Internet addiction is a compulsive disorder that impacts a significant number of individuals in the United States and worldwide. Internet addiction is a preoccupation with the Internet that includes excessive usage, unsuccessful attempts to quit, and using the Internet to escape problems. Individuals who experience Internet addiction demonstrate characteristics similar to other behavioral addicts, including salience, mood changes, and conflict in their lives. Furthermore, individuals addicted to the Internet experience psychological issues, such as depression, anxiety and suicide ideation, as well as cognitive issues, such as difficulties with executive functioning. Neuroimaging studies provide support for changes in neuronal connections associated with Internet addiction, particularly in areas of the brain related to emotions and impulse control. Grounded in the principles of cognitive psychology is Internet and Facebook addiction, as these forms of media tend to offer variable interval schedules of reinforcement, rewards, and punishment. It is no surprise that a major approach to treating this form of addiction uses cognitive behavioral therapy. ADD SUBJECT should give this disorder a permanent place within the field of psychiatry as an official psychiatric diagnosis because of the psychological and biological evidence in support of the existence of an Internet addiction.
The Internet has significantly impacted society. This form of communication allows scientists to share knowledge to a worldwide audience, allows companies to conduct business on a global scale, and instantly places information about virtually any topic at the fingertips of ordinary citizens. Social media, such a Facebook, enables individuals from around the world to connect with each other at any time, sharing photographs, insights about their lives, or the latest YouTube video. The Internet, including social media, has truly transformed communication.
In spite of the benefits afforded by the Internet and social media, there is a downside. Some individuals are unable to self-regulate their time appropriately and develop an addiction. For example, 19 year-old Ryan played online computer games for up to 32 hours at a time, leading to failing out of college. Peter, a 30 year-old sex addict, was unable to control his use of Internet porn. Both young men are residents of reSTART, a residential Internet addiction facility located in Seattle, Washington (Campoamor, 2016). Internet addiction is comparable to, and defined in a similar manner as, a gambling addiction or an impulse control disorder, which includes characteristics such as a preoccupation with the Internet, large amounts of time spent on the activity, irritability with loss of access, unsuccessful attempts to quit, lying to cover up use, and using the Internet to escape problems (Northrup, et al., 2015). Although not all researchers agree on the specific diagnostic criteria associated with Internet addiction, consensus appears to exist regarding the presence of excessive Internet use, withdrawal symptoms such as depression or anger when use there is restricted use, a tolerance characterized by increased use of the Internet to control negative emotions, and negative consequences, such as problems with relationships or employment (Northrup, et al., 2015; Griffiths, & Kuss, 2015, p.393). These characteristics suggest that excessive or uncontrollable Internet and social media use can lead to significant disruptions in one’s life.
This form of addiction is a prevalent problem worldwide. According to Cheng and Li (2014), the global prevalence of this problem is 6%, which is just below the 8% prevalence in the Unites States. The highest prevalence of Internet addiction exists in the Middle East, with 10.9% of Internet users classified as addicts (Cheng, & Li, 2014). While these figures refer to individuals with an average age of 18 years, research suggests that younger adolescents are not immune from addiction. Ha and Hwang (2014) reported an Internet addiction rate of 2.8% among adolescents between 11-19 years. Internet addiction appears to span from adolescence into adulthood.
Although research exists that addresses the issue of Internet and social media addiction, the psychiatric profession has not yet officially recognized these problems as true behavioral addictions. In fact, the only behavioral addiction currently addressed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is pathological gambling (Andreassen, et al., 2012). However, the DSM-5 has determined that a diagnosis of Internet Gaming Disorder warrants further attention for possible inclusion in the manual (American Psychiatric Association, 2013). In spite of the lack of formal recognition, research evidence pertaining to the characteristics of Internet and social media addicts, the cognitive-behavioral model of problematic Internet use, and the consequences of excessive use strongly suggests that Internet and Facebook addiction is a true disorder.
