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Tubular hells: A brief look at ‘addiction’ to watching YouTube videos

 

A few days ago, I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). As Gaita reported:

“The story profiles a middle school student whose obsessive viewing of YouTube content led to extreme behavior changes and eventually, depression and a suicide attempt. The student finds support through therapy at an addiction recovery center…The student in question is a young girl named Olivia who felt at odds with the ‘popular’ kids at her Oakland area school. She began watching YouTube videos after hearing that it was a socially acceptable thing to do… Her viewing habits soon took the place of sleep, which impacted her energy and mood. Her grades began to falter, and external problems within her house – arguments between her parents and the death of her grandmother – led to depression and an admission of wanting to hang herself. Her parents took her to a psychiatric hospital, where she stayed for a week under suicide watch, but her self-harming compulsion continued after her release. She began viewing videos about how to commit suicide, which led to an attempt to overdose on Tylenol[Note: The name of the woman – Olivia – was a pseudonym].

McClurg interviewed Olivia’s mother for the PBS article and it was reported that Olivia went from being a “bubbly daughter…hanging out with a few close friends after school” to “isolating in her room for hours at a time”. Olivia’s mother also claimed that her daughter had always been kind of a nerd, a straight. A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked a lot about their latest YouTube favorites”. According to news reports, all Olivia would do was to watch video after video for hours and hours on end and developed sleeping problems. Over time, the videos being watched focused on fighting girls and other videos featuring violence.

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The news story claimed that Olivia was “diagnosed with depression that led to compulsive internet use”. When Olivia went back home she was still feeling suicidal and then spent hours watching YouTube videos on how to commit suicide (and it’s where she got the idea for overdosing on Tylenol tablets).

After a couple of spells in hospital, Olivia’s parents took her to a Californian centre specialising in addiction recovery (called ‘Paradigm’ in San Rafael). The psychologist running the Paradigm clinic (Jeff Nalin) claimed Olivia’s problem was “not uncommon” among clients attending the clinic. Nalin believes (as I do and have pointed out in my own writings) that treating online addictions is not about abstinence but about getting the behaviour under control but developing skills to deal with the problematic behaviour. He was quoted as saying:

“I describe a lot of the kids that we see as having just stuck a cork in the volcano. Underneath there’s this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt…The best analogy is when you have something like an eating disorder. You cannot be clean and sober from food. So, you have to learn the skills to deal with it”.

The story by Gaita asked the question of whether compulsive use of watching YouTube could be called a genuine addiction (and that’s where my views based on my own research were used). I noted that addiction to the internet may be a symptom of another addiction, rather than an addiction unto itself. For instance, people addicted to online gambling are gambling addicts, not internet addicts. An individual addicted to online gaming or online shopping are addicted to gaming or shopping not to the internet.

An individual may be addicted to the activities one can do online and is not unlike saying that an alcoholic is not addicted to a bottle, but to what’s in it. I have gone on record many times saying that I believe anything can be addictive as long there are continuous rewards in place (i.e., constant reinforcement). Therefore, it’s not impossible for someone to become addicted to watching YouTube videos but the number of genuine cases of addiction are likely to be few and far between. Watching video after video is conceptually no different from binge watching specific television series or television addiction itself (topics that I have examined in previous blogs).

I ought to end by saying that some of my own research studies on internet addiction (particularly those co-written with Dr. Attila Szabo and Dr. Halley Pontes and published in the Journal of Behavioral Addictions and Addictive Behaviors Reports – see ‘Further reading’ below) have examined the preferred applications by those addicted to the internet, and that the watching of videos online is one of the activities that has a high association with internet addiction (along with such activities such as social networking and online gaming). Although we never asked participants to specify which channel they watched the videos, it’s fair to assume that many of our participants will have watched them on YouTube), and (as the Camelot lottery advert once said) maybe, just maybe, a few of those participants may have had an addiction to watching YouTube videos.

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

Further reading

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

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

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Griffiths M.D. & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3, 74-77.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

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

A diction for addiction: A brief overview of our papers at the 2017 International Conference on Behavioral Addictions

This week I attended (and gave one of the keynote papers at) the fourth International Conference on Behavioral Addictions in Haifa (Israel). It was a great conference and I was accompanied by five of my colleagues from Nottingham Trent University all of who were also giving papers. All of the conference abstracts have just been published in the latest issue of the Journal of Behavioral Addictions (reprinted below in today’s blog) and if you would like copies of the presentations then do get in touch with me.

mark-haifa-keynote-2017

Griffiths, M.D. (2017). Behavioural tracking in gambling: Implications for responsible gambling, player protection, and harm minimization. Journal of Behavioral Addictions, 6 (Supplement 1), 2.

  • Social responsibility, responsible gambling, player protection, and harm minimization in gambling have become major issues for both researchers in the gambling studies field and the gaming industry. This has been coupled with the rise of behavioural tracking technologies that allow companies to track every behavioural decision and action made by gamblers on online gambling sites, slot machines, and/or any type of gambling that utilizes player cards. This paper has a number of distinct but related aims including: (i) a brief overview of behavioural tracking technologies accompanied by a critique of both advantages and disadvantages of such technologies for both the gaming industry and researchers; (ii) results from a series of studies carried out using behavioural tracking (particularly in relation to data concerning the use of social responsibility initiatives such as limit setting, pop-up messaging, and behavioural feedback); and (c) a brief overview of the behavioural tracking tool mentor that provides detailed help and feedback to players based on their actual gambling behaviour.

