Information on diagnosis and treatment of Internet addiction, plus negative consequences of addictive use of the Internet.

Kimberly S. Young
University of Pittsburgh at Bradford

Young, K.,(January 1999) Internet addiction: symptoms, evaluation and treatment. In L. VandeCreek & T. Jackson (Eds.). Innovations in Clinical Practice: A Source Book (Vol. 17; pp. 19-31). Sarasota, FL: Professional Resource Press.

SUMMARY

The Internet itself is a neutral device originally designed to facilitate research among academic and military agencies. How some people have come to use this medium, however, has created a stir among the mental health community by great discussion of Internet addiction. Addictive use of the Internet is a new phenomenon which many practitioners are unaware of and subsequently unprepared to treat. Some therapists are unfamiliar with the Internet, making its seduction difficult to understand. Other times, its impact on the individual's life is minimized. The purpose of this chapter is to enable clinicians to better detect and treat Internet addiction. The chapter will first focus on the complications of diagnosis of Internet addiction. Second, the negative consequences of such Internet abuse are explored. Third, how to properly assess and identify triggers causing the onset of pathological Internet use are discussed. Fourth, a number of recovery strategies are presented. Lastly, since Internet addiction is an emergent disorder, implications for future practice are presented.

Complications In Diagnosing Internet Addiction

Negative Consequences Of Addictive Use Of The Internet

• Familial Problems
• Academic Problems
• Occupational Problems

Assessment Of Pathological Internet Use

• Applications
• Emotions
• Cognitions
• Life Events

Treatment Strategies For Pathological Internet Use

• Practice The Opposite
• External Stoppers
• Setting Goals
• Abstinence
• Reminder Cards
• Personal Inventory
• Support Groups
• Family Therapy

Future Implications Of Pathological Internet Use

References

COMPLICATIONS IN DIAGNOSING INTERNET ADDICTION

Notions of technological addictions (Griffiths, 1996) and computer addiction (Shotton, 1991) have previously been studied in England. However, when the concept of Internet addiction was first introduced in a pioneer study by Young (1996), it sparked a controversial debate by both clinicians and academicians. Part of this controversy revolved around the contention that only physical substances ingested into the body could be termed "addictive." While many believed the term addiction should be applied only to cases involving the ingestion of a drug (e.g., Rachlin, 1990; Walker, 1989), defining addiction has moved beyond this to include a number of behaviors which do not involve an intoxicant such as compulsive gambling (Griffiths, 1990), video game playing (Keepers, 1990), overeating (Lesuire & Bloome, 1993), exercise (Morgan, 1979), love relationships (Peele & Brody, 1975), and television-viewing (Winn, 1983). Therefore, linking the term "addiction" solely to drugs creates an artificial distinction that strips the usage of the term for a similar condition when drugs are not involved (Alexander & Scheweighofer, 1988).

 

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The other controversial element related to the use of the Internet addiction is that unlike chemical dependency, the Internet offers several direct benefits as a technological advancement in our society and not a device to be criticized as "addictive" (Levy, 1996). The Internet allows a user a range of practical applications such as the ability to conduct research, to perform business transactions, to access international libraries, or to make vacation plans. Furthermore, several books have been written which outline the psychological as well as functional benefits of Internet use in our daily lives (Rheingold, 1993; Turkle, 1995). In comparison, substance dependence is not an integral aspect of our professional practice nor does it offer a direct benefit for its routine usage.

In general, the Internet is a highly promoted technological tool making detection and diagnosis of addiction difficult. Therefore, it is essential that the skilled clinician understand the characteristics which differentiate normal from pathological Internet use.

Proper diagnosis is often complicated by the fact that there is currently no accepted set of criteria for addiction much less Internet addiction listed in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV; American Psychiatric Association, 1995). Of all the diagnoses referenced in the DSM-IV, Pathological Gambling was viewed as most akin to the pathological nature of Internet use. By using Pathological Gambling as a model, Internet addiction can be defined as an impulse-control disorder which does not involve an intoxicant. Therefore, Young (1996) developed a brief eight-item questionnaire which modified criteria for pathological gambling to provide a screening instrument for addictive Internet use:

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

Patients were considered "addicted" when answering "yes" to five (or more) of the questions and when their behavior could not be better accounted for by a Manic Episode. Young (1996) stated that the cut off score of "five" was consistent with the number of criteria used for Pathological Gambling and was seen as an adequate number of criteria to differentiate normal from pathological addictive Internet use. I should note that while this scale provides a workable measure of Internet addiction, further study is needed to determine its construct validity and clinical utility. I should also note that a patient's denial of addictive use is likely to be reinforced due to the encouraged practice of utilizing the Internet for academic or employment related tasks. Therefore, even if a patient meets all eight criteria, these symptoms can easily be masked as "I need this as part of my job," "Its just a machine," or "Everyone is using it" due to the Internet's prominent role in our society.

NEGATIVE CONSEQUENCES OF ADDICTIVE USE OF THE INTERNET

The hallmark consequence of substance dependence is the medical implication involved, such as cirrhosis of the liver due to alcoholism, or increased risk of stroke due to cocaine use. However, the physical risk factors involved with an addiction to the Internet are comparatively minimal yet notable. While time is not a direct function in defining Internet addiction, generally addicted users are likely to use the Internet anywhere from forty to eighty hours per week, with single sessions that could last up to twenty hours. To accommodate such excessive use, sleep patterns are typically disrupted due to late night log-ins. The patient typically stays up past normal bedtime hours and may report staying on-line until two, three, or four in the morning with the reality of having to wake for work or school at six a.m. In extreme cases, caffeine pills are used to facilitate longer Internet sessions. Such sleep depravation causes excessive fatigue often making academic or occupational functioning impaired and may decrease one's immune system, leaving the patient vulnerable to disease. Additionally, the sedentary act of prolonged computer use may result in a lack of proper exercise and lead to an increased risk for carpal tunnel syndrome, back strain, or eyestrain. While the physical side-effects of utilizing the Internet are mild compared to chemical dependency, addictive use of the Internet will result in similar familial, academic, and occupational impairment.

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Familiar Problems

The scope of relationship problems caused by Internet addiction has been undermined by its current popularity and advanced utility. Young (1996) found that serious relationship problems were reported by fifty-three percent of Internet addicts surveyed. Marriages, dating relationships, parent-child relationships, and close friendships have been noted to be seriously disrupted by "net binges." Patients will gradually spend less time with people in their lives in exchange for solitary time in front of a computer.

Marriages appear to be the most affected as Internet use interferes with responsibilities and obligations at home, and it is typically the spouse who takes on these neglected chores and often feels like a "Cyberwidow." Addicted on-line users tend to use the Internet as an excuse to avoid needed but reluctantly performed daily chores such as doing the laundry, cutting the lawn, or going grocery shopping. Those mundane tasks are ignored as well as important activities such as caring for children. For example, one mother forgot such things as to pick up her children after school, to make them dinner, and to put them to bed because she became so absorbed in her Internet use.

Loved ones first rationalize the obsessed Internet user's behavior as "a phase" in hopes that the attraction will soon dissipate. However, when addictive behavior continues, arguments about the increased volume of time and energy spent on-line soon ensue, but such complaints are often deflected as part of the denial exhibited by the patients. Addictive use is also evidenced by angry and resentful outbursts at others who question or try to take away their time from using the Internet, often times in defense of their Internet use to a husband or wife. For example, "I don't have a problem," or "I am having fun, leave me alone," might be an addict's response when questioned about their usage.

Matrimonial lawyers have reported seeing a rise in divorce cases due to the formation of such Cyberaffairs (Quittner, 1997). Individuals may form on-line relationships which over time will eclipse time spent with real life people. The addicted spouse will isolate socially himself or herself and refuse to engage in once enjoyed events by the couple such as going out to dinner, attending community or sports outings, or travel, and preferring the company of on-line companions. The ability to carry out romantic and sexual relationships on-line further deteriorates the stability of real life couples. The patient will continue to emotionally and socially withdraw from the marriage, exerting more effort to maintain recently discovered on-line "lovers."

Internet use then interferes with real life interpersonal relationships as those who live with or who are close to the Internet addict respond in confusion, frustration, and jealousy around the computer. For example, Conrad sent this e-mail to me which explains, "My girlfriend spends from 3 to 10 hours a day on the net. Often engaged in cybersex and flirting with other men. Her activities drive me nuts! She lies about it so I have gone out on the net to 'get the goods' to confront her with it. I am finding myself spending almost as much time now. I just broke it off with her in an effort to put some sanity back into my own life. It is a sad story. By the way, we are not kids, but middle-aged adults." Similar to alcoholics who will try to hide their addiction, Internet addicts engage in the same lying about how long their Internet sessions really last or they hide bills related to fees for Internet service. These same characteristics create distrust and over time will hurt the quality of once stable relationships.

Academic Problems

The Internet has been touted as a premiere educational tool driving schools to integrate Internet services among their classroom environments. However, one survey revealed that eighty-six percent of responding teachers, librarians, and computer coordinators believe that Internet usage by children does not improve performance (Barber, 1997). Respondents argued that information on the Internet is too disorganized and unrelated to school curriculum and textbooks to help students achieve better results on standardized tests. To further question its educational value, Young (1996) found that fifty-eight percent of students reported a decline in study habits, a significant drop in grades, missed classes, or being placed on probation due to excessive Internet use.

Although the merits of the Internet make it an ideal research tool, students surf irrelevant web sites, engage in chat room gossip, converse with Internet penpals, and play interactive games at the cost of productive activity. Alfred University's Provost W. Richard Ott investigated why normally successful students with 1200 to 1300 SATs had recently been dismissed. To his surprise, his investigation found that forty-three percent of these students failed school due to extensive patterns of late night log-ons to the university computer system (Brady, 1996). Beyond tracking Internet misuse among students, college counselors began seeing client's whose primary problem was an inability to control their Internet use. A survey initiated by counselors at the University of Texas at Austin found that of the 531 valid responses, 14% met criteria for Internet addiction (Scherer, in press). This resulted in forming a campus-wide seminar called "It's 4am, and I Can't, Uh-Won't Log Off" to increase awareness about the risk factors of Internet misuse among students. Dr. Jonathan Kandell at the University of Maryland at College Park's Counseling Center went so far as to initiate an Internet addiction support group when he noticed academic impairment and poor integration in extracurricular activities due to excessive Internet use on campus (Murphey, 1996).