Characteristics of Internet and Facebook Addicts
Behavioral addicts, such as those addicted to the Internet, share a number of common characteristics. The criteria for behavioral addiction include salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse (Rosenberg, & Feeder, 2014, p.3). Salience refers to the degree of importance in a person’s life. In this regard, for an addict, the Internet would dominate his thoughts and behaviors. Mood modification, another behavioral criteria, refers to the resulting emotional effect after performing the behavior. Some individuals may feel an adrenaline rush, while others may feel a peaceful sense of escapism. Tolerance refers to an increasing amount of behavior needed to achieve the same effects, while withdrawal symptoms are unpleasant feelings that result from the inability to engage in the behavior. Conflict refers to the clash between the addict and other individuals or activities within that person’s life. Conflict may also occur within the individual, such as struggling with a loss of control. Finally, relapse occurs when the individual returns to previously harmful or excessive behaviors after a period of cessation (Rosenberg, & Feeder, 2014, p.3). These characteristics of behavioral addicts may also apply to those with problematic Internet use.
Individuals with problematic Internet or Facebook use demonstrate a number of different characteristics suggestive of addiction. For example, Internet addiction positively correlates with impulsivity, anxiety, aggression, and hostility. Capetillo-Ventura, and Juarez-Trevino (2015) reported that medical students who scored at a level indicative of addiction on Young’s Internet Addiction test were more likely to be impulsive, anxious, aggressive, and demonstrate less work effort. These individuals also demonstrated a higher propensity for insomnia, social dysfunction, and depression. Individuals with Internet addiction and social dysfunction are more likely to demonstrate hostility, paranoia, lower levels of social responsibility and family support, as well as negative coping strategies (Qiang, et al., 2015).
Also associated with the traits of neuroticism and extraversion is Internet addiction, or more specifically, Facebook addiction. Scores on the Bergen Facebook Addiction Scale (BFAS) that assess for the six primary characteristics of behavioral addiction, correlated with neuroticism, which refers to emotional instability or the tendency to express negative emotions, and extraversion, which refers to being full of energy and willing to engage with the outside world. In addition, scores on this assessment negatively correlated with conscientiousness, which refers to self-discipline and impulse control (Adreassen, et al., 2012; Wu, et al., 2015).
Risk Factors for Internet Addiction
There are a number of risk factors that serve as predictors of Internet and Facebook addiction. Predictors of Internet addiction include the presence of Internet access at home, male gender, increased income level, and time spent online gaming (Ak, Koruklu, & Yilmaz, 2013). Predictors of Facebook addiction include time commitment, social motivations, depression, anxiety, and insomnia. Demographics other than income level and gender, as well as the desire to obtain information for academic or personal purposes, do not serve as risk factors for Internet addiction (Koc, & Gulyagci, 2013).
The evidence supporting Internet and Facebook addiction as a real addiction includes neurological factors. Magnetic resonance imaging of the brains of individuals with Internet addictions demonstrate patterns consistent with those of other types of addicts. For example, associated with Internet addiction is the activation of the amygdala-striatal system, an area of the brain involved in impulse control (Turel, et al., 2014). Internet addicts also demonstrate disruptions in the frontal, occipital, and parietal lobes (Wee, et al., 2014). Associated with impairments in the ability to process information and emotions, learning and memory, and executive function are these disruptions (Wee, et al., 2014).
Psychiatric comorbidities often accompanies Internet addiction. Individuals who score higher on measures of Internet addiction are more likely diagnosed with psychiatric comorbidities and are at increased risk of suicide ideation and attempts (Wu, et al., 2015). For example, in a study of 1,100 individuals drawn from the general public, Wu, et al. (2015) reported that 65% of Internet addicts possess another psychiatric diagnosis, 47% of addicts had thought about suicide within the past week, and 23% had attempted suicide at least once in their lifetimes. In addition, Internet addiction positively correlates with alcohol abuse, attention-deficit hyperactivity disorder, depression, and anxiety (Ho, et al., 2014).