Calado, F., Alexandre, J. & Griffiths, M.D. (2017). Youth problem gambling: A cross-cultural study between Portuguese and English youth. Journal of Behavioral Addictions, 6 (Supplement 1), 7.

  • Background and aims: In spite of age prohibitions, most re- search suggests that a large proportion of adolescents engage in gambling, with a rate of problem gambling significantly higher than adults. There is some evidence suggesting that there are some cultural variables that might explain the development of gambling behaviours among this age group. However, cross­cultural studies on this field are generally lacking. This study aimed to test a model in which individual and family variables are integrated into a single perspective as predictors of youth gambling behaviour, in two different contexts (i.e., Portugal and England). Methods: A total of 1,137 adolescents and young adults (552 Portuguese and 585 English) were surveyed on the measures of problem gambling, gambling frequency, sensation seeking, parental attachment, and cognitive distortions. Results: The results of this study revealed that in both Portuguese and English youth, the most played gambling activities were scratch cards, sports betting, and lotteries. With regard to problem gambling prevalence, English youth showed a higher prevalence of problem gambling. The findings of this study also revealed that sensation seeking was a common predictor in both samples. However, there were some differences on the other predictors be- tween the two samples. Conclusions: The findings of this study suggest that youth problem gambling and its risk factors appear to be influenced by the cultural context and highlights the need to conduct more cross-cultural studies on this field.

Demetrovics, Z., Richman, M., Hende, B., Blum, K., Griffiths,
M.D, Magi, A., Király, O., Barta, C. & Urbán, R. (2017). Reward Deficiency Syndrome Questionnaire (RDSQ):
A new tool to assess the psychological features of reward deficiency. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • ‘Reward Deficiency Syndrome’ (RDS) is a theory assuming that specific individuals do not reach a satisfactory state of reward due to the functioning of their hypodopaminergic reward system. For this reason, these people search for further rewarding stimuli in order to stimulate their central reward system (i.e., extreme sports, hypersexuality, substance use and/or other addictive behaviors such as gambling, gaming, etc.). Beside the growing genetic and neurobiological evidence regarding the existence of RDS little re- search has been done over the past two decades on the psychological processes behind this phenomenon. The aim of the present paper is to provide a psychological description of RDS as well as to present the development of the Reward Deficiency Syndrome Questionnaire (developed using a sample of 1,726 participants), a new four-factor instrument assessing the different aspects of reward deficiency. The results indicate that four specific factors contribute to RDS comprise “lack of satisfaction”, “risk seeking behaviors”, “need for being in action”, and “search for overstimulation”. The paper also provides psychological evidence of the association between reward deficiency and addictive disorders. The findings demonstrate that the concept of RDS provides a meaningful and theoretical useful context to the understanding of behavioral addictions.

Demetrovics, Z., Bothe, B., Diaz, J.R., Rahimi­Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze,
J., Nuyens, P. Karila, L., Nagygyörgy, K., Griffiths, M.D. & Király, O. (2017). Ten-Item Internet Gaming Disorder Test (IGDT-10): Psychometric properties across seven language-based samples. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • Background and aims: The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a brief instrument developed to assess Internet Gaming Disorder as proposed in the DSM­5. The first psychometric analyses carried out among a large sample of Hungarian online gamers demonstrated that the IGDT-10 is a valid and reliable instrument. The present study aimed to test the psychometric properties in a large cross-cultural sample. Methods: Data were collected among Hungarian (n = 5222), Iranian (n = 791), Norwegian (n = 195), Czech (n = 503), Peruvian (n = 804), French­speaking (n = 425) and English­ speaking (n = 769) online gamers through gaming­related websites and gaming-related social networking site groups. Results: Confirmatory factor analysis was applied to test the dimensionality of the IGDT-10. Results showed that the theoretically chosen one-factor structure yielded appropriate to the data in all language­based subsamples. In addition, results indicated measurement invariance across all language-based subgroups and across gen- der in the total sample. Reliability indicators (i.e., Cronbach’s alpha, Guttman’s Lambda-2, and composite reliability) were acceptable in all subgroups. The IGDT- 10 had a strong positive association with the Problematic Online Gaming Questionnaire and was positively and moderately related to psychopathological symptoms, impulsivity and weekly game time supporting the construct validity of the instrument. Conclusions: Due to its satisfactory psychometric characteristics, the IGDT-10 appears to be an adequate tool for the assessment of internet gam- ing disorder as proposed in the DSM-5.

Throuvala, M.A., Kuss, D.J., Rennoldson, M. & Griffiths, M.D. (2017). Delivering school-based prevention regarding digital use for adolescents: A systematic review in the UK. Journal of Behavioral Addictions, 6 (Supplement 1), 54.

