By Adi Jaffe, Ph.D., and Yalda T. Uhls, MA, MBA
1 in 3 people consider the Internet to be as important as air, water, food and shelter. Given how intensely people feel about this technology, is it any wonder that some psychologists are convinced that Internet addiction is a real pathology? True, claiming that people are as dependent on the Internet as they are on air, food, or water is obviously a non-starter; it's pretty clear that the actual role of technology is far less compulsory in terms of human survival.
But does this kind of dependence, compulsory or otherwise, qualify as an addiction?
While the DSM only currently recognizes specific dependence on substances as an addiction, it is apparent that a subset of people who overuse the Internet and digital media tools also display behaviors exhibited by substance abusers. In the last decade, as the problem became more widely acknowledged, a few psychological measures have been developed to identify Internet addiction. While none of these are perfect, certain measures are becoming more accepted in the field (like Young's Internet Addiction Test). Using these scales, studies have identified correlates of Internet addiction and found that ADHD, depression, social phobia and hostility were all linked to excessive Internet use, a pattern reminiscent of correlates of alcohol and drug addictions as well.
The internet is just a tool, why should people who overuse it be considered addicts?
Some of the most compelling evidence comes from Asia. In Korea, a country where technology is deeply enmeshed in the culture and Internet cafes abound, Internet addiction is considered one of the country's most serious problems. In the last decade, many people have died after marathon sessions of playing online video games, presumably from exhaustion and lack of nutrition, as they ignored their basic needs so they could continue to play a game. It's a bit reminiscent of animal studies in which rats with electrodes implanted in their dopamine "pleasure centers" forgo food for lever presses to their own demise. China has struggled with similar issues and in 2007 the country restricted game use to less than three hours a day (it's important to note that there's some loose consensus that more than 38 hours of recreational internet use a week is problematic). In Korea, where they may be ahead of the curve in terms of dealing with the issue, more than 1,000 counselors have been trained in the treatment of Internet addiction and nearly 200 hospitals enlisted in the effort. Moreover, preventive measures were recently introduced in schools and free Internet rescue camps are offered throughout the country.
In America, current estimates are that a child between the ages of 8-18 uses media (tv, books, computers, mp3 players and video games) nearly eight hours a day, while extreme users spend up to 12 hours a day with media, every day of the week. Children are spending more time with screens than with their parents or at school; are we doing enough to protect vulnerable children from developing an addiction to the Internet? No laws currently exist to protect children from excessive internet use. Doesn't society have a responsibility to protect children, in the way we attempt to protect them from drugs and alcohol? If so, what would such protection look like and how would it be enforced?
You might be asking yourself whether people are actually addicted to the Internet itself or whether the Internet is simply a tool where other more basic pathologies, such as poor impulse control or social phobias, or fetishes are played out?
In the case of certain online behaviors, it may be simple to define the behavior as problematic because similar behavior offline has long been established as socially unacceptable when performed to excess. For example, well established addictive behaviors such as gambling or sexual activity are easily played out online. Even respected public leaders such as former congressman Anthony Weiner admit they have problems that are beyond their own control and that they need professional treatment. In case you haven't heard about Weiner, he was the Congressman who resigned after being exposed for texting sexually explicit photos of himself to constituents he had never met. Sounds like something an ignorant teenager might do right? So when does this kind of behavior cross the threshold to compulsion or addiction when performed repeatedly?
Examples such as Weiners' may be relatively easy to identify as a problematic compulsion but when online behavior is sanctioned by society as in the case of sending non-sexual texts, emails, or surfing the Internet for hours on end, it is more difficult to determine exactly when the line between normal and dysfunctional is crossed. Indeed, when one considers the "crackberry" nickname given to certain smart phones, a direct comparison to addiction seems relevant. Nevertheless, those who constantly check emails at the dinner table, on vacations, and while driving, are often extremely successful executives whose business culture demands this level of connectedness. And some of the most accepted teens are those who are intrinsicly "plugged-in" to social networking sites. Indeed, some schools even promote the use of digital media as an exciting learning tool; for example, the curriculum for one elementary school in New York is designed entirely around video games.Given the potential for harmful behavior, how do we reconcile overuse of the Internet when our culture often validates and supports its use?
With all of these difficult issues still to be resolved, the answer to the question of whether or not Internet addiction is the same as substance abuse is obviously not yet, and may never be, crystal clear. However, according to everything we know right now, it seems obvious that for at least a small subset of Internet users, online life can become disruptive to normal functioning. The question is how to minimize that sort of risk as our society becomes more and more globally dependent on technology.
If you think you might have a problem with the Internet, ask yourself the following questions - if you answer yes to more than 5 of these problems, you may need to seek treatment.
1. Do you often feel preoccupied with the Internet (think about previous online activity or anticipate next online 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 your Internet use?
4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
5. Do you stay online 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 your involvement with the Internet?
8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?
As with other compulsive or addictive behavioral patterns, the key to combating internet-addiction-like symptoms is to intervene early. Since many addicts start out using their respective drug/behavior of choice as a coping mechanism, realizing early on that unhealthy patterns of behavior are developing is crucial. If a child draws his or her self-esteem from retreat into the online world, it would be extremely helpful to find additional activities that could similarly boost confidence. If compulsive use patterns do develop, it is likely going to take a concerted effort to break them without bringing up serious resistance. Techniques such as Motivational Interviewing (MI) will likely prove as useful in this domain as they have with substance abuse and addiction - gentle guidance is often more effective than cornering a troubled individual and forcing them to act.
The good news? Internet withdrawal is not likely to cause much in terms of physiological withdrawal symptoms, so if cutting off access does become necessary, at least there's no risk of going into shock, cardiac arrest, or DT-like symptoms. Still, expect that psychological withdrawal-like symptoms will be similar to those experienced with many drugs: Depression,anhedonia, anxiety, irritableness, sleep disturbances, and more are all likely to be part of the picture. If we're talking about cutting off a child, expect screaming... lot's of screaming.
For more information about technology and its effects on human development, visit Yalda T. Uhls' website: Inthedigitalage.com
Cisco Survey on Internet, 2011: http://www.cisco.com/en/US/netsol/ns1120/index.html
American Psychiatric Association. (2008). Issues for DSM-V: Internet addiction.
Byun, S., Ruffini, C. R., Mills, J. E., Douglas, A. C., Niang, M., Stephchenkova, S., Lee, S. K., et al. (2009). Internet addiction: Metasynthesis of 1996-2006 quantitative research.Cyberpsychology and Behavior, 12(2), 203-207.
Christakis, D. A. (2010). Internet addiction: A 21st century epidemic? BMC Medicine, 8.
Kaiser Family Foundation 2010, Generation M 2: Media in the lives of 8-18 year olds
Young, K.S. (1998). Internet addiction: The emergence of a new clinical disorder. CyberPsychology & Behavior 1:237-244.
© 2011 Adi Jaffe, All Rights Reserved
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