Psychologists have developed assessment tools to measure Internet and Facebook addiction. Young’s Internet Addiction Test classifies individuals as average Internet users, those whose usage causes frequent daily problems, and those whose Internet usage causes significant daily problems. Although widely used, this test only detects 42% of Internet addicts in a clinical population (Kim, et al., 2013). In an effort to improve upon this, Northrup, et al. (2015) developed the Internet Process Addiction Test, which focuses on the different uses of the Internet. This assessment tool measures the frequency of use of the Internet to engage in different processes, including surfing, gaming, social networking, and gambling. Other questions pertain to the use of the Internet for escapism, attempts to decrease Internet use, loss of interest in other activities, and using the Internet in spite of harmful consequences such as missed school or relationship problems (Northrup, et al., 2015). An additional psychological assessment tool is the Bergen Facebook Addiction Scale that assesses for the six elements of addiction, including salience, mood changes, tolerance, withdrawal, conflict, and relapse (Adreassen, et al., 2012).
Internet and Facebook Addiction from a Cognitive-Behavioral Perspective
Social networking sites possess characteristics that encourage addiction, including variable interval schedules of reinforcement, classically conditioned cues, physiological arousal, and the activation of the appetite pathway (Hormes, Kearns, & Timko, 2014). A variable interval schedule of reinforcement reinforces a behavior after an inconsistent amount of time. On Facebook, this occurs when Facebook users post new material online. Since these posts occur at random time points, the reinforcement occurs at varying intervals. An example of a classically conditioned queue is the mobile notifications that occur when a Facebook user’s friends post new content. These cues serve as reinforcers for the behavior of Facebook usage. Furthermore, physiological arousal, such as a sense of excitement or anxiety, occurs as well as activation of the appetite pathway, which leads to hunger and the desire for food intake (Hormes, Kearns, & Timko, 2014).
Facebook games, such as Candy Crush Saga, also demonstrate a foundation in cognitive psychology. Groves, Skues, and Wise (2014) examined the features of online games in order to determine how they encouraged problematic Internet use. The authors analyzed 10 popular games on Facebook, including tile matching games and simulation and role-playing games. One feature of tile matching games that encourages excessive use is the achievement-related status updates, such as posting high scores. This reinforces the idea of competition and serves as a reminder to continue playing the game. In addition, notifications by friends requesting additional lives or extra moves can prompt users to return to the game to help their friends (Groves, Skues, & Wise, 2014).
Tile matching games also use reward and punishment features to encourage participation. Rewards include the ability to view one’s progress in the game and how that progress compares with friends. In addition, players may earn special tokens or prizes to help them complete additional levels. Punishment takes the form of a limited number of lives for each round of play. When one runs out of lives, that forces the user to stop playing or, in some cases, use actual money to purchase additional lives (Groves, Skues, & Wise, 2014).
The Cognitive-Behavioral Model of Generalized and Problematic Internet Use may explain Internet addiction. This model contains a number of direct and indirect relationships among factors related to problematic Internet use. For example, a preference for online social interactions significantly relates with both mood regulation and deficits in self-regulation. The latter of these two factors, mood regulation and efficient self-regulation also correlate with each other. These relationships suggest that individuals who use the Internet as a means to cope with negative emotions are less likely able to regulate their activity online. Another relationship exists between deficits in self-regulation and negative consequences. Individuals who have difficulty regulating their time on the Internet are at increased risk for experiencing negative consequences, such as difficulty in school or with interpersonal relationships (Gamez-Guadix, Orue, & Calvete, 2013).
This model also highlights indirect relationships between variables associated with Internet use. Deficient self-regulation, such as that demonstrated through obsessions and compulsions, serves as a mediating role between online social interaction or mood regulation and negative consequences (Gamez-Guadix, Orue, & Calvete, 2013). In other words, difficulty with the self-regulation of Internet use determines in part the types of consequences experienced as a result of participation in social media or the use of the Internet to regulate one’s mood.
