Internet addiction? Bollocks more like

‘Internet addiction’ is in the news this week, as the authorities in China are threatening to recognize it as a clinical syndrome. It has steadily been accruing column inches of late having received a substantial profile boost in March when Dr Jerald Block suggested in an editorial American Journal of Psychiatry that it is a ‘common disorder’ and deserving of a place in the upcoming DSM-V.

It’s telling that internet addiction disorder (IAD) was originally proposed as a joke. In 1995 New York Psychiatrist Dr Ivan Goldberg decided to parody the complexities of DSM-IV by means of a disorder of his own invention, and was surprised when his bleary-eyed colleagues stepped forward as sufferers and asked him for help. Ironically in response Goldberg set up an online internet addiction support group. This apart, he remains a less than committed advocate. Here he is, talking to the New Yorker:

IAD is a very unfortunate term. It makes it sound as if one were dealing with heroin, a truly addicting substance that can alter almost every cell in the body. To medicalize every behavior by putting it into psychiatric nomenclature is ridiculous. If you expand the concept of addiction to include everything people can overdo, then you must talk about people being addicted to books, addicted to jogging, addicted to other people.

Although the rise and rise of the World Wide Web and its possible misuse is worthy of study and debate, I disagree with the classification of internet overuse as an ‘addiction disorder’. The concept contains so many holes, you could use it to strain pasta.

In a psychiatric sense ‘addiction’ is best applied to the use of psychoactive substances where it is described in terms of dependence syndrome. In brief: in order to keep us alive, the brain has evolved reward pathways which make us feel better about fundamental things that are in our interest, such as eating and sex. The trick that drugs such as heroin pull is to reward us in the same way for an activity that has no intrinsic value. Thus, for an individual, the taking of heroin then takes on a much higher priority than other behaviours, which once had a greater value. The presence of a withdrawal syndrome is also important.

An obsession with the internet shares few characteristics with a dependence syndrome. But this is only a small part of the folly of IAD. Framing overuse of the internet as a psychiatric condition, medicalises it and leads to us thinking about its treatment in terms of psychiatric interventions where more prosaic ones might be more appropriate. Here’s Block again, pen in one hand and in this other his prescription pad and section papers.

South Korea considers Internet addiction one of its most serious public health issues. Using data from 2006, the South Korean government estimates that approximately 210,000 South Korean children (2.1%; ages 6–19) are afflicted and require treatment About 80% of those needing treatment may need psychotropic medications, and perhaps 20% to 24% require hospitalization Am J Psychiatry 165:306-307, March 2008

You can almost hear the ambulance sirens. If something is sufficiently hazardous to require 1.6% of South Korea’s population of 6-19 year olds to take psychotropic medication, surely the authorities should think about banning it? And should we believe these figures? Block cites various symposia and reports, but little in the way of peer reviewed research. Any attempt to understand the natural history of internet overuse goes unmentioned.

Some of the strongest advocates for the IAD model are involved with selling addiction treatments and so cannot be regarded as unbiased. Dr Block owns a patent on technology that can restrict computer access. If we heed their advice mental health services will again recruit mildly dysfunctional people, for whom it can offer little help. More appropriate action would require looking into why some people appear more comfortable convening with a computer screen to the expense of other arguably more wholesome activities. I would not be at all surprised if provision for alternative activities in relentlessly urban Beijing or Seoul are lacking. Or that China’s brave new world requires many families to live apart and where their only communication is via the internet. For the totalitarian minded, It’s also a useful excuse for limiting internet access.

And even if none of the above objections were valid, the internet is not simply one thing to be addicted to, but rather a portal to allow a wide range of activities. As a media it can be no more addictive than a book, or as part of the social milieu it can no more be addictive than the air to breathe (that is, it is a category error – see comment below). And the question must be asked of how much additional information is convey in an IAD diagnosis, when the behaviour could more usefully be described in terms of more established diagnoses.

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Links

Wikipedia: Internet addiction disorder

News

The Times 11 November 2008 Internet addiction made an official disorder in China

China Daily 10 November 2008 Internet addiction ‘not just a bad habit’

BBC health 29 September 1999: Internet addicts ‘need help’

In support of IAD

Addiction Inbox: Internet addiction: A novel disease

Centre for internet addiction recovery

Criticism of IAD

PsychCentral 10 November 2008: China declares internet addiction, imprisons addicts

PsychCentral 18 March 2008: What’s that smell? Internet addiction disorder in the news

Mindhacks 20 August 2007 Why there is no such thing as internet addiction 16 December 2008 ‘Internet Addiction’ built on foundations of sand (thanks to Paul for this link)

Publications

Internet Addiction: Metasynthesis of 1996–2006 Quantitative Research

Online Information, Extreme Communities and Internet Therapy: Is the Internet Good for Our Mental Health?

Addendum 24 July 2009:

When we say something is real, it becomes real in its consequences:
Case study: Electric shock therapy in China for internet ‘addiction’
China bans electric shock treatment to cure internet ‘addiction’

7 Responses to “Internet addiction? Bollocks more like”

  1. deClerambault says:

    I’m not so sure I’d be so strict in my definition of addiction FP. If you bring the dependence syndrome necessity into it (tolerance, withdrawal etc.) one narrows the field to basically booze, benzos and opiates – cocaine wouldn’t count for one, and yet there are certainly “cocaine addicts”, who are certainly rewarded for their addiction, be that by intermittant reinforcement, idealising the good-self internal object, or regulating dopaminergic mesolimbic reward pathways (depending on your favoured model, naturally;)
    Similarly you can apply that to gambling or any compulsive behaviours that impair function. So yes, as a discrete pathological entity IAD is most probably bollocks, but as a behaviour that could cause suffering and functional disability, is it really any more daft than anything you could find flicking through DSM or ICD. (Controversial?!)

