Internet Guidelines for parents of adolescent and young adults in recovery from substance use.

The Nature of the Web-Connected World Warning Signs of Problematic Internet Use Specific Online Risks: Gaming, Pornography, Gambling Promoting Healthy Internet Use Identifying Appropriate Treatment How Treatment Centers Provide Help Resources

THE NATURE OF THE WEB-CONNECTED WORLD

More than nine out of 10 of those ages 12-17 are online (September 2012 survey). Nearly eight in 10 have a cell phone and almost half (47%) of those own a smartphone. More than eight of 10 online teens use social media.1

• Nineteen percent have posted updates, comments, photos, or videos that they later regretted sharing.2
• Greater TV and computer use among children is related to increased psychological difficulties.3
• Twenty-two percent of teenage girls and eighteen percent of boys have “taken nude or semi-nude photos of themselves and sent them to someone or posted them online.”4
• Many youth consider sexting a “serious problem for people their age” but still feel pressured to do so. “One in three 14-24 year-olds have engaged in some form of sexting.” 5
• One in six online teens say they have been contacted online by someone they did not know in a way that made them feel scared or uncomfortable. “Unwanted contact from strangers is relatively uncommon, but 17% of online teens report some kind of contact that made them feel scared or uncomfortable. Online girls are more than twice as likely as boys to report contact from someone they did not know that made them feel scared or uncomfortable (24% vs. 10%).”6

Are there any special considerations for adolescents with substance use issues?

• Substance abuse problems can be exacerbated or addressed by content online.
• Some online communities model and reinforce self-destructive behaviors. Others model healthy ones.
• Some types of internet use may serve as a trigger for relapse.

The online world includes both hazards and forms of help for families and adolescents with substance abuse issues.

WARNING SIGNS OF PROBLEMATIC INTERNET USE

• Changes in health
  • Weight gain/loss
  • Headaches and back aches
  • Vision/eye strain
  • Change in sleeping patterns
  • Decline in personal hygiene
• Unexplained changes in social behavior (e.g., relationship with parent or guardian changes)
  • Difficulty engaging with friends and family
  • Contact with “friends” online replaces in-person connections
  • Lack of interest in social and daily life activities
  • Unable to talk about things other than the internet
• Falling behind at school
• Change in spending habits
• Secretive internet use (e.g., using the internet behind closed doors)
• Negative emotional reaction after being online
• Overreacting to being told about online monitoring
• Withdrawal symptoms (e.g., feel moody, depressed, or anxious) when device is inaccessible

Online gaming, gambling, and pornography may present special risks for adolescents with substance abuse issues.

ONLINE GAMING

What is internet gaming disorder?

Nine criteria are tied to internet gaming disorder by the DSM-57:

1. Pre-occupation with Internet games.
2. Withdrawal symptoms when Internet gaming is taken away.
3. Tolerance – the need to spend increasing amounts of time in Internet games.
4. Unsuccessful attempts to control the participation in Internet games.
5. Loss of interest in previous hobbies and entertainment.
6. Continued excessive use of Internet games despite knowledge of psychosocial problems.
7. Has deceived family members, therapists, or others regarding the amount of Internet gaming.
8. Use of internet games to escape or relieve a negative mood.
9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in Internet games.

How common is the problem?

• According to a recent study, the prevalence of pathological gaming is between 7%-10%.8
• A 2014 study linked gaming for more than three hours a day among 10- to 15-year-olds to lower levels of life satisfaction and pro-social behavior.9
• Youth who are more impulsive, have lower social competence and empathy, and have poorer emotional regulation skills are more likely to become pathological gamers.10

What should I do if my child has a problem?

• Monitor apps and games, especially mobile games. Don’t let gaming become a lifestyle.
• Review ratings of games. No M-rated games for adolescents. Common Sense Media and ikeepsafe provide detailed ratings for videogames.
• If internet gaming is interfering with teen’s school or social life, parents may want to seek professional help.

ONLINE PORNOGRAPHY

What is pornography?