Negative Consequences of Internet and Facebook Addiction
As with any type of addiction, Internet and Facebook addiction can have detrimental consequences. Li, et al., (2015) used a focus group approach to investigate health or psychosocial consequences associated with excessive Internet use among 27 university students. In this study, they defined excessive Internet use as 25 or more hours per week spent online. Participants in this study first access the Internet at a mean age of 9.3 years and first acknowledged having a problem with Internet use at the age of 16.2 years. Several themes emerged from the focus group data. Students identified a number of factors that triggered their Internet use, including strong feelings and moods, boredom, stress, and as a means of escaping difficult situations. A second theme emerging from this study was that participants typically use the Internet in order to engage in social media, complete schoolwork, or participate in other Internet activities such as video games or posting on forums. The third theme of this study directly addressed the consequences of excessive Internet use. Participants reported adverse health consequences such as sleep deprivation, lack of exercise, and poor posture. Psychological consequences included anger, frustration, sadness and depression, as well as discomfort with face-to-face communication (Li, et al., 2015).
Just as excessive Internet use associates with negative consequences, so does excessive Facebook use. Kittinger, Correia, and Irons (2012) administered the Internet Addiction Test to a sample of undergraduate students in order to investigate the relationship between problematic Internet use and Facebook use. Results indicated that over one-third of research subjects used Facebook more than once a day, and one-fourth more than five times a day. When compared with individuals who used Facebook less than 15 minutes per day, those who used Facebook more than 90 minutes per day experienced increased incidence of being late, being in trouble, losing track of time, and spending too much time online. In addition, excessive users were more likely to be told by someone else that they were addicted to the Internet and were more likely to actually feel addicted to Facebook (Kittinger, Correia, & Irons, 2012). These results suggest that individuals with problematic Facebook use experienced significant difficulties in time management.
Facebook users not only use Facebook for social interaction, but also to play games. For example, a popular game is Candy Crush Saga. In this game, the user must match three candies in order to earn points and rewards that can be used later in the game. Each time a user completes a game board, the game shows his or her score in comparison with the scores of several other friends who have also completed that board. Therefore, not only is there an incentive to complete each game board for the sake of earning points, but there is also an incentive to outscore one’s friends.
Existing treatment strategies for Internet addiction focus on cognitive behavioral therapy. King, et al. (2012) provided a review of cognitive behavioral techniques effective for Internet addiction. These strategies target distorted thoughts or thought processes and the use of reinforcement. The therapist may attempt to modify the client’s maladaptive cognitions related to self and the world as well as help the client improve self-efficacy. Another important aspect of cognitive behavioral therapy is helping the client to identify automatic thoughts related to going online, and the situations that lead to Internet use (King, et al., 2012).
Young (2011) described another treatment model for Internet addiction, the CBT-IA. This model uses cognitive behavioral therapy in conjunction with harm-reduction therapy in a three-phase approach. During the first phase of treatment, the counselor uses behavior modification to help the client reduce the time spent online. In the next phase, the counselor uses cognitive restructuring to combat feelings of denial and justification pertaining to Internet use in the client. Finally, the counselor uses harm reduction therapy to treat any issues related to excessive Internet use. Harm reduction therapy acknowledges that individuals develop addictions because of a variety of different influences in their lives, including biological, social, and psychological factors. The goal of this therapy is to address these other issues while at the same time taking small steps to reduce the harm caused by Internet addiction (Young, 2011).
Response and Critique
Characteristics of Internet and Facebook Addicts
One of the most convincing arguments for the existence of an Internet or Facebook addiction is that individuals with these problems demonstrate the characteristics of behavioral addictions. Rosenberg and Feeder (2014) discussed six of these characteristics, including salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse. For individuals with an Internet addiction, it is evident that this form of communication plays a salient role in their lives. For example, Li, et al. (2015) studied a group of students who use the Internet excessively, defining excessive use as greater than 25 hours per week online. In addition, participants in this study reported negative consequences such as sleep deprivation and lack of exercise. Taken together, these pieces of data suggest that the study subjects placed high importance on Internet usage. Twenty-five hours per week is a significant amount of time to spend on one activity. In fact, it is probably similar to the amount of time a college student spends in class and studying or working a part-time job. Furthermore, the activity of Internet use appears to be more importance than sleep or exercise for some of these individuals. Results from this study support the idea that, among addicts, the Internet is salient in their lives.
