Addiction recovery help by replacement

contributing author: Katie McGrath

It’s easy to see why some people search for ways to escape their everyday life. Daily obstacles and challenges are common, and sometimes, life can seem like a difficult, if not impossible, test of wills. Addiction recovery help is about finding another option.

People turn to many different coping methods, including addictive behaviors such as drinking alcohol, using drugs, or gambling (1). But many other behaviors that aren’t considered as deviant as those just mentioned can also develop unhealthy patterns, including excessive work, promiscuous or risky sex, and high adrenalin activities like car and motorcycle racing, skydiving, rock climbing, and other forms of “extreme sports.”

In fact, researchers have found that drug users and extreme sports athletes rationalize their respective involvements in very similar ways (2).

Unfortunately, if the activities are used for escape, people usually find the relief they get to be temporary. When the “high” is finished, they find their problems alive and well as life comes back at them full-force. A temporary distraction, no matter how exciting or effective (like extreme sports, alcohol, or drug use) is just that – temporary.

The idea of “switching addictions” has come up in psychological research in the past (4). The question is: Can addicts substitute their choice addiction for a behavior that is actually beneficial?

Some research suggests that they can.

Yoga is one of he activities that may help drug addicts refocus their attention

Activities like exercise (running, yoga, and such), art (painting, photography), and other hobbies (such as gardening), may provide a source of comfort for drug users looking for a way to “fill in” the void left by drugs and/or alcohol. Each of these activities may provide the repetitive, mindful, pursuit that people who are prone to addiction may seek without many of the harms and dangers.

When I stopped getting high, one of the hardest things was figuring out what to do with my free time that didn’t involve using drugs. It was what I was used to doing when I was happy, sad, or bored. Now, I would be all those things, but the drugs weren’t there. It took me more than a year to get comfortable with movies, the gym, and books as replacements for what I knew how to do best – using drugs.

Running and other forms of exercise can be useful in recovery

In future posts, we’ll go over some specific ideas for changing behavior that may be useful for addicts trying to stop. We’ll also suggest specific strategies to keep from developing unhealthy habits even in these new, more constructive habits, while keeping them long-term. Addiction recovery can be tough, but actively replacing activities can help.

Question of the day:
If you’ve quit drugs or other addiction, do you have any suggestions regarding new habits you picked up that helped you in developing a new, healthier life?

Citations:

1. Hart, A. D. When coping becomes addiction.

2. Larkin, M., Griffiths, M. D. (2004). Dangerous sports and recreational drug-use: Rationalizing and contextualizing risk. Journal of Community & Applied Social Psychology, 14, pp. 215-232.

Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use

We know that addiction can go beyond drug use, but are we becoming addicted to making our bodies perfect?

I put “addiction” in parentheses here because I think it’s important to distinguish substance-related addictions from behavioral ones. There’s no doubt that people’s behavior can become compulsive in the same way addicts become compulsive about using, but I’ve seen no evidence that behavioral addictions interfere with brain function in the way that cocaine, methamphetamine, and opiates alter actual brain mechanisms.

Still, this recent trend of obsessive plastic surgery is a dual-headed “addiction”, one that is both physical and social.  In many ways, people are now able to change aspects of their being that were once thought unalterable including their own physical appearances. To gain social acceptance, if you have money, you now have new tools!

This may also play a big role for those who are love addicted, at least if they have money… Continue reading “Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use”

Why the addiction-brain connection has to be part of the addiction treatment picture

Dr. Dodes recent article, apparently trying to blow up the myth of addiction as a neurophysiological disorder, sounded persuasive, although its underpinning was oversimplified and it’s understanding of the brain-science involved in addiction, and other associated mental health disorders, was lacking. Hopefully, by presenting a more complete picture of the evidence for a brain-aspect to addiction, I can un-bias the discussion somewhat. I, for one, don’t believe that neuroscience will ever be the only factor important in addiction – an individual’s environment, social influences, and other factors will always end up playing important parts as well – still, I think that to dismiss all of the evidence for biological factors at play in the development of addiction is foolhardy. Especially when there’s so much of it that was glossed over in Dr. Dodes’ introduction.