• Material is considered pornographic if it contains sexually explicit material depicting naked or semi-naked bodies engaged in genital stimulation or sexual acts.11

Does internet pornography present unique risks?

• Internet pornography differs from other forms of pornography in that it is easily accessible, anonymous, and often free.12 Easy access makes habitual use easier.

How common is the problem?

• One online study found that: “Ninety-three percent of boys and 62% of girls were exposed to online pornography during adolescence.”13

Why is exposure to pornography a problem?

• Exposure to pornography is associated with negative development (e.g., experiencing difficulty with one’s intimate relationships)14 and attitudes consistent with violence toward women.15
• Exposure to pornography can affect individuals differently depending on a complex set of factors. In some circumstances consumption of pornographic material may lead to increased aggressive behavior.16

Sexting as pornography

• Adolescents may experience peer pressure to participate in sexting ….“[S]ame-sex popularity, other-sex popularity, perceived peer pressure and need for popularity, are associated with sexting and mobile porn use among teenagers ages 11-20.”17
• Mention of legal regulations may be reacted to as a “forbidden fruit” or otherwise paradoxically among teens. Thus, instruction in the law often does not work as a prevention strategy for teens. However, it is important that parents know that “In many US states, those sending or receiving nude pictures of individuals under 18 risk charges as serious as possession or distribution of child pornography, carrying penalties that include being listed on a sex offender register. In addition, for those featured in the photos, there may be serious psychological consequences.”18

What should I do if my child has a problem?

• If an adolescent has a large amount of pornography, his or her parent may want to seek professional help.
• Be mindful of the source of pornography. If a teen has received pornography from another person, he or she may be at risk for abuse.
• Use the discovery of pornography as an opportunity to discuss sexual health, intimacy, and sexual imagery with your child.
• Understand the law in your state.
• Talk with adolescents about the risks of sexting. Remind them that there is no guarantee that a picture or post shared with someone else will remain private.

ONLINE GAMBLING

What are the signs of problematic gambling?

According to DSM-5, a person suffering from pathological gambling will have at least four of the following characteristics19:

1. Needs to gamble with increasing amounts of money.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling.
5. Often gambles when feeling distressed.
6. After losing money gambling, often returns another day to get even.
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, educational, or career opportunity because of gambling.
9. Relies on others to provide money to relieve financial problems.

How common is the problem?

Between 9.9 and 14.2 % of adolescents are at risk for having or returning to a serious gambling problem. “Between 4.4% and 7.4% of adolescents exhibit seriously adverse compulsive or pathological patterns of gambling activity.”20

What should I do if my child has a problem?

• Parents who discover that an offspring is engaged in online gambling activities should consider the discovery an opportunity to learn more. Ask if they are playing for money, using a credit card, and if so, whose credit card?
• If they are gambling on a practice or demo site, note that ‘practice’ may encourage higher bets and greater losses when gamblers transition into real venues using money.
• If you suspect your child may have an online gambling problem you can seek help through the National Council on Problem Gambling (www.ncpgambling. org) or by calling 1-800-GAMBLER (426-2537). For additional information, see “Sources of Help” on page 11.

Parental involvement in children’s media use has immediate and long-term effects on a wide range of children’s physical, social, and academic health outcomes including more sleep, increased school performance, lower exposure to media violence, and decreased aggressive behavior.

PROMOTING HEALTHY INTERNET USE

What is the parental role in promoting healthy internet use?

• Understand the range of technology that adolescents are exposed to inside and outside of the home.
• Learn what is appropriate technology use by age and stage of child development.
• Co-view, co-play, and actively discuss digital media.
• Start a conversation about media and technology use at home and explain why your family disapproves of certain online behaviors. Common Sense Media has family media agreements that are customizable to your family needs.
• Set clear technology use rules that are specific to your child. Create limits on the amount of use (i.e., limit technology use by time of day or weekends) and content (i.e., limit access to specific sites).
• Encourage adolescents and young adults to think critically about digital media and develop their own self-monitoring skills.
• Enforce technology rules.

