Addicted to the internet? There may be help

Photo: AP

Do you ever find yourself not being able to tear yourself away from Facebook, Twitter or other social networking sites?  Do you spend endless hours on blogs, message boards, IM chat rooms or even computer video games?  Well, if you said 'yes' to any of the above, you may just be a typical, plugged-in, tech-savy person.  Or you may have a problem. 

Like any addiction or compulsive behavior, what generally separates those who have a problem from those who don't, is whether the behavior interferes with one's life in such a way as to essentially make it unmanageable.  Its probably ok to spend hours on a message board talking politics, but if you spend so many hours a day doing it that it interferes in a negative way with your work, your family life and responsibilities, well, you may just have a problem.  And, like with most addictions and compulsive behaviors, you wouldn't be alone given. apparently, internet/online addiction is on the rise.  Here is a typical description of what such a disorder usually entails:

The have been cases reported of college students failing courses because they would not take time off from Internet use to attend classes. Other symptoms of addiction may include lack of sleep, fatigue , declining grades or poor job performance, apathy , and racing thoughts. There may also be a decreased investment in social relationships and activities. A person may lie about how much time was spent online or deny that they have a problem. They may be irritable when offline, or angry toward anyone who questions their time on the Internet.

Demographics
In the past, people reported to have an Internet addiction disorder were stereotyped as young, introverted, socially awkward, computer-oriented males. While this stereotype may have been true in the past, the availability of computers and the increased ease of access to the Internet are quickly challenging this notion. As a result, problematic Internet use can be found in any age group, social class, racial or ethnic group, level of education and income, and gender.

Diagnosis
As previously noted, Internet addiction disorder has not yet been added as an official diagnosis to the DSM . The following, however, is a set of criteria for Internet addiction that has been proposed by addiction researchers. The criteria are based on the diagnostic standards for pathological gambling.

The patient must meet all of the following criteria:

    •    He or she is preoccupied with the Internet (thinks about previous online activity or is anticipating the next online session).
    •    He or she needs to spend longer and longer periods of time online in order to feel satisfied.
    •    He or she has made unsuccessful efforts to control, cut back, or stop Internet use.
    •    He or she is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use.
    •    He or she repeatedly stays online longer than he or she originally intended.
The person must meet at least one of the following criteria:
    •    He or she has jeopardized or risked the loss of a significant relationship, job, educational or career opportunity because of Internet use.
    •    He or she has lied to family members, a therapist, or others to conceal the extent of involvement with the Internet.
    •    He or she uses the Internet as a way of escaping from problems or of relieving an unpleasant mood (such as feelings of helplessness, guilt, anxiety, or depression).
 

It's important to point out that there is no real consensus as to whether internet addiction disorder should be included in the psychiatric manual of official mental illness diagnoses, the DSM-V.  This is important for several reasons, not the least of which is getting insurance coverage for treatment for internet addiction:

In June 2007, the American Medical Association declined to recommend to the American Psychiatric Association that they include IAD as a formal diagnosis in DSM-V,[8] and recommended further study of "video game overuse."[9] Some members of the American Society of Addiction Medicine opposed identifying Internet overuse and video game overuse as disorders.[10] Among the research identified as necessary are a ways to define "overuse" and to differentiate an "Internet addiction" from obsession, self-medication for depression or other disorders, and compulsion.

According to Maressa Orzack, director of the Computer Addiction Study Center at Harvard University's McLean Hospital, between 5% and 10% of Web surfers suffer some form of Web dependency.[12]

Another supporter, David Greenfield, Ph.D. of the Center for Internet Behavior conducted a study with ABC News.com in 1999 and is author of Virtual Addiction. He believes that some services available over the Internet have unique psychological properties which induce dissociation, time distortion, and instant gratification, with about 6% of individuals experiencing some significant impact on their lives. However, he says it may not best be seen as an addiction but rather as a compulsion.

Greenfield claims that sex, gaming, gambling, and shopping online can produce a mood-altering effect.