  2. NothernIrelandExile says:

    I want to know what it is that they all find so good on the internet that they think they are addicted??? Please can someone tell me?

    It’s a fun way to pass some time at work, to keep in touch with friends and to read the news etc but to be honest, I’d struggle to find anything that could amuse me for more than an hour. Perhaps I’m not down with the technology, but I like seeing real people and chatting in person.

    There must be a lot of very lonely and isolated people out there if they are spending so long at their computers. I feel sorry for them, but I don’t think they are sick. I’d prescribe them a dose of reality and an afternoon with friends. Problem solved.

  3. Oliver Smith says:

    I spend many hours a day on the internet on top of what I spend on it doing research for university. Some would say that my level of internet usage could be somewhat unhealthy and I’ve struggled without it whilst not having an internet connection in my house. However, this struggling to cope without it was mainly down to the fact that I need internet access to complete my university studies, this is even more the case when i cannot get to the library all that often to use the paper copies of statutes, case reports etc (not to mention the fact that locating a case on the internet is so much easier than in a book and it is also so much easier to tell whether said case is still good law or not on the internet). In short, my struggling without the internet was not down to an addiction.

    I think we are going down a dangerous route when we try to medicalise everything and anything. If we continue to do this people will stop taking responsibility for their actions and instead start to blame it on medical problems, which are then being entertained by medical professionals. Psychiatry, by its very nature, is very open to such manipulation. ADHD is a good example to use in order to illustrate what I mean. Here we have a condition that does exist, but has now become an excuse for badly behaved children. There is little doubt that many children have attracted the diagnoses of being ADHD when in actual fact a lack of parental discipline and control is the root cause of their poor behaviour. The willingness of doctors to diagnose children as being ADHD and then prescribe Methylphenidate Hydrochloride (a.k.a Ritalin) has lead to the dismisal of the existance of ADHD by many people (including professionals such as teachers) and has also landed Psychiatrists specialising in Children and Adolecents with a bad name.

    This of course should not detract from those adictions and other psychiatric conditions that we reconise and know which destroy peoples lives every day. These are serious and do need the treatment and recognition that they currently attract.

    Again, this is a topic that I could argue about for quite some time (especially when it is opened up outside of Psychiatry to Medicine in general). However, I shall leave it here for just now.

    Oliver

  4. deClerambault says:

    I’ve often heard talk of “medicalising” problems but I’m really not sure what’s being meant – does this allude to a “medical model” of treatment (whatever that is)? or perhaps a purely biological understanding of a problem. Because you know what? I may not have been the most attentive student but I’m pretty sure they didn’t teach it at med school.

    So what is this dangerous route that we’re on the precipice of by our “medicalisation”? Does a biopsychosocial model of understanding threaten some arcane notion of free will and therefore personal responsibility?

    No.

    Many people come to psychiatrists with numerous problems, some of which they are aware of, some less so – and I’m certainly not implying a lack of agency here.
    Regardless of what ICD-10 diagnosis they attract be it ADHD, PTSD schizophrenia or whatever. The thing they’ve all got in common is some difficulty in functioning, and some of them may need some help making a change and that might mean help arriving at a point when they are able to “take responsibility”.

    As for ADHD – you make it sound as though a willingness to diagnose a treatable condition is a bad thing. I hope you mean a willingness to WRONGLY diagnose (which is just plain bad doctoring). You know there’s more to it than just seeing a naughty boy and saying “You have ADHD. Here take these pills”.

  5. Becca says:

    I would agree with deClerambault that internet addiction can be considered as analagous to an addiction to gambling. It certainly doesn’t have the physical component of alcoholism or drug addiction, but it can certainly foster destructive behaviour.

    I have some experience of this. I have always been a very avid reader and certainly as a child used to read very much for escapism. Ever since I have had access to the internet I’ve fond it difficult to restrict my use and it does end up negatively impacting my life and preventing me from doing things I otherwise want to do. A few years ago I was going through a very difficult period in my life and became a member of an online forum at about that time. For a time, my life revolved around this forum and the topic of discussion (a TV show), I had a completely overinflated sense of the importance of the forum compared with the rest of my life, I withdrew almost completely from day-to-day life and friends and very nearly failed my degree, but insulated myself from feeling any pain or concern about this by distracting myself on the internet. I fully acknowledge that my internet obsession was a symptom of other problems in my life, but I think that in many ways you could say the same for other non-physiological addictions.

    Fortunately this has a happy ending, I managed to pull myself back from the brink with huge help from many others, passed my degree and though I still struggle with restricting my internet time, the problem was clearly related to other issues in my life at that time and has never recurred at anything like the same level.

  6. Paul says:

    Mind Hacks makes a similar case, and that the term ‘internet addiction’ is really a category error.

    http://www.mindhacks.com/blog/2008/12/internet_addiction.html

  7. Felicia says:

    To my opinion, internet addiction is becoming a serious problem nowadays. If you have kids that are on the computer and/or Internet for any length of time, you know that getting them to log off can be quite a chore. That’s why many parents turn to Internet filters to protect their children. For example, I use http://www.internettimer.net/ by my friend’s advice. Very-to-use and helps me set specific time periods for use by each child in the family.

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