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Teens are spending increasing amounts of time online. Although there are many benefits, there are also risks related to excessive use.
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Internet addiction is a type of behavioral addiction. Precise definitions vary and establishing clear diagnostic criteria is needed.
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It is important to recognize signs and symptoms of problematic Internet use and addiction including compulsive use, withdrawal, tolerance, and adverse consequences.
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Internet addiction is highly associated with depression, attention
Child and Adolescent Psychiatric Clinics of North America
Internet Addiction and Other Behavioral Addictions
Section snippets
Key points
Neurobiology
The addictive process involves problems with aberrant reward systems and impulsivity.14, 22 Past research suggests that neural circuits in the brain involving reward get hijacked and rewired during the process of addiction.14, 23 Specifically, mesolimbic dopaminergic projections to the nucleus accumbens from the ventral tegmental area have been implicated.14 Dopamine increases in the nucleus accumbens with the administration of drugs of abuse or certain behaviors (gaming, gambling, sexual
Prevalence
Prevalence estimates of IA vary owing to methodologic differences and a lack of consensus diagnostically as well as the contribution of regional/cultural differences. Surveys in the United States and European countries suggest a range of prevalence between 1.5% and 8.2%.11 The incidence of problematic Internet use in a large young European sample (11,356 adolescents in 11 European countries) found a prevalence of 4.4%, which was higher in males who preferred online gaming than females who
Clinical presentation
Clinical Vignette James is a 16-year-old boy who spends most of his time online. He struggles to make it to school and has missed many days. He has a tendency to procrastinate and supposedly does “homework” online while actually gaming instead. He spends more than 5 hours online on school nights and goes to bed around 2 am. This has led to increasing conflict at home. Of note, James has been diagnosed with major depression and social anxiety disorder.
Compulsive use, tolerance, withdrawal, and
Assessment
Young was the first to define IA in clinical terms, developing the Young Diagnostic Questionnaire and the Internet Addiction Test.11 Young defines IA by the presence of 5 or more items out of 8 endorsed regarding Internet use: preoccupation, tolerance, withdrawal, failure to control, more use than intended, functional impairment, lying about use, and use to escape a dysphoric mood.11 The Internet Addiction Test consists of 20 questions about Internet use that are answered on a 5-point scale,
Diagnosis
The proposed criteria for Internet gaming disorder in DSM-5 include:
- a.
Preoccupation with Internet games (individual thinks about previous gaming activity or anticipates playing the next game; Internet gaming becomes the predominant activity in daily life);
- b.
Withdrawal symptoms when the Internet is taken away (typically irritability, anxiety, sadness);
- c.
Tolerance (the need to spend increasing amounts of time on Internet games to achieve the same “high”);
- d.
Unsuccessful attempts to control or cut down the
Clinical management
There is growing demand for evidence-based recommendations for the treatment of IA. Treatment for IA is currently largely based on interventions and strategies used in substance use disorders. The goal in any addiction treatment is to modify neurobiological as well as psychosocial risk factors in combination with limiting exposure or access to a substance or behavior.3, 11, 14
Summary
Although the Internet remains a powerful and positive force in the lives of many, a minority of users may become addicted. This is of particular concern for adolescents, because they are spending increasing amounts of time online and they are uniquely vulnerable to the development of addictive behavior.
IA is a type of behavioral addiction that resembles substance use disorders in phenomenology and neurobiology. Although this disorder has received attention from both scientists and the media,
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