According to the Center for Internet Addiction Recovery (whose director is Kimberly S. Young, a researcher who has lobbied for the recognition of net abuse as a distinct clinical disorder), "Internet addicts suffer from emotional problems such as depression and anxiety-related disorders and often use the fantasy world of the Internet to psychologically escape unpleasant feelings or stressful situations."[13] Over 60% of people seeking treatment for IAD claim involvement with sexual activities online which they consider inappropriate, such as excessive attention to pornography or involvement in explicit sexual conversations online.[14] More than half are also addicted to alcohol, drugs, tobacco, or sex.[13]

In a 2008 editorial published in the American Journal of Psychiatry, Jerald J. Block, M.D. argues that Internet addiction should be included as a disorder in the DSM-V. He notes that symptoms of IA mirror other compulsive/impulsive disorders, including: 1.) excessive use (often associated with a loss of sense of time); 2.) withdrawal symptoms when access is denied; 3.) increasing tolerance (including growing needs for exposure to obtain the same effects); and, 4.) negative repercussions (including social isolation). He further observed that diagnosis was complicated because 86% of study subjects showing IA symptoms also exhibited other diagnosable mental health disorders.

 

There does seem to be a growing consensus for formally treating internet (and video game) addiction as a mental disorder to be included in the DSM-V.  However, some in the mental health field believe a distinction should be made between a full-blown internet addiction and a disorder and state that calling it an 'addiction', may be too strong a term.  And then just to confuse things further, the phrase "web dependency" or the word "compulsion" is also used  by some to describe an individual whose web/internet usage has become such a preoccupation that they are unable to meet many of their life obligations such as taking part in school, work and family life.  Dr. Kimberly Young has been studying internet addiction for over a decade and she has an excellent website with resources about her work and findings.

While China has been treating individuals with internet addiction for quite a while (often using extremely controversial methods and practices), the United States has not had free-standing programs or facilities specifically for the treatment of individuals whose use of the internet or video games has been deemed pathological [by a mental health professional].  Until now:

Alexander, 19, needed help to break an addiction he calls as destructive as alcohol or drugs. He found it in this suburb of high-tech Seattle, where what claims to be the first residential treatment center for Internet addiction in the United States just opened its doors.

The center, called ReSTART, is somewhat ironically located near Redmond, headquarters of Microsoft and a world center of the computer industry. It opened in July and for $14,000 offers a 45-day program intended to help people wean themselves from pathological computer use, which can include obsessive use of video games, texting, Facebook, eBay, Twitter and any other time-killers brought courtesy of technology.

"We've been doing this for years on an outpatient basis," said Hilarie Cash, a therapist and executive director of the center. "Up until now, we had no place to send them."
Internet addiction is not recognized as a separate disorder by the American Psychiatric Association, and treatment is not generally covered by insurance. But there are many such treatment centers in China, South Korea and Taiwan—where Internet addiction is taken very seriously—and many psychiatric experts say it is clear that Internet addiction is real and harmful.

[snip]

Whether such programs work in the long run remains to be seen. For one thing, the Internet is so pervasive that it can be nearly impossible to resist, akin to placing an alcoholic in a bar, Cash said.

The effects of addiction are no joke. They range from loss of a job or marriage to car accidents for those who can't stop texting while driving. Some people have died after playing video games for days without a break, generally stemming from a blood clot associated with being sedentary.

I recently emailed Darren Littlejohn, author of The 12-Step Buddhist, to see what he thought about the plausibility of a 12-step program as part of a treatment program for internet/online addiction and he stated:

I think it's possible that if people are experiencing the problems common to other behavioral addictions that yes, they could respond to 12 Steps in approach. I did what I believe was the world's first study on Computer Addiction as an undergrad in about 1990, when I first became aware of my own tendencies. So this isn't a new idea, but the addiction to communication through social media, texting and other technologies is putting this in the spotlight. If people start to lose jobs or relationships over it, then maybe a spin off 12 Step program would be in order. It seems a little more obvious with video games than computers or the Internet in general.
 

While there still exists some controversy about what exactly 'internet addiction' is, whether it is a "condition" or a "compulsion" or "disorder" and whether it should receive a formal designation by the American Psychiatric Association, there is no debate about the fact that social media and the internet are an integral part of our daily lives and as time goes on, there is likely to be more and more research which will hopefully shed light on a condition that has become for some, a very real, life-altering problem.