  • Background: To date, the evidence base for school-delivered prevention programs for positive digital citizenship for adolescents is limited to internet safety programs. Despite the inclusion of Internet Gaming Disorder (IGD) as a pro- visional disorder in the DSM-5, with arguable worrying prevalence rates for problematic gaming across countries, and a growing societal concern over adolescents’ digital use, no scientifically designed digital citizenship programs have been delivered yet, addressing positive internet use among adolescents. Methods: A systematic database search of quantitative and qualitative research evidence followed by a search for governmental initiatives and policies, as well as, non­profit organizations’ websites and reports was conducted to evaluate if any systematic needs assessment and/or evidence-based, school delivered prevention or intervention programs have been conducted in the UK, targeting positive internet use in adolescent populations. Results: Limited evidence was found for school-based digital citizenship awareness programs and those that were identified mainly focused on the areas of internet safety and cyber bullying. To the authors’ knowledge, no systematic needs assessment has been conducted to assess the needs of relevant stakeholders (e.g., students, parents, schools), and no prevention program has taken place within UK school context to address mindful and positive digital consumption, with the exception of few nascent efforts by non­profit organizations that require systematic evaluation. Conclusions: There is a lack of systematic research in the design and delivery of school-delivered, evidence-based prevention and intervention programs in the UK that endorse more mindful, reflective attitudes that will aid adolescents in adopting healthier internet use habits across their lifetime. Research suggests that adolescence is the highest risk group for the development of internet addictions, with the highest internet usage rates of all age groups. Additionally, the inclusion of IGD in the DSM-5 as provisional disorder, the debatable alarming prevalence rates for problematic gaming and the growing societal focus on adolescents’ internet misuse, renders the review of relevant grey and published research timely, contributing to the development of digital citizenship programs that might effectively promote healthy internet use amongst adolescents.

Bányai, F., Zsila, A., Király, O., Maraz, A., Elekes, Z., Griffiths, M.D., Andreassen, C.S. & Demetrovics, Z. (2017). Problematic social networking sites use among adolescents: A national representative study. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Despite being one of the most popular activities among adolescents nowadays, robust measures of Social Media use and representative prevalence estimates are lacking in the field. N = 5961 adolescents (49.2% male; mean age 16.6 years) completed our survey. Results showed that the one-factor Bergen Social Media Addiction Scale (BSMAS) has appropriate psychometric properties. Based on latent pro le analysis, 4.5% of the adolescents belonged to the at-risk group, who reported low self-esteem, high level of depression and the elevated social media use (34+ hours a week). Conclusively, BSMAS is an adequate measure to identify those adolescents who are at risk of problematic Social Media use and should therefore be targeted by school-based prevention and intervention programs.

Bothe, B., Toth-Király, I. Zsila, A., Griffiths, M.D., Demetrovics, Z. & Orosz, G. (2017). The six-component problematic pornography consumption scale. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Background and aims: To our best knowledge, no scale ex- ists with strong psychometric properties assessing problematic pornography consumption which is based on an over- arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornography Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption. Methods: The sample comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model. Results: A confirmatory factor analysis was carried out leading to an 18­item second­order factor structure. The reliability of the PPCS was good and measurement invariance was established. Considering the sensitivity and specificity values, we identified an optimal cut­off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be- longed to the at-risk group. Discussion and Conclusion: The PPCS is a multidimensional scale of problematic pornography consumption with strong theoretical background that also has strong psychometric properties.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

More term warfare: Is the concept of ‘internet addiction’ a misnomer?

A recent study by Professor Phil Reed and his colleagues published in the Journal of Clinical Psychiatry provided some experimental evidence that internet addicts may be conditioned by what they view on the screen. Given that I was the first person in the world to publish an academic paper on internet addiction back in November 1996 it’s good to see that the number of studies into internet addiction has grown substantially over the last 20 years and that there are now hundreds of studies that have investigated the disorder worldwide in many different ways.

This newly published study is one of the few in the field that has investigated internet addiction from an experimental perspective (as opposed the majority that use self-report survey methods and the increasing number of neuroimaging studies examining what happens inside the brains of those who spend excessive amounts of time online).

Professor Reed’s study involved 100 adult volunteers who were deprived of internet access for four hours. The research team then asked the participants to name a colour (the first one that they could think of) and then gave them 15 minutes to access any websites that they wanted to on the internet. The research team monitored all the sites that the participants visited and after the 15-minute period they were again asked to think of the first colour that came to mind. The participants were also asked to complete various psychometric questionnaires including the Internet Addiction Test (IAT). The IAT is a 20-item test where each item is scored from 0 [not applicable] or 1 [rarely] up to 5 [always]. An example item is How often do you check your e-mail before something else that you need to do?” Those scoring 80 or above (out of 100) are typically defined as having a probable addiction to the internet by those who have used the IAT in previous studies.

