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PREVALENCE OF INTERNET ADDICTION AND
CORRELATIONS WITH FAMILY FACTORS AMONG SOUTH
KOREAN ADOLESCENTS
Park, Soo Kyung;Kim, Jae Yop;Cho, Choon Bum
Family Therapy; 2009; 36, 3; ProQuest Central
pg. 163

Int J Child Adolesc Health 2013;6(4):475-486 ISSN: 1939-
5930
© Nova Science Publishers, Inc.
Development of an integrated intervention model
for Internet addiction in Hong Kong
Daniel TL Shek, PhD, FHKPS, BBS,
,3,4,5 and Hildie Leung1
1Department of Applied Social Sciences, The Hong
Kong Polytechnic University, Hong Kong, PR China
2 Centre for Innovative Programmes for Adolescents and
Families Public Policy Research Institute, The Hong
Kong Polytechnic University, Hong Kong, PR China
3Kiang Wu Nursing College of Macau, Macau, PR
China
4Department of Social Work, East China Normal
University, Shanghai, PR China
5Division of Adolescent Medicine, Department of

Pediatrics, Kentucky Children’s Hospital, University of
Kentucky College of Medicine, Lexington, Kentucky,
United States of America
BBS, JP, Chair Professor of Applied Social Sciences,
Faculty of Health and Social Sciences, Department of
Applied Social Sciences, The Hong Kong Polytechnic
University, Room HJ407, Core H, Hunghom, Hong Kong.
E-mail: [email protected] polyu.edu.hk
Abstract
In response to the severe lack of indigenously developed
preventive and counseling services for young people
displaying Internet addiction problem, the Community
Chest of Hong Kong funded a pioneering project entitled
“Youngster Internet addiction prevention and counseling
service”. Besides provision of preventive services at the
community, school, family and individual levels,
individual-based and family-based counseling services were
developed for young people displaying Internet addiction
problem. In this paper, the major features of the counseling
model are outlined, including emphases on controlled and
healthy use of the Internet, understanding the change
process in adolescents with Internet addiction problem, use
of motivational interview methods, adoption of a family
perspective, multi-level counseling at the individual, peer
and family levels, and the use of both case and group
approaches. The process of intervention in this counseling
model is also described. Evaluation findings provide
support for this integrated intervention model.

Keywords: Internet addiction; family intervention;
individual counseling; motivational interviewing
Introduction
Despite potential educational and entertainment value
of the Internet, its attractive nature may create
addiction in young people. In fact, there are research
findings showing that problematic or pathological use
of the Internet adversely affects the physical,
psychological, social, and spiritual health of
adolescents (1,2). There are also research findings
showing that problem use of the Internet is quite
prevalent in young people in the West (3,4) and the
Asian contexts (5,6). For instance, according to a
report on youth Internet addiction disorder published
in 2009, approximately 14.3% of adolescents in China
aged between 13-17 years and 15.6% of those aged
between 18-23 years who had access to computers
Daniel TL Shek and Hildie Leung
476
suffered from Internet addiction (7). Studies
conducted in Taiwan found that 18.8% of high school
students (8) and 17.9% of senior high school students
(9) were classified as being addicted to the Internet.

With specific reference to Hong Kong, Leung
(10) concluded that 37.9% of the respondents were
identified as Internet addicts. In another study (11), it
was estimated that roughly 20% of the respondents
could be classified as Internet addicted. In a
longitudinal study of Internet addiction in students in
Hong Kong, findings showed that Internet addiction is
a common risk behavior in secondary school students.
Using Young’s 10-item Internet Addiction Test,
roughly one-fourth of Secondary 1 and Secondary 2
students could be classified as having Internet
addiction. Besides, both psychosocial and familial
factors have been associated with Internet addiction
among youths (12-14). Specifically, Shek and Lu (12)
found that the possession of positive and clear identity
and general positive youth development predicted a
lower probability of Internet addiction. Furthermore,
adolescents with divorced parents were more likely to
engage in pathological use of the Internet; perceived
parental rearing behaviors that were lacking
emotional warmth, rejecting, and punitive, were also
associated with Internet addiction in adolescents (15).
In contrast to the growing Internet addiction in
the global contexts, related work on intervention is
scattered and was conducted in unsystematic manners
(16,17). Furthermore, there is very little published
work on successful intervention models in the
Chinese contexts. Intervention models in the Chinese
contexts are important because there is evidence
showing that Chinese people displayed more
pathological gambling behavior than did non-Chinese
people (18,19). The widespread use of opium in
China before the Opium War also suggests that we
need Chinese models on addiction.

