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Is “Internet addiction” a distinct mental disorder?

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For a decade, mental health clinicians and researchers have been arguing the merits of defining a new mental disorder, what some would call “Internet addiction.” This tag refers to a recognizable phenomenon, but addiction researchers dispute the value of the label. Skeptical experts advocate caution about establishing any new diagnostic category, especially when the body of literature is small and limited to anecdotal reports and surveys, as it is in this case. Also, criteria for identifying a problem have not been rigorously validated. One obstacle to establishing a valid diagnostic construct is that many behaviors are channeled through the Internet—gambling and gaming, talk, and sex, to name a few popular ones. And the presence of other mental disorders among potential addicts is the rule rather than the exception. Disorders of mood, anxiety, impulse control, attention, and personality are common. For all these reasons, it is difficult to call “Internet addiction” a unified disorder. The Internet has become a fact of life in the 10 years since people began to worry about becoming addicted to it. As with cell phones or electricity, many of us have come to depend on this new technology. Frequently, high Internet use is a sign—not of addiction—but of being deeply engaged at work or having fun. One may therefore ask whether the Internet itself is “addictive,” or whether the activities and information the Internet makes so readily available to users are addictive. Probably it is the latter. The Internet is the equivalent of an electronic needle: a potent and efficient delivery system that provides ready access to a wide range of rewards and pleasures. Shopping, gambling and pornography can be infused directly and in high doses from the Internet, anywhere and any time. While some may view this as a stretch, Dr. Howard Shaffer, an addictions specialist at Harvard Medical School, has suggested that we move away from the idea that addiction is a property of a particular drug or activity.

By mail Dr. Michael Miller Harvard Mental Health Letter 10 Shattuck St., 2nd Floor Boston, MA 02115

HARVARD MENTAL HEALTH LETTER

All pleasing activities tend to activate the same reward circuits in the brain. Substance-related and impulse-control disorders share elements of craving, loss of control, and painful consequences. Thus, the various categories of dependency or excessive behavior are more alike than different. No matter what we call it, any activity that pulls a person away from important relationships and work responsibilities can cause conflict, distress, and loss. People who describe themselves as “addicted” to the Internet report that they lose sleep because they can’t log off. Some experience a distortion of time. They can run into financial difficulty, relationship problems, academic failure, or job losses. As elsewhere with human behavior, however, there is a blurry boundary between pleasures and problems, or adaptive and maladaptive behaviors. People who chat online may be making social connections or finding personal support that would be otherwise unavailable to them. What looks like wasting time online may turn out to be learning and mastering skills that can be applied productively elsewhere. A person may be avoiding a higher-risk behavior (cruising for sex) by substituting one that carries less risk (viewing pornography). A new diagnostic label is no substitute for a comprehensive evaluation followed by treatment of underlying mental disorders. Clinicians need no newer a technique than to encourage a person to reflect seriously on how Internet use functions in his or her life. The Internet may be a new pipeline for delivering rewarding experiences, but—until we know more—it is probably not helpful to invent new terms to describe problems that are as old as human nature.

Michael Craig Miller, M.D. Editor in Chief

By e-mail mental _ [email protected] (please write “Ask the Doctor” in the subject line)

www.health.harvard.edu

Because of the volume of correspondence we receive, we can’t answer every letter or message, nor can we provide personal medical advice.

OCTOBER 2007