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Internet addiction disorder

Internet addiction disorder (IAD), also known as problematic Internet use or pathological Internet use, is excessive Internet use that interferes with daily life. Addiction, defined by Webster Dictionary as a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal", was traditionally used to depict a person's dependence on the substance. More recently, the concept has been applied to behavioral dependence[1] including internet use.[2] The problem of Internet addiction evolves together with the development and spread of the Internet. As adolescents (12–17 years) and emerging adults (18–29 years) access the Internet more than any other age groups and undertake a higher risk of overuse of the Internet, the problem of Internet addiction disorder is most relevant to young people.[3]

Internet addiction disorder
Living in a black hole..JPG
Internet addiction might be a subset of broader forms of addiction to technology.
SpecialtyPsychiatry

Excessive use of the Internet has been found by various studies to disrupt individuals' time use and have a series of health consequences. But the existence of Internet addiction as a mental disorder is not yet well recognized. The current version of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) noted that Internet gaming disorder (one type of IAD) is a condition that requires more research in order to be considered as a full disorder in 2013.[4]

Contents

PresentationEdit

ComplicationsEdit

Health consequencesEdit

Mental health consequences

A longitudinal study of Chinese high school students (2010) suggests that individuals with moderate to severe risk of Internet addiction are 2.5 times more likely to develop depressive symptoms than their IA-free counterparts.[5]

Brain function consequences

Using an age- and gender-matched Chinese adolescent sample, Yan Zhou and associates (2009) demonstrate that IA adolescents have a lower gray matter density in the "left anterior cingulate cortex, left posterior cingulate cortex, left insula, and left lingual gyrus" than adolescents in the control group, indicating the presence of brain structural changes in Internet addicts.[6]

Similar results have been confirmed by CB Weng and colleagues (2011) with a group of 17-year-olds who were diagnosed online game addiction (OGA) and another group without addiction. In their study, adolescents who were addicted had "lower gray matter volume in left orbitofrontal cortex, left medial prefrontal cortex, bilateral insula, left posterior cingulate cortex, and left supplementary motor area.[7]

Social consequencesEdit

The best-documented evidence of Internet addiction so far is time-disruption, which subsequently results in interference with regular social life, including academic, professional performance and daily routines.[8] Some studies also reveal that IA can lead to disruption of social relationships in Europe and Taiwan.[9][10] It is, however, also noted by others that IA is beneficial for peer relations in Taiwan.[11]

Dr. Keith W. Beard (2005) articulates that "an individual is addicted when an individual’s psychological state, which includes both mental and emotional states, as well as their scholastic, occupational and social interactions, is impaired by the overuse of [Internet]".[12]

As a result of its complex nature, some scholars do not provide a definition of Internet addiction disorder and throughout time, different terms are used to describe the same phenomenon of excessive Internet use.[13] Internet addiction disorder is used interchangeably with problematic Internet use, pathological Internet use, and Internet addictive disorder. In some cases, this behavior is also referred to as Internet overuse, problematic computer use, compulsive Internet use, Internet abuse, harmful use of the Internet, and Internet dependency.

Physical Symptoms

Physical Symptoms include a weakened immune system due to lack of sleep. Loss of exercise, increased risk for Carpel Tunnel Syndrome and eye and back strain.[14]

Withdrawal

Symptoms of withdrawal might include agitation, depression, anger and anxiety when the person is away from technology. These psychological symptoms might even turn into physical symptoms such as rapid heartbeat, tense shoulders and shortness of breath.[15]

Related disordersEdit

 
People using their smartphones.

Online gambling addictionEdit

According to David Hodgins, a professor of psychology at the University of Calgary, online gambling is considered to be as serious as pathological gambling. It is known as an "isolated disorder" which means that those who have a gambling problem prefer to separate themselves from interruptions and distractions. Because gambling is available online, it increases the opportunity for problem gamblers to indulge in gambling without social influences swaying their decisions. This is why this disorder has become more a problem at this date in time and is why it is so difficult to overcome. The opportunity to gamble online is almost always available in this century opposed to only having the opportunity in a public forum at casinos for example. Online gambling has become quite popular especially with today's adolescents. Today's youth has a greater knowledge of modern software and search engines along with a greater need for extra money. So not only is it easier for them to find opportunities to gamble over any subject, but the incentive to be granted this money is desperately desired.

