let her set up a Facebook account and an Instagram account, but they have the passwords and would monitor the content regularly.
Over time, they noticed that Mariah was using her phone more and more often. She was constantly on social media. She was also texting all of the time. When Mariah’s mom would ask her who she was texting, she would say “Oh, just a friend” but not give any more explanation as to who it was. When her mom would come over to look at the phone screen, she would quickly close the apps she was using. This started to cause a lot of fights with her mother.
At first, her father wasn’t as worried as her mom was. He said, “She’s a teenager; it’s what they do.” Mariah’s mom takes the phone away at night, so when she found out that her dad was allowing her to be on the phone all night long, she was concerned. They had a co-parenting meeting, in which Mariah’s mom expressed that she was worried this behavior was affecting Mariah’s sleep and causing her to be more irritable. Mariah’s mom explained that her teachers had said she was sassing them, plus she wasn’t getting her homework done. Her dad agreed to take the phone away at night. However, the first night that he tried to do so, Mariah threw a tantrum. She was screaming and crying and couldn’t seem to control her emotions. Her dad was so overwhelmed that he gave the phone back to her for the night.
He met with Mariah’s mother again. They decided that they needed to set up stricter boundaries with Mariah’s device use. Plus, they decided that it was time to dig deeper into her texting and social media use. They discovered that she had changed the passwords on her accounts, and they didn’t know how to access them. When they eventually got into her social media, they discovered that she had been sending topless photos to boys online. Some of them were in other states, and Mariah had clearly never met them in person, which made her parents worried about who was actually seeing those photos. When her parents tried to talk to her about it, she exploded, screaming about them invading her privacy. At a loss, her parents decided that it was time to seek professional help from a therapist.
Mariah is showing several warning signs of Internet addiction. She is using social media and texting more and more often. She is using her phone in the middle of the night, which is compromising her sleep. She doesn’t want to engage in extracurricular activities like soccer that she used to love. Although she used to get along well with her teachers and be able to get good grades in school, that’s slipping and getting replaced with negative behaviors. All of these are signs that her use of social media could be problematic.
Her secrecy around what she’s doing online and the fact that she’s been sending risqué photos to people she doesn’t know are of particular concern. These are risk-taking behaviors that could pose a significant threat to her real-life safety. They also put her at risk of cyberbullying, so-called revenge porn, catfishing and grooming from online predators, and various problems with her real-life peers. Her parents are right to be concerned.
However, we should be careful not to pathologize Mariah’s behavior. Texting, social media use, and beginning to explore her own sexuality are all age-appropriate behaviors. Although her secrecy is concerning, it’s normal for young teens to start seeking independence from their parents and to feel upset when their privacy is violated. Despite being of concern, we should recognize the normalcy of these problems among teens Mariah’s age today.
Moreover, her therapist not only should take care to consider Internet addiction but also look at other potential issues in Mariah’s life before making any diagnosis. Many of Mariah’s problems are warning signs of depression—lack of interest in activities, not doing her homework, and mood swings including outbursts. It is possible that Mariah has depression from an unrelated cause and that her misuse of social media is just a symptom of that. It’s also possible that she has both depression and Internet addiction, and the two conditions are making each other worse. A therapist should evaluate her completely and neither assume that the Internet is the problem nor avoid addressing that it might be.
It’s helpful that her parents are on the same page and are seeking early intervention. They may work together to limit Mariah’s use of the Internet. They may opt to take away her cell phone for a period of time, institute stricter rules about when and how she can use it, and/or monitor her activities more vigilantly. They will also want to engage in discussion with her about why they are concerned and what behaviors they would prefer to see. They should also work to address any other underlying issues that arise in therapy. They may wish to supplement Mariah’s individual therapy with family counseling to help address both underlying issues and how to negotiate use of social media in their homes.
Sam is a seventeen-year-old gender-fluid individual who uses the pronouns they/them. They began gaming when they were very young. At first, they enjoyed gaming with the family, but soon they became more interested in gaming with friends. Some of their friends from real life also really enjoyed gaming, so when everyone couldn’t get together in person, they would meet online in the games instead. Everyone’s parents felt like gaming was a supplement to their real-life activities. They noticed benefits for their kids including improved motor skills, better problem-solving abilities, and enhanced ability to work together as a team. All of the friends were in a gaming guild together, and it seemed to strengthen their real-life relationships.