 

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Occupational Problems

Internet misuse among employees is a serious concern among managers. One survey from the nations top 1,000 companies revealed that fifty-five percent of executives believed that time surfing the Internet for non-business purposes is undermining their employees' effectiveness on the job (Robert Half International, 1996). New monitoring devices allow bosses to track Internet usage, and initial results confirm their worst suspicions. One firm tracked all traffic going across its Internet connection and discovered that only twenty-three percent of the usage was business-related (Machlis, 1997). There is growing availability of such monitoring software as employers not only fear poor productivity, but they need to stop the use of valuable network resources for non-business related purposes (Newborne, 1997). Managers have been forced to respond by posting policies detailing acceptable and unacceptable Internet use.

The benefits of the Internet such as assisting employees with anything from market research to business communication outweigh the negatives for any company, yet there is a definite concern that it is a distraction to many employees. Any misuse of time in the workplace creates a problem for managers, especially as corporations are providing employees with a tool that can easily be misused. For example, Evelyn is a 48 year old executive secretary who found herself compulsively using chat rooms during work hours. In an attempt to deal with her "addiction," she went to the Employee Assistance Program for help. The therapist, however, did not recognize Internet addiction as a legitimate disorder requiring treatment and dismissed her case. A few weeks later, she was abruptly terminated from employment for time card fraud when the systems operator had monitored her account only to find she spent nearly half her time at work using her Internet account for non-job related tasks. Employers uncertain how to approach Internet addiction among workers may respond to an employee who has abused the Internet with warnings, job suspensions, or termination from employment instead of making a referral to the company's Employee Assistance Program (Young, 1996).

ASSESSMENT OF PATHOLOGICAL INTERNET USE

Symptoms of Internet addiction are ones that may not always be revealed in an initial clinical interview; therefore, it is important that clinicians routinely assess for the presence of addictive Internet use. In order to properly assess for pathological Internet use, I need to first review controlled drinking models and moderation training for eating disorders which have established that certain triggers or cues associated with past alcohol, drug, or food use will onset binge behavior. Triggers or cues which may initiate binge behavior come in different forms such as certain people, places, activities, or foods (Fanning & O'Neill, 1996). For example, a favorite bar might be a trigger for excessive drinking behavior, fellow drug users with whom the patient used to party might trigger his or her drug use, or a certain type of food may lead to binge eating.

Triggers go beyond concrete situations or people, and may also include negative thoughts and feelings (Fanning & O'Neill, 1996). When feeling depressed, hopeless, and pessimistic about the future, an alcoholic may resort to drinking. When feeling lonely, unattractive, and down about oneself, an overeater may binge on whatever is in the refrigerator. Depression or low self-esteem may act as triggers which initiate binge-like behavior in order to temporarily run away, avoid, or cope with such negative thoughts and feelings.

Finally, addictive behaviors may be triggered or cued in reaction to an unpleasant situation in a person's life (Fanning & O'Neill, 1996; Peele, 1985). That is, major life events such as a person's bad marriage, dead-end job, or being unemployed may trigger binge related behavior associated with alcohol, drugs, or food. Many times, the alcoholic will find it simpler to drink in order to cope with recent news of being unemployed than to go out and search for a new job.

Addictive behaviors often act as a lubricant to cope with missing or unfulfilled needs which arise from unpleasant events or situations in one's life. That is, the behavior itself momentarily allows the person to "forget" problems. In the short term, this may be a useful way to cope with the stress of a hard situation, however, addictive behaviors used to escape or run away from unpleasant situations in the long run only end up making the problem worse. For example, an alcoholic who continues to drink instead of dealing with the problems in marriage, only makes the emotional distance wider by not communicating with one's spouse.

Addicts tend to recall the self-medicating effects of their addictions, and forget how the problem grows worse as they continue to engage in such avoidant behavior. The unpleasant situation then becomes a major trigger for continued and excessive use. For example, as the alcoholic's marriage gets worse, drinking increases to escape the nagging spouse, and as the spouse's nagging increases more, the alcoholic drinks more.

In this same manner, Internet addiction operates on triggers or cues which lead to "net binges." I believe that behaviors related to the Internet have the same ability to provide emotional relief, mental escape, and ways to avoid problems as do alcohol, drugs, food, or gambling. Therefore, origins for such net binges can be traced back to the following four types of triggers which need to be assessed, (a) applications, (b) feelings, (c) cognitions, and (d) life events.

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Applications

The Internet is a term which denotes a variety of functions accessible on-line such as the World Wide Web (WWW), chat rooms, interactive games, news groups, or database search engines. Young (1996) noted that addicts typically become addicted to a particular application which acts as a trigger for excessive Internet use. Therefore, the clinician needs to determine which applications are most problematic for the addicted user. A thorough assessment should include an examination of the extent of use among particular applications. The clinician should ask the patient several relevant questions, (a) What are the applications you use on the Internet? (b) How many hours per week do you spend using each application? (c) How would you rank order each application from best to least important? and (d) What do you like best about each application? If this is difficult to note, the patient may keep a log near the computer in order to document such behaviors for the next week's session.

The clinician should review the answers to the above questions in order to determine if a pattern emerges, such as reviewing those applications ranked one or two in terms of importance and how many hours the patient spends on each. For example, the patient may rank chat rooms as number one in terms of importance and use them 35 hours per week compared to lower ranked newsgroups which are only used 2 hours per week. Another patient may rank newsgroups as number one and use them 28 hours per week compared to the lower ranked World Wide Web which is only used 5 hours per week.

Emotions

Peele (1991, pg. 43) explained the psychological hook of addiction as "it gives you feelings and gratifying sensations that you are not able to get in other ways. It may block out sensations of pain, uncertainly, or discomfort. It may create powerfully distracting sensations that focus and absorb attention. It may enable a person to forget or feel "okay" about some insurmountable problems. It may provide an artificial, temporary feeling of security or calm, of self-worth or accomplishment, of power and control, or intimacy or belonging." It is these perceived benefits which explain why a person keeps coming back to the addictive experience.

Addictions accomplish something for the person, however illusory or momentary these benefits may actually be. Because of the mental pleasure that people find in their addictions, they begin to behave more intensely about them. Feelings of excitement, euphoria, and exhilaration typically reinforce addictive patterns of Internet use. Addicts find pleasant feelings when on-line in contrast to how they feel when off-line. The longer a patient is away from the Internet, the more intense such unpleasant feelings become. The driving force for many patients is the relief gained by engaging in the Internet. When they are forced to go without it, they feel a sense of withdrawal with racing thoughts "I must have it,' "I can't go without it," or "I need it." Because addictions serve a useful purpose to the addict, the attachment or sensation may grow to such proportions that it damages a person's life. These feelings translate into cues which cultivate a psychological longing for the euphoria associated with the Internet.

To best focus on emotional triggers, the clinician should ask the patient "How do you feel when off-line?" The clinician should then review the responses and determine if they range on a continuum of unpleasant feelings such as lonely, unsatisfied, inhibited, worried, frustrated, or troubled.

The clinician would then ask the patient "How do you feel when using the Internet?" Responses such as excited, happy, thrilled, uninhibited, attractive, supported, or desirable indicate that use of the Internet has altered the patient's mood state. If it is difficult for the patient to determine such emotions, ask the patient to keep a "feelings diary." Have the patient carry a notebook or card in order to write down feelings that are associated with being both off-line and on-line.

Cognitions

Addictive thinkers, for no logical reason, will feel apprehensive, when anticipating disaster (Twerski, 1990). While addicts are not the only people who worry and anticipate negative happenings, they tend to do this more often than other people. Young (1996) suggested that this type of catastrophic thinking may contribute to addictive Internet use in providing a psychological escape mechanism to avoid real or perceived problems. In subsequent studies, she found that maladaptive cognitions such as low self-esteem and worth, and clinical depression triggered pathological Internet use (Young, 1997a, Young 1997b). Young (1997a) hypothesized that those who suffer from deeper psychological problems may be the ones who are drawn the most to the anonymous interactive capabilities of the Internet in order to overcome these perceived inadequacies.

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Dr. Maressa Hecht-Orzack of McLean Hospital founded the Computer/Internet Addiction Service in the Spring of 1996. She indicated that the referrals she received were from various clinics throughout the hospital instead of direct self-referrals for Internet addiction. She reported that primarily depression and bi-polar disorder in its depressive swing were co-morbid features of pathological Internet use. Hecht-Orzack noted that patients typically hide or minimize their addictive Internet use while being treated for the referred disorder. Since it is likely that a patient will self-refer more readily for a psychiatric illness than for pathological Internet use, the clinician should screen for maladaptive cognitions which may contribute to the patient's addictive use of the Internet. Clinicians should evaluate if patients maintain deep core beliefs about themselves such as "I am no good" or "I am a failure" in order to determine if these may contribute to their pathological Internet use. It is important to note that intervention should focus on effective management of the patient's primary psychiatric illness and note whether this treatment ameliorates the symptoms of pathological Internet use.

Life Events

A person is vulnerable to addiction when that person feels a lack of satisfaction in one's life, an absence of intimacy or strong connections to others people, a lack of self-confidence or compelling interests, or a loss of hope (Peele, 1991, pg. 42). In a similar manner, individuals who are dissatisfied or upset by a particular area or multiple areas of their lives have an increased likelihood of developing Internet addiction because they don't understand another way of coping (Young 1997a, Young 1997b). For example, instead of making positive choices that will seek out fulfillment, alcoholics typically drink which dulls the pain, avoids the problem, and keeps them in a status quo. However, as they become sober, they realize that their difficulties have not changed. Nothing is altered by drinking, yet it appears easier to drink than to deal with the issues head on. Paralleling the alcoholics' behaviors, patients use the Internet to dull the pain, avoid the real problem, and keep things in status quo. However, once off-line, they realize that nothing has changed. Such substitution for missing needs often allows the addict to temporarily escape the problem but the substitute behaviors are not the means to solve any problems. Therefore, it is important for the clinician to assess the patient's current situation in order to determine if he or she is using the Internet as a "security blanket" to avoid an unhappy situation such as marital or job dissatisfaction, medical illness, unemployment, or academic instability.

For example, Mary is a discontented wife who views her marriage as empty, full of discord, and sexual dissatisfaction. Mary discovers Cybersex as a disease free outlet to express desires both fantasized about or neglected within her marriage. She also meets new on-line friends in a chat room, or in a virtual area which allows multiples users to speak to one another in real time. These new on-line friends are the ones to whom she turns in order to obtain the intimacy and understanding missing with her husband.