Communication Is Crucial

• Create open, non-judgmental, lines of communication. Children should feel comfortable coming to parents with problems they experience offline and online.
• Remind children that what they do online affects their reputation and their future.
• Talk about the need to protect privacy online.
• Pruning and revising profile content should be an important part of teens’ online internet use.Adolescents should know how to:
  • Delete something that they posted in the past and deactivate a profile.
  • Remove comments from others on their profile or account.
  • Delete their name from photos tagged to identify them.

19% have posted updates, comments, photos, or videos that they later regretted sharing.

THE 3 Ms OF PARENTAL INVOLVEMENT:

Monitoring, Modeling, and Mentoring

Modeling:

Parents should demonstrate appropriate use of technology:

• No technology while driving
• No technology at the dinner table
• No technology while interacting with children, family members, or in social settings
• Use technology to find useful information and to engage in fun/productive sharing with family and friends.
• Use technology to seek help.
  • Find online support groups.
  • Find expert advice and parental help guides.
  • Find licensed treatment centers.
  • Identify prosocial websites and video games. For example, SIM games or iCivics.
  • Identify online communities that reinforce coping skills.

Monitoring:

Parents should know what their children are doing online. Here are some tips on how to monitor your child’s online activity:

• For adolescents, all technology should be observable when feasible.
• Consider placing filtering and monitoring software on all forms of technology. Decide whether you will inform your child that s/he is being monitored.
• Lights out, technology off. Consider gathering phones in a central place at night.

Mentoring:

Parents should be engaged in their children’s world.

• Build interests that are not digital.
• Create robust offline environment for children that includes plenty of exercise, parent/child activities, family time/meditation, etc.
• Help children structure their daily routines (i.e., school, family meals, sports, clubs, church, etc.)

CRITERIA FOR IDENTIFYING APPROPRIATE TREATMENT

• State-licensed, board-certified clinicians
• Licensed to treat adolescents and young adults
• Licensed to treat mental health and substance use problems
• Provides evidence based treatments
• Includes family in treatment implementation
• Aftercare and case management available

HOW TREATMENT CENTERS PROVIDE HELP

• Evaluate whether internet use pattern represents a normal, at risk, or pathologic behavior
• Develop plan for family to support recovery
• Help family understand and implement an appropriate role in the treatment process
• Understand what needs are being met by problematic internet use and identify other ways of meeting those needs (e.g., social needs, competence needs)
• Work with the family to improve communication

SOURCES OF HELP

Locating licensed treatment centers

Substance Abuse and Mental Health Services Administration

Phone: 1-800-662-HELP (4357)

The mission of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services is to reduce the impact of substance abuse and mental health illness on America’s communities. SAMHSA offers a Behavioral Health Treatment Services locator on its website for persons seeking treatment facilities in the U.S. or U.S. Territories for substance abuse/addiction and/or mental health problems and operates a confidential, free, 24-hour-a-day, 365-day-a-year, helpline, in English and Spanish, for individuals and family members facing substance use and/or mental health disorders.

Network of Care for Mental Health and Behavioral Health:

Phone number: 1-800-LIFE-NET

The Network of Care for Mental Health and Behavioral Health provides an online information portal for individuals, families and social service agencies seeking access to mental health services and substance use treatment programs. The organization also maintains a help line. 1-800-LIFE-NET is a free, confidential, multi-lingual, mental health and substance abuse information, referral, and crisis prevention hotline available to anyone at any time.

The National Council on Problem Gambling

Phone: 1-800-522-4700 or 1-800-GAMBLER (1-800-426-2537)

The National Council on Problem Gambling (NCPG) is the national advocate for programs and services to assist problem gamblers and their families. The NCPG website includes a list of resources on problem gambling issues, links to other problem gambling related websites, an online directory of International Certified Gambling Counselors, and a locator for inpatient and residential treatment. The NCPG also operates a helpline that serves as a single national access point to local resources for those seeking help with a gambling problem.