With the funding from the Community Chest of
Hong Kong, a pilot project entitled “Youngster
Internet addiction prevention and counseling service”
was launched by the Jockey Club Wah Ming Lutheran
Integrated Service Centre, Hong Kong Lutheran
Social Service, and Lutheran Church-Hong Kong
Synod (LC-HKS). The major objectives of this pilot
project were: a) to provide preventive education
programs at the community, school, family, and
individual levels; and b) to conduct a pilot project on
individual- and family-based counseling services for
young people who have displayed Internet addictive
behavior. In this paper, the basic features of the
intervention model and the process of intervention are
outlined.
Features of the intervention model
As there are few validated intervention models for
Internet addiction in the global and local contexts, the
Research Team attempted to pull together
intervention strategies and techniques together in the
fields of substance abuse, family counseling, and peer
support group. Essentially, the intervention model
adopted in this pilot project has the following
features:
1. Emphasis on controlled and healthy use of the
Internet: Instead of proposing complete
abstinence of Internet use, it is argued that
Internet use is intrinsically neutral. As such,
controlled and healthy use was regarded as the

desired outcome. This principle can also facilitate
the involvement of the adolescent client in the
counseling process.
2. Understanding the change process in
adolescents with Internet addiction behavior: In
the stages of change model (20, 21), there are
several stages in the process of change, including
pre-contemplation, contemplation, determination,
action, maintenance, and relapse. In the pre-
contemplation stage, the client may not think that
his/her Internet use behavior is problematic and
he/she does not consider changing his/her Internet
use behavior. In the contemplation stage, the
person starts to realize that his/her Internet use
behavior is problematic and considers the
possibility of changing. However, the
consideration is ambivalent in nature. In the
determination stage, the person decides to change
his/her Internet use behavior. In the action stage,
the person starts to decrease his/her online time.
The person is successful in changing if he/she can
maintain the changed Internet use behavior.
Otherwise, relapse occurs and he/she might go
through the stages of change again.
Intervention model for Internet addiction
477
This model was used in the present context to
understand the needs of adolescents with Internet
addiction problem and their family members. In the

intervention model, counseling tasks in relation to
these different stages of change were devised. The
details are described in table 1 and table 2.
Table 1. Individual-Based and Family-Based Counseling Tasks
in the First Few Stages of the Change Process
Stages of
Change
Individual-Based Counseling Family-Based Counseling
Pre-
Contemplation
and feeling with respect to different areas such
as school, peer and family contexts.
Understanding the needs and concerns of the
client.
aspects of Internet use.
wants and the current Internet use behavior.
used
by their children’s Internet addictive
behavior.

children’s needs and other problems behind
the Internet addictive behavior.
maintain the Internet addictive behavior.
and no change which is in favor of changing
current Internet use behavior.
-efficacy so as to enhance the
possibility of change.
lans for changing Internet use
behavior, not just an Internet use time table, but
also a short-term plan about study or career.
Different resources, such as the Youth Pre-
Employment Training Program might be
introduced whenever appropriate.
ging the client to join peer support groups,
interest classes, or voluntary services.
-child
communication, thus improving their mutual
understanding and relationships.
tterns
which maintain the Internet addictive
behavior.
patterns of dealing with the conflict about
Internet use, which in turn promote healthy

Internet use habits.
kills for
handling the difficulties in carrying out the
action plan.
-efficacy.
difficulties during the changing process.
Table 2. Individual-Based and Family-Based Counseling Tasks
in the Maintenance and Relapse Stages
Stages of
Change
Individual-Based Counseling Family-Based Counseling
with the risk of relapse.
developing healthy Internet use habits.
Relapse
from relapse and motivating to re-cycle through
the stages of change.