Pleasure center activation is only part of the picture in addiction

Firstly, supporters of the notion that addiction is, at least partly, an outcome of specific brain function point not only to pleasure center activation, but also to a whole host of findings showing genetic variability that is either protective from, or a risk factor for, dependence on drugs and likely also behavioral addiction like eating disorders, compulsive gambling, and maybe sex addiction as well (you can start out looking up ALDH2-2 variability and alcoholism and cocaine addiction, DRD4 and stimulant addiction, and many more).

While it is true that all those who consume addictive substance activate the brain similarly, there are considerable differences in the specific of that activation in reaction to drugs. Some release more dopamine while others have more “active” versions of specific important receptors; neurotransmitter recycling is quick in some, but not all, and drug metabolism is different in different individuals in ways that have been shown to be important not just for addiction risk, but also for the probability of treatment success. Just look at the nicotine and CPY26 literature for an example. It’s right there.

Additionally an entire body of literature exists that shows differential activation, as well as structural differences, between addicts and non-addicts in regions as varied as the OFC, PFC, Insula, and more. This is not to mention a slew of evidence that shows different behavioral test performance on risk-taking, impulsivity, and delay-discounting, all personality variables highly associated with addiction. If one simply ignore all of this evidence, it may be easy to believe that there is no biological explanation for these phenomena, but that’s just wrong.

To say that mesolimbic activation (what the good doctor called “pleasure centers”) is the only evidence for physiological factors in addiction is dismissive at best.

Drug addiction develops in only some drug users

The notion that not everyone who takes drugs becomes addicted is nothing close to evidence against a brain explanation for addiction. Everyone’s motor–cortex, striatum, and substantia nigra (the areas of the brain responsible for movement) activate in the same way during movement, but only a small group ends up suffering from Parkinson’s or Huntington’s disorders. One fact does not preclude the other but instead may specifically point to the fact the group which develops the disorder has somewhat different neurological functioning. Researchers aren’t concerned with explaining why all individuals can become addicted to drugs, but rather why that small subgroup develops compulsive behavior. A short reading of the literature makes that fact pretty clear. Additionally, while Dr. Dodes’ claims otherwise, imaging technology HAS produced evidence explaining this “mystery”, including differences in the ways addicted smokers respond to smoking-related triggers, and an increased dopamine response in cocaine addicts to cues, and well as to cocaine.

As mentioned in the motor disorder section above, ingestion of chemicals is not at all necessary for brain disorders to occur or indeed develop later in life. Dr. Dodes example of shifting addiction could be used as evidence for an underlying neurological difference just as well as it would serve to make his point… Or even better. If there’s a faulty basic mechanism attached to rewarding behaviors, it doesn’t really matter what the behavior is, does it? Sex addiction, gambling, and more can all be explained using a similar mechanism, though drugs of abuse may just have a more direct impact. I know, I’ve written about them all.

The Vietnam vet heroin story used by Dr. Dodes as evidence that emotional, rather than physiological, factors are responsible for addiction actually fits right in line with the notion of predisposition and underlying differences, and I’m surprised to hear a physician point to group differences as an indicator of no neurobiological basis. Indeed, when it comes to the emotional reactivity associated with drug associated cues, normal learning literature, as well as drug-specific learning research, has revealed over and over that drug-related stimuli activate brain regions associated with drug reward in the same way that natural-reward predictors do for things like food and sex. Once again, these facts are part of the basic understanding of the neuroscience of learning, with or without drug abuse involvement.

My own dissertation work shows that it is very likely that only a subsection of those exposed to nicotine will develop abnormal learning patterns associated with that drug. However, among those, learning about drug-related stimuli (as in “triggers”) continues in an exaggerated manner long after the other “normal” animals have stopped learning. That sort of difference can lead to a seriously problematic behavioral-selection problem whereby drug-related stimuli are attended to, and pursued, more so than other,  non-drug-related ones. If that sounds familiar, it should, since drug users continuously pursue drug-associated activities and exposures in a way that seems irrational to the rest of the world. It just might be due to such a mechanism and others like it.

Some important points about science in Dr. Dodes’ article

One very true fact about mental health pointed out by Dr. Dodes is that diseases like schizophrenia, which used to be explained simply as demon possession and evidence of witchcraft can now be, to a large extent, explained by the study of behavioral neuroscience and cognition. The same is true for bipolar disorder, depression, ADHD, and a host of other such conditions. In fact, the study of psychology has only been able to rely on technological advances that allow us to “see” brain function for a few short decades, leading to incredible advances in the field that I think will continue. The thinking that no such advances have, or will continue to be, made in the study of addiction is, in my opinion short sighted.