New York State Office of Alcoholism and Substance Abuse Services

Phone: 1-877-846-7369

The New York State Office of Alcohol and Substance Abuse Services (OASAS) oversees one of the nation’s largest addiction services systems with more than 1,600 prevention, treatment and recovery programs. The OASAS plans, develops and regulates the state’s system of chemical dependence and gambling treatment agencies and operates a helpline that provides free referrals to treatment facilities in the area.

reSTART, Center for Digital Technology Sustainability Website: http://www.netaddictionrecovery.com Phone: 1-800-682-6934

The reStart Internet Addiction Recovery Program is designed to help launch tech dependent youth and adults back into real life interactions. reStart works with individuals, couples and families to promote a better understanding of problematic digital technology use; assist users in discovering the underlying issues that may be co-occuring with excessive use patterns; and work together to design an individualized plan to promote a healthy, balanced lifestyle.

The Center for Internet Addiction and Recovery

The Center for Internet Addiction and recovery was founded by Dr. Kimberly Young in 1995. It provides treatment for internet gambling, online gaming, sexting, and internet pornography using Dr. Kimberly Young’s specialized cognitive behavior therapy for Internet addiction.

The Center for Internet Addiction and Recovery offers assessment, evaluations, private counseling, outpatient therapy, and inpatient treatment. In particular, the Center for Internet Addiction & Recovery has developed a specialized Parent Coaching program for parents who suspect that a son or daughter may be addicted to technology. The site also provides free educational resources and articles on evaluation and treatment of technology addictions for adults and children.

Technology Guidelines for Parents

3-6-9-12 Parenting Guidelines: Rules for Every Age

Created by Dr. Kimberly S. Young, founder of the Center for Internet Addiction & Recovery, the 3-6-9-12 Parenting Guidelines: Rules for Every Age is a guide for parents that outlines safe ways of integrating technology to a child at home at each developmental stage. Young children have far more access to media technology now than they did even two years ago. Parents need to be proactive in controlling how much screen time kids have on devices today. Children now rely on technology for the majority of their play, grossly limiting challenges to their creativity and imaginations, as well as necessary challenges to their bodies to achieve optimal sensory and motor development. The 3-6-9-12 Parenting Guidelines outlines steps parents can take at each age from birth to the teenage years so children can use technology responsibly.

The Center on Media and Child Health:

The Center on Media and Child Health at Children’s Hospital Boston, Harvard Medical School, and Harvard School of Public Health is dedicated to understanding and responding to the effects of media on the physical, mental, and social health of children through research, translation, and education. The Center on Media and Child Health’s website includes a special page with advice for parents about how to use media to promote the physical and mental health of children and adolescents.

Common Sense Media

Common Sense Media is a non-partisan, not-for profit organization dedicated to improving the lives of kids and families by providing trustworthy information and education on digital media and technology, including independent ratings and reviews of digital media based on age-appropriateness and learning potential.

Common Sense Media’s website, especially its Educate Families resources, provides parents with guidance on how to navigate and discuss the impact of digital media on kids’ social, emotional, and intellectual development.

CyberWise provides state-of-the-art resources on how to use digital media confidently and safely. Their website includes free videos, ebooks, and news about keeping kids safe online, as well as The Digital Citizenship Learning Center, which prepares young people and adults to use digital media safely, confidently, and wisely.

The Internet Keep Safe Coalition (iKeepSafe.org) is a non-profit international alliance of more than 100 policy leaders, educators, law enforcement members, technology experts, public health experts and advocates that has created a collection of products and tools to teach parents and educators how to safely use technology and how to pass this information down to their children.

National Cyber Security Alliance 

The National Cyber Security Alliance (NCSA) is a nonprofit organization working with government, industry, nonprofits and academic sectors to help computer users keep themselves, their organizations, their systems, and their sensitive information secure online and to encourage a culture of cybersecurity. Their website includes tips for parents on how to teach kids to become good digital citizens.

