Steve Resnick, M.D

By: centraljersey.com
Internet Addiction is a controversial topic. There is disagreement whether it is a true "addiction" and how the problem should be classified. Is it an "illness," "problem" or a normal change in lifestyle related to the advances in technology?
These are all questions that are currently being addressed and remain unanswered. The American Psychiatric Association is currently working on the fifth version of the Diagnostic Statistical Manual (DSM-V), and at this time has not added Internet Addiction as a separate diagnosis. It is often classified as an "Impulse Control Disorder," with criteria similar to Pathological Gambling.
Additionally, deciding what is "normal" versus what is a "problem" is complicated. We have never seen a device or activity that developed so quickly, and became so pervasive in our lives, as computers and the Internet. Television could only be used at home. Telephones used to be the same. Many people now have access to the Internet every minute of every day. Computers and the Internet are not only used for recreation, but have become necessary for work, school, and social life. A teenager basically needs a computer to do his homework, as well as to maintain a social life.
Even though the concept of Internet Addiction is vague, complicated, and controversial, it is clear that many people have very serious problems with excessive use of the Internet.
The problems vary, and can be broken down into several categories:
– Online gambling.
– Online pornography.
– Online shopping.
– Social Networking.
– Online game-playing.
The first three areas – gambling, pornography and shopping – are, for the most part, problems that are not specific to the Internet, but aggravated by it. Sometimes, these behaviors are more of a coping mechanism for other issues (e.g., depression), similar to overeating when anxious or depressed.
The other areas – social networking, game-playing, and some other issues – are more specific to the Internet.
Compulsive gambling has been a problem long before computers were around. Many would go to the racetrack or a casino, which required leaving your house and traveling. Now, with the Internet, a few clicks can let you play numerous different games of chance. Also, since the cost of maintaining a website is small, the amount that a website keeps is less than casinos or other gambling venues. That, along with the fact that there are so many casual online gamblers, can make certain games like online poker quite profitable to experienced players, lowering their concerns about losing money.
Online shopping is similar. Instead of having to go out to a store to shop, and perhaps several stores for different items, you can sit at home to shop. Recent studies have shown that the amount spent on online shopping is close to, if not surpassing, store shopping. The ability to get bargains, check price at several sites within minutes, enticing emails with coupons and sale notices, and a barrage of advertising while surfing the Internet, all combine to make shopping online often harder to resist than going to a store.
Obtaining pornography can be embarrassing when trying to buy a magazine or rent a DVD. Getting something by mail is easier. Easier still is being able to obtain porn directly on the Internet. It’s simple, you can watch things immediately, and there is a tremendous variety to suit one’s specific tastes. It can even be interactive, while remaining anonymous. Again, the Internet makes some things easier, often too easy.
Probably the most addictive online problem is online game-playing, especially MMORPGs (Massively Multiplayer Online Role-Playing Games).In MMORPGs, the gamer takes the role of a fantasy character and has several missions he can accomplish, often with the cooperation of one or more other players. Not only is there gratification in accomplishing tasks, but a strong social component, as well. It has been estimated that with "World of Warcraft" (one of the most popular games), the average gamer spends 20 hours a week playing. Western spending on subscription MMORPGs in 2008 as $1.4 million, and as of October 2010, "World of Warcraft" alone had over 12 million subscribers. Internet game-playing often requires teamwork, and therefore may require adjusting one’s schedule to accommodate team plans. Online game-playing can often become the main focus of a gamer’s life.
Other online activities can also have a negative impact if done excessively, such as blogging, surfing for information, selling (e.g., eBay), etc.
Whatever we decide to call it, Internet activity has to be assessed to first determine if it is excessive, and then if it is a true problem requiring treatment.
Dr. Kimberly Young, a prominent researcher and clinician in Internet Addiction, has developed the Internet Addiction Diagnostic Questionnaire (IADQ). Five of the following symptoms are considered necessary for a diagnosis.
1. Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?
2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?
4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
5. Do you stay online longer than originally intended?
6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
7. Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?
8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?
Other symptoms Include:
– Failed attempts to control behavior.
– Heightened sense of euphoria while involved in computer and Internet activities.
– Neglecting friends and family.
– Neglecting sleep to stay online.
– Being dishonest with others.
– Feeling guilty, ashamed, anxious, or depressed as a result of online behavior.
– Physical changes such as weight gain or loss, backaches, headaches, carpal tunnel syndrome.
– Withdrawing from other pleasurable activities.
There is also a more in-depth Internet addiction test, composed of 20 multiple choice questions. This can be found at www.PsychIT.org and www.netaddiction.com .
The best treatment for the various forms of Internet Addiction requires an individualized, multi-faceted approach. First, an accurate diagnosis by a professional is important, to determine if there is a true problem, what subtype it is, and if there are any concurrent issues, such as depression, anxiety disorders, or other addictions.
Next, a treatment plan, which could have several parts, should be made. This would vary from person to person, but could include a 12-step program (such as Gamblers Anonymous, etc.), psychotherapy, family involvement, usage-limiting software, and possibly medication.
Internet Addiction is a new problem, and our understanding of it is still growing. Resources such as websites and support groups are starting to develop. Treatment needs to be individualized with respect to diagnosis, as well as which treatments would be helpful.
Though there are many variables and still a lot to be learned, there is much hope for helping those that suffer.
Dr. Steve Resnick is a board-certified psychiatrist with an office at 1000 Herrontown Road, Princeton. He treats multiple problems, including mood disorders, anxiety disorders, and other issues. Dr. Resnick has appeared on television and radio and has written several articles for newspapers and journals. He manages two websites: www.MindAndBodyInfo.com and www.PsychIT.org, and can be contacted at his office, 609-683-0707.