However, over time, things changed for Sam. While the other teens seemed to be able to balance gaming with the rest of their responsibilities at school, activities, and family life, Sam seemed to become obsessed with gaming. They didn’t want to get together with their friends in real life anymore; they’d rather just see them in the game. When the gaming guild wasn’t online, Sam would game with strangers from the online world. In the last year, Sam has become particularly interested in virtual reality gaming, begging their parents to spend increasing amounts of money on gaming accessories to enhance the virtual reality experience.
Sam’s parents are concerned. They’ve always had a hard time in school. They were diagnosed with attention deficit hyperactivity disorder (ADHD) at age eleven. They were sent home from middle school more than once for aggressive outbursts. Once Sam got into high school, they seemed less aggressive but more withdrawn. Their grades got worse. The only time that they got excited in school was when they were able to do a presentation on the fictional world from the games. That was last year. This year Sam is barely attending classes at all. Their parents can’t wake them up to go to school in the mornings, and they’re at risk of failing senior year. Sam says that it doesn’t matter. They say that school isn’t teaching them anything anyway and that they learn a lot more from the Internet than they’ve ever learned in class.
Although Sam wasn’t acting aggressively at school anymore, their aggression at home has increased. Whenever Sam’s parents suggest that Sam put their games away and join the family, they resist, and if the parents insist, Sam gets very upset. There are several holes in their bedroom wall due to such incidents. Sam’s parents are also increasingly concerned about their health. Sam will sit at the computer for upward of twenty hours at a time, not sleeping and refusing meals. Their parents don’t want them to snack on junk food, but it’s the only thing they’ll eat—quickly, with eyes still on the screen—so sometimes the parents give in. They can’t remember the last time that Sam joined them for an activity outside of the house. They’re worried about Sam, and they are also frustrated; if Sam doesn’t have any plans to finish school or get a job, then will they have to support them forever while they spend all of their time in an online world?
Sam appears to be in active addiction with online gaming. This is evidenced by the fact that they’re obsessed with gaming to the exclusion of all other activities, that they get angry (which is a withdrawal symptom) when asked to stop gaming, that school performance has gone down as what seems to be a direct result of online gaming, and that there are health concerns including lack of sleep and poor nutrition. At the very least, Sam does not have a balanced relationship with online gaming and the rest of life.
It’s of particular concern that Sam has an ADHD diagnosis. As we saw in Chapter 6, people with ADHD have a greater risk of developing addiction than their peers. Perhaps this is the reason that Sam seemed to become addicted to gaming, whereas their friends are able to control and balance their use. It’s sometimes hard to discern cause and effect because Internet addiction can mimic symptoms of ADHD, but because Sam was diagnosed with ADHD when they were young, it’s likely that they had ADHD first and have since developed Internet addiction. So, Sam will likely have the dual diagnosis of both mental health disorders: ADHD and Internet addiction. Sam’s therapist will have to work with them to determine whether to treat both mental health issues at the same time or address first one and then the other. It will be important to look at the medications Sam is already on for ADHD to get a complete picture.
One potential intervention for Sam could be wilderness camp therapy. This type of therapy would take Sam entirely away from technology for a detox period while also providing them with activities to keep their brain engaged. Wilderness therapy includes both peer support and professional counseling; it will be important to choose a program with counselors who understand both ADHD and Internet addiction. Spending several weeks or months in this type of program might offer Sam the opportunity to build a sense of competence outside of the gaming world, which could foster new outside interests. The slower pace of the natural world compared with that of the gaming world could be very frustrating for Sam at first, but adjusting to that change could help Sam in the long run.
If Sam and their parents choose a wilderness camp, they will also likely want to follow up with individual and/or family therapy. It sounds as if Sam’s parents have given up a lot of control in their household. It’s age-appropriate for Sam to have a lot of independence, but their parents should still set boundaries. Family therapy could help them establish appropriate boundaries, set new rules around gaming and online activities, and improve their overall family communication so as to heal their fractured relationships.
Joseph is a twenty-three-year-old male who lives with his girlfriend who is the same age. They have been dating for about a year and moved in together recently. He is in college and works part-time on campus in a work-study program. He is doing moderately well in school, and there are no complaints from his job. However, he and his girlfriend are fighting a lot recently due to problems associated with his addiction to Internet pornography.