ZoneIn Program

Zone’In is a company that offers educational programs that help children improve attention, develop literacy skills and achieve technology balance. Zone’In offers several free resources for parents, as well as products for purchase.

Filtering, tracking, and blocking software

NO COST

Top Ten Review

Top Ten Review is an online publishing company that provides free reviews of software, electronics, and web services. Their website includes a page devoted to keeping your home and family safe.

AVAILABLE FOR PURCHASE

eBlaster

Is a monitoring program offered by SpectorSoft that records everything that a child does online, reports online activity to parents, alerts parents of potential danger when any word or phrase on their “watch list” is used, and blocks specific websites or people parents are concerned about.

Facebook Nanny

NetNanny is a parental control software program that provides parents with the power to protect children by filtering out harmful content. NetNanny features include blocking pornography, predators, and other harmful content, setting time limits on internet use, sending alerts and reports to parent’s email, and creating user profiles to tailor protection to individual family needs.

ParentsWare 

ParentsWare builds parental monitoring and guidance applications for families. The mobile solutions developed by ParentsWare provide parents the crucial tools to gain influence over their children’s time online — from social sites to everyday searches.

WebCurfew 

WebCurfew is a 100% cloud-based internet monitoring service that allows parents to see every device in their home, filter content, and set specific times of the week that they don’t want their children to view the internet, and sends reports that allow parents to track internet use by date, website, and frequency.

Proactive Parenting Network 

The Proactive Parenting Network (PPN) provides online safety tools, monitoring services, and educational resources from leading knowledge providers that empower relationships between parents and their children in an ever-changing digital world.

Glossary:

A basic glossary of mental health-related terms can be found at: Cope Care Deal

Notes:

1. Madden, Mary, Lenhart, Amanda, Duggan, Maeve, Cortesi, Sandra, & Gasser, Urs. (2013a). Teens and technology 2013. Retrieved from http://www.pewinternet. org/2013/03/13/main-findings-5/
2. Madden, Mary, Lenhart, Amanda, Cortesi, Sandra, Gasser, Urs, Duggan, Maeve, Smith, Aaron, and Beaton, Meredith. (2013b). Teens, social media, and privacy. 
3. Page, Angie S., Cooper, Ashley R., Griew, Pippa, & Jago, Russell. (2010). Children’s screen viewing is related to psychological difficulties irrespective of physical activity. Pediatrics, 126(5), e1011-e1017. doi: 10.1542/peds.2010-1154
4. The National Campaign to Prevent Teen and Unplanned Pregnancy. (2008). Sex and tech: Results from a survey of teens and young adults. Washington, DC: Author.
5. Madden, et. al., 2013b
6. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. Arlington, VA, American Psychiatric Association, 2013.
7. Gentile, Douglas A., Choo, Hyekung, Liau, Albert, Sim, Timothy, Li, Dongdong, Fung, Daniel, & Khoo, Angeline. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127(2), e319-e329. doi: 10.1542/peds.2010-1353
8. Przybylski, Andrew K. (2014). Electronic gaming and psychosocial adjustment. Pediatrics. Advance online publication. doi: 10.1542.
9. Gentile, 324.
10. Kor, Ariel, Zilcha-Mano, Sigal, Fogel, Yehuda A., Mikulincer, Mario, Reid, Rory C., Potenza, & Marc N. (2014). Psychometric development of the Problematic Pornography Use Scale. Addictive Behaviors, 39(5), 861-868. doi: 10.1016/j. addbeh.2014.01.027

12. Kor, et. al., 862.

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2. Oddone Paolucci, Elizabeth, Genius, Mark, & Violato, Claudio. (2000). A meta-analysis of the published research on the effects of pornography. National Foundation for Family Research and Education. 
3. Hald, Gert Martin, Malamuth, Neil M., & Yuen, Carlin. (2009). Pornography and attitudes supporting violence against women: revisiting the relationship in nonexperimental studies. Aggressive Behavior, 36(1), 14-20. doi: 10.1002/ab.20328
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