Another characteristic common to behavioral addicts is mood modification. The research presented in the literature review supports the occurrence of mood changes resulting from Internet use. For example, some individuals who use the Internet excessively demonstrate increased aggression and hostility (Capetillo-Ventura, & Juarez-Trevino, 2015), while others may demonstrate paranoia, depression, anger, frustration, or discomfort (Qiang, et al., 2015; Li, et al., 2015). Since these moods associate with excessive Internet use, it stands to reason these moods do not occur when individuals are not using the Internet. Mood changes associated with the behavior of Internet or social media use are indicative of an addiction.
Conflict is another characteristic of addiction that appears prevalent among Internet addicts. Excessive Internet use associates with social dysfunction and lower levels of family support (Qiant, et al., 2015). Another character trait of an excessive Internet user is emotionally unstable (Adreassen, et al., 2012) and having difficulty with face-to-face communication (Li, et al., 2015). These characteristics suggest that individuals addicted to the Internet have difficulty with interpersonal relationships. These individuals may have difficulty communicating with others outside of the online world and may have difficulty controlling their emotions when they do. A lack of family support could also indicate conflict within the family related to Internet use.
The remaining characteristics of behavioral addiction, including tolerance, withdrawal symptoms, and relapse, did not seem to be a focus of the literature. It would be interesting to conduct additional studies investigating the physical and psychological effects of Internet use cessation among those who use it excessively. In addition, another interesting study would investigate how Internet usage time has increased among potential Internet addicts. Studies such as these could potentially provide additional support for the inclusion of Internet addiction as an official psychiatric diagnosis.
One of the more interesting findings in this literature review was the biological evidence that suggests the brains of Internet addicts differ from those without the addiction. Studies suggested that certain areas of the brain were more active in addicts, such as the areas involved in impulse control (Turel, et al., 2014), emotions, and executive function (Wee, et al., 2014). These findings seem reasonable, as Internet addicts tend to experience a number of emotions, such as anxiety and depression.
Executive functioning plays an important role in time management. Results from the study by Kittinger, et al. (2012) provided interesting insights into this phenomenon. Subjects in this research study who used Facebook more than 90 minutes per day reported an increased incidence of being late and losing track of time. If Internet addiction associates with changes in the portion of the brain related to executive functioning, it makes sense that individuals with this problem would have difficulty keeping track of time.
Impulse control was another area addressed in the neuroimaging study. In relation to this, Ho, et al. (2014) reported that Internet addiction positively correlated with attention-deficit hyperactivity disorder, a disorder characterized in part by a lack of impulse control. Furthermore, higher scores on an assessment of Internet addiction demonstrated a negative correlation to self-discipline and impulse control (Adreassen, et al., 2012; Wu, et al., 2015). It is interesting that biological studies of the brain supports psychological studies of behavior. Taken together, this evidence suggests that excessive Internet use is not just a psychological issue, but a biological one as well.
One of the most disturbing findings in this literature review was the association of Internet addiction with suicide. Ho, et al. (2014) reported that, among a sample of Internet addicts, 47% of them had thought about suicide during the past seven days, and 23% of them had actually attempted suicide at some point in their life. This is not necessarily surprising, given the relationship between suicide and feelings of depression (Ho, et al., 2014). However, when one considers that about 8% of residents in the United States may be classified as Internet addicts (Cheng, & Li, 2014), this means that of the approximate 28 million addicts (given an approximate population of 350 million in the United States), just over 13 million individuals have thought about suicide in the past week. These numbers are frightening, and they highlight the necessity of identifying and treating those who are addicted to the Internet.
Cognitive Principles Associated with Internet Addiction
According to the body of literature surrounding Internet and Facebook addiction, there appears to be underlying cognitive components to the disorder. One of the most notable characteristics of Facebook use is the presence of variable interval schedules of reinforcement (Hormes, Kearns, & Timko, 2014). Users of Facebook have the ability to download an app onto their mobile phones that will provide notifications every time a Facebook page updates. For example, if a Facebook friend posts a new comment or a video, the individual receives a visual and auditory signal on the mobile phone. Since Facebook friends may post comments or information at any time of day and any number of times, there is likely no consistent pattern to the notifications. Therefore, reinforcement of the behavior to use Facebook occurs at variable intervals, as the individual reads the notifications and then checks the Facebook page.