otions caused
by relapse.
and those still needing to be improved.
family environment and motivating them not
to give up.
478
3. Utilization of motivational interviewing model:
Motivational interviewing is a directive, client-
centered counseling style for eliciting behavior
change by helping clients to explore and resolve
ambivalence (22-24). It assumes that the
responsibility and capability for change are
within the client. Five basic principles are
intrinsic to motivational interviewing. These
include: a) expression of empathy via reflective
listening to convey understanding of the client’s
thinking and feeling; b) pointing out discrepancy
between the client’s current behavior and future
goals; c) avoid unnecessary arguments which
evoke resistance to change; d) resistance and
ambivalence are viewed as normal and are
explored openly; e) support self-efficacy by
building the client’s confidence that he/ she can

make a change. There are research findings
supporting the effectiveness of motivational
interviewing in the context of addiction
(reference?).
4. Adoption of the family perspective: Instead of
simply blaming adolescents for addictive
behavior, it is noteworthy that such behavior may
be a result of different ecological factors,
particularly family factors (25,26). According to
the family perspective, an adolescent with
Internet addictive behavior represents a symptom
of a dysfunction within a family rather than the
individual’s maladjustment. For example, the
child’s Internet addictive behavior might be a
symptom of the marital and parenting conflicts
amongst the parents. Furthermore, it is proposed
that change in an individual member of the family
system would cause change in other family
members as well as the whole family system. For
example, a father changing his way in dealing
with the son’s Internet addictive behavior can
improve his relation and communication with the
son, and the son might react by becoming more
willing to cooperate when the father disciplines
his Internet use behavior. Indeed studies have
found Internet-specific parenting practices, such
as the increase in quality of parent-child
communication on the use of Internet (27), and
the maintenance of appropriate parental norms
regarding Internet use (28), to be negatively
associated with pathological Internet use among
adolescents.
In short, Internet addiction often occurs in the
family context which results in serious conflicts

between the adolescents and their parents. As
there are family theories and research suggesting
that family factors are etiological as well as
therapeutic factors underlying addiction
problems, family-based counseling is considered
important in this pilot project. The systemic view,
which is the foundation of different family
therapies, was employed as the theoretical
backdrop of family-based counseling utilized in
this project.
51. Multi-level counseling model: Based on the
preceding discussion, an intervention model
incorporating the following elements was
developed:
intervention model is an integration of the
process of change model and motivation
interviewing techniques. It is proposed that
different counseling elements are intrinsic to
different stages of change (see Table 1 and
Table 2). The techniques intrinsic to the
individual-based counseling model can be
seen in Table 3.
systemic and family perspectives, it is argued
that intervention at the family level such as
enhancement of family functioning and
improvement of parenting skills are
important. The related family counseling
tasks in relation to different stages can be
seen in Table 1 and Table 2. The techniques
intrinsic to the family-based counseling
model can be seen in Table 4.

intervention at the individual and family
levels, peer relation is also important for
adolescents. In the context of addiction, peer
influence has been found to be an important
factor for substance abuse (29). At the same
time, peer support is also very important for
the maintenance of healthy Internet use habit.
As such, different supportive activities
including volunteer groups and interest
479
classes were organized in this pilot project.
The objectives of these activities included the
improvement of social skills, establishment
of supportive social network, realization of
one’s strengths and potentials, and promotion
of healthy social engagement amongst the
program participants.
Table 3. Summary of Individual-Based Counseling Techniques
Motivational Interviewing
Elicitation of Self-Motivational Statements
-motivational statements regarding adolescent clients’
talk of concerns about online behavior, desire, reasons, ability

and commitment for change were elicited.
rather than being told or imposed.
Handling Resistance
resistance of changing the Internet addictive behavior might
induce
the adolescent clients to say the opposite.
-sided reflection highlighted the ambivalence
experienced, with the emphasis that the adolescent clients had
the
responsibility to choose whether they wanted to change.
Good Things and Less Good Things
the adolescent clients, followed by the less good things about
going online.
“less good things” after the “good things”. Both sides had been
discussed thoroughly and summarized appropriately.
Decisional Balance
things” except that it focused on future behavior.
and cons of changing the Internet addictive behavior
were identified and compared with the pros and cons of not
changing the behavior.
and they could choose to live in the way they really wanted.
Values Exploration
statements.
values and their current online behavior, and perceived barriers
and opportunities of decreasing discrepancies were discussed.
whether their behavior fulfilled their short-term needs while