Those classed as “high problem [internet] users” on the basis of IAT scores (and who were deprived internet access) were more likely to choose a colour that was prominent on the websites they visited during the 15-minute period after internet deprivation. This wasn’t found in those not classed as internet addicts. Professor Reed said:

“The internet addicts chose a colour associated with the websites they had just visited [and] suggests that aspects of the websites viewed after a period without the net became positively valued. Similar findings have been seen with people who misuse substances, with previous studies showing that a cue associated with any drug that relieves withdrawal becomes positively valued itself. This is the first time though that such an effect has been seen for a behavioural addiction like problematic internet usage”.

While this is an interesting finding there are some major shortcomings both from a methodological standpoint and from a more conceptual angle. Firstly, the number of high problem internet users that were deprived internet access for four hours comprised just 12 individuals so the sample size was incredibly low. Secondly, the individuals classed as high problem internet users had IAT scores ranging from 40 to 72. In short, it is highly unlikely that any of the participants were actually addicted to the internet. Thirdly, although the IAT is arguably the most used screen in the field, it has questionable reliability and validity and is now very out-dated (having been devised in 1998) and does not use the criteria suggested for Internet Disorder in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Using more recently developed instruments such as our own Internet Disorder Scale would have perhaps overcome some of these problems.

There are also much wider problems with the use of the term ‘internet addiction’ as most studies in the field have really investigated addictions on the internet rather than to the internet. For instance, individuals addicted to online gaming, online gambling or online shopping are not internet addicts. They are gambling addicts, gaming addicts or shopping addicts that are using the medium of the internet to engage in their addictive behaviour. There are of course some activities – such as social networking – that could be argued to be a genuine type of internet addiction as such activities only take place online. However, the addiction is to an application rather than the internet itself and this should be termed social networking addiction rather than internet addiction. In short, the overwhelming majority of so-called internet addicts are no more addicted to the internet than alcoholics are addicted to the bottle.

A shorter version of this article was first published in The Conversation

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. & Kuss, D.J. (2015). Online addictions: The case of gambling, video gaming, and social networking. In Sundar, S.S. (Ed.), Handbook of the Psychology of Communication Technology (pp.384-403). Chichester: Wiley-Blackwell.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Osborne, L. A., Romano, M., Re, F., Roaro, A., Truzoli, R., & Reed, P. (2016). Evidence for an internet addiction disorder: internet exposure reinforces color preference in withdrawn problem users. Journal of Clinical Psychiatry, 77(2), 269-274.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Net gains: A brief overview of our recent papers on Internet addiction

Following my recent blogs where I outlined some of the papers that I and my colleagues have published on mindfulness, I got a couple of emails asking if I could do the same thing on other areas that we have been researching into. So, here it is.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

  • Introduction: Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants’ preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use. Methods: A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (Mean age= 30 years, SD = 10.84) were recruited online via several English-speaking online forums. Results: Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved. Conclusions: The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

  • Research into Internet addiction (IA) has grown rapidly over the last decade. The topic has generated a great deal of debate, particularly in relation to how IA can be defined conceptually as well as the many methodological limitations. The present review aims to further elaborate and clarify issues that are relevant to IA research in a number of areas including: definition and characterization, incidence and prevalence rates, associated neuronal processes, and implications for treatment, prevention, and patient-specific considerations. It is concluded that there is no consensual definition for IA. Prevalence rates among nationally representative samples across several countries vary greatly (from 1% to 18.7%), most likely reflecting the lack of methodological consistency and conceptual rigor of the studies. The overlaps between IA and other more traditional substance-based addictions and the possible neural substrates implicated in IA are also highlighted. In terms of treatment and prevention, both psychological and pharmacological treatments are examined in light of existing evidence alongside particular aspects inherent to the patient perspective. Based on the evidence analyzed, it is concluded that IA may pose a serious health hazard to a minority of people.

Lai, C-L., Mak, K-K., Cheng, C., Watanabe, H., Nomachi, S., Bahar, N., Young, K.S., Ko, H-C., Kim, D. & Griffiths, M.D. (2015). Measurement invariance of Internet Addiction Test among Hong Kong, Japanese, and Malaysian adolescents: An item response analysis. Cyberpsychology, Behavior and Social Networking, 18, 609-617.

  • There has been increased research examining the psychometric properties on the Internet Addiction Test (IAT) in different populations. This population-based study examined the psychometric properties and measurement invariance of the IAT in adolescents from three Asian countries. In the Asian Adolescent Risk Behavior Survey (AARBS), 2,535 secondary school students (55.9% girls) aged 12-18 years from Hong Kong (n=844), Japan (n=744), and Malaysia (n=947) completed a survey in 2012-2013 school year. A nested hierarchy of hypotheses concerning the IAT cross-country invariance was tested using multigroup confirmatory factor analyses. Replicating past findings in Hong Kong adolescents, the construct of the IAT is best represented by a second-order three-factor structure in Malaysian and Japanese adolescents. Configural, metric, scalar, and partial strict factorial invariance was established across the three samples. No cross-country differences on Internet addiction were detected at the latent mean level. This study provided empirical support for the IAT as a reliable and factorially stable instrument, and valid to be used across Asian adolescent populations.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

  • Kimberly Young’s initial work on Internet addiction (IA) was pioneering and her early writings on the topic in- spired many others to carry out research in the area. Young’s (2015) recent paper on the ‘evolution of Internet addiction’ featured very little European research, and did not consider the main international evidence that has contributed to our current knowledge about the conceptualization, epidemiology, etiology, and course of Internet-related disorders. This short commentary paper elaborates on important literature omitted by Young that the present authors believe may be of use to researchers. We also address statements made in Young’s (2015) commentary that are incorrect (and therefore misleading) and not systematically substantiated by empirical evidence.