The Cognitive-Behavioral Model of Generalized and Problematic Internet Use provides interesting insight into the cognitive aspects of Internet addiction. The two most prevalent components of this model appeared to be mood regulation and deficits in self-regulation (Gamez-Guadix, Orue, & Calvete, 2013). The latter of these, deficits in self-regulation, may relate to difficulty with impulse control. This lack of impulse control or self-regulation associates with negative consequences, such as difficulty in school or with interpersonal relationships. Success in school depends in part upon self-discipline and the willingness to put forth effort at learning. Individuals who have difficulty with self-regulation may struggle with using their time wisely. Rather than complete homework or study first, the addicted individual may give into the desire to use the Internet.
Diagnosis and Treatment of Internet Addiction
A number of diagnostic tools are available to help identify individuals who likely struggle with Internet or Facebook addiction. The fact that these tools exist is evidence that members of the scientific community do consider Internet addiction a true disorder. According to Kim, et al. (2013), one of the most widely used assessment tools, Young’s Internet Addiction Test, can only detect 42% of Internet addicts within a clinical population. This is not an encouraging number and one that suggests a need for a more valid tool. It appears that Northrup, et al. (2015) developed such a tool by modifying the original test to focus on the processes associated with Internet addiction. The elements of this new test demonstrated strong and statistically significant correlations with the scales of Young’s Internet Addiction Test (Northrup, et al., 2015). Thus, Northrup, et al. (2015) contended that their version of the Internet addiction test possessed high levels of convergent and concurrent validity. However, the authors did not report on the reliability of their assessment tool. Therefore, one should use caution when using this new tool in diagnosing Internet addiction.
While it may not be feasible to use these tests as screening tools in schools, it may be important for educators to at least recognize the risk factors associated with Internet addiction. Pertinent risk factors include male gender, time spent gaming or online, depression, anxiety, and insomnia (Ak, et al., 2013; Koc, & Gulyagci, 2013). Educators spend a great deal of time with students and are in a position to notice these risk factors and act upon them. One risk factor mentioned in the literature was access to Internet in the home (Ak, et al., 2013). This particular risk factor was self-evident, as without Internet access in the home, individuals are not likely to find significant amounts of time to spend online. It is possible that Internet addiction could cross over into the workplace, and employees could spend excessive amounts of time online at their place of employment. However, employers would likely discover these individuals quickly, which could prevent or severely reduce Internet access.
Individuals who struggle with Internet addiction may find hope through cognitive behavioral therapy. Although the research evidence in support of this therapy is limited, it does show promise in reducing addictive behaviors and the resulting symptoms. This form of therapy is effective at reducing Internet usage, improving quality of life and depressive symptoms, and improving time management skills (King, et al., 2012). It makes sense that counselors base an effective treatment on cognitive behavioral therapy given the underlying cognitive aspects of Internet addiction, including reinforcement and punishment. It is interesting to note, however, that King, et al. (2012) also briefly discussed the use of medication in treating this addiction. For example, they associated the use of methylphenidate, a drug used to treat attention deficit disorder, over an eight week period with improved addiction. In addition, they associated the use of bupropion, an anti-depressant, for six weeks with reduced craving for online video games and diminished cue-associated brain activity (King, et al., 2012). Although there is a need for further research, it does appear that there are promising options for those who struggle with Internet addiction.
Although Internet addiction is not recognized as an official mental disorder and debate exists over whether it should, the research evidence suggests it is indeed a true addiction. Individuals addicted to the Internet or Facebook demonstrate a number of characteristics common to individuals with behavioral addictions, including salience, mood changes, and conflict in their lives. Furthermore, as with any addiction, Internet addiction has negative consequences that impact daily functioning and interpersonal relationships. One of the most frightening negative consequences is suicide ideation. The association of suicide ideation with Internet addiction, as well as the many negative outcomes associated with this compulsive behavior, underscores the need to acknowledge Internet addiction as an official psychiatric disorder. By acknowledging Internet addiction as a disorder, scientists and psychiatrists are more likely to devote time in developing improved diagnostic tools and effective treatment strategies.
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