Are you Addicted to the Internet?

ReSTART seems to be just like any other residential treatment centre – located near Seattle, USA, it offers psychotherapy, exercise, counselling and other treat-ments to overcome addiction [1]. But there is one difference: ReSTART treats Internet Addiction Disorder (IAD), defined as the pathological use of the internet to the extent that it interferes with the functioning of normal life [2]. 

The term IAD was coined as early as 1995 by Ivan Goldberg. Though first meant in jest, the term has now spread and recent studies in China and Taiwan claim to identify IAD in 10.6% and 5.9% of college students respectively. [3][4] There are also now a multitude of support groups such as the Centre for Internet Addiction Recovery, which offers self-help articles, self-assessment and counselling from a psychiatrist. [1] A similar service can be found at the Com-puter Addiction Study Centre at the McLean Hospital in Belmont, USA. [5]

Despite this, there is still much debate whether IAD should be recognised as an official pathological condition by the American Psychiatric Association. This would then include IAD in the 2012 edition of the Statistical Manual of Mental Disorders, hence making it valid for treatment insur-ance. Supporters of the notion argue that IAD symptoms mirror that of other compulsive disorders such as drug ad-diction: excessive use, often accompanied by time distortion; withdrawal symptoms when access is denied; increasing tolerance, requiring greater exposure to obtain the same effects; and negative repercussions from the activity, includ-ing social isolation. [6] The significance of this discussion is illustrated by a case recently taken to court, where an IBM employee maintained that he was being illegally terminated on the grounds of using online sex chat rooms at work. As a sufferer of IAD, he argued, he had a right to protection from the Americans with Disabilities Act. [7]

Sceptics of IAD however raise the question: “is the Internet addictive, or are addicts using the Internet?” [8] IAD may not be a condition per se, but merely another manifestation of existing disorders. In a study at the Centre for Internet Addiction Recovery, some 50% of reported cases of IAD are known to have previous histories of addictive behaviour. [9] In addition, problems arise over the specific definition of IAD: one can have a pathological obsession with a specific aspect of the Internet, such as viewing pornography or online gambling, but that does not make the Internet itself addictive. [10] Such people are arguably addicted to those activities anyway and the Internet just happens to be another, easy medium in which they can pursue their obsessions. Wrongly ascribing the source of patients’ addictions could have serious consequences on their potential to recover.

Regardless of the justifiability of IAD as an official pathology, it cannot be denied that the Internet is holding an increasingly prominent place in our lives. What makes the Internet so compelling to us? Perhaps one of the most elegant theories is that based on Maslow’s hierarchy, which lays out the human ‘needs’ from the fundamental to the more spiritual. [11] Psychologists, such as Dr John Suler, postulate that we need to satisfy them all for a holistic mental welfare; when one seeks the Internet to compensate for the deprivation of some of those needs in real life, it turns into obsession. [12] The transient satisfaction that one gets from such obsessions can then act as reinforcers, which further exacerbate the behaviour. 

Maslow argues the most basic needs requiring fulfil-ment are physiological, particularly sexual desire. Cybersex is easily accessible, anonymous and medically safe; people can therefore be more open and experimental, protecting their real life social status if it all goes wrong. Indeed, 1 in 5 people seeking IAD treatment claim involvement with inap-propriate sexual activities online, including pornography and explicit cybersex. [13]

Above lies the need for human contact. Humans have an intrinsic need for a sense of belonging; we seek out social recognition to affirm our sense of self. The unique aspect of the Internet compared to other addictive substances is that it is primarily a social interaction platform, providing a low-risk and minimal-pressure way to establish relation-ships. [14] Simply being a user of a particular online com-munity can create an instant sense of camaraderie, and fears of losing this sense of identity in the fast-changing world of the Internet lead to compulsively spending more and more time online. The Internet therefore becomes a “surrogate social life – a vital source of interpersonal contact despite its non-physical nature.” [15] Even those who are read-only ‘lurkers’ can gain a voyeuristic satisfaction from electronical eavesdropping. [8] 

At the penultimate level lies the need for learning and the accompanying self-esteem. Psychological operant theory says that learning is facilitated best when reinforce-ment – the reward – is supplied as close in time as possible to the subject’s response. Online interactions can offer such instantaneous feedback: seeing the results of one’s efforts, such as being appointed a moderator in recognition of par-ticipation in a community, or finally mastering the technical aspects of an online game can be extremely gratifying. Only when one starts to use online achievements to make up for their real feelings of failure or inadequacy does it become an addiction.