TREATMENT STRATEGIES FOR PATHOLOGICAL INTERNET USE

Use of the Internet is legitimate in business and home practice such as in electronic correspondence to venders or electronic banking. Therefore, traditional abstinence models are not practical interventions when they prescribe banned Internet use. The focus of treatment should consist of moderation and controlled use. In this relatively new field, outcome studies are not yet available. However, based upon individual practitioners who have seen Internet addicted patients and prior research findings with other addictions, several techniques to treat Internet addiction are: (a) practice the opposite time in Internet use, (b) use external stoppers, (c) set goals, (d) abstain from a particular application, (e) use reminder cards, (f) develop a personal inventory, (g) enter a support group, and (h) family therapy.

The first three interventions presented are simple time management techniques. However, more aggressive intervention is required when time management alone will not correct pathological Internet use. In these cases, the focus of treatment should be to assist the patient in developing effective coping strategies in order to change the addictive behavior through personal empowerment and proper support systems. If the patient finds positive ways of coping, then reliance upon the Internet to weather frustrations should no longer be necessary. However, keep in mind that in the early days of recovery, the patient will most likely experience a loss and miss being on-line for frequent periods of time. This is normal and should be expected. After all, for most patients who derive a great source of pleasure from the Internet, living without it being a central part of one's life can be a very difficult adjustment.

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Practice the Opposite

A reorganization of how one's time is managed is a major element in the treatment of the Internet addict. Therefore, the clinician should take a few minutes with the patient to consider current habits of using the Internet. The clinician should ask the patient, (a) What days of the week do you typically log on-line? (b) What time of day do you usually begin? (c) How long do you stay on during a typical session? and (d) Where do you usually use the computer? Once the clinician has evaluated the specific nature of the patient's Internet use, it is necessary to construct a new schedule with the client. I refer to this as practicing the opposite. The goal of this exercise is to have patients disrupt their normal routine and re-adapt new time patterns of use in an effort to break the on-line habit. For example, let's say the patient's Internet habit involves checking E-mail the first thing in the morning. Suggest that the patient take a shower or start breakfast first instead of logging on. Or, perhaps the patient only uses the Internet at night, and has an established pattern of coming home and sitting in front of the computer for the remainder of the evening. The clinician might suggest to the patient to wait until after dinner and the news before logging on. If he uses it every weeknight, have him wait until the weekend, or if she is an all-weekend user, have her shift to just weekdays. If the patient never takes breaks, tell him or her to take one each half hour. If the patient only uses the computer in the den, have him or her move it to the bedroom.

External Stoppers

Another simple technique is to use concrete things that the patient needs to do or places to go as prompters to help log off. If the patient has to leave for work at 7:30 am, have him or her log in at 6:30, leaving exactly one hour before its time to quit. The danger in this is the patient may ignore such natural alarms. If so, a real alarm clock or egg timer may help. Determine a time that the patient will end the Internet session and preset the alarm and tell the patient to keep it near the computer. When it sounds, it is time to log off.

Setting Goals

Many attempts to limit Internet usage fail because the user relies on an ambiguous plan to trim the hours without determining when those remaining on-line slots will come. In order to avoid relapse, structured sessions should be programmed for the patient by setting reasonable goals, perhaps 20 hours instead of a current 40. Then, schedule those twenty hours in specific time slots and write them onto a calendar or weekly planner. The patient should keep the Internet sessions brief but frequent. This will help avoid cravings and withdrawal. As an example of a 20-hour schedule, the patient might plan to use the Internet from 8 to 10 p.m. every weeknight, and 1 to 6 on Saturday and Sunday. Or a new 10-hour schedule might include two weeknight sessions from 8:00 - 11:00 p.m., and an 8:30 am - 12:30 p.m. treat on Saturday. Incorporating a tangible schedule of Internet usage will give the patient a sense of being in control, rather than allowing the Internet to take control.

Abstinence

Previously, I discussed how a particular application may be a trigger for Internet addiction. In the clinician's assessment, a particular application such as chat rooms, interactive games, news groups, or the World Wide Web may be the most problematic for the patient. If a specific application has been identified and moderation of it has failed, then abstinence from that application is the next appropriate intervention. The patient must stop all activity surrounding that application. This does not mean that patients can not engage in other applications which they find to be less appealing or those with a legitimate use. A patient who finds chat rooms addictive, may need to abstain from them. However, this same patient may use e-mail or surf the World Wide Web to make airline reservations or shop for a new car. Another example may be a patient who finds the World Wide Web addictive and may need to abstain from it. However, this same patient may be able to scan news groups related to topics of interest about politics, religion, or current events.

Abstinence is most applicable for the patient who also has a history of a prior addiction such as alcoholism or drug use. Patients with a premorbid history of alcohol or drug addiction often find the Internet a physically "safe" substitute addiction. Therefore, the patient becomes obsessed with Internet use as a way to avoid relapse in drinking or drug use. However, while the patient justifies the Internet is a "safe" addiction, he or she still avoids dealing with the compulsive personality or the unpleasant situation triggering the addictive behavior. In these cases, patients may feel more comfortable working towards an abstinence goal as their prior recovery involved this model. Incorporating past strategies that have been successful for these patients will enable them to effectively manage the Internet so that they can concentrate on their underlying problems.

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Reminder Cards

Often patients feel overwhelmed because, through errors in their thinking, they exaggerate their difficulties and minimize the possibility of corrective action. To help the patient stay focused on the goal of either reduced use or abstinence from a particular application, have the patient make a list of the, (a) five major problems caused by addiction to the Internet, and (b) five major benefits for cutting down Internet use or abstaining from a particular application. Some problems might be listed such as lost time with one's spouse, arguments at home, problems at work, or poor grades. Some benefits might be, spending more time with one's spouse, more time to see real life friends, no more arguments at home, improved productivity at work, or improved grades.

Next, have the patient transfer the two lists onto a 3x5 index card and have the patient keep it in a pants or coat pocket, purse, or wallet. Instruct patients to take out the index card as a reminder of what they want to avoid and what they want to do for themselves when they hit a choice point when they would be tempted to use the Internet instead of doing something more productive or healthy. Have patients take the index card out several times a week to reflect on the problems caused by their Internet overuse and the benefits obtained by controlling their use as a means to increase their motivation at moments of decision compelling on-line use. Reassure patients that it is well worth it to make their decision list as broad and all-encompassing as possible, and to be as honest as possible. This kind of clear-minded assessment of consequences is a valuable skill to learn, one that patients will need later, after they have cut down or quite the Internet, for relapse prevention.

Personal Inventory

Whether the patient is trying to cut down or abstain from a particular application, it is a good time to help the patient cultivate an alternative activity. The clinician should have the patient take a personal inventory of what he or she has cut down on, or cut out, because of the time spent on the Internet. Perhaps the patient is spending less time hiking, golfing, fishing, camping, or dating. Maybe they have stopped going to ball games or visiting the zoo, or volunteering at church. Perhaps it is an activity that the patient has always put off trying, like joining a fitness center or put off calling an old friend to arrange to have lunch. The clinician should instruct the patient to make a list of every activity or practice that has been neglected or curtailed since the on-line habit emerged. Now have the patient rank each one on the following scale: 1 - Very Important, 2 - Important, or 3 - Not Very Important. In rating this lost activity, have the patient genuinely reflect how life was before the Internet. In particular, examine the "Very Important" ranked activities. Ask the patient how these activities improved the quality of his or her life. This exercise will help the patient become more aware of the choices he or she has made regarding the Internet and rekindle lost activities once enjoyed. This will be particularly helpful for patients who feel euphoric when engaged in on-line activity by cultivating pleasant feelings about real life activities and reduce their need to find emotional fulfillment on-line.

Support Groups

Some patients may be driven towards addictive use of the Internet due to a lack of real life social support. Young (1997c) found that on-line social support greatly contributed to addictive behaviors among those who lived lonely lifestyles such as homemakers, singles, the disabled, or the retired. This study found that these individuals spent long periods of time home alone turning to interactive on-line applications such as chat rooms as a substitute for the lack of real life social support. Furthermore, patients who recently experienced situations such as a death of a loved one, a divorce, or a job loss may respond to the Internet as a mental distraction from their real life problems (Young, 1997c). Their absorption in the on-line world temporarily makes such problems fade into the background. If the life events assessment uncovers the presence of such maladaptive or unpleasant situations, treatment should focus on improving the patient's real life social support network.

The clinician should help the client find an appropriate support group that best addresses his or her situation. Support groups tailored to the patient's particular life situation will enhance the patient's ability to make friends who are in a similar situation and decrease their dependence upon on-line cohorts. If a patient leads one of the above mentioned "lonely lifestyles" then perhaps the patient may join a local interpersonal growth group, a singles group, ceramics class, a bowling league, or church group to help meet new people. If another patient is recently widowed, then a bereavement support group may be best. If another patient is recently divorced, then a divorcees support group may be best. Once these individuals have found real life relationships they will rely less upon the Internet for the comfort and understanding missing in their real lives.

I am routinely asked about the availability of Internet addiction support groups. To date, McLean Hospital in Belmont, Massachusetts and Proctor Hospital in Peoria, Illinois are two of the few treatment centers which offer Computer/Internet Addiction Recovery services. However, I suggest that clinicians attempt to find local drug and alcohol rehabilitation centers, 12 Step recovery programs, or clinicians in private practice who offer recovery support groups that will include those addicted to the Internet. This outlet will be especially useful for the Internet addict who has turned to the Internet in order to overcome feelings of inadequacy and low self-esteem. Addiction recovery groups will address the maladaptive cognitions leading to such feelings and provide an opportunity to build real life relationships that will release their social inhibitions and need for Internet companionship. Lastly, these groups may help the Internet addict to find real life support to cope with difficult transitions during recovery akin to AA sponsors.

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Family Therapy

Lastly, family therapy may be necessary among addicts whose marriages and family relationships have been disrupted and negatively influenced by Internet addiction. Intervention with the family should focus on several main areas: (a) educate the family on how addictive the Internet can be, (b) reduce blame on the addict for behaviors, (c) improve open communication about the pre-morbid problems in the family which drove the addict to seek out psychological fulfillment of emotional needs on-line, and (d) encourage the family to assist with the addict's recovery such as finding new hobbies, taking a long over-do vacation, or listening to the addict's feelings. A strong sense of family support may enable the patient to recover from Internet addiction.

FUTURE IMPLICATIONS OF PATHOLOGICAL INTERNET USE

Over the past few years, study of the psychological ramifications of the Internet has grown. At the 1997 American Psychological Association convention, two symposia presented research and theories examining the effects of on-line behavior patterns compared to only one poster presentation in the prior year. The emergence of a new psychological journal is being developed that will focus upon aspects of Internet use and addiction. It is difficult to predict the results of these early endeavors. However, it is feasible that with years of collective effort, Internet addiction may be recognized as a legitimate impulse control disorder worthy of its own classification in future revisions of the Diagnostic and Statistical Manual of Mental Disorders. Until then, there is a need for the professional community to recognize and respond to the reality of Internet addiction and the threat of its rapid expansion.