Joseph first started watching porn online when he was a freshman in high school. All of his friends were showing each other different clips and sites. Throughout high school, they continued to share pornography with one another, often one-upping each other to see who could find something more hard-core or unique than the last thing that they saw. Toward the end of high school, though, his friends spent more time focusing on college and relationships with peers. Joseph, on the other hand, turned more and more to Internet pornography.
Whereas it had been easy for him to get aroused when he was younger, it started to take more and more intense scenes to arouse him as he got older. He started venturing into forms of kink that made him feel embarrassed and uncomfortable. He wasn’t even sure that he liked these types of scenarios, but nothing else was novel enough to arouse him anymore. He no longer shared his online porn interests with his friends but instead became more and more secretive about it.
When he moved out of his mom’s house during his second year of college, he hit rock bottom with his pornography addiction. He started thinking obsessively about porn all of the time. He would spend hours of each day trying to find the perfect clip. He spent less and less time with peers. He struggled in school, and he ended up failing out of the first college that he attended. After failing out, he had to return home. It was then that he admitted to himself, and his mother, that he thought he might have a problem.
Joseph started therapy for a pornography addiction. He did outpatient cognitive behavioral therapy (CBT) to help him better understand what had led him down this path and to resolve the problem. With his permission, his mom was allowed to control the Wi-Fi password, and she would turn the Wi-Fi off except during very limited hours to help him restrict his use. Eventually, he got things under control, and he felt like he was doing well. He got back into a new college program, and he met his current girlfriend.
However, once he and his girlfriend moved in together, things started to backslide. He felt anxious about the relationship. Given the free rein of not being in his mother’s house anymore, he started to look at porn online a little bit again to relieve some of that anxiety. When his girlfriend found out, she wasn’t upset at first. She figured it was common for people their age to watch porn, and she didn’t know about his history of addiction. However, it quickly became clear that he had a more serious problem. She brought up her concerns that he was watching porn instead of spending time with her.
Joseph immediately recognized that he was having a relapse. Instead of returning to in-person therapy, he joined an online support group for people with an online pornography addiction. He has been able to break the addiction but is now undergoing withdrawal symptoms. He has libido flatline; he can’t seem to get an erection at all and doesn’t have any interest in having sex with his girlfriend. This is causing a lot of arguments between them. She would like to go to couples’ therapy, but he doesn’t want to go.
Joseph has an online porn addiction, which was diagnosed in therapy in the past, and he has self-diagnosed that he is in a relapse. Some people can watch a little bit of online porn and have no problem, but for Joseph it started to interfere with his entire life. Because he has a history of failing out of school and losing out on peer relationships as a direct result of his addiction, it’s important that he take this relapse very seriously. He’s currently doing well at work and school and is in a serious relationship that is in jeopardy if he falls further into addiction.
It seems that there were two major triggers for the relapse: leaving the structured environment of his mother’s home and dealing with anxiety around his new relationship. He wanted to escape the feelings of anxiety, and perhaps never completely learned how to do that in a healthy way, so he turned to online porn. He was able to do so because there was no structure in place (external or self-imposed) to reduce his access to pornography. It’s also problematic that he hadn’t revealed his past history of addiction to his girlfriend because she didn’t know to help him look out for the warning signs. Plus it points to secrecy in their relationship, which is a risk of Internet addiction.
Online therapy has some potential to help Joseph, and it’s good that he’s working toward a solution. However, online peer groups vary in quality. Because of his history of addiction, Joseph might be better off returning to in-person therapy. Alternatively, if he prefers online therapy at this time, he might want to look for a licensed counselor, particularly one with training in both CBT and Internet addiction, since CBT did work for him in the past.
It’s concerning that he hasn’t sought in-person therapy, particularly because his girlfriend would like to try couples’ counseling to deal with the problems in their relationship. This suggests that perhaps on some level, Joseph doesn’t want to deal head-on with his problems. Maybe he’s embarrassed about his porn addiction. Or maybe something else is going on, and he’s not ready to address it. For example, it could be that he’s not happy in the relationship and doesn’t want to stay in it but can’t admit that, so he’s using his addiction to escape. By not seeking professional help, he’s setting himself up for further relapse and subconsciously could want to blame any future relationship failure on the addiction.
