Internet Addiction and Other Behavioral Addictions

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Section snippets

Key points

  • Teens are spending increasing amounts of time online. Although there are many benefits, there are also risks related to excessive use.

  • Internet addiction is a type of behavioral addiction. Precise definitions vary and establishing clear diagnostic criteria is needed.

  • It is important to recognize signs and symptoms of problematic Internet use and addiction including compulsive use, withdrawal, tolerance, and adverse consequences.

  • Internet addiction is highly associated with depression, attention

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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References (87)

  • J.Y. Yen et al.

    The comorbid psychiatric symptoms of internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility

    J Adolesc Health

    (2007)
  • C.H. Ko et al.

    The associations between aggressive behaviors and internet addiction and online activities in adolescents

    J Adolesc Health

    (2009)
  • D.J. Kuss et al.

    Internet addiction in students: prevalence and risk factors

    Comput Hum Behav

    (2013)
  • W.J. Chou et al.

    Multi-dimensional correlates of internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder

    Psychiatry Res

    (2015)
  • S. Bernardi et al.

    Internet addiction: a descriptive clinical study focusing on comorbidities and dissosociative symptoms

    Compr Psychiatry

    (2009)
  • C.H. Ko et al.

    The association between internet addiction and psychiatric disorders: a review of the literature

    Eur Psychiatry

    (2012)
  • C.F. Yen et al.

    The association of internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder

    Compr Psychiatry

    (2014)
  • I.H. Lin et al.

    The association between suicidality and internet addiction and activities in Taiwanese adolescents

    Compr Psychiatry

    (2014)
  • K. Kim et al.

    Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey

    Int J Nurs Stud

    (2006)
  • C.H. Ko et al.

    Proposed diagnostic criteria and the screening and diagnosing tool of internet addiction in college students

    Compr Psychiatry

    (2009)
  • A.J. Van Rooij et al.

    Compulsive internet use: the role of online gaming and other internet applications

    J Adolesc Health

    (2010)
  • C.H. Ko et al.

    The exacerbation of depression, hostility, and social anxiety in the course of internet addiction among adolescents: a prospective study

    Compr Psychiatry

    (2014)
  • A. Winkler et al.

    Treatment of internet addiction: a meta-analysis

    Clin Psychol Rev

    (2013)
  • D.L. King et al.

    Assessing clinical trials of internet addiction treatment: a systematic review and CONSORT evaluation

    Clin Psychol Rev

    (2011)
  • M.P. Twohig et al.

    Acceptance and commitment therapy as a treatment for problematic internet pornography viewing

    Behav Ther

    (2010)
  • D.H. Han et al.

    The effect of methylphenidate on internet video game play in children with attention-deficit/hyperactivity disorder

    Compr Psychiatry

    (2009)
  • C. Holden

    Behavioral addictions debut in proposed DSM-V

    Science

    (2010)
  • M.N. Potenza

    Should addictive disorders include non-substance-related conditions?

    Addiction

    (2006)
  • J.E. Grant et al.

    Introduction to behavioral addictions

    Am J Drug Alcohol Abuse

    (2010)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • E. Aboujaoude

    Problematic internet use: an overview

    World Psychiatry

    (2010)
  • K.S. Young

    Internet addiction: the emergence of a new clinical disorder

    Cyberpsychol Behav

    (1998)
  • M. Shaw et al.

    Internet addiction: definition, assessment, epidemiology and clinical management

    CNS Drugs

    (2008)
  • A. Weinstein et al.

    Internet addiction or excessive internet use

    Am J Drug Alcohol Abuse

    (2010)
  • D.J. Kuss et al.

    Internet and gaming addiction: a systematic literature review of neuroimaging studies

    Brain Sci

    (2012)
  • C.J. Hammond et al.

    Neurobiology of adolescent substance use and addictive behaviors: prevention and treatment implications

    Adolesc Med State Art Rev

    (2014)
  • L. Kann et al.

    Youth risk behavior surveillance—United States, 2013

    MMWR Surveill Summ

    (2014)
  • D.J. Kuss et al.

    Online gaming addiction? Motives predict addictive play behavior in massively multiplayer online role-playing games

    Cyberpsychol Behav Soc Netw

    (2012)
  • K. Choi et al.

    Internet overuse and excessive daytime sleepiness in adolescents

    Psychiatry Clin Neuroci

    (2009)
  • L. Milani et al.

    Quality of interpersonal relationships and problematic internet use in adolescents

    Cyberpsychol Behav

    (2009)
  • K. Nalwa et al.

    Internet addiction in students: a cause for concern

    Cyberpsychol Behav

    (2003)
  • D.A. Christakis et al.

    Trapped in the net: will internet addiction become a 21st century epidemic?

    Arch Pediatr Adolesc Med

    (2009)
  • Stewart CS. Obsessed with the internet: a tale from China. 2010. Available at:...
  • Cited by (105)

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