Surveys have found that about 47 million have ventured on-line and analysts estimate that another 11.7 million are planning to go on-line in the next year (Snider, 1997). With the growing popularity of the Internet, mental health practitioners should respond to the potential for an increased demand in treatment specifically designed to care for the Internet addicted patient.

Since this is a new and often laughed about addiction, individuals are reluctant to seek out treatment fearing that clinicians may not take their complaints seriously. Drug and alcohol rehabilitation centers, community mental health clinics, and clinicians in private practice should avoid minimizing the impact to patients whose complaint involves Internet addiction and offer effective recovery programs. Advertisement of such programs both on-line and within the local community may encourage those timid individuals to come forward to seek the help they need.

Among university settings and corporations, it would be prudent to recognize that students and employees, respectively, can become addicted to a tool provided directly by the institution. Thus, college counseling centers should invest energy in the development of seminars designed to increase awareness among faculty, staff, administrators, and students on the ramifications of Internet abuse on campus. Lastly, Employee Assistance Programs should educate human resource managers on the dangers of Internet misuse in the work place and offer recovery services for those found to be addicted as an alternative to suspension or termination from employment.

To pursue such effective recovery programs, continued research is essential to better understand the underlying motivations of Internet addiction. Future research should focus on how psychiatric illness such as depression or obsessive-compulsive disorder may play a role in the development of pathological Internet use. Longitudinal studies of Internet addicts may reveal how personality traits, family dynamics, or communication skills influence the way people utilize the Internet. Lastly, outcome studies are needed to determine the efficacy of various therapy modalities and compare these outcomes against traditional recovery modalities.

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next:Internet Addiction Books

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REFERENCES

Alexander, B.K., & Scheweighofer, A. R. (1988). Defining "Addiction". Canadian Psychology, 29, 151-162.

American Psychiatric Association. (1995). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.) Washington, DC: Author

Barber, A. (March 11, 1997). Net's educational value questioned, USA Today, p. 4D

Beck, A.T., Wright, F.D., Newman, C.F., & Liese, B.S. (1993). Cognitive therapy of substance abuse. New York, NY: Guilford Press.

Brady, K. (April 21, 1997). Dropout rise a net result of computers. The Buffalo News, p. A1.

Fanning, P., & O'Neill, J.T. (1996). The Addiction Workbook: A step-by-step guide to quitting alcohol and drugs. Oakland, CA: New Harbinger Publications, Inc.

Griffiths, M. (1995). Technological addictions. Clinical Psychology Forum. 76, 14 - 19.

Griffiths, M. (1990). The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31 - 42.

Keepers, G. A. (1990). Pathological preoccupation with video games. Journal of the American Academy of Child and Adolescent Psychiatry. 29(1), 49 - 50.

Lesieur, H. R., & Blume, S. B. (1993). Pathological gambling, eating disorders, and the psychoactive substance use disorders. Comorbidity of Addictive and Psychiatric Disorders. 89-102.

Levey, S. (Dec.30/Jan. 6, 1997). Breathing is also addictive, Newsweek, p. 52- 53.

Machlis, S. (April 4, 1997). Gotcha! Computer monitors riding the web wave, Computerworld, p.1.

Morgan, W. (1979). Negative addiction in runners. Physician and Sportsmedicine, 7, 56-69.

Murphey, B. (June, 1996). Computer addictions entangle students. The APA Monitor, p. 38.

Newborne, E. (April 16, 1997). Bosses worry Net access will cut productivity, USA Today, p. 4B.

Peele, S., & Brodsky, A. (1991). The truth about addiction and recovery: The life process program for outgrowing destructive habits. New York, NY: Simon & Schuster.

Peele, S., & Brodsky, A. (1979). Love and addiction. Scarborough, Ontario: New American Library of Canada.

Press Release, (October 10, 1996). Surf's up! Is productivity down? Robert Half International, p. 1.

Quittner, J. (April 14, 1997). Divorce Internet Style, Time, p. 72.

Rachlin, H. (1990). Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1, 294-297.

Rheingold, H. (1993). The virtual community: Homesteading on the electronic frontier. Reading, MA: Addison-Wesley.

Scherer, K. (In press). College life on-line: Healthy and unhealthy Internet use. The Journal of College Student Development.

Shotton, M. (1991). The costs and benefits of "computer addiction." Behaviour and Information Technology. 10(3), 219 - 230.

Snider, M. (February 11, 997). Growing on-line population making Internet 'mass media' USA Today, p. 1

Turkle, S. (1995). Life behind the screen: Identity in the age of the Internet. New York, NY: Simon & Schuster.

Twerski, A. (1990). Addictive thinking: Understanding self-deception. New York, NY: HarperCollins

Walker, M. B. (1989). Some problems with the concept of "gambling addiction": should theories of addiction be generalized to include excessive gambling? Journal of Gambling Behavior, 5, 179 - 200.

Walters, G. D. (1992). Drug-seeking behavior: Disease or lifestyle? Professional Psychology: Research and Practice, 23(2), 139-145.

Winn, M. (1977). The plug-in drug. New York, NY: Viking Penguin, Inc.

Young, K. S. (1996). Internet addiction: The emergence of a new clinical disorder. Paper presented at the 104th annual meeting of the American Psychological Association, August 11, 1996. Toronto, Canada.

Young, K. S. & Rodgers, R. (1997a). Depression and its relationship with pathological Internet use. Poster presented at the 68th annual meeting of the Eastern Psychological Association, April 11, 1997, Washington, DC.

Young, K. S. & Rodgers, R. (1997b). The relationship between depression using the BDI and pathological Internet use. Poster presented at the 105th annual meeting of the American Psychological Association August 15, 1997. Chicago, IL.

Young, K. S. (1997c). What makes on-line usage stimulating? Potential explanations for pathological Internet use. Symposia paper presented at the 105th annual meeting of the American Psychological Association, August 15, 1997. Chicago, IL.

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1.		Addiction-Proof Your Child Will your kids drink or smoke marijuana? Quite possibly. But don't panic. In a world where binge drinking, recreational and prescription drug abuse, chronic overeating and anorexia, and internet gambling and pornography are all too common among teens, it's time to rethink conventional wisdom about addiction. We clearly need something more than "just say no." This book is the alternative.
2.		7 Tools to Beat Addiction Once again, Dr. Stanton Peele confronts the sacred cows of the addiction / recovery industry with a new book that shows how to overcome addiction with or without treatment. In 7 Tools to Beat Addiction, Peele liberates readers from the disease model of addiction and presents a program for recovery based on his thoroughly grounded and sane perspective on the nature of addictions of all kinds.
3.		Resisting 12-Step Coercion: How to Fight Forced Participation in AA, NA, or 12-Step Treatment Stanton Peele, Charles Bufe, with Archie Brodsky Stanton and his colleagues respond to the overwhelming use of coercive referrals to substance abuse treatment (read "12-step treatment") in the United States with a primer on the legal, ethical, and clinical aspects of such treatment. The authors find that the empirical basis for claims that 12-step treatment is useful is weak at best. Important research has found no benefits — or even negative results — from assignment to AA and related treatments, and certainly other treatments are at least as effective. Moreover, a personal resolution to participate in a particular treatment is an important component in effective therapy.
4.		The Meaning of Addiction Stanton Peele The Meaning of Addiction presents an entire non-reductive, experiential model of addiction. It became a major nondisease text, including use at Harvard. It has become the classic expression of the extensive research that shows addiction cannot be resolved biologically — lived human experience and its interpretation are central to the incidence, course, treatment, and remission of addiction.
5.		The Truth About Addiction and Recovery Stanton Peele & Archie Brodsky, with Mary Arnold In this revolutionary analysis of addiction, Stanton Peele and Archie Brodsky draw on years of research to refute the contention that addictions are biologically based diseases that last a lifetime. Examining addiction within the context of people's lives, they show that addictive behavior is a way of coping with situational stress — and that it can be overcome without medical treatment or 12-step groups. A practical nondisease approach to addiction, based on the methods both of self-curers and of effective motivational, skills-training, and community-based therapies.
6.		Diseasing of America Stanton Peele A popular book explaining the movement in America toward disease theories of behaviors and their negative consequences for law, morality, and social and individual health. Diseasing of America was widely reviewed, largely positively, including JAMA, Health Affairs, American Health, Psychology Today, Psychiatric News, and JSA.

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Detailed information on drug addiction treatment including components of the most effective drug treatment program.

• Principles of Drug Addiction Treatment Preface
• FAQ: Defining Drug Addiction Treatment
• FAQ: Difficulty in Quitting Drug Addiction
• FAQ: Effectiveness of Drug Addiction Treatment
• FAQ: Length of Drug Addiction Treatment
• FAQ: What Helps People Stay in Drug Treatment?
• FAQ: Medications for Drug Addictions
• FAQ: Criminal Justice System's Role in Treating Drug Addiction
• FAQ: Drug Addiction Treatment and AIDS
• FAQ: 12-Step, Self-Help Programs for Drug Addiction
• FAQ: Role of Family-Friends in Drug Treatment
• FAQ: Cost-Effectiveness of Drug Treatment
• Drug Addiction Treatment in the U.S.
• General Categories of Drug Treatment Programs
• Treating Criminal Justice-Involved Drug Abusers and Addicts
• Scientifically Based Approaches to Drug Addiction Treatment
  • Alcohol, Cocaine Relapse Prevention
  • The Matrix Model
  • Supportive-Expressive Psychotherapy
  • Individualized Drug Counseling
  • Motivational Enhancement Therapy
  • Behavioral Therapy for Adolescents
  • Multidimensional Family Therapy (MDFT) for Adolescents
  • Multisystemic Therapy (MST)
  • Combined Behavioral and Nicotine Replacement Therapy for Nicotine Addiction
  • Community Reinforcement Approach (CRA) Plus Vouchers
  • Voucher-Based Reinforcement Therapy in Methadone Maintenance Treatment
  • Drug Abstinence Contingencies and Vouchers
• Drug Addiction, Substance Abuse Resources

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Self-Therapy For People Who ENJOY Learning About Themselves

There are only three possible ways to spend our time and energy. We can only work, rest, or play.

We work to produce things of value. We rest to recharge our bodies and minds. We play just for the fun of it.

Ideally, we should spend about one-third of our awake time doing each of these. But our culture is so busy that many people have forgotten how to play.

I could bore you by seriously discussing all this in great detail, but let's play instead!

