Internet Addiction: Consensus, Controversies, and the Way Ahead

Article excerpt

Abstract

Objectives: To review the fast-growing literature on Internet addiction.

Methods: Descriptive review, using electronic databases as well as hand-search of relevant publications or cross-references from 1970 to 2010.

Results: There are no universally accepted definitions for the captioned condition, but investigators seem to agree that it involves problematic computer usage that is time-consuming and causes distress or impairs functioning in important life domains. Several aetiological models have been proposed, from the diverse perspectives of learning theory, cognitive behavioural theory, social learning, reward deficiency, culture, genetics and neurobiology. Controversies abound, ranging from conceptual (whether behavioural addictions are true addictions), technical (which component of Internet use is a person 'addicted' to), and practical (how should Internet addiction be diagnosed, if it exists at all). However, using various instruments and populations, Internet addiction has been suggested as having a prevalence of 0.3 to 38%, with a young male preponderance. Several screening, diagnostic, and severity assessment instruments are now available, but few have been subjected to rigorous psychometric testing. Psychiatric co-morbidity is common. Treatment modalities lack a firm evidence base, but antidepressants, mood stabilisers, and cognitive behavioural therapy and other psychotherapies have been used.

Conclusions: Recently, the American Psychiatric Association recommended including Internet addiction in its forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, but only as an appendix and not in the main body of the addictive disorders. This appears to be a fairly balanced and cautious approach, which can hopefully give rise to more meaningful research in this important but controversial area.

Key words: Behavior, addictive; Internet; Psychotherapy

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(ProQuest: ... denotes formulae omitted.)

Introduction

The Internet is an integral part of modern life for many people. The idea that almost any subjectively rewarding activity (e.g. drug use, shopping, working, running, gambling, using the computer, and using the Internet), which can become the object of addiction, has become increasingly popular.1-4 Although the earliest reports on the phenomenon of excessive use of the Internet date back to the 1970s, it was not until the early 1990s that reports began to appear in the medical and psychological literature for what Griffiths5 called a 'technological addiction', described it as a 'non-chemical addiction involving human-machine interaction'.

Young6 was one of the first to describe excessive and problematic Internet use as an addictive disorder. 'Internet addiction' is not a recognised diagnostic category in the 10th edition of the International Classification of Diseases (ICD-10) or the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and thus considerable nosological ambiguity surrounds the phenomenon.7 Although much literature is available from abroad, India has been a silent spectator despite its large population and increasing levels of computer and Internet use. Hence, it was worth reviewing the fast-growing literature in this important area wherever it stemmed from.

The data search strategies for this review included electronic databases as well as hand-searches of relevant publications or cross-references from 1970 to 2010. The electronic search included PubMed and other search engines (e.g. Google Scholar and PsychINFO). Cross-searches of electronic and hand-searched key references often yielded other relevant materials. The search terms used, in various combinations, were: 'Internet', 'computer', 'addiction', 'dependence', 'assessment', 'scales', 'prevalence', 'treatment', 'co-morbidities', and 'correlates'.

Definitions and Proposed Diagnostic Criteria

Although no universally accepted definitions for the condition, investigators seem to agree that it involves problematic computer usage that is time-consuming and causes distress or impairs functioning in important life domains. …