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Internet addiction: evaluation and treatment |
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Internet addiction: evaluation and treatment Practitioners need to be aware of new type of addiction The internet is a neutral device originally designed to facilitate research among academic and military agencies. The way some people have come to use this medium, however, has created a stir among the mental health community, and internet addiction has become a serious topic of discussion. Addictive use of the internet is a new phenomenon that many practitioners are unaware of and consequently unprepared to treat. Some therapists are unfamiliar with the internet, making its seductive powers difficult to understand. Sometimes its impact on the afflicted person's life is minimised as many practitioners do not recognise the legitimacy of the disorder. This editorial reviews the diagnostic criteria, associated features, subtypes, consequences, and treatment implications of internet addiction, to help prepare clinicians on these issues in practice. The best method clinically to detect compulsive use of the internet is
to compare it with criteria for other established addictions. Of all
the diagnoses referenced in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) pathological gambling was
viewed as most akin to this phenomenon.¹ Prior research
defined internet addiction as an impulse control disorder that does not
entail an intoxicant.2 - 5 By using pathological gambling as
a model, this research developed a qu
Patients are considered "addicted" when answering "yes" to five (or more) of the questions and when their behaviour cannot be better accounted for by a manic episode. The cut off score of "five" is consistent with the number of criteria used for pathological gambling and seen as an adequate number of criteria to differentiate normal from pathological internet use.4 It should be noted that although this scale provides a workable measure of internet addiction, further study is needed to determine its construct validity and clinical utility. Additionally, associated features of this disorder include sleep deprivation, moderate physical complaints such as back strain, eyestrain, and carpal tunnel syndrome, and frequent time distortion. Internet addiction is a broad term covering a wide variety of behaviours and impulse control problems. It is further categorised in five specific subtypes. Cybersexual addiction: compulsive use of adult websites for cybersex and cyberporn. Cyber-relationship addiction: overinvolvement in online relationships. Net compulsions: obsessive online gambling, shopping, or day trading. Information overload: compulsive web surfing or database searches. Computer addiction: obsessive computer game playing (for example, Doom, Myst, or Solitaire). Most people agree that the internet is a productive tool, but research findings document serious negative consequences when it is used in an addictive manner.5 - 8 The anonymity of electronic transactions has been identified as a consistent factor underlying internet addiction, often providing a virtual context that cultivates a subjective escape from emotional difficulties (such as stress, depression, or anxiety) or problematic situations or personal hardships (for example, job burnout, academic troubles, sudden unemployment, or marital discord). The escape mechanism provided serves to relieve moments of mental tension and stress and reinforces future behaviour. Recent cases have also shown that anonymity serves to encourage deviant, deceptive, and even criminal online acts such as the development of aggressive online personas or the viewing and downloading of illegal images (for example, child pornography).9 Treatment includes various inventions with a primary focus on techniques from cognitive behavioural and interpersonal psychotherapy to regulate and moderate internet use and to address underlying psychosocial issues often coexistent with this addiction (for example, social phobia, mood disorders, marital dissatisfaction, job burnout, childhood sexual abuse). Finally, it should be emphasised that systematic intake evaluations that assess computer usage among clients are essential to further understanding of the role of compulsive use of the internet in other established addictions (such as alcoholism or sexual compulsivity) and psychiatric conditions (for example, major depression, bipolar disorder, attention deficit disorder). Kimberly S Young executive director Center for On-Line Addiction, Bradford, PA 16701, USA
Rapid Responses Internet addiction : A reply to Kimberly S. Young The internet appears to have become an ever-increasing part of many people's day-to-day life and there have been reports in the popular press for the last four years about "internet addiction" in a number of countries including the US and the UK. For many people, the concept of internet addiction seems far-fetched particularly if their concepts and definitions of addiction involve the taking of drugs. Despite drug-based definitions of addiction, there is now a growing movement which views a number of behaviours as potentially addictive including many behaviours which do not involve the ingestion of a psychoactive drug (e.g. gambling, computer game playing, exercise, sex). Such diversity has led to new all encompassing definitions of what constitutes addictive behaviour. In addition to press reports, academics have also alleged that social pathologies may be beginning to surface in cyberspace. These have been termed "technological addictions"1,2 and have been operationally defined as non-chemical (behavioural) addictions which involve human-machine interaction. They can either be passive (e.g. television) or active (e.g. computer games) and usually contain inducing and reinforcing features which may contribute to the promotion of addictive tendencies3. Technological addictions can thus be viewed as a subset of behavioural addictions4 and feature core components of addiction, i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse5. The recent editorial on this issue by Kimberley Young makes a lot of interesting points (Internet addiction : evaluation and treatment). However, there are a number of areas that I would like to take issue with. Firstly, I agree with Young that the way of determining whether non-chemical (i.e. behavioural) addictions are addictive in a non-metaphorical sense is to compare them against clinical criteria for other established drug-ingested addictions. However, the problem with the criteria suggested by Young (criteria which I have used in my own studies too) is that they:
Secondly, Young attempts to make distinctions between 'cybersexual addictions', 'cyber-relationship addictions', 'net compulsion', 'information overload' and 'computer addiction'. I would argue that many of these excessive users are not "internet addicts" but just use the internet excessively as a medium to fuel other addictions. A gambling addict or a computer game addict is not addicted to the internet. The internet is just the place where they engage in the behaviour. However, in my own research I have certainly identified a small number of cases who appear to be addicted to the internet itself. These are usually people who use internet chat rooms or play fantasy role playing games - activities that they would not engage in except on the internet itself. These individuals to some extent are engaged in text-based virtual realities and take on other personas and social identities as a way of making themselves feel good about themselves. In these cases, the internet provides an alternative reality to the user and allows them feelings of immersion and anonymity which may be psychologically rewarding. Such immersion may actually lead to an altered state of consciousness which in itself may be highly psychologically and/or physiologically rewarding. Thirdly, Young bases many of her assertions on the empirical work she has carried out. However, there are some serious concerns about the samples she has used. Young has been examining excessive internet usage using an adapted version of the DSM-IV criteria for psychoactive substance dependence6. Although Young should be congratulated for putting the concept of internet addiction on the academic map, it is worth noting that all of Young's previous research has relied on self-selected samples who replied to adverts asking for "avid internet users" (mainly middle-aged women who took the time to fill out her internet questionnaires). Any respondent who scored three or more affirmative responses on the adapted version of the DSM-IV were operationally defined as "internet dependent" (although she has now increased the number of affirmative answers to five). It is unlikely that every single one of her dependent internet users was a bona fide internet addict (particularly because those defined as internet-dependent only had to score three or more on the dependency checklist). Examining all the empirical evidence, it can be argued that excessive usage in a majority of cases appears to be purely symptomatic but that for what appears to be an exceedingly tiny minority, the internet may be addictive. There is no doubt that internet usage among the general population will start to increase over the next few years and that if social pathologies do exist then this is certainly an area for development that should be of interest and concern to all those involved in health issues. Dr. Mark Griffiths Psychology Division, Nottingham Trent University Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, United Kingdom
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