Check out these examples. We'll start by looking at play we can "squeeze in" while working.

PLAYING AT WORK

On your way to and from work: Tune to the silliest radio station and imagine doing such silly things yourself later that day at work or at home.

During work hours: Turn routine activities into games like wastebasket basketball.

Alone, working on a busy project: Imagine what would happen if you did the whole project exactly wrong and showed it to your boss or coworkers that way (with a backup that was done right to protect yourself, of course). Consider actually doing it sometime!

With others, working on a busy project: Exaggerate how hard all of you are working. Say things that make fun of how seriously all of you have been taking it. ("This whole company would go broke if we bought these paper clips from the wrong vendor!")

While eating: Play with the food in your mouth. Experiment by mixing various tastes in new ways.

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While bored: Surf the Internet. Read a humorous book. Return to a favorite vacation spot mentally. (If you tell your boss your assignments are done you will be protected if you get caught doing these things!)

PLAYING WHILE WORKING ALONE AT HOME

Doing the dishes: Notice the different tones each dish makes when it hits the other dishes and silverware. Or mentally note the deepest and the highest tones that happen naturally while you finish.

Yard work: Pay attention to the patterns as you cut the grass. Experiment with circles and ovals and triangles and such. Decide which way is most enjoyable when you want to take your time.

Doing the bills: Play with different handwriting styles. If you are a man, aim at making your signature look like a woman's. Play with a handwriting style that conveys authority, or is childlike.

Fixing food: Eat whatever you want regardless of all other factors at least once a week. When you are bored with a meal, think about what you'll eat the next time you eat whatever you want.

Doing the laundry: Sacrifice an old white cloth by putting it with the colored clothes just to see if you can predict what shade it will be when the laundry is done.

Doing the dishes: Have a special box where both of you always put disposable glassware. Once a month or so, take turns smashing them right after you are done with the dishes. Call it your "Third Tuesday of the Month Smashathon." (Protect your eyes.)

Yard work: See who can come up with the most bizarre idea about how to use a corner of your property. Then ask yourselves whether you might want to actually do it.

Doing the bills: Think together about silly notes you could include in each envelope to make the person who opens it take special notice of your payment. Then do it!

Fixing food: Each person fixes the same meal at the same time, but one of you - "the experimenter" - can secretly add any flavor they want to their creation. See if you ever like the experimental dish better. Throw it away if you don't.

Doing the laundry: Have a battle with your lover, throwing the warm laundry from the dryer. Notice how great if feels on your skin! [I was stumped here. So this idea came from a reader.]

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Have playful, experimental, silly, exciting, intense sex, alone or with your partner. (This is the most important way adults play.)

Go to a new city and walk around with no intention other than to explore and experience it as it is. Say "Hi" to each person you meet just to notice their reaction.

Go to a comedy club expecting to laugh. Don't notice or comment on the jokes that fall flat. Focus on the ones that work for you.

Print a bunch of pictures of yourself and your friends. Make changes in them to see how each person would look blond, bald, with a mustache and beard, if their eyes were closer together, if they had a tiny or huge nose, etc. (Computer photo programs are needed for this one... or, if you can draw, you can make sketches instead.)

See what happens if you do your favorite hobby in a purposely lousy way. Photographers can take ugly shots. Dancers can stumble around. Golfers can swing wildly.

 

HAVE FUN YOUR OWN WAY!

Think of all the different hobbies people have. If you don't collect stamps or bowl or golf or attend operas you probably think that those who do are just wasting their time.

No matter what kind of fun we have, we can be ridiculed. Miserable grouches will ridicule every kind of fun, and even people with a great sense of humor will think our idea of fun isn't "really" fun.

That's how having fun works. It's what makes having fun so deeply satisfying. We are being ourselves FOR ourselves, not for anyone else.

Enjoy Your Changes!

Everything here is designed to help you do just that!

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next: Knowing

10. How can families and friends make a difference in the life of someone needing treatment for drug addiction?

Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is important, especially for adolescents. Involvement of a family member in an individual's addiction treatment program can strengthen and extend the benefits of the program.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Oh Mind; Patience, Control, Discipline and Duty, are members of the same family, and they are truly eager for you to be adopted as their very own. If you were to pledge a commitment to leading a life by their example, they would surely give you an honored place at their table. The fruits of this family are many and a banquet awaits you born of their prosperous lifestyle.

Oh dear one, to you I will sing...

Wait in Peace, I'm coming soon.

Wait in Love, my gifts you'll know.

Wait in Hope, and don't let go.

Wait in Peace, wait in Peace for me.

I see you trying, so very hard.

I see the Love deep within your Heart.

I know your Patience, is from your Love.

Believe I'm always with you.

Wait in Peace, I'm coming soon.

Wait in Love, my gifts you'll know.

Wait in Hope, and don't let go.

Wait in Peace, wait in Peace for me.

Do not forget me, I'm here for you.

Just ask me gently, and stand by me.

I can move mountains, and peoples Hearts.

To help you live, once again.

Wait in Peace, I'm coming soon.

Wait in Love, my gifts you'll know.

Wait in Hope, and don't let go.

Wait in Peace, wait in Peace for me.

Be kind to yourself, be gentle, be quiet. Stand firm amidst the stormy winds yet bend with them that they may not break you. See how there is more strength in the supple and the green than in the hardened and the dried. I am the Flower of Consciousness. I am the Eternal Bloom...

I am the Heart and I always speak the Truth

Mind... let me speak to you of "Pride and the sense of Separateness".

If it is Life that you seek, if it is the Truth of Life that you seek, if it is the Glory of Life that you seek, then you must become pure. You must become whole. So subtle are the things that can mask the brilliant nature of the True Self. So often the outcomes of decided actions shall be deemed trivial, paltry or inconsequential. Without a second thought, numerous actions are chosen and the desires that influence expertly conceal the thought of many outcomes in a disguise of insignificance. But know that every thought and action has a consequence. Some consequences are actively sought after, some are masterfully denied.

Oh Heart... how does one become totally free of consequences?... neither denying them or seeking them.

A mighty wave is still part of the Ocean, yet it has been given a sense of separate identity. No one ever says, "Look at the Ocean rising". Clearly the wave is just an attribute of the Ocean in action prompted by winds, currents, and tides. The Ocean is responding to the influences of its surroundings. (Nature). It is doing it's duty. It does not say, "Look at me, I have become a great wave" or "I will be the mightiest of waves".

Consider ripples also. They do not say, "See how gentle and serene a ripple am I". or "What beauty and tranquility I am able to impart". Oh Mind, it is the same for you within your surroundings. When the course of natural events brings you to do a good thing, a noble thing, or a great thing, do not lose your sense of identity as being separate from the task. Become the task. Let it come alive through you and allow yourself and the task to remain pure and untainted from any sense of Pride. Perform all your daily actions without Pride.

Do not see yourself as a "Mighty Wave" or even as "Gentle and Soothing Ripples". The wave that sees itself as Mighty must also see it's demise. But the wave that sees itself as the Ocean performing the duty of a wave will continue unperturbed to be reborn in a new form with new strength. By never losing it's sense of identity, it remains whole. It remains at one with itself. So it must be with you. Seek not the ways that cultivate separateness. Become unified. Rather than see yourself as a doer of actions, see yourself as the Ocean does... as Nature in motion responding to the elements within your life. Be hurled by fierce winds. Be Still and reflect a glittering Sun, but retain the sense of unity the way that Nature as "the Whole" does.

Remember, your life is Nature playing the role as the sum total of cause and effect, and you are part of the total, part of the cause, and part of the effect. Oh Mind, it is so important that you abandon this sense of separateness within all aspects of your life. Keep in mind that no task is lesser or greater than the other. They are all equal since they are of the Whole. As they are born of the Whole, the Whole remains complete, and when they finally dissolve, the Whole shall remain intact.

This dynamic action of life maintains evenness and balance amid constant change. During a storm, the Ocean only changes it appearance. After a storm, it is intact... nothing has changed. A storm is just a storm. It is neither good or bad. Only thinking born of duality and separateness will see it as anything different. See also how calm waters can leave a ship idle and aimless. To sailors of long ago, such conditions would fill them with fear and concern. Yet to others, the exact same condition could mean a chance for some peaceful recreation. Therefore, stillness, like a storm is neither good or bad. They are simply of one quality. They are only different manifestations of the Whole.

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Oh Mind... it is difficult to be as pure in resolve as the Ocean, so be watchful for the subtle traps of Pride that nurture separateness. The presence of Pride will always wash over, or even abandon the Truth that the Heart would impart. This is because actions motivated from Pride can bring praise and an egotistical luster to the perception of yourself in the eyes of others. To obtain such false support of yourself in this way, is yet another illusion of duality which maintains ignorance of the true strength and support that can be found within.

Oh Mind, you are an Ocean that can manifest Waves or Ripples as the circumstances direct. Remain whole.. remain pure. I am the Heart and I always speak the Truth

Oh Mind... though I talk of abandoning the sense of separateness, I can only bring you to this thinking through the ways that cultivate separateness.

The sense of "You", and The sense of "I" that I talk in, may begin to cause a conflict within you. Although you hear me talking of how we are really one, and you are the attentive listener to the ways of my Love, the illusion of apparent individuality is the Truth of Universality.

Because of language, it is said...

"We are." "They are." "You are."

"I am the Husband."... "I am the Wife." "I am the Mother." ... "I am the Child."

"I am the Worker." ... "I am the Student."

Thus, the infinite expanse of inner consciousness becomes constricted through the finite or limited means of speech. This constant use of the finite form of expression, encourages the sense of separateness and duality among the embodied beings.

Oh Heart... how is this so?

Since the substance of the Inner Truth can never be appreciated by the use of mere words, the totality of the experience within can only be conveyed partially. When someone hears of another's Truth, they will only ever come to understand a fragment of it. Separation is then born from the link of Love being incomplete. Although the infinite is always the source of Feelings, Love and Inner Truth, the tools of expression, (that is... the Mind, as well as the body being empowered by the Mind), will bring about an identification to the impermanent and finite. This is then falsely perceived as the reality of permanence and truth.

The experience of the one loses its potency through the translation into speech, and the Mind amid its misperceptions and confusion from unknowing and fears, is distracted away from the Truth of the Inner Self. Considering that the Mind is the means to perceptions and realizations, never does it come to realize that the power which moves the Mind into the expression of Love, talent or speech, is that which it has constantly been seeking for so long... hence, this ongoing search for lasting and true contentment.