Finally, at the pinnacle is the need for self-actualisa-tion: the striving towards the development of oneself as an individual and realising true inner thoughts. The anonym-ity afforded by the Internet allows people to become more expressive and less inhibited [16]; for many, their online persona feels more ‘real’ to them and they may discover new aspects of themselves, analogous to musicians discovering their true natures through their music. 

So how can one distinguish people for whom the Internet is just a passionate pastime, and those who are truly, pathologically addicted? Though the distinction ap-pears to be more in the shades of grey, Suler’s integration principle provides one possible definition: “Internet use becomes pathological when it is dissociated from in-person life.” [17] Healthy Internet users can use the Internet as a creative outlet, a mode of self-expression enriching and supplementing their real life. With addicts, their life diminishes into the addiction rather than being integrated within it – it becomes a mode of escapism that substitutes their life. Thus, recovery from addiction is only possible when one releases their needs and anxieties that they had locked away in the obsession, and integrates their psyche as a synergistic whole. A more empirical approach may utilise our understanding of other addictions: the World Health Organisation defines ‘addiction’ to drugs and alcohol as “[being] dominated by substance use to the virtual exclusion of all other activi-ties and responsibilities. The term addiction also conveys the sense that such substance use has a detrimental effect on society, as well as on the individual.” [18] The parallels between the two approaches are clear. 

The consensus in the psychological world therefore appears to be ambivalent: while the Internet provides op-portunity for addiction, those who become addicted are more likely to have already been predisposed to other addic-tive behaviours. The Internet appears to simply be another medium through which people can express themselves, and the satisfaction they gain from doing so can, as with most pleasures, lead to excesses. So even if you do compulsively check our email and Facebook every time you wake up in the night, you’re not necessarily an internet addict – yet!     

Junko Takata is a second year studying Biological Natural Sciences at Downing College.

References:

[1]ReSTART, Internet Addiction Recovery Program: treatment for Internet, gaming, texting and video game excessive use. http://www.netaddictionrecovery.com/[2] Internet Addictive Disorder (IAD) Diagnostic Criteria [Online] http://www.psycom.net/iadcriteria.html[3] Wu HR, Zhu KJ. “Path analysis on related factors causing Internet addiction disorder in college students”. Chin J Public Health 20, 2004: 1363–1364[4] Chou C, Hsiao MC. “Internet addiction, usage, gratification, and pleasure experience: the Taiwan college students’ case”. Comput Educ 35 (2000): 65–80.[5] Kershaw, S. “Hooked on Web: Help Is on the Way”. New York Times [Online], 2005 Dec 1. http://www.nytimes.com/2005/12/01/fashion/thursdaystyles/01addict.html?_r=1&ex=1184731200&en=29b02b567c2ef1ef&ei=5070[6] Block JJ. Issues for DSM-V: Internet Addiction. American Journal of Psychiatry. 2008 March; 165:3; p. 306-307. Available from: http://ajp.psychiatryonline.org/cgi/content/full/165/3/306[7] McIlvaine, AR. Internet Addiction: The Next Disability? Human Resource Executive [Online], 2007 Feb 28 http://www.hreonline.com/HRE/story.jsp?storyId=9942461[8]King SA. Is the Internet Addictive, or Are Addicts Using the Internet? 1996.  http://webpages.charter.net/stormking/iad.html[9] The Centre for Internet Addiction [Online]. http://www.netaddiction.com/index.php?option=com_content&view=article&id=65&Itemid=89[10] Padilla-Walker LM, Nelson LJ, Carroll JS, Jensen AC. “More than just a game: Video game and Internet use during emerging adulthood”. Journal of Youth & Adolescence. 2009 DOI 10.1007/s10964-008-9390-8[11] Maslow AH. A Theory of Human Motivation. Psychological Review 50(4), (1943):370-96.[12] Suler, J. To get what you need: healthy and pathological internet use. 1999.http://www-usr.rider.edu/~suler/psycyber/getneed.html[13] “Cybersex/Cyberporn”. 2009, Aug 15. http://www.netaddiction.com/index.php?option=com_content&view=article&id=57&Itemid=80[14] Coate J.  Cyberspace Innkeeping: Building Online Community. 1992[15] North T. The Internet and Usenet Global Computer Networks; An investigation of their culture and its effects on new users. 1994 [16] Reid EM. Cultural Formations in Text-Based Virtual Realities. 1994 Jan. [17] Suler J. “Bringing online and offline living together: the integration principle” [Online]. 2000 Jan.  http://www-usr.rider.edu/~suler/psycyber/integrate.html[18] Lexicon of alcohol and drug terms published by the World Health Organisation [Online]. http://www.who.int/substance_abuse/terminology/who_lexicon/en/[19] “Duty Calls” by XKCD, under CC-BY-NC. Available from: http://xkcd.com/386