Stavropoulos, V., Kuss, D.K., Griffiths, M.D. & Motti-Stafanidi, F. (2016). A longitudinal study of adolescent internet addiction: The role of conscientiousness and classroom hostility. Journal of Adolescent Research, in press.

  • Over the last decade, research on Internet addiction (IA) has increased. However, almost all studies in the area are cross-sectional and do not examine the context in which Internet use takes place. Therefore, a longitudinal study examined the role of conscientiousness (as a personality trait) and classroom hostility (as a contextual factor) in the development of IA. The participants comprised 648 adolescents and were assessed over a 2-year period (while aged 16-18 years). A three-level hierarchical linear model was carried out on the data collected. Findings revealed that (a) lower conscientiousness was associated with IA and this did not change over time and (b) although being in a more hostile classroom did not initially have a significant effect, it increased girls’ IA vulnerability over time and functioned protectively for boys. Results indicated that the contribution of individual and contextual IA factors may differ across genders and over time. More specifically, although the protective effect of conscientiousness appeared to hold, the over-time effect of classroom hostility increased the risk of IA for girls. These findings are discussed in relation to the psychological literature. The study’s limitations and implications are also discussed.

Ostovar, S., Allahyar, N., Aminpoor, H. Moafian, F., Nor, M. & Griffiths, M.D. (2016). Internet addiction and its psychosocial risks (depression, anxiety, stress and loneliness) among Iranian adolescents and young adults: A structural equation model in a cross-sectional study. International Journal of Mental Health and Addiction, in press.

  • Internet addiction has become an increasingly researched area in many Westernized countries. However, there has been little research in developing countries such as Iran, and when research has been conducted, it has typically utilized small samples. This study investigated the relationship of Internet addiction with stress, depression, anxiety, and loneliness in 1052 Iranian adolescents and young adults. The participants were randomly selected to complete a battery of psychometrically validated instruments including the Internet Addiction Test, Depression Anxiety Stress Scale, and the Loneliness Scale. Structural equation modeling and Pearson correlation coefficients were used to determine the relationship between Internet addiction and psychological impairments (depression, anxiety, stress and loneliness). Pearson correlation, path analysis, multivariate analysis of variance (MANOVA), and t-tests were used to analyze the data. Results showed that Internet addiction is a predictor of stress, depression, anxiety, and loneliness. Findings further indicated that addictive Internet use is gender sensitive and that the risk of Internet addiction is higher in males than in females. The results showed that male Internet addicts differed significantly from females in terms of depression, anxiety, stress, and loneliness. The implications of these results are discussed.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Billieux, J., Deleuze, J., Griffiths, M.D., & Kuss, D.J. (2015). Internet addiction: The case of massively multiplayer online role playing games. In N. El-Guebaly, M. Galanter, & G. Carra (Eds.), The Textbook of Addiction Treatment: International Perspectives (pp.1516-1525). New York: Springer.

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

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

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.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

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 (2nd Edition), (pp.141-163). New York: Academic Press.

Widyanto, L. & Griffiths, M.D. (2011). Unravelling the Web: Adolescents and Internet Addiction. In Virtual Communities: Concepts, Methodologies, Tools and Applications (pp. 2433-2453). Hershey, Pennsylvania: Idea Publishing.

Playing the field: Another look at Internet Gaming Disorder

Research into online addictions has grown considerably over the last two decades and much of it has concentrated on problematic gaming, particularly MMORPGs (Massively Multiplayer Online Role-Playing Games). In the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), Internet Gaming Disorder (IGD) (also commonly referred in the literature as problematic gaming and gaming addiction) was included in Section 3 (‘Emerging Measures and Models’) as a promising area that needed future research before being included in the main section of future editions of the DSM.

The DSM-5 proposed nine criteria for IGD (of which five or more need to be endorsed over the period of 12 months and result in clinically significant impairment to be diagnosed as experiencing IGD). More specifically the criteria include (1) preoccupation with games; (2) withdrawal symptoms when gaming is taken away; (3) the need to spend increasing amounts of time engaged in gaming, (4) unsuccessful attempts to control participation in gaming; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, gaming; (6) continued excessive use of games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of gaming; (8) use of gaming to escape or relieve a negative mood;  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in games.

There is no agreement on the prevalence of IGD as the vast majority of studies have surveyed non-representative self-selected samples using over 20 different screening instruments. A review of problematic gaming prevalence studies that I published with Orsi Király, Halley Pontes, and Zsolt Demetrovics (in the 2015 book Mental Health in the Digital Age: Grave Dangers, Great Promise) reported a large variation in the prevalence rates (from 0.2% up to 34%). However, we noted that there were many factors that could have accounted for the wide variation in prevalence rates including the type of gaming examined (i.e., some studies just examined online gaming, whereas others examined console gaming or a mixture of both), sample size, participants’ age range, participant type (i.e., some surveyed the general population while others assessed gamers only), and instruments used to assess gaming.

