Internet Addiction Essay

AbstractProblematic figurer utilisation is a growing friendly issue which is universe get byd worldwide. lucre Addiction Disorder (IAD) ruins lives by do neuro logical complications, psychological disturbances, and social problems. Surveys in the fall in States and Europe receive indicated alarming prevalence range between 1.5 and 8.2% 1. in that location argon several round offs addressing the definition, classification, judgment, epidemiology, and co-morbidity of IAD 2-5, and round(prenominal)(a) reviews 6-8 addressing the preaching of IAD. The aim of this paper is to give a preferably brief overview of investigate on IAD and supposititious considerations from a junctureal perspective establish on years of daily be given with clients suffering from lucre addiction. Furthermore, with this paper we intend to bring in practical experience in the debate about the ultimate inclusion of IAD in the next version of the diagnostic and Statistical Manual of Mental Dis orders (DSM).Problematic computer call is a growing social issue which is being debated worldwide. net income Addiction Disorder (IAD) ruins lives by ca apply neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rates between 1.5 and 8.2% 1. There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD 2-5, and some reviews 6-8 addressing the word of IAD. The aim of this paper is to give a preferably brief overview of research on IAD and theoretical considerations from a practical perspective based on years of daily work with clients suffering from internet addiction. Furthermore, with this paper we intend to bring in practical experience in the debate about the eventual inclusion of IAD in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Keywords Addiction, Computer, net, reSTART, Treatmen t.INTRODUCTIONThe idea that problematic computer give meets criteria for an addiction, and therefore should be included in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th ed. text edition Revision 9 was first proposed by Kimberly Young, PhD in her seminal 1996 paper 10. Sincethat succession IAD has been extensively studied and is indeed, surrenderly under consideration for inclusion in the DSM-V 11. Meanwhile, both China and South Korea have identified net profit addiction as a signifi enkindlet public health threat and both countries support education, research and treatment 12. In the United States, disdain a growing body of research, and treatment for the unhealthiness uncommitted in out-patient and in-patient settings, there has been no formal governmental response to the issue of meshwork addiction. While the debate goes on about whether or non the DSM-V should designate net income addiction a mental disorder 12-14 the gre at unwashed electric currently suffering from Internet addiction are seeking treatment. Because of our experience we support the phylogenesis of uniform diagnostic criteria and the inclusion of IAD in the DSM-V 11 in order to advance public education, diagnosis and treatment of this important disorder.CLASSIFICATIONThere is ongoing debate about how best to classify the behavior which is characterized by many hours spent in non-work engine room-related computer/Internet/ television system game activities 15. It is accompanied by changes in mood, preoccupation with the Internet and digital media, the inability to control the nitty-gritty of while spent interfacing with digital applied science, the regard for more time or a new game to achieve a desired mood, backdown symptoms when not engaged, and a continuation of the behavior despite family conflict, a diminishing social life and ominous work or academic consequences 2, 16, 17. Some researchers and mental health practitioner s see excessive Internet use as a symptom of an another(prenominal) disorder much(prenominal) as anxiety or falling off rather than a separate entity e.g. 18.Internet addiction could be considered an Impulse control disorder (not other than specified). Yet there is a growing consensus that this constellation of symptoms is an addiction e.g. 19. The Ameri give the sack Society of Addiction euphony (ASAM) recently released a new definition of addiction as a chronic headway disorder, formally proposing for the first time that addiction is not limited to substance use 20. All addictions, whether chemical or behavioral, share certain indications including salience, compulsive use (loss of control), mood modification and the alleviation of distress, tolerance and withdrawal, and the continuation despite negative consequences.DIAGNOSTIC CRITERIA FOR IADThe first serious proposal for diagnostic criteria was advanced in 1996 by Dr. Young, modifying the DSM-IV criteria for pathologic ga mbling 10. Since then variations in both name and criteria have been put forward to capture the problem, which is at once more or less popularly known as Internet Addiction Disorder. Problematic Internet Use (PIU) 21, computer addiction, Internet dependence 22, compulsive Internet use, pathologic Internet use 23, and many other labels can be pitch in the literature. Likewise a variety of often overlapping criteria have been proposed and studied, some of which have been validated. However, empirical studies