Article Type : Review Article
Authors : Chaudhury S, Mujawar S and Saldanha D
Keywords : Internet addiction; Compulsive web surfing; Gaming addiction; Online addictions
The total number of internet users in India is expected to
increase to over 550 million 2020, and about 72% of users are young adults. At
present internet addiction is not recognized in the addictive disorders
spectrum and, therefore, no corresponding diagnosis in the Diagnostic and
Statistical Manual of Mental Disorder. Internet use disorder/ abuse is
characterized by excessive or poorly controlled preoccupations, urges, or
behaviours related to internet use that leads to impairment or distress. It is
also possible that those who suffer from deeper psychological problems are most
attracted to the anonymous interactive environment of the Internet in order to
surmount these problems. Co-morbidities include depression, ADHD, impulse
control disorders, alcohol abuse, social anxiety etc. Depression and anxiety can
also be part of withdrawal symptoms. Its many negative effects can be seen in
such individuals and these effects which are discussed in the article below. A
number of paper pencil tests are available assess Internet Addiction the most
popular being the Internet Addiction Test (IAT) by Kimberly Young. Many
treatment options are showing good results include practicing the opposite,
external stoppers, use of alarm clocks, proper schedule, recovery groups and
family support.
In India the number of
internet users is expected to exceed 550 million and more in 2020 [1] and among
these about 72% of users are young adults [2]. The profile of a typical
Internet user in India is as follows: youths (82%), accessing Internet through
cyber cafes (97%), with the aim of checking mail (93%), and for general
information search (89%) [3]. Internet addiction disorder (IAD) is of varied
types including information overload or compulsive web surfing; computer addiction
of programming or game playing; compulsions of online auctions; gambling or
trading; and online-sexual relationship addictions [4,5]. At this time internet
addiction is not recognized within the addictive disorders spectrum and,
therefore, no corresponding diagnosis in the Diagnostic and Statistical Manual
of Mental Disorder. Unfortunately the proposal for its inclusion within the
fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM)
was not accepted. Internet use disorder/ abuse is characterized by excessive or
poorly controlled preoccupations, urges, or behaviours associated with internet
use that leads to impairment or distress. It shares the characteristics of
addictive disorders like salience, mood dysregulation, tolerance, withdrawal
symptoms, and relapse [6]. It may operate on triggers or cues which cause net
binges because it provides emotional relief, mental escape, and ways to avoid
problems as do alcohol, drugs, food, or gambling. Therefore, the origins for
such net binges may be traced back to the four types of triggers which can be
present- (a) applications, (b) feelings, (c) cognitions, and (d) life events.
We need to decide which applications are most problematic for the addicted
user. An intensive assessment should include an examination of the extent of use
among particular applications [7]. Internet use provides an artificial,
temporary feeling of security or calm, of self-worth or accomplishment, of
power and control, or intimacy or belonging [8]. Maladaptive cognitions like
low self-worth, and depression trigger pathological Internet use. People who
suffer from deeper psychological problems could also be those who are drawn the
most to the anonymous interactive capabilities of the web so as to overcome
these problems [9,10]. Individuals who are dissatisfied or upset by a specific
area or multiple areas of their lives have an increased likelihood of
developing Internet addiction because they don’t have another ways of coping
[9,10]. Co-morbidities include depression, ADHD, impulse control disorders, alcohol
abuse, social anxiety etc [11,12]. Depression and anxiety may be a part of
withdrawal symptoms [13]. There is evidence for involvement of specific
serotonin genotype in internet addiction and depression indicating similarities
of neurochemical changes in both disorders [14]. Reasons for excessive internet
use vary. Some use the internet to get rid of their lonely feeling; others to
cope with life stressors or depression. Excessive internet use by some people
with social anxiety may be a means to gratify their desire to socialize and
also an attempt to overcome their anxiety for face to face interactions.