Sometimes addiction changes over time. The individual can benefit from not only relearning their coping skills but also digging deeper to gain further insight into their addiction. Joseph may find that talk therapy is helpful for that. On the other hand, if he decides to keep treating himself through peer support online, he might at least want to implement a structured method of contemplative computing or some form of digital diet to help him in daily life.
Matthew is a thirty-three-year-old father of two young children. He has been married to their mother for almost ten years. They used to have a great relationship, but after the children came along, they seemed to grow apart. Matthew feels that she focused all of her attention on them, and it made him feel lonely and unvalued in his home. In the past few years, whenever he’s home, he spends all of his time on online gaming.
Matthew had always enjoyed gaming when he was younger and never had any problems with it. He would sometimes lose track of time because he would get so immersed in a game, but it never presented any serious issues in his life. When he got married, he stopped gaming so much because he and his wife would do other things with their downtime such as go to movies together and throw parties with friends. Once he started finding himself bored at home, it made sense to him to return to online gaming. He enjoys coming home from work, heading to the computer, and relaxing in that online world.
His wife is not happy with this situation. Her perspective is that he doesn’t want to spend any time with her and the kids. He would rather have fun in the online gaming world than sit down to a family dinner or help the kids with bath time and bedtime. She feels completely disconnected from him. When she tries to talk to him about it, he gets upset. He says, “I go to work and earn the money for this family. I’m not out at a bar or with other women. I’m right here in the house. So, what if I want to chill out with my game?” Matthew’s online friends agree with his perspective and say that his wife is nagging him too much.
Recently, Matthew’s wife has been considering getting a divorce. She had hoped that the problem would pass, but it seems like it’s getting worse. Recently, her youngest son walked over to his dad when Matthew was gaming because he wanted to ask his dad to read a book to him. Matthew didn’t even hear what the child was saying, and his son got very upset at being ignored. He threw a tantrum, and his mother was unable to make him feel better for nearly an hour. Another recent problem was that their oldest son tried gaming with their dad. She had concerns about her young child playing violent video games but thought that at least it could be a way for him to bond with his father. Unfortunately, Matthew got really upset because his young son couldn’t keep up in the game and made him lose out on some points that he wanted to acquire. He exploded, his son ended up in tears, and Matthew went back to his game alone. At her wits’ end, Matthew’s wife is starting to think it would be better if he weren’t there at all.
It’s hard to say whether or not Matthew has a full-blown gaming addiction. He’s never had a problem with it before now. He’s able to hold down a job, and gaming doesn’t interfere with his finances. He hasn’t noted any particular health symptoms associated with gaming. In fact, he doesn’t think that there’s a problem at all. But it’s of great concern that he seems to be increasingly distant from his family, even to the point of blowing up at his young son for “losing” a game, and that’s one warning sign that there’s a problem. It might not qualify as an addiction, but it also might be one.
An addiction often develops when a person wants to escape uncomfortable feelings. It sounds as though that’s exactly what Matthew has been doing—trying to escape the discomfort in his family that developed after the birth of his children. Something about being a father makes him feel incompetent and unneeded, and perhaps gaming offers him not just an escape but a place where he feels like he’s competent at something. He excels at online gaming, and he has peer support there, whereas at home it just feels like he’s doing everything wrong.
The gaming seems to be making the problem at home worse. Ironically, although he thinks that his family doesn’t need him and that he’s useless there, his family is actually very clearly making bids for his attention. They want him engaged with their daily activities, like reading a book to the kids at bedtime, but he’s so immersed in his game that he can’t seem to see that. Perhaps this is because he has an addiction and is blind to their bids. Perhaps he feels like if he tried to participate in family time, it would just be a fight, so he turns to gaming instead. Either way, the family is in trouble.
If Matthew wants to resolve the problems at home, then he might benefit from seeking individual or family counseling. These are two very different approaches to the problem, and he would have to determine which is best for him. Since he doesn’t feel like online gaming is a problem, he wouldn’t likely seek therapy specifically for Internet addiction. However, he could get therapeutic help to deal with his family issues. He recognizes that there’s a problem there, and talking to a professional—alone or with his family—could help him deal with those underlying issues. If it turns out that there’s a true Internet addiction, that might arise later in therapy and could be dealt with in turn. It may instead be the case that resolving his family issues naturally causes him to turn to gaming less frequently.