This is why in easy times, the undisciplined mind will not make any progress in either worldly or Spiritual matters. Upon finding a peace that allows it to rest, the Mind shall not consider anything else to purposely bring about change. However things do change, and since change is forced upon people, there is always work to be done. The world will call out for your attention, and as long as you walk this earth, I too shall call for your attention. As such, easy times are essentially times of deserved rest, but they must never be considered permanent.

But Heart... what are you saying? Do you mean that I can never find the rest I seek?

Oh Mind, this very question is tainted with the fear and uncertainty born out of desires. Have you not been listening to any of my words to you? Forget the notion that the purpose of life is sleep. Drop your desires. Renounce that which does not belong to the moment. The opposites reside in this world, and by the laws of nature you are bound to experience them. Within these conditions, the only way to remain stable is to keep remembering that they are all of equal quality.

Desires shall then be the separating influence to destroy your discrimination. The Mind being the Active instrument of expression sees itself alone as the conscious power within the body, and from it's busy-ness and hurried ways, the Soulful Silence, (which never has the need of asserting it's majesty), is blindly overlooked. The Eye being the means to vision, can only ever have a vision of itself in a mirror. Only then can it's characteristics and nature become evident. Likewise, if the Mind is to truly know itself, it must reflect itself in infinite stillness. Such a mirror is the Living Inner Silence... the perfect Lake of Bliss... the serene tranquility of God. I am the Heart and I always speak the Truth

Mind... let me speak to you of "The Moment". The Joy of living resides in the Moment. This Moment... this blessed eternal event is all that is real. Your Truth is born of the Moment. What is the past?... What is the future?... Are you alive in either of them? Are they not just concepts?... Has not the past subsided into Mind dust?... Has not the Mind created a future out of its own anticipations? Is not the fabric of time an illusion then?

If all awareness consciousness were suddenly to extinguish itself and leave the World freely floating, what memories would then remain? What would remain to conceive that the world had a past ? What would be left to conceive that consciousness had a past? The past and future are manufactured by the Mind... an invention no less. Time is simply a measuring stick, and the past and future are the molded clay of Mind stuff.

Ask yourself, "What are memories?". when you find that answer, you will also obtain the answer to, "What is the past?" Indeed... What past? ... Whose past? The past of an Ant, or Your Own past. They are not the same, yet you and an Ant once shared a living moment separated only by physical distance. The common Truth that once bonded you has since dissolved, only to come alive again in a new moment.

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At one instant, you had a collective identity of being... that is, both of you lived in that Moment... that was the common Truth. But go back and talk to each other about that Moment and there will be no identity. His past will be different to your past. This illusive Truth then!... why does it all seem so slippery ? Where did it go you might ask. I tell you it went nowhere. Ask the Ant, he knows. Say to him, "Where does your Truth lie ?". He will not say... "In knowledge of engineering the nest". He will not say... "In the growing abundance of the Larder". He will say... "In my Duty".

He is wise, for like him, you will also find that your Duty and your Freedom reside in the Moment. There is no work or task that can be done in the past or future of the Mind, and there is no freedom to experience any newness. The past and future are not places that you can go to and be truly alive. Let ME assist you with your tasks and duties. I can Still the Mind if you choose to focus on what calls for you presence; your dedication and your Love.

There is true freedom in my abode, and I would always welcome you with Open and Loving arms. Stay with me. The Lure of that which can take you out of the Moment is furtive and very strong. Enticing as it may be, it is not the Truth. Be watchful of drifting away from me. Be diligent in your efforts in refusing to succumb to the Play of the Waking Dream.

Stay with Me in the Moment. Here!.. right Now as you take in these very words of mine.

Breath in... Stop!... hold your breath for a time and listen.....

Listen to the silence within.

You are here with me. You are truly in my company

Breath out!... Stop!...Listen!....................

Yes!.. it is me you are embracing. I am alive. I am not images or sounds. I am not that which brings on sadness. I am not that which prompts you to zealous joy. I am not that which will enrage you to fight a cause for me. These are either your own fantasies or copies of things that no longer exist. I am the eternal Truth. I am always being born. I am always new, though I am older than you and younger than you. I am Truth. I am Now. I am the Heart and I always speak the Truth

HEART!!!... what is this barrage of metaphors you throw at me. Enough!... I am dizzy with concepts. I am cluttered and complicated. Concepts... Concepts... who needs them!

Ahhh... Thy wick has ignited from the spark of my Love. Indeed, concepts... who needs them you say. Who needs the weight of complicated mental gymnastics. Who needs volumes of formulae or shelves of reference material for living. But I ask you Mind... what have you been doing for most of your life. Let us visit your library once again. Tell me... what is it that we see. I will tell you. It is rows upon rows of concepts. Some based on ignorance. Some that have served a purpose and should have been thrown out long ago. And many established from fear. Again I say to you, Clear out this library of yours and stay with me.

Do not fear the process of coming to new understandings. I ask you not to remember what I say word for word. Contemplate and digest. In time the pure essence of my words will dwell permanently within you, and you shall act naturally with the Moment. Go to your distant memories and dwell in them if you must but remember that the Truth is alive. Why choose the company of ghosts who only give the illusion of Truth. Shall you continue to choose these foolish ways upon an awakening by knowledge ?

Tell me... can you conjure up such magnificence as a living Sunset? Can you match the tranquility that touches the Soul from the living sounds of Flutes and Violins?... or of the purple haze of morning's twilight where faint stars are still to be seen. Can you swoon in delight by smelling an imaginary Rose ?

Upon the dissolution of the Moment, Truth ceases to exist. But we are Blessed beyond our wildest dreams since the Moment is continually being re-created. Possessing this eternally renewed awareness is the greatest gift that God can give, for if there is no awareness, then not even Love can be given or expressed. Remember... beyond the Mind, there is no past or future. There is only the Now. It is your Life. It is your Joy. It is your Truth.

Oh Heart, your ways are so powerful and full of Love. Now I see how you guide me. With such gentleness, you reflect my foolishness until I can no longer stand it. You intensify my wayward manners to such a degree that I end up tripping over them. To think that I could entertain a notion that regards your words as insignificant. Such is the vanity of ignorance.

I see now that the best lessons come through our own ordeals. Words will always assist, but they will never take the place of an experience that allows the Inner Bell of Truth to be struck. And the way you bring a lesson home. Oh Heart... it is nothing short of perfect. Since you Love me so very dearly and so very truly, your perfect Love stands unperturbed by the wheels you have to set in motion to bring about the necessary understanding.

Only perfect Love is mighty enough, and only perfect Love is serene enough to allot the task. But Heart... there still remains a mystery for me. All this talk of the living moment being the only reality, what about the truths and teachings of great beings and scholars of days gone by. Have their efforts suddenly become false overnight? Does the Truth decay like rotting fruit? If I come to an understanding today, will I be held in ridicule tomorrow?

Oh Mind... The Truth is always the Truth, and it is alive in the hearts of mankind. It also lives in the Sunsets, and the Waves, and the Flowers. It can live in no other place than the Moment. Do not consider the History of Mankind as becoming false overnight. Though the events of History have long since passed to take up residence in people's minds, the learning and experience gained lives on as the Truth. Such Truth has survived the ages intact because it lives in people's hearts. Like the Moment itself, the Truth is continually being renewed and refreshed... passed from Moment to Moment, Generation to Generation, Age to Age. There is no Truth outside the Moment. I am the Heart and I always speak the Truth

---

Oh Heart... could you now tell me something of Giving. So often in my life I have been a giver. A giver of my energies, a giver of my time, a giver of gifts, but all my best efforts seem to dissolve like smoke.

Dear Mind, what is it you hope to achieve when you give? If your giving has a motive of reward, then what you do receive will eventually vanish as you have said in a puff of smoke. It is not enough to give of worldly things... even though they might be given with good intentions and kindness. If one does not give out Love constantly from the Heart, then the permanence of your efforts will be the same as the permanence of your physical gifts.

The ability to constantly give out Love comes from Awareness. It is an ongoing thing from being able to consistently live in the moment. Here, the needs of the moment can always be met when Nurtured Awareness maintains an ability to recognize a need, and then bring forth a response that has a motive of pure Love. If you give a gift, do not give it so as to maintain a sense of being a "Kind Giver", but let your giving be in tune with the "Needs of the moment".

Seek no praise or rewards. Be free within yourself so that your giving is a reflection of your own state. Let your giving be as pure as your essential nature. Let yourself be unattached to the giving. Let it be as unconditional as my Love is for you. See clearly that your giving is not the compensation of a limited self, but rather an expression of Love that knows no limits. When your desire to give contains a desire to receive however subtle it may be, you must be prepared for the outcome. Just as you are open to happiness in receiving, so you must also be open to disappointment, or even sorrow should your expectations fall short of the Truth. Always keep company with me and your giving will naturally become purified.

Oh Heart, these desires of mine! Oh how they cause me endless trouble. Even the desire to obtain happiness causes me sorrow just as the desire to escape pain does. It makes no sense!... I am bound either way. Is it the destiny of Man to simply endure it all? Is there no life other than a life of opposites? Heat and Cold. Dark and Light. Sorrow and Joy. Sleeping and Waking. Company and Solitude. Nothing is permanent! Where oh where is the singular happiness that we all dream of. Is it in fact just that... a dream? What is a desireless state?

Even now I toss and turn as the power of the opposites come into play. This very phrase "Desireless" fills me with fear of being dead in a living body. Such is my comprehension that it is bound by limitations as I grapple with mysterious concepts. And yet, at the same time, I have known how easily you can expand my understandings in an instant. Is there no end to this duality?

Oh Heart, the desire to know my future circumstances causes me endless grief as I wonder and dream of how Loving my life might be one day. Forever I am lured into the dream of hope. How strange that even noble aspirations can make my very core ache. Where are the Green Valleys of Ancient Scripture to be found? Where is repose?

Oh Mind... you are not your desires.

You are freedom bound by Ignorance.

You are freedom bound by Passion.

You are freedom bound by Virtue.

Such are the three qualities of Man that bind him into action from desires. Each of varying degrees within all people. Some with a measure of symmetry, some with a dominant aspect. Some where only the attribute of Virtue might stand out. But know that all these qualities will keep Man bound to actions through the presence of his desires.

Heart !... I don't understand. The way you weave the words Virtue and Desire together confuses me. Surely the Righteous and Holy would not have desires.

Mind... be broad in your understanding of the word Desire. Do not be tempted to associate it only with failing or morality. Of course the Righteous and Holy have desires. What else drives the noble to be charitable ? Nothing other than a desire to help. Bound by Virtue, Man will do great deeds. He will help the needy. He will teach his knowledge and shed light; understandings, and peace. He will illumine others as his own Love becomes illuminated. Bound by Passion, man will pursue things with great effort and energy; always striving for flawlessness in the task of obtaining a desire. Devoted to a desire, worthy or otherwise, the enormity of the opposites is truly experienced. Far is the fall back to Earth for those who jump and catch the Moon. These are the ones that burn with yearning.