Intra-family conflicts and permissive or indulgent parenting has been shown to
be related to excessive internet use.
It has many negative
effects. Due to excessive internet used people are less motivated to interact
with each other. As a result they tend to spend less time in the company of
family members and friend. Over a period of time this leads to social isolation
and depression. At home parents and adolescent children may vie to use the
internet. This adds to new struggles in the family life leading to
incompatibility and, deterioration in the mental health and increasing stress
and isolation [15]. The increasing use of internet affected national and
religious identity, self-identity, and mental health [16]. Sleep patterns are
disrupted due to late night log-ins. In extreme cases, caffeine pills are used
to stay awake for longer sessions. Sleep deprivation causes fatigue, academic
or occupational impairment and decrease in immunity. The sedentary act of
computer use results in a lack of exercise and leads to an increased risk for
carpal tunnel syndrome, back strain, or eyestrain. There is also a rise in
divorce cases due to the online affairs [17]. Students may have a decline in
study habits, drop in grades or missing classes due to excessive Internet use.
Tests Used to Assess Internet Addiction
Internet Addiction Test
(IAT) developed by Kimberly Young [18] is a self-rated scale prepared for use
as a screening tool and assessing the level of internet addiction. It is a
popular scale that has been used all over world. It contains 20 questions
related to internet usage to be scored on Likert scale from 1(rarely) to 5
(always). A total score of <20 represent normal user, between 20 to 49
represent mild addiction, between 50 to 79 represent moderate addiction,
between 80 to 100 severe addiction. Internet use to the point of addiction,
however, can have wide-ranging consequences that can affect personal, occupational,
social, physical and psychological domains of the individual’s life. Serious
relationship problems including conflicts in marriage and high rate of divorce
due to “cyber affairs” have been reported by various studies [19]. Internet-Related
Problem Scale (IRPS) [20] was developed by Armstrong et al. It is a 20-item
scale comprising questions relating to tolerance, craving, and negative impacts
of Internet use. It significantly correlated to the number of hours spent
online and the MMPI-2Addiction Potential Scale.
Management
Many Treatment options
are available. Practicing the Opposite which involves reorganization one’s time
is a major part of treatment. The aim is to have patients disrupt their normal
routine and re-adapt new time patterns of use and thus, break the habit. External
Stoppers are helpful wherein the patient uses concrete things that the patient
needs to do or place to go as prompters to help log off. Use of alarm clocks
might help. Many attempts to limit Internet usage fail because of ambiguous
plans. A proper schedule of Internet usage will give the patient a sense of
being in control, rather than allowing the Internet to take control. The
patient should make a list of the, (a) five major problems caused by addiction
to the Internet, and (b) five major benefits for cutting down Internet use or
abstaining from a particular application. The patient should transfer the two
lists onto an index card and take out the index card as a reminder to reflect
on the problems caused by their Internet overuse. Recovery groups address the
maladaptive cognitions and provide an opportunity to build real life
relationships that will release their social inhibitions and need for Internet
companionship. These groups may help the Internet addict find real life support
to cope with difficult times during recovery similar to AA sponsors. It is
necessary among addicts whose marriages and family relationships have been
disrupted. Intervention should focus on several main areas: (a) educate the
family on how addictive the Internet can be, (b) reduce blame on the addict for
behaviours, (c) improve open communication about the pre-morbid problems in the
family which drove the addict to seek out psychological fulfilment of emotional
needs on-line, and (d) encourage the family to assist with the addict’s
recovery such as finding new hobbies, taking a long over-do vacation, or
listening to the addict’s feelings. A strong sense of family support may enable
the patient to recover from Internet addiction [21].
With the increasing
availability and low cost of internet use the users of internet are
multiplying. The advent of smartphone has greatly improved the accessibility
and more people are spending increasing amounts of time on the net. It is
likely that the number of people with internet addiction will increase in the
future. It is time that the disorder is recognized and treated before it takes
epidemic proportions.