As I mentioned above, I don’t for a second think that the entire explanation for drug abuse and addiction will come from neurophysiological evidence. The doctor points out that “If we could take a more accurate image of addiction in the brain, it would encompass much of the history and many of the events that make us who we are.” I agree that we need to advance our technology as well as expand our understanding, but I think that to discount neuroscientific explanations completely is a big mistake.

Internet Porn Addiction – Why is free porn so irresistible and what can love addicts do?

online-porn101In a recent post on Internet addiction, we briefly mentioned addictions to internet pornography. There’s no doubt that the easy access, and anonymity, of online access to any and every sexual whim conceivable is at the heart of online porn’s draw. Here we will take a more in-depth look at how Internet porn addiction develops.

The internet porn addiction connection

Excessive use of online porn can be thought of as a manifestation of both Internet addiction and sex addiction. In fact, porn addiction is one of the most commonly reported sex addiction problems, especially among younger individuals and among what Dr. Carnes calls “Phase 1” sex addicts, or the lighter version of sex addiction that doesn’t involve others.

Porn addiction develops much like a drug addiction. After an initially rewarding experience with pornography (a common experience given the cycles of sex we’d mentioned in an earlier post), individuals may experience uncontrollable urges to obtain sexual satisfaction through that form of entertainment (1). The connection between internet porn and sexual gratification is positively reinforced, and the urges become more frequent and more powerful. These connections can become so strong that simply sitting down at a computer elicits a sexual response.

Like in drug addiction the problems arise when urges to view porn conflict with an individual’s daily responsibilities. Instead of leaving for work on time, the addict may decide to stay at home and watch porn – Some porn addicts report staying at home for porn sessions that can last as long as 8-10 hours. The shame and guilt that often accompany these compulsive sexual experiences are also thought to greatly affect the experience of sex addicts and to reinforce the positive experience they receive from their shameful act. Many porn addicts report that they end up in a distressing situation where their shameful sexual release is the only positive experience they get to have.

It should be noted that the majority of people who use online pornography do so recreationally, with little ill effect (2). As is the case with drug addiction, it is only a sub-group of people that become “addicted” and suffer serious consequences from their porn addiction (e.g. lost jobs, disturbed marriages).

Whether we are talking about pornography, gambling or shopping, our golden rule for diagnosing behavioral addictions has been: no impairment, no addiction.

The toll of porn addiction and the refuge of he internet

Internet Porn Addiction can also bring about a different psychological toll than the shame we discussed earlier. As tolerance develops, individuals with porn addiction may also begin to need more deviant material to achieve the same high. This is again similar to the increased quantity and variety need experienced by many drug users and it’s where rape fantasies, fetishes, and child pornography often come into play. Exposure to such material can grossly distort beliefs about human sexuality and ruin interpersonal relationships. Patients that progress in this fashion often report feeling unsatisfied with their sexual experiences and unsatisfied with their partners (2).

We noted that in addiction, shame is a major component of the addiction cycle. This is especially true for sexual addiction. Social norms tell the sex-addict that there is shame in buying an adult magazine (like playboy or hustler) and that there is shame in soliciting a prostitute. Internet porn substantially reduces the risk of getting caught, and therefore of being shamed. Many individuals who experience porn addiction are able to hide their activity from their partners and remain completely anonymous on the web. Online porn is easily accessible, it’s available all the time, and getting free porn is easy. When you add complete anonymity into the mix, you get a recipe for a potentially serious addiction (2).

Porn addiction help – Some Advice

Relapse is common during recovery as patients often experience withdrawal symptoms when their normal consumption of pornography is reduced. In this case, like in many others, relapse is to be thought of as a misstep, and not a failure. See our post on treatments for sexual addiction to see how porn addiction is usually dealt with. In addition to these standard methods, patients can often benefit from the use of Internet filters and “accountability” software that sends a report of their online activity to a partner or therapist. Again, it’s important to recognize that although porn addiction is serious, there are solutions out there and sex addiction help resources in general are growing with the recent jump in awareness brought about by high profile cases like that of Tiger Woods.