There have been a handful of studies that have reported the prevalence of IGD using nationally representative samples. The prevalence rates reported were 8.5% of American youth aged 8–18 years, 1.2% of German adolescents aged 13-18 years, 5.5% among Dutch adolescents aged 13-20, and 5.4% among Dutch adults, 4.3% of Hungarian adolescents aged 15-16 years, 1.4% of Norwegian gamers, and 1.6% of European youth from seven countries aged 14-17 years.

There are now over 20 different screening instruments including a number of new ones specifically incorporating the IGD criteria (including a number that I have co-developed with Halley Pontes). The multiplicity of problematic gaming screens remains a key challenge in the field and partially reflects the lack of consensus in terms of the assessment of the phenomenon. A comprehensive 2013 review that I published with Daniel King and others in Clinical Psychology Review examined the criteria of 18 problematic gaming screens. The 18 screens had been utilized in 63 quantitative studies (N=58,415 participants). The main weaknesses identified were (i) inconsistency of core addiction indicators across studies, (ii) a general lack of any temporal dimension, (iii) inconsistent cutoff scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or untested dimensionality. We also questioned the appropriateness of certain screens for certain settings, because those used in clinical practice may require a different emphasis than those used in epidemiological, experimental, or neurobiological research settings.

Research into IGD is needed from clinical, epidemiological, and neurobiological aspects of IGD. There has been an increasing number of neurobiological studies on IGD and a 2014 meta-analysis by Dr. Y. Meng and colleagues in Addiction Biology of 10 neuroimaging studies investigating the functional brain response to cognitive tasks from IGD using quantitative effect size signed differential mapping meta-analytic methods. found reliable clusters of abnormal activation in IGD within the regions comprising the bilateral medial frontal gyrus/cingulate gyrus, the left middle temporal gyrus and fusiform gyrus when compared to healthy controls. The same review also found that greater amounts of time spent per week playing was associated with hyper-activity in the left medial frontal gyrus and the right cingulate gyrus. Despite the useful findings reported, one of the major limitations of this meta-analysis was that 90% of the studies reviewed were conducted in Asian countries or regions, which might be problematic since prevalence rates of IGD in these populations are usually inflated compared to prevalence rates reported in Western countries. Furthermore, a systematic review of neuroimaging studies examining Internet addiction (IA) and IGD by Daria Kuss and myself in the journal Brain Sciences concluded that:

“These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains”

Over the last decade, a number of studies have investigated the association between IGD (and its derivatives) and various personality and comorbidity factors. Our recent review in the book Mental Health in the Digital Age: Grave Dangers, Great Promise summarized the research examining the relationship between personality traits and IGD. Empirical studies have shown IGD to be associated with (i) neuroticism, (ii) aggression and hostility, (iii) avoidant and schizoid tendencies, loneliness and introversion, (iv) social inhibition, (v) boredom inclination, (vi) sensation-seeking, (vii) diminished agreeableness, (viii) diminished self-control and narcissistic personality traits, (ix) low self-esteem, (x) state and trait anxiety, and (xi) low emotional intelligence. However, we noted that it was difficult to assess the aetiological significance of such associations because these personality factors are not unique to problematic gaming. Our review also reported that IGD had been associated with various comorbid disorders, including (i) attention deficit hyperactivity disorder, (ii) symptoms of generalized anxiety disorder, panic disorder, depression, and social phobia, and (iii) various psychosomatic symptoms.

According to a 2013 editorial in the journal Addiction, Nancy Petry and Charles O’Brien (2013), IGD will not be included as a separate mental disorder in future editions of the DSM until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) aetiology and associated biological features have been evaluated.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Please note: Additional input from Daria Kuss and Halley Pontes

Further reading

Gentile, D. (2009). Pathological video-game use among youth ages 8–18: A national study. Psychological Science, 20(5), 594-602. doi: 10.1111/j.1467-9280.2009.02340.x

Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.

Griffiths, M. D., King, D. L., & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4. doi: 10.2217/npy.13.82

Griffiths, M. D., Király, O., Pontes, H. M., & Demetrovics, Z. (2015). An overview of problematic gaming. In E. Aboujaoude & V. Starcevic (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp. 27-45). Oxford: Oxford University Press. doi: 10.1093/med/9780199380183.003.0002

Griffiths, M. D., & Pontes, H. M. (2014). Internet Addiction Disorder and Internet Gaming Disorder are not the same. Journal of Addiction Research & Therapy, 5(4), e124. doi: 10.4172/2155-6105.1000e124

Griffiths, M. D., & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3(1), 74-77. doi: 10.1556/JBA.2.2013.016

King, D. L., Haagsma, M. C., Delfabbro, P. H., Gradisar, M. S. & Griffiths, M. D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33(3), 331-342. doi: 10.1016/j.cpr.2013.01.002

Király, O., Griffiths, M. D., & Demetrovics, Z. (2015). Internet Gaming Disorder and the DSM-5: Conceptualization, debates, and controversies. Current Addiction Reports, 2(3), 254-262. doi: 10.1007/s40429-015-0066-7

Király, O., Griffiths, M. D., Urbán, R., Farkas, J., Kökönyei, G., Elekes, Z., Tamás, D., & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior, and Social Networking, 17(12), 749-754. doi: 10.1089/cyber.2014.0475

Király, O., Sleczka, P., Pontes, H. M., Urbán, R., Griffiths, M. D., & Demetrovics, Z. (2016). Validation of the ten-item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.11.005

Kuss, D. J., & Griffiths, M. D. (2015). Internet addiction in psychotherapy. London: Palgrave.

