Use this survey as a guide to determine if video games and/or Internet use maybe a problem in your life, but do not use the survey to make a “clinical diagnosis”.

	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
1. How often do you find that you stay online longer than you intended?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
2. How often do you neglect household chores to spend more time online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
3. How often do you prefer the excitement of the Internet to intimacy with your partner?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
4. How often do you form new relationships with fellow online users?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
5. How often do others in your life complain to you about the amount of time you spend online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
6. How often do your grades or school work suffer because of the amount of time you spend online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
7. How often do you check your e-mail before something else that you need to do?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
8. How often does your job performance or productivity suffer because of the Internet?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
9. How often do you become defensive or secretive when anyone asks you what you do online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
10. How often do you block out disturbing thoughts about your life with soothing thoughts of the Internet?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
11. How often do you find yourself anticipating when you will go online again?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
12. How often do you fear that life without the Internet would be boring, empty, and joyless?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
13. How often do you snap, yell, or act annoyed if someone bothers you while you are online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
14. How often do you lose sleep due to late-night log-ins?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
15. How often do you feel preoccupied with the Internet when off-line, or fantasize about being online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
16. How often do you find yourself saying “just a few more minutes” when online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
17. How often do you try to cut down the amount of time you spend online and fail?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
18. How often do you try to hide how long you’ve been online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
19. How often do you choose to spend more time online over going out with others?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always
20. How often do you feel depressed, moody, or nervous when you are off-line, which goes away once you are back online?	Not Applicable	Rarely	Occasionally	Frequently	Often	Always

Sources

Brown, R.I.F. (1991). Gaming, gambling and other addictive play. In J.H. Kerr & M.J. Apter (Eds.), Adult place: A reversal theory approach (pp. 101-118). Amsterdam: Swets & Zeitlinger.