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Exploring Internet addiction

June 10, 2013
by An-Pyng Sun, PhD, LCSW
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An-Pyng Sun, PhD, LCSW

The invention of the computer and the emergence of the Internet have revolutionized our lifestyle. These technologies benefit many of us in multiple ways, but they also create negative results for some. One negative effect involves becoming “addicted” to the activities associated with the computer and the Internet.

Although most understand the importance of avoiding the tendency to equate “excessive consumption” or “overuse” with “addiction,” it is helpful here to reiterate the clinical features of addiction:

    •    The activity involves an appetitive process, which provides reward, euphoria, or pleasurable experiences to the person.
    •    It is salient to the person, preoccupying him/her cognitively (for example, constantly thinking of the next fix or engagement of Internet use) and behaviorally (for example, once logged in or online, becoming unwilling to take part in daily living activities such as eating or sleeping).
    •    It involves the three classic addiction symptoms and characteristics: withdrawal (experiencing irritability when not engaging in the activity), tolerance (the need to participate in the activity more to achieve previous effects), and relapse (attempting to stop the addictive activity but failing).
    •    It produces negative consequences in the person in areas such as interpersonal relationships, job or school performance, and overall health.

In addition to these clinical features, scholars in the addiction field insist that an activity or behavior meet the requirements of two other areas to be considered an addiction. They are the neurobiological area and genetic area.

The new DSM-5 has grouped gambling disorder together with substance use disorder under the category of Substance-Related and Addictive Disorders. More research has been accumulated on gambling disorder than on other behavioral addictions, and gambling disorder is so far the only behavioral addiction (not counting binge eating) that is acknowledged as a formal diagnosis in the field’s diagnostic manual. On the other hand, “Internet Use Disorder” or “Internet Gaming Disorder” has not been recognized as a formal diagnosis, but instead has been placed under Section III of the DSM-5, awaiting more research data for verification.

Some beginning brain imaging data have shown a possible different brain process and structure when comparing the brains of individuals with Internet addiction with those of individuals without the addiction. For example, one study indicated that certain brain regions among participants with Internet addiction tend to be activated when these individuals view gaming-related pictures, while such activation does not occur when these participants view mosaic pictures or when participants without Internet addiction view gaming-related pictures. More research is needed in this area.

Precipitating factors
Several theories might explain the phenomenon of why Internet use for some precipitates addiction. First, the “triple A” engine of Internet activities—availability, affordability and anonymity—creates an unprecedentedly convenient and user-friendly medium, which heightens the risk of addictions such as sex or gambling addiction. One researcher in the field equates the Internet with a gateway drug, suggesting that it opens the door for various addictions.

Also, Internet activities, similar to gambling activities, involve a variable-ratio schedule rather than a fixed-ratio schedule when providing rewards and reinforcement. Such a schedule acts more unpredictably than a fixed-ratio schedule and thus presents the activity as more novel, generating a higher level of excitement.

One major enticement is that some Internet activities, especially the massively multi-player online role-play games, are designed to and can fulfill some people’s needs for self-representation, self-value, self-esteem, self-actualization, a sense of achievement, and social interaction, all of which may be missing or less attainable in their real life. The more they invest their time and effort in the virtual world, the more they fall behind in their pursuit of their real-life goals. And the more they fall behind in their real-life goals, the more they are compelled to indulge in their virtual world.

All these precipitating and enticing characteristics may be further accentuated when a person is vulnerable genetically to addiction; has a co-occurring psychiatric disorder such as depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD); and/or is in a dysfunctional environment with a lack of support.

How to help individuals
Because research on behavioral addiction is still in its infancy, most treatment for behavioral addiction, such as gambling disorder and Internet use disorder, follows the models of substance abuse treatment. Because total abstinence from Internet or computer use is not feasible for people who often need computers and the Internet at work or school, it can be suggested that they be abstinent only from the websites that they are addicted to (for example, online pornography sites or gambling sites) and that they maintain moderate exposure to general computer use.

Cognitive-behavioral therapy (CBT) and other psychosocial treatment are also applied, helping a person identify and manage triggers for Internet binges, and also remember that although the Internet binge or engagement might help avoid unpleasant feelings and provide immediate relief or temporary gratification, the long-term consequences are often harmful.