Kuss, D. J., & Griffiths, M. D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2(3), 347-374. doi: 10.3390/brainsci2030347

Kuss, D. J., Griffiths, M. D., Karila, L., & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20(25), 4026-4052. doi: 10.2174/13816128113199990617

Lemmens, J. S., Valkenburg, P. M., & Gentile, D.A. (2015). The Internet Gaming Disorder Scale. Psychological Assessment, 27(2), 567-582. doi: 10.1037/pas0000062

Meng, Y., Deng, W., Wang, H., Guo, W., & Li, T. (2014). The prefrontal dysfunction in individuals with Internet Gaming Disorder: A meta-analysis of functional magnetic resonance imaging studies. Addiction Biology, 20(4), 799-808. doi: 10.1111/adb.12154

Müller, K. W., Janikian, M., Dreier, M., Wölfling, K., Beutel, M. E., Tzavara, C., Richardson, C., & Tsitsika, A. (2015). Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. European Child and Adolescent Psychiatry, 24(5), 565-574. doi: 10.1007/s00787-014-0611-2

Petry, N. M., & O’Brien, C. P. (2013). Internet gaming disorder and the DSM-5. Addiction 108(7), 1186–1187. doi: 10.1111/add.12162

Pontes, H. M., & Griffiths, M. D. (2015). New concepts, old known issues: The DSM-5 and Internet Gaming Disorder and its assessment. In J. Bishop (Ed.), Psychological and Social Implications Surrounding Internet and Gaming Addiction (pp. 16-30). Hershey, PA: Information Science Reference. doi: 10.4018/978-1-4666-8595-6.ch002

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143. doi: 10.1016/j.chb.2014.12.006

Pontes, H. M., Szabo, A., & Griffiths, M. D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25. doi: 10.1016/j.abrep.2015.03.002

Pontes, H., Király, O. Demetrovics, Z., & Griffiths, M. D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H. M., Kuss, D. J., & Griffiths, M. D. (2015). Clinical psychology of Internet addiction: a review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23. doi: 10.2147/NAN.S60982

Rehbein, F., Kliem, S., Baier, D., Mößle, T., & Petry, N. M. (2015). Prevalence of Internet Gaming Disorder in German adolescents: Diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction, 110(5), 842–851. doi: 10.1111/add.12849

Thomas, N., & Martin, F. (2010). Video-arcade game, computer game and Internet activities of Australian students: Participation habits and prevalence of addiction. Australian Journal of Psychology. 62(2), 59-66. doi: 10.1080/00049530902748283

van Rooij, A. J., Schoenmakers, T. M., & van de Mheen, D. (2015). Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with ‘video game addiction’. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.10.018

Wittek, C. T., Finserås, T. R., Pallesen, S., Mentzoni, R. A., Hanss, D., Griffiths, M. D., & Molde, H. (2015). Prevalence and predictors of video game addiction: A study based on a national representative sample of gamers. International Journal of Mental Health and Addiction, 1-15. doi: 10.1007/s11469-015-9592-8

Young, K.S. (1999). Internet addiction: Symptoms, evaluation and treatment. Innovations in clinical practice: A source book, (Vol. 17; pp. 19-31). Sarasota, FL: Professional Resource Press.

Term warfare: Internet Gaming Disorder and Internet Addiction Disorder are not the same

Over the last 15 years, research into various online addictions has greatly increased. Alongside this, there have been scholarly debates about whether internet addiction really exists. Some may argue that because internet use does not involve the ingestion of a psychoactive substance, then it should not be considered a genuine addictive behaviour. However, the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) re-classified ‘Gambling Disorder’ as a behavioural addiction rather than as a disorder of impulse control. The implications of this reclassification are potentially far-reaching. The most significant implication is that if an activity that does not involve the consumption of drugs (i.e., gambling) can be a genuine addiction accepted by the psychiatric and medical community, there is no theoretical reason why other problematic and habitual behaviours (e.g., shopping, work, exercise, sex, video gaming, etc.) cannot be classed as a bone fide addiction.

There have also been debates among scholars that consider excessive problematic internet use to be a genuine addiction as to whether the those in the field should study generalized internet addiction (the totality of all online activities) and/or specific addictions on the internet such as internet gambling, internet gaming and internet sex. Since the late 1990s, I have constantly argued that there is a fundamental difference between addictions on the internet, and addictions to the internet. I argued that the overwhelming majority of individuals that were allegedly addicted to the internet were not internet addicts but were individuals that used the medium of the internet as a vehicle for other addictions. More specifically, I argued that internet gambling addicts and internet gaming addicts were not internet addicts but were gambling and gaming addicts using the convenience and ubiquity of the internet to gamble or play video games.