provide an inconsistent set of criteria to define Internet addiction 24. For an overview see Byun et al. 25. whiskers 2 recommends that the adjacent five diagnostic criteria are required for a diagnosis of Internet addiction (1) Is absent-minded with the Internet (thinks about previous online activity or anticipate next online session) (2) Needs to use the Internet with increased unions of time in order to achieve satisfaction (3) Has made unsuccessful efforts to control, c ut back, or stop Internet use (4) Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use (5) Has stayed online longer than originally intended.Additionally, at least one of the following must be present (6) Has jeopardized or risked the loss of a significant relationship, job, educational or kicker opportunity because of the Internet (7) Has be to family members, therapist, or others to conceal the extent of involvement with the Internet (8) Uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) 2. There has been alike been a variety of assessment tools employ in evaluation. Youngs Internet Addiction Test 16, the Problematic Internet Use Questionnaire (PIUQ) developed by Demetrovics, Szeredi, and Pozsa 26 and the Compulsive Internet Use Scale (CIUS) 27 are all examples of instruments to assess for this disorder.PREVALENCEThe considerable var. of the prevalence rates reported for IAD (between 0.3% and 38%) 28 may be attributable to the fact that diagnostic criteria and assessment questionnaires use for diagnosis vary between countries and studies often use highly selective samples of online surveys 7. In theirreview Weinstein and Lejoyeux 1 report that surveys in the United States and Europe have indicated prevalence rates varying between 1.5% and 8.2%. separate reports place the rates between 6% and 18.5% 29. Some obvious differences with respect to the methodologies, cultural factors, outcomes and assessment tools forming the understructure for these prevalence rates notwithstanding, the rates we encountered were commonplacely high and sometimes alarming. 24ETIOLOGYThere are diametrical models available for the development and maintenance of IAD like the cognitive-behavioral model of problematic Internet use 21, the anonymity, convenience and hunt down (ACE) model 30, the access, affordability, anonymity (Triple-A) engin e 31, a phases model of pathological Internet use by Grohol 32, and a comprehensive model of the development and maintenance of Internet addiction by Winkler & Drsing 24, which takes into account socio-cultural factors (e.g., demographic factors, access to and acceptance of the Internet), biological vulnerabilities (e.g., genetic factors, abnormalities in neurochemical processes), psychological predispositions (e.g., personality characteristics, negative affects), and specific attributes of the Internet to explain excessive troth in Internet activities 24.NEUROBIOLOGICAL VULNERABILITIESIt is known that addictions activate a gang of sites in the brain associated with pleasure, known together as the reward center or pleasure channel of the brain 33, 34. When activated, dopamine release is increased, along with opiates and other neurochemicals. Over time, the associated receptors may be affected, producing tolerance or the need for increasing stimulation of the reward center to prod uce a high and the subsequent characteristic behavior patterns needed to avoid withdrawal. Internet use may also lead specifically to dopamine release in the nucleus accumbens 35, 36, one of the reward structures of the brain specifically involved in other addictions 20. An example of the honour nature of digital technology use may be captured in the following statement by a 21 year-old male in treatment for IAD I feel technology has brought so much joy into my life. No other activity relaxes me or stimulates me like technology. However, when depression hits, I tend to use technology as a wayof retreating and isolating.REINFORCEMENT/REWARDWhat is so rewarding about Internet and video game use that it could become an addiction? The surmisal is that digital technology users experience multiple layers of reward when they use various computer applications. The Internet functions on a uncertain ratio reinforcement schedule (VRRS), as does gambling 29. Whatever the application (general surfing, pornography, chat rooms, message boards, social networking sites, video games, email, texting, cloud applications and games, etc.), these activities support unpredictable and variable reward structures. The reward experienced is intensified when unite with mood enhancing/stimulating content. Examples of this would be pornography (sexual stimulation), video games (e.g. various social rewards, identification with a hero, immersive graphics), go out sites (romantic fantasy), online poker (financial) and special interest chat rooms or message boards (sense of belonging) 29, 37.BIOLOGICAL PREDISPOSITIONThere is increasing evidence that there can be a genetic predisposition to addictive behaviors 38, 39. The theory is that individuals with this predisposition do not have an adequate number of dopamine receptors or have an meagre amount of serotonin/dopamine 2, thereby having difficulty experiencing normal levels of