Citations:

1. Griffiths, M. (2001) Sex on the internet: Observations and implications for internet sex addiction, The Journal of Sex Research, 38(4)

2. Cline, V.B. (2002) Pornography’s Effects on Adults and Children

Anonymous No More: Jennie Ketcham and her sex addiction story

As part of our Anonymous No More series, we bring addiction stories of addicts who are in different stages of recovery and are willing to share their take with you without the veil of anonymity. The point is to once and for all humanize addiction, and addicts, and reduce the stigma of addiction as a condition that leaves people hopeless forever. Jennie Ketcham has already publicly shared some of her story with the world, and if her recovery from sex addiction isn’t an example of humanizing and de-stigmatizing the addict, I don’t know what is. From her humble beginnings, through her porn career, to her role on Dr. Drew’s show “Sex Rehab with Dr. Drew,” Jennie has been leaving her mark on this world for years. I know her story will leave a mark on you.

Jennie Ketcham – Sex Addiction is a slippery disease

Like in alcoholism or drug addiction, the sex addict must hit rock bottom before any change can be made. The biggest problem with this particular addiction is the intrinsically shame-based nature of the disease, with core issues making that first step into recovery the biggest and most difficult step one could ever take. To say, “I am a sex addict,” is to admit total and utter defeat in an arena that is most private and sacred.

My name is Jennie Ketcham, and I am a sex addict. My bottom line behavior, behavior I absolutely cannot participate in if I wish to lead a healthy and happy life, is compulsive masturbation, porn, sex with strangers, sex outside my committed relationship, selling sex for money, and sexualizing people, places and things when I feel uncomfortable. For most people, these behaviors are already unacceptable. For a sex addict however, it’s regular Tuesday night. I am 27 years old, my sexual sobriety date is April 6th, 2009, and I ended up in the program of recovery by mistake, but it was the best mistake I ever made. And believe me, I’ve made plenty.

Up to April 6th, 2009, I was a Porn Star. I’d been in the adult business since 2001, and had worked my way to the upper echelons of porn. By the time I quit, I was managing a webcam studio, directing and producing my own content, and working whenever I wanted. I had heard about Dr. Drew and his new rehab show, “Sex Rehab with Dr. Drew,” and thought it would be the perfect publicity stunt for my webcam studio. I figured if I could get national press, the studio would take off and I’d be able to retire a happy woman. This is the superficial line of thinking that led me to rehab. These are the reasons I actually needed to be there.

Jennie the sexually addicted porn star

When I lost my virginity at thirteen, I realized I have something boys want, and decided to use my sexuality as a means of getting what I want. From my first sexual experience to my last pre-recovery, I was detached, emotionless, and cruel: it was a power struggle and I wanted to win. However, it never appeared as such, always the actress, and I played my sexual exploits off as curiosity and apathy. I’d have sex because I was curious. I wouldn’t call them (him/her) again because I didn’t care. When I joined the porn business it felt like the perfect career. I could have sex with as many people as I wanted, and didn’t have to care about any of them. And they wouldn’t care about me. I’ve never been able to accept love, and this is one of my biggest problems.

I’ve been a compulsive cheater since my first boyfriend, have never been able to maintain a monogamous relationship, and never felt any guilt about my extra-curricular activities. The problem isn’t that I lacked a conscience, it’s that I never felt significant enough to make an impact on any one person’s life. When I joined the porn industry I was no longer required to be monogamous, as it was my job to have sex. It became harder and harder to care about anybody I had sex with, and if feelings of love did start, I’d shut the relationship down before I could destroy it with my behavior.

I’ve been a compulsive masturbator since I started performing in hardcore boy/girl scenes. I decided to train myself to orgasm to non-sexual things, and nearing the end of the behavior, found myself masturbating upwards of 6 hours every day I wasn’t working. At the time I thought I was bored. In recovery, I am able to see the underlying issues, and have found a solution that works for me.