By passion, he can become greedy. By passion, he can become restless and longing. By passion, he is forever active in pursuits. He can create great accomplishments the likes of Art, Music, Literature, or he can be passionately stubborn or jealous. He can be passionately greedy with possessions and fortunes. He can burn with envy, and he can burn with the passion of sensuality. Such passion can elevate him to extraordinary heights as he obtains a desire, but when he sees his hopes collapse, his very passion will amplify his pain such that he can know the deepest anguish. He is the one who knows the extremes for he has the energy that can bring his downfall and pick him up again to continue in his ways.

---

Oh Mind, the passionate shall also be lacking in refined discrimination as their inner burning shall send them forth to obtain that desire, blind to the realities of outcomes, and heedless to any prompting of the whispered Truth. Bound by ignorance, man will pursue things without the correct understanding of their fundamental nature and hence, bear the underlying consequences of an obtained desire with regret. Such desires drive people to persist in unprincipled ways. Their life is a gamble as they run from one desire to another servicing laziness, gratification and pleasure. There is no long term point of view of life since they see life without direction or clear hope. Their plans relate to speedy acquisition of things. Risk is seen as an inherent part of life, and they are surely caught in an ever deepening whirlpool of struggle and effort. Those that live by this quality being predominate shall forever maintain an unexpanded view of life. They shall lack experience in many of life's joys and sufferings which are both valuable and vital teachings.

Oh Mind... Man must surely rid himself of his bondage of Ignorance, for he will struggle endlessly in delusion and pain. Great is the fight he must partake in to rise above the quality of Ignorance. In the quality of Passion, his very passion can at least serve him when he finally comes to want knowledge of the Truth and meaning of life. In the quality of Virtue, he is surely climbing steadfastly to the Supreme Truth of God, but understand that he can become just as stuck as any other shall be if he is continually forced into action by desires.

Mind, know that as Man is influenced by the waves of the world, the three qualities will rise and subside in various proportions. One day a man is wise, the next day his discrimination is torn asunder by anger. One day a man has fervor, the next he is despairing and discouraged. Motivated by the quality of the commanding desire, he must be prepared for the consequences as it becomes fulfilled or otherwise.

Oh Mind, you must remember that any of your previous mistakes born of desire shall all have their own natural consequences. Some might have a big impact upon you, others not so. From the fact that some of these consequences may take years to come to light, you may falsely and suddenly think that you are a victim of uncompassionate fate. Mysterious indeed are the scales that met out life's justice. Trust that God can take hold of all these circumstances and weave them with perfect compassion into the tapestry of your life. The timing shall be perfect. The way it unfolds shall be perfect.

Oh Mind, pay attention to your trials and understand that God is supremely just to all. The little child Loves the Father as best as he can... as best as he knows, but the Fathers Love is greater. Stay immersed in the Heart amid life's trials. To be any other place except the Heart in such times is futile. Forget anger, forget self pity, forget blaming. These qualities do not belong in Heaven but you do. Heaven is where the heart is and the Heart is with you now. The Heart is continually calling you.

Oh Mind, God is closer than you think. Trust the Love... trust the Love... Trust that Heaven continually has its eye upon you... watching, waiting, ready with the helping hand, ready with the lesson. Such is the reason for reaching the state beyond desires. To always simply be the Ocean performing the duty of the Wave. To live fully in the moment performing the actions of the days requirements. Oh how the characteristic of Patience excels in the one who strives for and maintains a Life in such freedom.

Oh Mind, by understanding that when you come to long for me only, you will have found the permanence you have been seeking all your life. My Love is Real, my Love is True, and my Love is Forever. I am your dreams. I am your peace. I am talents and all the best things you seek, and much much more. It is through knowledge of these three qualities that true freedom can be obtained. Ignorance must firstly be eradicated by the very awakening through knowledge of these subtle but powerful forces. The very want to know the Truth will bring the Supreme assistance in this mighty task. Passion must be subdued and held in firm control, for the energy to act can be redirected to the quality of Virtue. Since Virtue brings Wisdom and Illumination, this quality will serve Man and allow him to come closer and closer to God through the eventual attainment of the desireless state.

But Heart!... so much work is done by virtuous and noble people as they skill themselves to help the needy. Such people dedicate a greater part of their lives to good works. The world needs such people. What would happen if everyone became desireless? What work would get done? I see the world as a living tapestry of workers, and just like a desert Termite mound without industry, it seems to me that the world would also collapse.

Oh Mind, the world would never collapse if everyone became desireless. The world would be perfect if this were the case.

In the state of desirelessness that I want you to live by, there is total harmony with humanity and the divine will. There are so many who are pursuing their dreams and inspirations under the illusion that they are the instigator and doer, but the creative power behind such works has the Supreme intelligence and Supreme control behind it all. Foolish it is indeed for man to think that it is he who runs the world. This world would have collapsed aeons ago if it were not for the Love of God constantly overseeing the great vision of freedom.

Oh Mind, have you ever asked yourself... "Why does Man work?"... and "How does mankind continue to evolve century after century despite his foolishness... despite his limited vision?"

Do you think that the world today is a product of a tiny fraction of the Earths population... a mere handful of what you might call gifted people? It is only compassion and grace that has allowed Mans actions and consequences to be sorted out in such a way that the chaos of ignorance, manages to escape the inescapable. So I will ask you! "Why does Man work?" Tell me!... Do you have an answer for me?

---

Oh Heart, to learn. Man must work to learn.

You are right. The requirement of work, forces the many out of sleep and into experiences. Oh Mind, understand that all the houses and buildings of the world will in time crumble. All manufactured objects will become useless or broken. Every flower and tree that springs forth will return to the soil. Everything of the Earth will stay with the Earth, but learning and understanding are truly permanent. God will send you into action through the gift of inspired pursuits, and the role you play in life shall be perfectly tailored for the learning you must acquire.

When a person reaches the desireless state, they are content in the work that unfolds as their duty. They do not stop working. They are freed from the suffering Ego that destroys the inner welfare, and with clarity they can observe the unfolding play of life to then take in the required learning. The collapse of the world would indeed come about if the invisible hand were not present. Oh Mind, the limited vision of man has not produced the Technological marvels of the modern era, nor did it envisage Kepler's mathematical model for planetary motions. It did not define Eratosthenes circumference of the Earth by the use of a mere stick and a shadow in the glorious days of ancient Alexandria. Oh Mind, can't you see that the inspiration that reveals the Secrets of the Universe comes from the source of those secrets? And how blessed and fortunate is the one who has attained the privilege of unfolding its secrets that the humandkind may benefit.

Can you now see how the merit of one person can affect so many others when a truth is revealed and then shared. Even the ignorant and selfish ultimately benefit from one persons merit. Be a channel for great grace. One drop into a pond will send ripples of energy in every direction in that pond. How wondrous is the home you have been given called the Cosmos. There is so much for man to learn, and the purification of the individual Soul is indeed a mighty task. You will be sent forth to learn, and you will obtain learning through the work you have been allotted. Do not waste your valuable time.

Drop your attachment to suffering and learn equally of the outer world as well as the inner world. Oh Mind, you said that the Termite mound would collapse if there is no industry. You said that the world would collapse if Men did not work through being desireless. But it is wrong to link a lack of industry with desirelessness. Oh how there is such freedom in this state. The Termites are by nature without desire. As such, their natural God given skills burst forth tirelessly in the maintenance and welfare of their community. Their incredible engineering feat of the mound with its amazing natural Air conditioning system is truly magnificent. Indeed, the nest would collapse if they desired days off, but they are content with their incarnation that allows them the experience of constant commitment to duty without any pull of desires. In that incarnation, they are free.

Can you now see the insights and understandings that have freed you to allow good things to be a part of your life, are the fruits of your efforts, your work and your truth. This world is a world of work... a world of effort... a world of maintenance. Be free to perform your blessed duty by distancing yourself from the emotion which would turn a task into a drudgery. It is self destructive to be emotionally attached to your work for it is serving the attainment of your freedom.

Oh Mind... you must never think that to be desireless is to be dead. Truly, it shall enable you to be Alive. Don't ever think that I would deny the use of your talents and abilities. On the contrary. These gifts you possess are of prime importance to the expression of your Love, and the assistance they provide in obtaining understandings and growth through the experience of Life.

I can choose the most wonderful use of your talents. I know when the time is perfect to encourage and inspire you. Since your talents originate from your Ageless Love, they are therefore Holy, and as such are worthy of honoring, nurturing and protection. If you allow me to guide you, be sure that the use of your talents will always serve you in the highest way. The more you allow yourself to be unhindered by desires, the more you shall allow yourself to experience life's greatness. You shall undoubtedly experience Divine Assistance.

But Heart, how do I reach such a state ? What harsh austerities would I have to endure before such pure self command could be obtained? What would I have to relinquish?

Do not fear any loss by being desireless. By virtue of the fact that you are bound by desires is in itself a statement of loss.

Oh Mind, you must watch and understand your desires as being distinct from yourself. It is only a form of energy that bubbles up from the deepest reaches of your being seeking release. Bred and nurtured by previous experiences, it will send you into action knowing that a chance for a settling comfort may be found. Many times this aim of comfort is achieved to stay with you for a time. Many times also it is not. It is here that sadness, despair, anger, hatred and delusion could manifest.

Delusion is most wretched, since the ignorance which inspires these desires has no way out of its mindful trap... it never wants to know the Truth of a thing. It is chained by worldly attachments... chained to the struggle of the impermanence of the opposites. The three qualities are inherent to all of mankind, but the desireless person has eliminated ignorance, and controls and directs his passionate energy to living in the light of Virtue. Such a person does not become actionless through his desirelessness, but acts as one with Nature... one with the flow of life. His plans relate to his needs, and his contentment is maintained by his simplicity in daily living. Established in wisdom, he will see learning and understanding in all things. He will see his own nature reflected in many things allowing him to gain many understandings of himself and life. Steadfast he remains against the pull of desires for he is surely guided by the Spirit.

By using the Mind purely as a tool for living, the Heart is kept immersed in the silent Inner Truth, and the faith in the reality of the inner truth is where strength and freedom are derived. Seated in understanding, there is always willingness to seek knowledge, and to gain understandings in all things new and old. Such a person is truly content with Gods plans, since his own Love has unquestionably acknowledged the Supreme's Love for him.