pleasure in activities that most people would find rewarding. To increase pleasure, these individuals are more likely to seek greater than average engagement in behaviors that stimulate an increase in dopamine, trenchantly giving them more reward but placing them at high risk for addiction.MENTAL HEALTH VULNERABILITIESMany researchers and clinicians have noted that a variety of mental disorders concur with IAD. There is debate about which came first, the addiction or the co-occurring disorder 18, 40. The story by Dong et al. 40 had at least the potential to clarify this question, reporting that higher scores for depression, anxiety, hostility, interpersonal sensitivity, and psychoticism were consequences of IAD. But imputable to the limitations of the resume further research is necessary.THE TREATMENT OF INTERNET ADDICTIONThere is a general consensus that total abstemiousness from the Internet should not be the goal of the interventions and that instead, an abstinence from problematic applications and a controlled and balanced Internet c ustom should be achieved 6. The following paragraphs illustrate the various treatment options for IAD that exist today. Unless studies examining the efficacy of the illustrated treatments are not available, findings on the efficacy of the presented treatments are also provided. Unfortunately, most of the treatment studies were of low methodological quality and used an intra- base design. The general lack of treatment studies notwithstanding, there are treatment guidelines reported by clinicians working in the line of business of IAD. In her book Internet Addiction Symptoms, Evaluation, and Treatment, Young 41 offers some treatment strategies which are already known from the cognitive-behavioral rise (a) practice opposite time of Internet use (discover patients patterns of Internet use and disrupt these patterns by offering new schedules), (b) use external stoppers (real events or activities prompting the patient to log off), (c) set goals (with regard to the amount of time), (d) abstain from a particular application (that the client is unable to control), (e) use reminder cards (cues that remind the patient of the costs of IAD and benefits of breaking it), (f) develop a personal muniment (shows all the activities that the patient used to engage in or cant find the time due to IAD), (g) enter a support congregation (compensates for a lack of social support), and (h) engage in family therapy (addresses relational problems in the family) 41. Unfortunately, clinical evidence for the efficacy of these strategies is not mentioned.Non-psychological ApproachesSome authors examine pharmacological interventions for IAD, perchance due to the fact that clinicians use psychopharmacology to treat IAD despite the lack of treatment studies addressing the efficacy of pharmacological treatments. In particular, selective serotonin-reuptake inhibitors (SSRIs) have been used because of the co-morbid psychiatric symptoms of IAD (e.g. depression and anxiety) for which SSRIs ha ve been found to be effective 42-46. Escitalopram (a SSRI) was used by DellOsso et al. 47 to treat 14 subjects with impulsive-compulsive Internet usage disorder. Internet usage returnd importantly from a mean of 36.8 hours/week to a baseline of 16.5 hours/week. In another theater Han, Hwang, and Renshaw 48 used bupropion (a non-tricyclic antidepressant) and found a decrease of craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex afterwards a sestet week period of bupropion sustained release treatment. Methylphenidate (a psycho stimulant medicate) was used by Han et al. 49 to treat 62 Internet video game-playing children diagnosed with attention-deficit hyperactivity disorder.After eight weeks of treatment, the YIAS-K scores and Internet usage times were significantly reduced and the authors cautiously refer that methylphenidate might be evaluated as a potential treatment of IAD. According to a study by Sh apira et al. 50, mood stabilizers might also remedy the symptoms of IAD. In addition to these studies, there are some case reports of patients treated with escitalopram 45, citalopram (SSRI)- quetiapine (antipsychotic) crew 43 and naltrexone (an opioid receptor antagonist) 51. A few authors mentioned that physical exercise could compensate the decrease of the dopamine level due to reduced online usage 52. In addition, sports exercise prescriptions used in the course of cognitive behavioral group therapy may enhance the effect of the intervention for IAD 53.Psychological ApproachesMotivational interviewing (MI) is a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalency 54. It was developed to help individuals give up addictive behaviors and learn new behavioral skills, using techniques much(prenominal) as open-ended questions, reflective listening, affirmation, and summarization to help individuals express their concerns about change 55. Unfortunately, there are currently no studies addressing the efficacy of MI in treating IAD, but MI seems to be moderately effective in the areas of alcohol, drug addiction, and diet/exercise problems 56. Peukert et al. 7 suggest that interventions with family members or other relatives like Community reinforcement and Family