Sex Rehab with Jennie Ketcham

In rehab with Dr. Drew, I was prohibited from masturbating, sexualizing, having sex, drinking, drugging, every numbing device I’d become accustomed to using. When the effects of these behaviors wore off, when my oxytocin levels started to even out, when the alcohol and marijuana drained from my system, I was left with uncomfortable feelings I couldn’t identify or process. With the help of trained specialists, I started to understand what was going on behind my compulsive, dangerous behavior, and with the program of recovery I’ve learned how to deal with life. I am powerless over compulsive sexual behavior, and my life had become unmanageable. I came to believe that a power greater than myself could restore me to sanity. I made a decision to turn my will and my life over to that power, and every day since has been better than before.

I was celibate for over nine months, trying to get back in touch with the Jennie pre-sex. I attend bi-weekly therapy sessions, and follow every direction given by either therapist or sponsor. I trust in the program of recovery, and have learned how to treat myself like the precious young woman I am. I have become a woman of grace and integrity, I have dreams that aren’t pornographic, and my first healthy committed relationship with a man I love. I have a relationship with my family, something that had fallen off in addiction, and am someone who does what she says she will do. There isn’t a single moment that goes by that I don’t worry about falling back into my destructive cycle, but now I have the tools necessary to live a healthy and productive life.

When I walked into rehab wanting publicity for my company, the joke was on me. I had accidentally walked into the first day of the rest of my life, and one minute in recovery is worth a thousand days in addiction. I am blessed through and through, and I take it one day at a time.

A final word on sex addiction recovery from Adi

You’ll notice that Jennie’s bottom-line behaviors are very far from the often stigmatized view of the sex-addict as a rapist, or pedophile. While there’s little doubt that there are sex addicts that fall into those categories, the vast majority of addict engage in activity that might, for others, be relatively benign but that has become compulsive in their own lives. My issues with sex addiction revolved around seeking sexual partners outside my marriage and migrated from my bedroom to online chat sites after I got caught cheating. What’s also very clear when reading about the recovery experienced by Jennie is that with the proper guidance, treatment, and time, addicts can go on to become fully functional in ways that many out there believe are nearly impossible. As Jennie mentioned in her reference to Oxytocin levels, a huge aspect of addiction recovery is letting the body reset, or at least attempt to re-establish, its  functioning to pre-addictive-behavior levels in the brain and elsewhere.

Jennie Ketcham used to live a life that left her unattached and cold, though for her, it didn’t seem like much was wrong until she saw the other side thanks to her stint on “Sex Rehab with Dr. Drew.” Most other addict’s aren’t very likely to end up on a reality show that specifically addresses their problem (though A&E’s intervention may help some of them), but the knowledge that others with similar problems have recovered and are living full productive lives that would have been unthinkable should give hope to every struggling addict. It’s what works in group therapy everywhere and what gets some people into treatment in the first place. By living her recovery without anonymity, Jennie is showing endless other addicts that life with addiction is possible. That’s what addiction stories do – they give hope.

Obesity, drug addiction, and dopamine

Eating junk-food can be addictive, and apparently, it causes brain changes that look eerily similar to drug addiction. That’s the message not only from the rapidly fattening waistlines of Americans everywhere, but also from the Johnson and Kenny labs at the Scripps Institute.

Food and drug addiction

The idea that obesity is caused by a compulsive pattern of eating, and that there could be a similarity between such compulsive eating and drug addiction isn’t super new. In fact, Dr. Volkow from NIDA seemed to make research into this association her goal when taking  the helm of the addiction research kingdom.

When you think about it, the notion isn’t far-fetched: Drug addicts continue to take drugs, in increasing amounts, even though they’d often like to stop (at some point) and in the face of negative consequences and the common loss of other important life functions (like family, work, etc.). Obese individuals are quite the same, eating more and more food regardless of their desire to adopt a healthier diet and in-spite of ridicule, low self-esteem, and decreased functioning that often accompanies extreme weight gain.

The research by Johnson and Kenny examined whether exposure to the kind of high-fat, super high-calorie foods that floods the junk-food market are responsible for creating food-addicts in a similar way to drugs that alter the brain in ways that make stopping more difficult.

Dopamine, reward, and junk-food

The study took three groups of rats and gave them either the regular chow diet lab animals are used to or the worse kind of birthday party food: bacon, sausage, cheesecake, pound cake, frosting and chocolate. You can imagine the party going on in the rat cages that got to eat that! Of the two groups that got to eat the crazy-fat food, one had unlimited access while the other got to binge for only one hour a day.