Marni is a fifty-three-year-old woman who lives at home alone. She has three children, the youngest of whom just left for college last year. She had been a stay-at-home mom when her children were young, and that was the best time of her life. She loved caring for them, baking with them, making costumes for Halloween, and participating in their school activities. As they got older, they needed her less, so she went back to work part-time. Her husband, who had supported the family, asked for a divorce when the youngest children were in high school. At that time, she had to get a full-time job. She started doing administrative work at an office, and she’s competent at it but doesn’t enjoy it at all.
Marni doesn’t really know what to do with herself now that her kids have all left the home. She works in order to pay her bills, but she doesn’t derive any satisfaction from the work. She longs for the old days when her house was filled with noise and laughter. She’s always asking her kids to come home on their school breaks, and she’s thrilled when they do. She can’t wait until they start having kids of their own so that she can be a grandma. But in the meantime, she’s just passing the time.
When she gets home from work, she immediately turns on the television for background noise. Then she starts browsing online. Since she works full-time now, she never feels like going out to the store, so she does all of her shopping online. It started out with just getting her groceries delivered once a week. She discovered that she really enjoyed browsing those online aisles, putting new foods in her cart that she never noticed at the grocery store. She loves that moment when the delivery person arrives, and she exchanges a quick hello and then gets to unpack everything she ordered.
In fact, she loves it so much that she started doing a lot of other online shopping as well. She visits Amazon almost every day to see what new items she might need for her home. She’s even started stockpiling items for her grandbabies, despite the fact that none of her children are ready to have kids yet. She loves picking out just the right thing and gets excited again when it arrives at her doorstep. Sometimes she even forgets what she ordered, so it’s particularly thrilling to get those little surprises in the mail.
Unfortunately, all of that shopping has added up. Marni has nearly maxed out all of her credit cards. She received the house in the divorce, and she has refinanced in it in order to cover her debts. She is thinking about digging into her retirement accounts because she needs more money. Despite hating her job, she’s been working overtime to help cover the costs of shopping online. Her children do not know that she’s in this situation.
Marni has friends who would like to spend time with her. However, she always tells them that she doesn’t have the money to go out. Recently, they’ve been making less of an effort to see her. When she’s not shopping online, she’s usually streaming television shows and simultaneously playing simple games, such as Farmville, on her phone. She doesn’t like that she spends her time that way but figures it’s better than spending money shopping. Inevitably, though, she always heads back to that Amazon button to see if there’s something new there that she “needs.”
Marni has an Internet addiction that is primarily focused on online shopping. However, when she’s able to restrict herself from online shopping, it does manifest in addiction to other forms of content such as simple games. This suggests that when she tries not to shop online, she experiences feelings of withdrawal, which is a huge red flag that she’s got an addiction. In order to quell the withdrawal, she turns to other online activities to soothe herself.
Her use has grown over time. She has stopped seeing her friends, claiming that she doesn’t have the money to go out but then spending that money shopping online instead. She is able to hold down her job, so the addiction hasn’t hindered her in that way, yet. However, she’s in serious debt due specifically to her online addiction. It’s compromised her future in that she’s refinanced her home and might use her retirement income to pay for her addiction. These are all serious problems that seem to only be growing with time. She has not admitted her problem to anyone else; keeping it a secret is another sign of addiction.
Marni seems to have developed this addiction specifically because of her change in life circumstances. Her husband left, and her children moved out on their own. Her identity as a mother, the experience of which gave her great joy, has changed. Having not fully processed that loss in a healthy way, Marni seems to be trying to escape those uncomfortable feelings of grief through her addiction. A therapist should assess Marni for depression, as it is possible that her grief turned into depression and that triggered the addiction. Marni likely gets a pleasant “feel good” hit of dopamine each time she puts something into her online shopping cart and again when it arrives at her doorstep. She’s trying to feel good more and more by engaging more and more in that behavior.
Most likely, dealing with the underlying emotional issues will help Marni in reducing her compulsion to shop online. However, because it’s become such an addictive activity, she and her therapist might want to address that issue directly as well. They may want to put a plan in place to help restrict her from online shopping while simultaneously dealing with the underlying issues of loss, change in identity, depression, and so forth. Hopefully, over time, Marni will find new ways of spending her time rather than shopping online. Perhaps she’ll get a job she actually likes or begin spending time out of the house with friends.