Training 57 could be useful in enhancing the motivation of an addict to cut back on Internet use, although the reviewers remark that control studies with relatives do not exist to date. Reality therapy (RT) is supposed to encourage individuals to choose to improve theirlives by committing to change their behavior. It includes sessions to show clients that addiction is a choice and to give them teach in time management it also introduces alternative activities to the problematic behavior 58.According to Kim 58, RT is a core addiction convalescence tool that offers a wide variety of uses as a treatment for addictive disorders su ch as drugs, sex, food, and works as closely for the Internet. In his RT group counseling chopine treatment study, Kim 59 found that the treatment program effectively reduced addiction level and improved self-esteem of 25 Internet-addicted university students in Korea. Twohig and Crosby 60 used an Acceptance & lading Therapy (ACT) protocol including several exercises adjusted to better fit the issues with which the sample struggles to treat six adult males suffering from problematic Internet pornography viewing. The treatment resulted in an 85% reduction in viewing at post-treatment with results being maintained at the three month follow-up (83% reduction in viewing pornography). Widyanto and Griffith 8 report that most of the treatments employed so far had utilized a cognitive-behavioral approach. The case for using cognitive-behavioral therapy (CBT) is justified due to the good results in the treatment of other behavioral addictions/impulse-control disorders, such as pathologic al gambling, compulsive shopping, bulimia nervosa, and binge eating-disorders 61.Wlfling 5 described a predominantly behavioral group treatment including identification of sustaining conditions, establishing of intrinsic motivation to reduce the amount of time being online, learning alternative behaviors, engagement in new social real-life contacts, psycho-education and exposure therapy, but unfortunately clinical evidence for the efficacy of these strategies is not mentioned. In her study, Young 62 used CBT to treat 114 clients suffering from IAD and found that participants were better able to manage their presenting problems post-treatment, show improved motivation to stop abusing the Internet, improved ability to control their computer use, improved ability to function in offline relationships, improved ability to abstain from sexually explicit online material, improved ability to engage in offline activities, and improved ability to achieve sobriety from problematic application s. Cao, Su and Gao 63 investigated the effect of group CBT on 29 sum school students with IAD and found that IAD scores of the experimental group were note than of the control groupafter treatment.The authors also reported improvement in psychological function. Thirty-eight adolescents with IAD were treated with CBT designed particularly for addicted adolescents by Li and Dai 64. They found that CBT has good effects on the adolescents with IAD (CIAS scores in the therapy group were significant lower than that in the control group). In the experimental group the scores of depression, anxiety, compulsiveness, self-blame, illusion, and retreat were significantly decreased after treatment. Zhu, Jin, and Zhong 65 compared CBT and electro acupuncture (EA) plus CBT assigning forty-seven patients with IAD to one of the two groups respectively. The authors found that CBT alone or feature with EA can significantly reduce the score of IAD and anxiety on a self-rating scale and improve self -aware health status in patients with IAD, but the effect obtained by the combined therapy was better.Multimodal TreatmentsA multimodal treatment approach is characterized by the implementation of several different types of treatment in some cases even from different disciplines such as pharmacology, psychotherapy and family counseling simultaneously or sequentially. Orzack and Orzack 66 mentioned that treatments for IAD need to be multidisciplinary including CBT, psychotropic medication, family therapy, and case managers, because of the complexness of these patients problems. In their treatment study, Du, Jiang, and Vance 67 found that multimodal school-based group CBT (including parent training, teacher education, and group CBT) was effective for adolescents with IAD (n = 23), particularly in improving emotional state and regulation ability, behavioral and self-management style. The effect of another multimodal intervention consisting of solution-focused brief therapy (SFBT), fami ly therapy, and CT was investigated among 52 adolescents with IAD in China. After three months of treatment, the scores on an IAD scale (IAD-DQ), the scores on the SCL-90, and the amount of time spent online decreased significantly 68.Orzack et al. 69 used a psychoeducational program, which combines psychodynamic and cognitive-behavioral theoretical perspectives, using a combination of Readiness to Change (RtC), CBT and MI interventions to treat a group of 35 men involved in problematic Internet-enabled sexual behavior (IESB). In this group treatment, the quality of life increased and the level of depressive symptoms decreasedafter 