The bottom line: Only the rats that got unlimited access to the fat-party food developed compulsive eating habits that resulted in roughly twice the weight gain of the other two groups and the ability to continue eating even in the face of signals for punishment (a light that they were trained to associate with shocks).

When the researchers looked deeper, they found that the brains of these rats suffered a significant reduction in the density of a specific kind of dopamine receptor (D2) in a brain part known as the striatum, the same kind of reduction common in drug addicted people and obese individuals. This receptor type is often thought to be important for regulation of impulses, both physical and otherwise. It therefore makes sense that losing this type of function would cause uncontrollable eating or drug taking.

Are drug- and food-addictions the same?

While this research isn’t saying that compulsive eating, or obesity, are the same as drug addiction, it does strongly suggest that there are common mechanisms in both. More importantly, it reveals a common process that unfolds when over-exposure to the reward, in this case food, occurs. This tells us that there can likely be common pathways to these different addictive disorders, though whether any specific person ended up a food- or drug-addict because of this kind of process is still an open question. I wonder if we’ll see something like this with sex addiction soon…

Citation:

Johnson and Kenny (2010) Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nature neuroscience, 13, 635-641.

Facebook, E-mail, Games, and Porn – A glimpse at Computer addiction

Contributing co-author: Andrew Chen

Computer addiction, including social networking and porn  addiction, can lead to serious dysfunction in some peopleThe idea of the internet being addictive may draw a chuckle until you realize that compulsive video gaming has been responsible for some horrifying deaths across the world, including examples from China and South Korea of addicts playing for 50+ straight hours before going into extreme cardiac arrest.

With 1.5 billion Internet users around the world today, the Internet has become an integral part of our society. With the huge success of the Internet, researchers have become interested in the possibility of a new disorder, Computer addiction (or internet addiction disorder).

What is internet addiction?

Internet Addiction Disorder (IAD) is a controversial term being used to describe problematic use of the Internet. IAD is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Many wonder if excessive Internet use really counts as an addiction. Excessive Internet use could just be a symptom of other underlying factors such as depression, anxiety, or occupational need. (1)

Those that believe excessive Internet use is a unique phenomenon have modified the criteria for diagnosing pathological gambling to diagnose IAD. For someone to have IAD, they must demonstrate five or more of the following:

1. Is preoccupied with the Internet (think about previous online activity or anticipate next online session).
2. Needs to use the Internet with increased amounts of time in order to achieve satisfaction.
3. Has made unsuccessful efforts to control, cut back, or stop Internet use.
4. Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use.
5. Has stayed online longer than originally intended.
6. Has jeopardized or risked the loss of a significant relationship, job, educational or career opportunity
because of the Internet.
7. Has lied to family members, therapist, or others to conceal the extent of involvement with the Internet.
8. Uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e. g., feelings of helplessness, guilt, anxiety, depression). (1)

Who gets computer addiction and to what?

Despite early beliefs that Internet addiction was most prevalent among introverted young males, new studies have shown that Internet addiction can affect people of any gender, age, and socioeconomic status (1).

People are most likely to develop unhealthy Internet habits using online social applications such as e-mail, instant messaging, and networking sites (e.g. Facebook, Myspace). Chat rooms and MMORPGs (Massively Multiplayer Online Role Playing Games) are especially addicting as they allow a user to instantly communicate with hundreds if not thousands of other users (2).

Online social interactions may help a person fulfill unmet real life social needs and thereby reinforce prolonged Internet use.

It should be noted that most studies of Internet use rely on self-report measures. This method undoubtedly leads to an underreporting of Internet pornography use. According to the AVN Media Network, people in the United States alone spend around three billion dollars on online porn. Aside from social applications, online porn certainly plays a significant role in Internet addiction.

So, does excessive Internet use truly characterize an addiction? That debate is not likely to end anytime soon. Either way, the Internet is here to stay and many individuals who have problems controlling their Internet use could benefit greatly from help, especially if their use involves a financial cost.

Citations:

1. Beard, K.W., Wolf, E.M. (2001) Modification in the proposed diagnostic criteria for internet addiction, Cyberpsychology & Behavior, 4(3)
2. Young, K.S., (1996) Internet addiction: Emergence of a new clinical disorder, Cyberpsychology & Behavior, 1(3)