J is a college sophomore seeking counseling for poor grades related to excessive internet use. He reports spending until 3 AM surfing the web and checking email first thing in the morning. While aware of the impact on his schoolwork, he finds web surfing gratifying due to the campus's fast internet speed. The biopsychosocial model best explains J's situation, with potential genetic predisposition and environmental/social stressors reinforcing his internet addiction. Treatment may include time management, coping strategies, and 12-step programs.

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Philip Guillet
Final Report
PC 650: Substance Abuse Counseling
Loyola University Maryland
Pastoral Counseling Department
Dr. Adona Wimberly
December 4, 2014

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Case Example:
J is a Caucasian, heterosexual male in his late teens. He is not married, and has
no kids. He is currently a sophomore in college. He is seeking counseling under the
behest of his parents. His grades throughout the first year of college were poor, and
received a cumulative GPA of 1.5. His parents allowed him to return to college under the
condition that he seek counseling. His parents had expressed concern to J that an
addiction to surfing the internet has interfered with his schoolwork, to the point where
his grades were as low as they were.
J has stated in session that most nights, he stays up until around 3:00 AM surfing
the web. He has also stated that “checking email” is the first thing he does when waking
up. He has expressed awareness that he is always mindful that he should be working,
but whatever website he visits preoccupies his attention more so than his school work.
When asked what makes web surfing so enjoyable and gratifying, he responds
that it’s because of the high speed of his campus’s Ethernet connection. Although he had
experienced fast web surfing at home prior to college, his campus’s high LAN bandwidth
seemed to be a novelty. That novelty seemed to be providing sensations of exhilaration
and excitement, almost as though he was exploring the internet for the first time.
Diagnosis:
To date, the DSM does not recognize “Internet Addiction” as a diagnosis. As a
result, there only exists subjective and arguable speculation for what would constitute
the basis of clinical judgment. However, research has been able to support multiple pre-

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existing diagnoses comorbid with what would formulate, in their estimation, an internet
addiction. Young and Rogers (1998) offered an interim term to be used until such time
as internet addiction can be acknowledged by the DSM: “Pathological Internet Use” or
“PIU”. This would be defined as: spending a minimum of 38 hours per week on internet
usage that is neither for academic nor employment purposes.
Yen et al. (2007) found a significant correlation between adolescents with
internet addiction and symptoms related to Major Depressive Disorder, Attention-
Deficit Hyperactivity Disorder, and Social Phobia. Although the research presented did
not distinguish which participants had received diagnoses prior to the study, or who
simply displayed symptoms of a particular diagnosis.
Young and Rogers (1998) were also able to find a significant relationship between
“Pathological Internet Use” and moderate to severe depression. Earlier research
conducted (Young, 1996) found that over half participants reported “severely” impaired
functioning within the following areas: academic, relationship, occupational, and
financial. Academic impairment defined as difficulty completing homework, a deficiency
in the amount of regular sleep, and inability to manage time spent on the internet
resulting in a slipping of grades. Relationship impairment included a gradual decrease
in time spent with people at the expense of more time in the internet. Occupational
impairment involved a decline in work related internet usage as well as an increase in
recreational internet usage. Neuborne (1997), using tracking software and spyware,
found that an average of 23% of all internet usage in his study was work related.
Financial impairment involves an inability to control “impulse spending” on internet
services. Although nowadays, overall rates are relatively low. However the concern is

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then raised by issues such as “micro-purchases”, and users that are able to “spend less”
but end up spending more time surfing and purchasing.
Psychoformulation
Abraham Maslow was a developmental psychologist who published his “Hierachy
of Needs” in 1954. In it, he expressed a hierarchical pattern of basic needs that must be
met in order for a person to progress self-actualization. The first part of the hierarchy
involves physiological needs, (e.g. food, shelter, etc.); secondly, safety; thirdly, love and
belonging (i.e. family and community); fourthly, esteem (i.e. empowerment and
efficacy); and finally, self-actualization (Simons et al, 1987). Although this model is
typically represented in pyramidal form, Maslow himself never intended it to be
portrayed as such (Kremer, 2013). Maslow also acknowledged the brain’s complexity
and capacity for processing on multiple levels, and also did not intend to imply that only
one need can be focused on and that it remains a focal point only until that need is met
(Goble, 1970).
What is reasonable to infer in some cases of internet addiction or PIU is that a
client may be attempting to self-soothe through the process of internet usage. Which
then leads to the question of what part of a client’s psyche may be needing to soothe? In
order to address that issue, a prior examination into what needs may be accommodated
through internet usage, and what needs may be filled. One of the more primal levels of
Maslow’s needs involves safety. It is a plausible assumption that safety, in this context,
involves physical protection. As a person may be able to sit quietly at a computer, he