16 (weekly) treatment sessions, but the level of problematic Internet use failed to decrease significantly 69. Internet addiction related symptom scores significantly decreased after a group of 23 middle school students with IAD were treated with Behavioral Therapy (BT) or CT, detoxification treatment, psychosocial rehabilitation, personality modeling and parent training 70.Therefore, the authors concluded that psychotherapy, in particular CT and BT were effective in treating middle school students with IAD. Shek, Tang, and Lo 71 described a multi-level counseling program designed for young people with IAD based on the responses of 59 clients. Findings of this study suggest this multi-level counseling program (including counseling, MI, family perspective, case work and group work) is promising to help young people with IAD. Internet addiction symptom scores significantly decreased, but the program failed to increase psychological well-being significantly. A six-week group counseling program (including CBT, social competence training, training of self-control strategies and training of communication skills) was shown to be effective on 24 Internet-addicted college students in China 72. The authors reported that the adapted CIAS-R scores of the experimental group were significantly lower than those of the control group post-treatment. The reSTART ProgramThe authors of this article are currently, or have been, affiliated with the reSTART Internet Addiction Recovery Program 73 in Fall City, Washington. The reSTART program is an inpatient Internet addiction recovery program which integrates technology detoxification (no technology for 45 to 90 days), drug and alcohol treatment, 12 step work, cognitive behavioral therapy (CBT), experiential adventure based therapy, Acceptance and Commitment therapy (ACT), brain enhancing interventions, animal assisted therapy, motivational interviewing (MI), mindfulness based relapse prevention (MBRP), Mindfulness based stress reduction (MBSR), interpersonal group psychotherapy, individual psychotherapy, individualized treatments for co-occurring disorders, psycho- educational groups (life visioning, addiction education, communication and assertiveness training, social skills, life skills, Life balance plan), aftercare treatments (monitoring of technology use, ongoing psychotherapy a nd group work), and go on care (outpatient treatment) in an individualized, holistic approach.The firstresults from an ongoing OQ45.2 74 study (a self-reported measurement of subjective discomfort, interpersonal relationships and social image performance assessed on a weekly basis) of the short-term impact on 19 adults who complete the 45+ days program showed an improved score after treatment. Seventy-four percent of participants showed significant clinical improvement, 21% of participants showed no reliable change, and 5% deteriorated. The results have to be regarded as preliminary due to the small study sample, the self-report measurement and the lack of a control group. Despite these limitations, there is evidence that the program is responsible for most of the improvements demonstrated.CONCLUSIONAs can be seen from this brief review, the field of Internet addiction is advancing rapidly even without its official recognition as a separate and distinct behavioral addiction and w ith continuing disagreement over diagnostic criteria. The ongoing debate whether IAD should be classified as an (behavioral) addiction, an impulse-control disorder or even an obsessive compulsive disorder cannot be satisfactorily resolved in this paper. But the symptoms we discover in clinical practice show a great deal of overlap with the symptoms commonly associated with (behavioral) addictions. as well it remains unclear to this day whether the underlying mechanisms responsible for the addictive behavior are the same in different types of IAD (e.g., online sexual addiction, online gaming, and excessive surfing).From our practical perspective the different shapes of IAD fit in one category, due to various Internet specific commonalities (e.g., anonymity, riskless interaction), commonalities in the underlying behavior (e.g., avoidance, fear, pleasure, entertainment) and overlapping symptoms (e.g., the increased amount of time spent online, preoccupation and other signs of addicti on). Nevertheless more research has to be done to get our clinical impression. Despite several methodological limitations, the strength of this work in comparison to other reviews in the international body of literature addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD 2-5, and to reviews 6-8 addressing the treatment of IAD, is that it connects theoretical considerations with the clinical practice of interdisciplinary mental health experts working for years in the field of Internet addiction.Furthermore, the current work gives a goodoverview of the current state of research in the field of internet addiction treatment. Despite the limitations stated above this work gives a brief overview of the current state of research on IAD from a practical perspective and can therefore be seen as an important and helpful paper for further research as well as for clinical practice in particular.