The Question of Internet Addiction

As the unity of the modern world becomes increasingly a technological rather than a social affair, the techniques of the arts provide the most valuable means of insight into the real direction of our own collective purposes
. ~ Marshall McLuhan

It’s a shame that Marshall McLuhan didn’t live long enough to see the Internet come into existence. I’d love to have heard what he’d have to say about its impact on society. After all, we live in a world where interpersonal communication has been suddenly and fundamentally transformed more than it ever has been in the history of the human experiment. Children learn to interact with touch-screens before they learn to talk, the boundaries of couplehood are established by an adjustment of relationship status on social media, and a family’s generation gaps are now defined by the technologies that separate them. The Internet has become inseparable from our identities and our relationships. It has connected us — and disconnected us — in ways that we are just now beginning to understand.

Internet Addiction Defined

The most widely used definition of Internet Addiction is “the inability of individuals to control their Internet use, resulting in marked distress and/or functional impairment in daily life.”

Some researchers describe Internet Addiction in terms similar to substance-based addiction, but others are hesitant to even use the word addiction at all, instead preferring instead to use terms such as “pathological,” “problematic,” “maladaptive,” or “excessive” to describe what are essentially the same types of Internet behavior. To quote Dr. Ronald Pies:

The term pathological use of electronic media (PUEM) is less emotionally “loaded” and more encompassing than internet addiction. PUEM would permit incorporation of problems related to new electronic technologies without endlessly multiplying psychiatric diagnoses.

All of these terms reflect a slightly different interpretation of the nature of Internet Addiction, and while academics could argue endlessly about the semantics, everyone agrees that pathological use of the Internet, whether problematic or truly addictive, is a serious problem worthy of clinical study.

The Controversy of Internet Addiction

After years of deliberation, the American Psychiatric Association chose not to formally include Internet Addiction in the latest DSM. Instead, a condition titled “Internet Gaming Disorder” was identified in Section III as a “condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.”

Essentially, the APA gave researchers a wink and a nod. They left the door open for a whole range of behavioral addictions, and the single most relevant controversy surrounding Internet Addiction still remains whether it should have been included in the DSM-V as a formal diagnosis.

Dr. Pies recognizes the gravity of the condition, but does not believe it merits inclusion:

So-called internet addiction should not be written off as another attempt by psychiatry to “medicalize” unfortunate or self-destructive behaviors. We already know that some individuals exhibiting severe overuse of the internet are in danger of serious emotional and physical complications. However, in my view, it is too soon to consider IA a full-fledged and discrete mental disorder.

On the other hand, Dr. Block believes quite simply that, “Internet addiction appears to be a common disorder that merits inclusion in DSM-V.” As Beard & Wolf put it, “The debate over the existence of Internet Addiction will probably continue for some time. Regardless of whether or not the term ‘Internet Addiction’ is used, there are people developing a harmful dependence on the Internet.”

Internet Addiction Programs

A number of clinical programs have been developed in recent years to address problematic use of electronic media, most notably, The Center for Internet Addiction founded by Dr. Kimberly Young.

In the following TED Talk, Dr. Young explains how in 1995, she became interested in Internet Addiction as a result of her friend’s husband becoming addicted to AOL chat rooms:

Dr. Young initially developed an eight-point questionnaire that assessed Internet Addiction by modifying the criteria for compulsive gambling. Based on the findings of that first questionnaire, as well as the criteria used to diagnose compulsive gambling and alcoholism, she created a more comprehensive diagnostic instrument now referred to as the Internet Addiction Test, which is still widely used by researches and clinicians today.

In 2009, Dr. Young opened the first hospital-based Internet Addiction treatment center in the United States that offers a voluntary, 10-day in-patient program for people who have been diagnosed with severe Internet Addiction. A few other treatment centers dedicated to Internet Addiction have also established themselves, most notably the reSTART Program, which claims to be the nations first retreat center program specializing in problematic Internet, video game, and technology use.

Internet Addiction Resources

Beyond clinical programs, there are a number of resources available for professionals working in this area. For instance, Dr. Young’s Center for Internet Addiction collaborated with the Zur Institute to offer a Certificate Program in “Psychology of the Web,” featuring special courses on Internet Addiction, Internet Sex Addiction, Online Gaming, and Cyberbullying. Dr. Young also offers enterprise and organization-level program development for agencies, hospitals, schools, and clinics that are considering opening an Internet Addiction recovery program.

The similarly named (but totally unaffiliated) Center for Internet and Technology Addiction founded by Dr. David Greenfield also offers a training series for mental health professionals that will help them gain a thorough understanding of the theory underlying compulsive Internet and digital media behavior, including online sexual and gaming addiction, as well as compulsive use of social media and texting.

A Treatment Philosophy

After twenty years of steady development, researchers and clinicians working in the field of Internet Addiction have established a fascinating body of work, but there is still much to be discovered about the nature (and the limits) of this disorder.

Therapists working with clients who need help for problematic use of electronic media would need to be competent in addiction treatment, but they would also need a specialized understanding of clinical assessment, the various types of Internet Addiction, and treatment and recovery strategies that are unique to the field.

In a larger sense, though, therapists need to recognize that whether problematic or beneficial, our use of the Internet now affects every aspect of our daily lives. In order to offer the highest level of care, therapists need to stay fluent in the latest media and technology trends, especially with regard to the new and varied ways in which people communicate. After all, our media and technology not only define us, but they are the very things we use to define ourselves.

  • Ronald Pies MD

    Thanks for your balanced and nuanced views on this subject, Mr. Harb, and for the call-out to my own work. Whether or not we consider “Internet Addiction” a discrete disorder, it is clear that we must recognize that some persons have serious problems controlling their use of the internet, and that their lives are adversely affected by this incapacity. We owe these individuals our understanding, help and treatment, apart from how we classify their condition.

    Best regards,
    Ronald Pies MD
    Professor of Psychiatry
    SUNY Upstate Medical U.
    and Tufts USM

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