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may sense his own online anonymity as form of protection. Also, the use of an avatar
(i.e. online persona) or created identity may also serve as a form of protection. This
would likely be prevalent in clients whose true identity was the subject of ridicule or
torment. Higher on the scale is “love and belonging”. Now that online support groups,
similar interest minded groups, and social networking have become popular, it is also
reasonable to assume that a client may be filling the need for communion and
acceptance by means of groups that exist solely online. While this in and of itself may
not be maladaptive or pathological, it may subsequently lead to impaired social
functioning.
In summation, from a developmental point of view, it is possible that during the
lifetime of a client, there occurred a disruption during when such primal needs were to
be met. As a result, the client may have been left with an unresolved anxiety that he or
she may be attempting to soothe through the use of the internet, and the subsequent
feelings of community, belonging, and safety that it brings.
Assessment:
One of the instruments available to help determine internet addiction is the
“Internet Addiction Diagnostic Questionnaire (IADQ)” (Young, 1996). This battery
assesses areas such as unsuccessful attempts to moderate internet usage, a general
preoccupation with the internet, using the internet as means of escape from thinking
about other problems, compromised relationships as a result of excessive internet
usage, etc.

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Concerning J’s stage of change, at this point, J is likely still within the pre-
contemplation stage. Although he has spoken freely of his awareness that his excessive
internet usage has disrupted his academic progress, his speech’s affect is incongruently
blunted. It is as though he’s reciting a script. While still in the early stages of counseling,
it is reasonable to infer that J is simply saying what he is expected to say, and that he
likely does not believe his own words.
At this point, it is recommended that J continue weekly counseling sessions in an
outpatient setting. He will also be referred to a local psychiatrist in order to further
assess and treat any additional underlying psychological concerns.
Model(s) of Addiction:
In J’s particular case, it is likely that the model of addiction which best describes
his experiences is the Biopsychosocial Model. The core concept behind this viewpoint is
that “addiction is the result of multiple, interacting variables, the strength of which vary
between individuals” (Fisher, Harrison, p. 38). Variables include genetic predisposition,
environmental conditions, social stressors, reinforced behaviour, etc.
Although unclear at this point, J may have a genetic predisposition to depression
or depressive symptoms. The symptoms may be manifesting in the form of social
withdraw, resulting in and reinforced by the large of amount of time spent using the
internet.

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Treatments:
Research in the field of treating internet over usage is minimal. Some of the basic
forms of treatment involve the development of time management skills. This may also
involve the use or props such as a timer to set, reminder cards, and software that blocks
applications from being opened after a certain amount of time. However, time
management skills seem to focus on moderating usage without addressing any
underlying pathologies. Young (1999) suggested additional coping strategies be taught
in order to change addictive behaviour through empowerment.
Additional issues to consider involve gender roles. A 2005 study showed that
nearly 66% of those addicted to online pornography are male (Retrieved from
www.safefamilies.org). Although J has not yet reported excessive time spent on online
pornography, his gender seems to indicate a higher susceptibility to an additional
addiction.
There does exist a 12-Step Program for those with internet addiction. The
“Internet & Tech Addiction Anonymous (ITAA)” is a support group in similar style and
structure to Alcoholics Anonymous. The group is open to not only addicts, but also
families and partners of those coping with recovering from excessive technology use.
According to their website, “ITAA offers hope, resources and support to persons
confronting the social, economic and interpersonal problems brought about by
an overuse of technology” (Retrieved from www.netaddictionanon.org).
Concerning a pastoral approach to treating a client with an internet addiction, I
would first like to gain a sense of what the client considers sacred. No matter what that

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sacredness involves, no matter how earthly or mundane it may be, it still will likely be a
pathway into his view of the Divine. If, for instance, he considers “safety and protection”
to be sacred, he and I may be able to work on finding the feeling of safety in various
other places. This may serve to broaden his horizons as far as what can provide him that
comforting feeling of security goes. And subsequently allow him to channel a Divine line
of communication through his personal ideas of sanctity.

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References:
Chou, C., Condron, L., Belland, J.C., 2005. A review of the research on internet
addiction. Educational psychology review, 17(4), 363-388.
DeAngelis, T. 2000. Is internet addiction real? American Psychological Association,
31(4).
Fisher, G.L., Harrison, T.C., (2013). Substance abuse: information for school
counselors, social workers, therapists, and counselors (5th ed.). Boston: Pearson.
Yen, J.Y., Ko, C.H., Yen, C.F., Wu, H.Y., Yang, M.J. 2007. The comorbid psychiatric
symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD),
depression, social phobia, and hostility. Journal of adolescent health, 41(1), 93-98.
Young, K.S., Rodgers, R.C. 1998. The relationship between depression and internet
addiction. CyberPsychology & behavior. 1(1), 25-28.
http://www.netaddiction.com/
http://www.netaddictionanon.org/