Internet addiction: How big a problem is it?

Yesterday, a study was reported in the British media that Chinese scientists had observed differences in the brains of people who obsessively use the internet similar to those found in people who have substance addiction. This led to the question of whether this was “proof that internet addiction exists”. I was asked for my comments by both the Guardian and the Daily Telegraph and I thought I would use my blog to put forward my own view on the topic.

There is currently a debate among psychologists and psychiatrists as to whether ‘Internet addiction’ constitutes a true addiction and should therefore be recognized as a psychiatric disorder in the American Psychiatric Association’s fifth edition of the forthcoming Diagnostic and Statistical Manual. The past 15 years have produced many empirical studies demonstrating that a significant number of individuals appear to report psychological problems associated with excessive Internet use. The extent and severity of these problems may be somewhat overestimated because of the relatively low methodological quality of many studies in this area. Most studies have utilized inconsistent criteria to identify Internet addicts and/or have applied recruitment methods that may have caused serious sampling bias. More specifically in relation to Internet addiction criteria used in most studies, I have asserted in a number of my publications that the main problems with the measures used is that they tend to (i) have no measure of severity, (ii) have no temporal dimension, (iii) overestimate the prevalence of problems, and (iv) take no account of the context of Internet use.

In a number of published literature reviews, I have also argued that those working in the Internet addiction field need to distinguish between addictions on the Internet, and addictions to the Internet. My view is that most ‘Internet addicts’ are not addicted to the Internet itself, but use it as a medium to fuel other addictions. I have also used case study evidence to argue that some very excessive Internet users may not have any negative detrimental effects as a consequence of their behavior and therefore cannot even be classed as addicted. In short, a gambling addict who uses the Internet to gamble is a gambling addict not an Internet addict. The Internet is just the place where they conduct their chosen (addictive) behavior. However, I am the first to concede that I have also observed that some behaviors engaged on the Internet (e.g., cybersex, cyberstalking etc.) may be behaviors that the person would only carry out on the Internet because the medium is anonymous, non face-to-face, and disinhibiting.

For these reasons, it is often argued that problematic Internet behaviors may be more appropriately conceptualised within existing known psychopathologies such as depression or anxiety. Nevertheless, a number of researchers (including myself) have argued that Internet addictions do exist and can arise from unhealthy involvement in a range of online activities. These activities may include browsing websites, online information gathering, downloading or trading files online, online social networking, online video gaming, online shopping, online gambling, and various online sexual activities such as viewing pornography or engaging in simulated sexual acts.

While there is no consensus regarding the clinical status of Internet addiction, there appears to be significant demand for treatment for Internet-related problems, particularly in China, Taiwan and South Korea, where the estimated prevalence of Internet addiction problems among adolescents ranges from 1.6% to 11.3%. The South Korean government has reportedly established a network of over 140 counselling centres for treatment of Internet addiction, and have introduced treatment programs at almost 100 hospitals. In addition, numerous ‘boot camp’-style programs for Internet-addicted adolescents have emerged in both China and Korea. In Western countries, clinics specializing in the psychological treatment of computer-based addictions have also emerged, including: the Center for Online and Internet Addiction located in Bradford, Pennsylvania, United States; the Computer Addiction Study Center, McLean Hospital, Belmont, Massachusetts, United States; the Broadway Lodge residential rehabilitation unit located in Somerset, England; and the Smith & Jones 12-step (Minnesota Model) clinic located in Amsterdam, Holland. Additionally, there are some online providers of treatment services for Internet addiction (e.g., www.netaddiction.com; www.netaddictionrecovery.com; www.onlineaddiction.com.au), many of which are modelled on 12-step self-help treatment philosophies including specific types of groups such as Online Gamers Anonymous.

Available evidence suggests that, internationally, a large number of individuals with Internet-related problems have received some form of treatment from a mental health or medical service provider. However, very few studies have examined the effectiveness of any such treatments, including counselling, psychotherapy, or pharmacological interventions. The number of studies in this area is not as large as the number of studies examining the general features and correlates of Internet addiction, or as the number of studies of psychological treatment for other behavioral addictions, such as pathological gambling.

Very recently, I – along with colleagues from the University of Adelaide (Dr Daniel King and Professor Paul Delfabbro) – published a systematic review of the Internet addiction treatment literature. Our review investigated the reporting quality of treatment studies according to the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. Our evaluation of the studies we reviewed highlighted several key limitations, including (a) inconsistencies in the definition and diagnosis of Internet addiction, (b) a lack of randomization and blinding techniques, (c) a lack of adequate controls or other comparison groups, and (d) insufficient information concerning recruitment dates, sample characteristics, and treatment effect sizes.

There were also wider issues as to whether the people being treated in the studies evaluated were actually bona fide ‘Internet addicts’ as some of the people treated may have been addicted to a specific application or activity on the Internet (e.g., gaming, gambling, social networking) rather than being addicted to the Internet itself. We also stressed that research is also needed into whether addicts who use a particular medium to engage in their activity require different types of intervention and/or treatment. For instance, do Internet gambling addicts need or require different treatment interventions than gambling addicts who do not use the Internet to gamble?

Finally, there appears to be a significant need for consensus concerning the clinical definition of Internet addiction and possible sub-forms relating to particular Internet applications and/or activities. This theoretical obstacle, which has existed for over 15 years, has hindered progress in all areas of this field, including the development and validation of a recognised diagnostic tool. Our evaluation of the literature using the CONSORT criteria identified many areas of study design and reporting in need of improvement. In particular, there is a need for more randomized, controlled trials, in both the pharmacological and non-pharmacological intervention literature.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

I would also like to thank Dr Daniel King and Professor Paul Delfabbro (University of Adelaide) for their additional input

Further reading

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications. pp. 61-75. New York: Academic Press.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2^nd Edition), pp.141-163. New York: Academic Press.

Widyanto, L. & Griffiths, M.D. (2009). Unravelling the Web: Adolescents and Internet Addiction. In R. Zheng, J. Burrow-Sanchez & C. Drew (Eds.), Adolescent Online Social Communication and Behavior: Relationship Formation on the Internet. pp. 29-49. Hershey, Pennsylvania: Idea Publishing.

Widyanto, L., Griffiths, M.D. & Brunsden, V. (2011). A psychometric comparison of the Internet Addiction Test, the Internet Related Problem Scale, and Self-Diagnosis. Cyberpsychology, Behavior, and Social Networking, 14, 141-149.