violated
the values they treasured in the long run.
Discussion of the Stages of Change
e were explained and the adolescent
clients were asked to determine their current stage.
they experienced different stages of change in the past and what
would cause them to move between different stages.
OARS (Open-end questions, Affirmations, Reflective listening,
and Summarization)
the acronym OARS (Open-end questions, Affirmations,
Reflective listening, and Summarization) were also applied.
Other Individual-Based Counseling Techniques
Feedback on Online Behavior
and the results were discussed.
Construction of Personal Inventory
glected after the
adolescent clients’ establishment of Internet addictive behavior
was
constructed.
negative impacts of deterring the engagement in interesting or
important activities due to the Internet addiction behavior.
Construction of Behavioral Contract
spending less time online.
olutions were
discussed.
Development of Career Plan
courses or applying jobs.
were unemployed, as they had a lot of free time to stay online if

the non-engaged situation persisted.
Note: Techniques are based on Miller (1995) and Treasure
(2004).
480
Table 4. Summary of Family-Based Counseling Techniques
Family-Based Counseling
Reframing the Symptoms of Internet Addiction
emphasized in the counseling process. The interaction
patterns regarding the adolescent clients’ Internet addictive
behavior (such as inconsistent parenting) were examined to
help the parents identify their influences.
behaviors, Internet addictive behavior could also be
reframed as their children’s attempt to fulfill their interpersonal
needs through online activities.
Dealing with Unbalanced Power
children’s superior computer knowledge might cause
their parents to feel powerless in disciplining their children’s
Internet use behavior. Support was given to the parents for
performing appropriate parenting roles.
-child service plan provided
by some Internet service providers, which enabled the
parents to control their children’s online time, could be

introduced as a way to empower the parents.
Resolution of Conflicts
Internet use behavior of the adolescent clients, such as when to
go offline and the adolescent clients staying online during meal
time, helping the parents and the adolescent clients to
resolve the conflicts was a very important task.
were introduced and discussed with the parents and the
adolescent clients.
the self, others, and the context in parent-child interaction
was important. This process attempted to find the solution
which was accepted by both the parents and the adolescent
clients.
Discussion of the Stages of Change
asked to identify which stage of change best described their
children’s current situation.
want to change” into “my child was in the pre-contemplation
stage, which was the first step of change”. It helped the parents
to understand that change was a progressive process instead
of simplifying it as a dichotomy of “change” or and “not
change”.
helped to identify appropriate actions to
motivate their children in the different stages of change.
Note: Techniques are based on Hanna and Brown (1995).
62. Utilization of case work and group work: As peer
relations are very important in adolescent
development, peer support group approach was used
as a supplement to the casework approach. With the
use of group dynamics, mutual support, and modeling

opportunities, group members can learn from each
other. With group atmosphere characterized by
empathy, sincerity, and respect, group members serve
not only to help them establish positive self-image,
but also act as role models for others. Peer support
group can also help group members establish social
support network, which would help them maintain
healthy Internet use habits.
In short, through the use of case work and group
work, the proposed intervention focused on enhancing
adolescents’ motivation to change, changing the
adolescents’ cognitions and Internet addictive
behavior, changing the dysfunctional familial
interactive patterns, and eventually helping the
adolescents to develop healthy Internet use habits.
Clients in the intervention program
A total of 59 cases participated in the project.
Generally speaking, cases that were identified as
Internet addicts by one of the assessment tools
described in the evaluation report (30,31) were
eligible for receiving the service. However, there was
one case that did not meet the above assessment
criteria. As he almost met the diagnostic criteria of
Young’s 10-item questionnaire (i.e., he responded
“Yes” to 3 of the questions) and he desperately
wanted to be helped, service was provided to him.
Regarding the gender of the program participants, 58
were males and 1 was female. Most of them were
early adolescents (aged 11- to 15 years; N=29) and