Prior to the publication of the latest DSM-5, there had also been debates as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. However, far from clarifying the debates surrounding generalized versus specific internet use disorders, the section of the DSM-5 discussing IGD noted that:

“There are no well-researched subtypes for Internet gaming disorder to date. Internet gaming disorder most often involves specific Internet games, but it could involve non-Internet computerized games as well, although these have been less researched. It is likely that preferred games will vary over time as new games are developed and popularized, and it is unclear if behaviors and consequence associated with Internet gaming disorder vary by game type…Internet gaming disorder has significant public health importance, and additional research may eventually lead to evidence that Internet gaming disorder (also commonly referred to as Internet use disorder, Internet addiction, or gaming addiction) has merit as an independent disorder” (p.796).

In light of what has been already highlighted in previous research, two immediate problematic issues arise from these assertions. Firstly, IGD is clearly seen as synonymous with internet addiction as the text claims that internet addiction and internet use disorder are simply other names for IGD. Secondly – and somewhat confusingly – it is asserted that IGD (which is by definition internet-based) can also include offline gaming disorders.

With regards to the first assertion, internet addiction and online gaming addiction are not the same. A number of recent studies (including ones I’ve co-authored) clearly shows that to be the case. The second assertion that IGD can include offline video gaming is both baffling and confusing. Some researchers consider video games as the starting point for examining the characteristics of gaming disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. For instance, I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. For me, IGD is clearly a sub-type of video game addiction. For people like Dr. Kimberley Young, ‘cyber-relationship addictions’, ‘cyber-sexual addictions’, ‘net compulsions’ (gambling, day trading) and ‘information overload’ are all internet addictions. However, many would argue that these – if they are addictions – are addictions on the internet, not to it. The internet is a medium and it is a situational characteristic. The fact that the medium might enhance addictiveness or problematic behaviour does not necessarily make it a sub-type of internet addiction.

However, recent studies have made an effort to integrate both approaches. For instance, some researchers claim that neither the first nor the second approach adequately captures the unique features of Massively Multiplayer Online Role-Playing Games (MMORPGs), and argue an integrated approach is a necessity. A common observation is that “Internet users are no more addicted to the Internet than alcoholics are addicted to bottles”. The internet is just a channel through which individuals may access whatever content they want (e.g., gambling, shopping, chatting, sex). On the other hand, online games differ from traditional standalone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players. Consequently, it could be argued that IGD can either be viewed as a specific type of video game addiction, or as a variant of internet addiction, or as an independent diagnosis. However, the idea that IGD can include offline gaming disorders does little for clarity or conceptualization.

Finally, it is also worth mentioning that there are some problematic online behaviours that could be called internet addictions as they can only take place online. The most obvious activity that fulfills this criterion is social networking as it is a ‘pure’ online activity and does not and cannot take place offline. Other activities such as gambling, gaming, and shopping can still be engaged in offline (as gamblers can go to a gambling venue, gamers can play a standalone console game, shoppers can go to a retail outlet). However, those engaged in social networking would not (if unable to access the internet) walk into a big room of people and start chatting to them all. However, even if social networking addiction is a genuine internet addiction, social networking itself is still a specific online application and could still be considered an addiction on the internet, rather than to it.

Based on recent empirical evidence, IGD (or any of the alternate names used to describe problematic gaming) is not the same as Internet Addiction Disorder. The gaming studies field needs conceptual clarity but as demonstrated, the DSM-5 itself is both misleading and misguided when it comes to the issue of IGD.

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

Further reading

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

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

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

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.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Pápay, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment. New York: Elsevier.

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Pontes, H., Király, O. Demetrovics, Z. & Griffiths, M.D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H., Kuss, D. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

Rush hour: Can you be addicted to adrenaline?

(N.B. A shorter version of this article was first published in Hopes & Fears magazine).

Conceptualising addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. However, there is now a growing movement that views a number of behaviors as potentially addictive including those that do not involve the ingestion of a drug. These include behaviors diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. The term ‘adrenaline junkies’ has now passed into popular usage and usually refers to potentially dangerous activities such as bungee jumping, sky diving, BASE jumping, etc. My own view is that any activity that features continuous rewards (i.e., constant reinforcement) could be potentially addictive. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioral – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

  • Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behavior (deterioration of socialized behavior). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In short, if any ‘adrenaline junkies’ fulfilled all my six criteria I would class them as an addict. However, I have come across very few adrenaline junkies that endorse all of my six criteria. My position is that it is theoretically possible for individuals to become addicted to adrenaline producing activities but in reality, very few actually are.

Addiction is an incredibly complex behavior and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behavior. In respect to ‘adrenaline addicts’ the most important factors are likely to be the individual’s personality and the potential of the reinforcing nature of the activity to produce mood modifying experiences.

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

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

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