Oh Mind, I ask you. What else can one do but have faith in the Inner Truth. If one cannot trust their silent Love, then they will never ever find trust at all. Oh Mind, rid yourself forever of the chain of consequences of actions. Seeking good deeds and bad deeds alike will always bind you to bare the fruit of such actions since the fruit of all actions can only be experienced in this world. Surrender to the Great Love... to the living Truth of your Heart. I know of your Love; I know of your willingness to help and be of service to others; but let me make the plans. Be confident that the best things shall unfold peacefully as the signature of my ways. Bear no fruits from acting through my guidance; my ways; and my Love. Save your hard earned pennies of merit in Heaven, for here on Earth, I will make you rich in the things of the Heart. Believe in me, for there is a freedom you could not possibly imagine that awaits the patient Soul. Become the desireless one and serve yourself as you serve God and Men alike. Become the Pure one. Become the Light, for your ultimate destiny is beyond the world.

Oh Heart, such Love as I sit and listen. The cup is overflowing. Such compassion you have for me. I want to say so much. Everything is valid yet nothing is valid. How do I prioritize my many questions? Is one question more worthy than another? I wonder where should I start, for I fear my many questions might be forgotten by me and therefore go unanswered as you continue to teach me.

Be patient, each and every question that lies within you will in time be answered. I will not let you forget what you need to learn. This is the duty of the Heart... to unite the individual with the Heart. There is no need for you to fear. Talk to me now in peace. Ask and you shall receive.

Oh Heart, you talk of redirecting passionate energy to the quality of virtue. How is this done ?

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next: I Am the Heart The Book Part 4

Community Reinforcement Approach (CRA) is an intensive 24-week outpatient therapy for treatment of cocaine addiction. The treatment goals are twofold:

1. To achieve cocaine abstinence long enough for patients to learn new life skills that will help sustain abstinence.
2. To reduce alcohol consumption for patients whose drinking is associated with cocaine use.

Patients attend one or two individual counseling sessions per week, where they focus on improving family relations, learning a variety of skills to minimize drug use, receiving vocational counseling, and developing new recreational activities and social networks. Those who also abuse alcohol receive clinic-monitored disulfiram (Antabuse) therapy. Patients submit urine samples two or three times each week and receive vouchers for cocaine-negative samples. The value of the vouchers increases with consecutive clean samples. Patients may exchange vouchers for retail goods that are consistent with a cocaine-free lifestyle.

This approach facilitates patients' engagement in treatment and systematically aids them in gaining substantial periods of cocaine abstinence. The approach has been tested in urban and rural areas and used successfully in outpatient detoxification of opiate-addicted adults and with inner-city methadone maintenance patients who have high rates of intravenous cocaine abuse.

References:

Higgins, S.T.; Budney, A.J.; Bickel, H.K.; Badger, G.; Foerg, F.; and Ogden, D. Outpatient behavioral treatment for cocaine dependence: one-year outcome. Experimental & Clinical Psychopharmacology 3(2): 205-212, 1995.

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Foerg, F.; Donham, R.; and Badger, G. Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry 51: 568-576, 1994.

Silverman, K.; Higgins, S.T.; Brooner, R.K.; Montoya, I.D.; Cone, E.J.; Schuster, C.R.; and Preston, K.L. Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry 53: 409-415, 1996.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

next: Voucher-Based Reinforcement Therapy in Methadone Maintenance Treatment
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Chapter 112 of the book Self-Help Stuff That Works

by Adam Khan:

PEOPLE LOVE TO BE APPRECIATED and they hate being told they're wrong. Given that, a good way to get what you want from others is to:

1. appreciate what you like
2. ignore what you don't like
3. never indicate - even in your tone of voice or body language - you think they're wrong.

Let's look at the first part: Appreciate what you like. Strongly appreciate anything the person does that's in the direction of what you want. Tell her or him why you appreciate it, how much you enjoy it, how it makes you feel, and how, specifically, it makes your life easier, happier, or whatever. Detail works better than vagueness or generalities.

It works to let people know what you want from them if you can tell them without making them feel wrong. But once they know what you want, find every opportunity you possibly can - when they do what you want - to praise it! If you want him to pick up his clothes, and he picks up one sock, praise it! Forget the stuff he didn't pick up. Keep at this and you'll see more and more of what you want and less and less of what you don't want. Be specific: What exactly do you appreciate? Why specifically do you appreciate it? Don't expect quick results. Just be consistent and enthusiastic with your appreciation and avoid any attempt to make him feel wrong, and you'll see a gradual shift over to what you want.

When you do this, at first you may feel somewhat awkward or uncomfortable. Most of us aren't accustomed to giving sincere, heartfelt appreciation face to face. Keep at it. Push through it. You'll find the awkwardness fades and you'll also finds the rewards well worth your trouble.

Now about the second and third parts (they go together): Ignore what you don't like, and avoid making people feel wrong. If you make someone feel wrong, what will he do? Answer: Try to be right! He will make an excuse for it, he will try to justify it. He'll want to make himself feel right, not change his ways. If you give someone the opportunity to feel appreciated for what he does that you like, and if you also leave the rest alone, he is very likely to change his ways. But if you make him wrong, you actually make it harder for him to change.

---

 

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The best way to get people to do what you want is to pretty much overlook what you don't want and enthusiastically appreciate what you do want. It's magic.


Downplay or overlook what you don't want and enthusiastically appreciate what you do want.

Yes, you...possess powers...which you habitually fail to use; and one of those powers you are probably not using to the fullest extent is your magic ability to praise people and inspire them with a realization of their latent abilities...Abilities wither under criticism; they blossom under encouragement.

- Dale Carnegie

 

Close friends are probably the most important contributor to your lifetime's happiness and your health.
How to Be Close to Your Friends

If you have hard feelings between you and another person, you ought to read this.
How to Melt Hard Feelings

Is it necessary to criticize people? Is there.a way to avoid the pain involved?
Take the Sting Out

Would you like to improve your ability to connect with people? Would you like to be a more complete listener? Check this out.
To Zip or Not to Zip

If you are a manager or a parent, here's how to prevent people from misunderstanding you. Here's how to make sure things get done the way you want.
Is That Clear?

Most the people in the world are strangers to you. Here's how to increase your feeling of connectedness to those strangers.
We're Family

next: Elicit Your Own Acknowledgment

Individual drug counseling coupled with other addiction therapies proves very helpful in treating cocaine and heroin users.

Individualized drug counseling focuses directly on reducing or stopping the addict's illicit drug use. It also addresses related areas of impaired functioning; such as employment status, illegal activity, family/social relations, as well as the content and structure of the patient's drug addiction recovery program. Through its emphasis on short-term behavioral goals, individualized drug counseling helps the patient develop coping strategies and tools for abstaining from drug use and then maintaining drug abstinence. The addiction counselor encourages 12-step participation and makes referrals for needed supplemental medical, psychiatric, employment, and other services. Individuals are encouraged to attend sessions one or two times per week.

In a study that compared heroin addicts receiving only methadone to those receiving methadone coupled with counseling, individuals who received only methadone showed minimal improvement in reducing opiate use. The addition of counseling produced significantly more improvement. The addition of onsite medical/psychiatric, employment, and family services further improved outcomes.

In another study with cocaine addicts, individualized drug counseling, together with group drug counseling, was quite effective in reducing cocaine use. Thus, it appears that this approach has great utility with both heroin addicts and cocaine addicts in outpatient treatment.

References:

McLellan, A.T.; Arndt, I.; Metzger, D.S.; Woody, G.E.; and O'Brien, C.P. The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association 269(15): 1953-1959, 1993.

McLellan, A.T.; Woody, G.E.; Luborsky, L.; and O'Brien, C.P. Is the counselor an 'active ingredient' in substance abuse treatment? Journal of Nervous and Mental Disease 176: 423-430, 1988.

Woody, G.E.; Luborsky, L.; McLellan, A.T.; O'Brien, C.P.; Beck, A.T.; Blaine, J.; Herman, I.; and Hole, A. Psychotherapy for opiate addicts: Does it help? Archives of General Psychiatry 40: 639-645, 1983.

Crits-Cristoph, P.; Siqueland, L.; Blaine, J.; Frank, A.; Luborsky, L.; Onken, L.S.; Muenz, L.; Thase, M.E.; Weiss, R.D.; Gastfriend, D.R.; Woody, G.; Barber, J.P.; Butler, S.F.; Daley, D.; Bishop, S.; Najavits, L.M.; Lis, J.; Mercer, D.; Griffin, M.L.; Moras, K.; and Beck, A. Psychosocial treatments for cocaine dependence: Results of the NIDA Cocaine Collaborative Study. Archives of General Psychiatry (in press).

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

next: Motivational Enhancement Therapy
~ all articles on Principles of Drug Addiction Treatment
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~ all addictions articles

Are you drinking too much? Are you worried about alcohol abuse or alcoholism? Here are the signs of problem drinking.

It's a common question. How do you know if you have a drinking problem? Drinking alcohol is a problem if it causes trouble in your relationships, at work or in school, in social activities, or in how you think and feel.

The signs of alcohol abuse

1. The need to drink before confronting certain situations
2. Frequent intoxication
3. A steady increase in the amount of alcohol consumed
4. Solitary drinking
5. Early morning drinking
6. Denial of drinking
7. Family disruptions over drinking
8. Blackouts or temporary amnesia
9. Continuing to drink despite adverse consequences from drinking

If you're still not sure if you have a problem with drinking alcohol, take this alcohol screening test. And check this out if you're interested in learning how to cut down on your drinking.

What is the difference between alcohol abuse and alcoholism?

Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control, or physical dependence. In addition, alcohol abuse is less likely than alcoholism to include tolerance (the need for increasing amounts of alcohol to get high).

Problem drinking can be successfully treated with brief intervention by primary care physicians. Alcohol addiction is a lifelong disease with a relapsing, remitting course.

Alcoholism is an addictive dependency on alcohol characterized by:

1. craving (a strong need to drink)
2. loss of control (being unable to stop drinking)
3. physical dependence and alcohol withdrawal symptoms
4. tolerance (increasing difficulty of becoming drunk)

Alcoholism is a type of drug dependence. There is both physical and psychological dependence on alcohol. Alcoholism is a primary, chronic, progressive, and sometimes fatal disease due to the habitual use of alcohol; often described as any "harmful use" of alcohol--meaning the alcoholic continues to drink despite recurrent social, personal, physical, or legal consequences as a result of their alcohol use.

Sources:

• DSM IV - American Psychiatric Association
• Substance Abuse and Mental Health Services Administration
• American Family Physician (Feb. 1, 2002 issue)

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