Or just all the stuff that humans have been addicted to for centuries — only now we do it online?
China is the only place in the world where internet addiction exists. Officially, that is.
There, psychiatrists use the CCMD-3, a different system of classifying disorders to the rest of the world, which commonly uses America’s DSM-5 or the WHO’s ICD-10. And Internet addiction is a recognised problem in their book.
The result is that, in China, it’s easier to get treatment for compulsive use of digital media. You can even go to a military-style ‘boot camp’ to work, exercise and socialise your way out of it. We don’t know if that’s the most effective clinical intervention, but it shows how seriously China takes the matter. Internet addiction is also high on the public health agenda in Japan and South Korea.
A global problem?
Western psychologists have been writing about ‘internet addiction’ since the early days of the web in the mid-1990s. But in two decades since, studies have failed to reach an agreement on what it is, and how much of a problem it represents.
Some authors talk about it in the language of dependency, using terms like craving, tolerance and withdrawal, as if the internet is a habit some people can’t kick, like heroin or gambling. Others use terms around impulse control, comparing problematic internet use to attention-deficit or obsessive-compulsive disorders, where hard-to-resist urges prompt behaviours.
Evidence has been found for both types of processes in use of the internet. This may be because ‘using’ the internet covers a huge range of activities. Shopping, gambling, emailing, gaming, surfing and accessing pornography are all mentioned in early studies.
In the last decade, new uses have emerged that didn’t exist when internet addiction was first described: social media and streaming of web-based videos. And it doesn’t help that these platforms — which generally make money through selling advertising — are deliberately designed to be addictive, keeping you online so you see more ads.
Uppers or downers?
Also, each use taps into slightly different psychological — and neurological — processes. A time-limited special offer on a shopping site or a bonus in an online game might give you a dopamine hit — motivating you to seek the outcome and feel rewarded. On the other hand, an anonymous chat room you visit regularly that’s full of people you trust might produce an opiate-based sense of soothing.
These variations in definition and effect are probably why the evidence is mixed and no single process of internet ‘addiction’ has been identified.
It could also explain why some people argue that the whole issue is overblown and no different to anything that’s come before. They say internet addiction is the emperor’s new clothes, arguing that the web merely facilitates the expression of problematic behaviours that have long existed in one form or other (like shopping or compulsive porn use).
To quote British public health guru Sir Muir Gray on internet addiction, speaking in 2008: “some people can become dependent on anything”.
Emperor’s new clothes
This old-new problem may be true for activities such as gambling. Ten years ago, if you wanted to place a bet, you walked to the betting shop and did it. Now, you pull up the app on your phone while on the train or in the pub.
Similarly, people have long felt depressed or anxious after comparing themselves to friends or celebrities — social media has just made that possible 24/7 with a wider range of people. (Several studies have also found that Fear of Missing Out — FoMO — is a key motivator for compulsive social media use.)
So, what can we say for sure about problematic internet use?
Well, as addiction specialist Prof. Marcantonio Spada argues, we know three things: 1) some people lose control of their online activity; 2) this can often produce distress, including sadness and anxiety; 3) it can also cause problems in daily functioning — socially, professionally, or financially.
But is this a new condition, or just a digitally-facilitated expression of behaviour that’s existed for decades, even centuries? Would the ancient Greeks have compulsively played their dice games online if they’d had smartphones and 4G in 1000 B.C.? Perhaps.
What lies beneath
However, there does seem to be something underlying it all: a ‘general’ sense of using the internet as a means to escape reality and regulate negative emotions. People with ‘general’ problematic internet use tend to be socially isolated, with low self-esteem and few friendships, seeking online contact as a social surrogate but often just ‘lurking’ in places like chat rooms, or on social media, rather than proactively communicating with others.
This is not something that was possible before the internet, in the way that gambling, shopping, gaming and watching porn were. In these general cases, internet dependency is at the centre of the process and becomes, in the words of Canadian psychologist Richard Davis, “the individual’s lifeline to the outside world”. In that respect, it is something new, and different.
General ‘problematic internet use’ (as it has been called) correlates significantly with mental health problems — like depression or obsessional thinking — and abuse of drugs and alcohol. Most evidence seems to show these difficulties exist before the person develops a digital addiction. For example, drug abuse has been shown to impair impulse control, raising the risk of problematic online behaviour.
There is also some suggestion that digital addiction further damages mental health. Research from China showed that development of an internet use problem predicted worse mental health a year later. And a team of researchers in India has theorised that digital addictions prompted greater alcohol and drug use as people sought further escape from the stress of their online behaviour.
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So, we can imagine a feedback loop between mental health problems, digital addictions, and substance misuse which, once established, keeps itself going.
It may even get worse as digital activity, drugs or alcohol become short-term coping strategies for psychological distress, leading to more problems with mental health and addictive behaviour. To our knowledge, no one has researched this yet.
This state of general addiction might describe one end of a spectrum, but what about ‘average’ internet users? Well, you might already notice some tendencies in yourself towards compulsive use. And you can measure how ‘problematic’ that is by answering this short questionnaire:
What can be done?
If you think you might be creeping into the territory of digital addiction, then try some practical steps to change your behaviour. Set limits for your internet or smartphone time, monitor use with an app like Moment, and design goals for yourself. These could include using the web to bolster offline friendships or arrange activities face-to-face. If you’re really struggling with it, speak to your doctor, who will refer you to the right place.
In the UK, there is currently no provision of treatment for digital addictions on the National Health Service, because it is not a recognised disorder. However, when the WHO releases ICD-11 next year, it will include gaming addiction as a diagnosis — meaning treatment will need to be made available for that specific issue.
In the meantime, there’s always a place at the Chinese military boot camp.