late adolescents (aged 16-18 years; N=27), with 3
program participants aged over 18 years. The
educational background of the program participants
was as follows: primary education (N=7); Secondary
1 to Secondary 3 (N=33); Secondary 4 to Secondary 5
(N=18); Secondary 6 or/and above (N=1). Different
sources of referral for the cases were identified,
481
including school social workers (N=27), parents
(N=22), teachers (N=5), non-school social workers
(N=4), and siblings (N=1).
The intervention process
Stage 1 (Initial Contact and Establishment
of Relationship)
For the cases referred by social workers and teachers,
relevant information including adolescent clients’
Internet use habits, impacts of their Internet use habits
on adolescent clients’ daily social functioning,
methods that had been used to help adolescent clients,
and the effects of those methods was collected. The
referrers were also informed that we would intake the
cases only if the adolescents met the assessment
criteria.

For most of the cases, it was the parents who
sought help (either by themselves or via school social
workers) for their children’s Internet addiction
problem. They usually felt helpless and wanted to
depend on the worker. In the initial contact, their
involvements in the counseling process were
emphasized and the stages of change were also
explained to them, such that they would be aware that
change was a process that needed time to take place.
In addition, the parents were asked about how they
dealt with the problem and how the parents and their
children reacted to each other’s reactions.
In the initial contacts with the adolescents,
information in different areas, including which online
games the adolescent clients played, time spent on the
Internet, adolescent clients’ interests and hobbies, and
initial impression about the referral was collected.
Other relevant information was also collected so as to
determine where (e.g., school or home), when (e.g.,
weekday after school or Sunday afternoon), and how
(e.g., individual interview, joint interview together
with parents or phone contact) to render the service to
them in the later stage of the counseling process. As
the adolescent clients were often at the stage of pre-
contemplation or contemplation, they were not really
motivated to see the worker. As such, acceptance and
empathy were crucial. It was important to make
connections with the adolescent clients by showing
the interest in “understanding” their thinking and
feelings rather than “solving” the Internet addiction
problem.

Stage 2 (Intervention involving individual-
based counseling, family-based counseling
and peer support group)
After establishing working relationships with the
adolescent client, the evaluation questionnaire
containing the Internet addiction assessment tools was
administered. Except the one case mentioned above, if
the adolescent client met the criteria in one of the
assessment tools, he/she would receive both
individual-based counseling and family-based
counseling and he/she would be invited to join the
peer support group. The major goal of the intervention
would be to help the adolescent client to develop
healthy Internet use habit (i.e., a decrease in Internet
addiction symptoms).
Individual-based counselling
The adolescent clients were often at the stage of pre-
contemplation or contemplation and they were
unmotivated to see the worker. Based on the
implementation experiences, three categories of
adolescent clients with Internet addiction problems
were identified.
did not have specific goals and they felt their
lives were boring. They spent a lot of time
online as they could not find other interesting
things for them to kill time. It was very

difficult to motivate them to change their
Internet use habits as they did not see that
there would be any serious negative
consequences. It was very difficult to
motivate them to move from the pre-
contemplation stage to contemplation and
determination stages by finding out their
needs and desire so as to narrow the
discrepancy between what they wanted and
what they had to do. It was a good way to
strengthen relationships with them through
activities and helped them to establish
482
meaningful connections with peers. At the
same time, it was crucial to facilitate the
adolescent clients and their parents to
improve the communication and mutual
understanding so that they could handle the
conflicts due to the adolescent clients’
Internet addictive behavior in a better way.
y included adolescent
clients with emotional problems who used
Internet as a way to escape from the
depressive mood. As long as they could
better handle their emotions, they would less
depend on the Internet and were motivated to
change. They could also develop their own
action plans and reduced the time on the

Internet. Thus, it was also essential for the
parents to understand that their children
concealed the emotional problems under the
Internet addictive behavior. This did not only
remove the stress which might intensify the
children’s emotional problems and drove
them to increase the Internet use for
escaping, but also provided a …

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