Online gaming addiction (Internet gaming disorder)Edit

Video game addiction is a known issue around the world. Incidence and severity grew in the 2000s, with the advent of broadband technology, games allowing for the creation of avatars, 'second life' games, and MMORPGs (massive multiplayer online role playing games). World of Warcraft has the largest MMORPG community on-line and there have been a number of studies about the addictive qualities of the game. Addicts of the game range from children to mature adults. A well-known example is Ryan van Cleave, a university professor whose life declined as he became involved in online gaming.[16] Andrew Doan, MD, PhD, a physician with a research background in neuroscience, battled his own addictions with video games, investing over 20,000 hours of playing games over a period of nine years.[17]

Online gaming addiction may be considered in terms of B.F. Skinner's theory of operant conditioning, which claims that the frequency of a given behaviour is directly linked to rewarding and punishment of that behavior. If a behaviour is rewarded, it is more likely to be repeated. If it is punished, it becomes suppressed.[18]

Orzack, a clinical psychologist at McLean Hospital in Massachusetts claims that 40 percent of World of Warcraft (WoW) players are addicted. Orzack says that the best way to optimize the desired behaviour in the subject is to provide rewards for correct behaviour, and then adjust the number of times the subject is required to exhibit that behaviour before a reward is provided. For instance, if a rat must press a bar to receive food, then it will press faster and more often if it doesn't know how many times it needs to press the bar. An equivalent in World of Warcraft would be purple (epic) loot drops.[19] Players in World of Warcraft will often spend weeks hunting for a special item which is based on a chance system, sometimes with only a 0.01% chance of it being dropped by a slain monster. The rarity of the item and difficulty of acquiring the item gives the player a status amongst their peers once they obtain the item.

Online Gamers Anonymous, an American non-profit organization formed in 2002, is a twelve-step, self-help, support and recovery organization for gamers and their loved ones who are suffering from the adverse effects of addictive computer gaming. It offers resources such as discussion forums, online chat meetings, Skype meetings and links to other resources.[20] Internet and Technology Addicts Anonymous (ITAA) founded in 2009, is a 12-step program supporting users coping with digital distractions.

Jim Rossignol, a finance journalist who reports on Internet gaming has described how he overcame his own addiction, and channeled his compulsion into a desirable direction as a reporter of Internet gaming and gaming culture.[21]

Communication addiction disorder (compulsive talking)Edit

Communication addiction disorder (CAD) is a supposed behavioral disorder related to the necessity of being in constant communication with other people, even when there is no practical necessity for such communication. CAD had been linked to Internet addiction.[22] Users become addicted to the social elements of the Internet, such as Facebook and YouTube. Users become addicted to one-on-one or group communication in the form of social support, relationships and entertainment. However interference with these activities can result in conflict and guilt. This kind of addiction is called social network addiction.

Social network addiction is a dependence of people by connection, updating and control of their and their friends social network page.[23] The correlation between the social network use and a decreasing of offline social relationships is a complex issue, depending not only from the time spent on them but also from the motivation in using them.[24] For some people in fact, the only important thing is to have a lot of friends in the network regardless if they are offline or only virtual; this is particularly true for teenagers as a reinforcement of egos.[25][26] Sometimes teenagers use social networks to show their idealized image to the others.[27] They generally start using social networks to improve face-to-face relationships. However, some of them use these tools as a showcase creating an idealized image to be accepted by groups and to reach a big number of friends. They spend a reduced time for face-to-face relationships, passing instead at least six hours per day on social networks.[24] However, other studies claim that people are using social networks to communicate their real personality and not to promote their idealized identity.[28]

Virtual reality addictionEdit

Virtual reality addiction is an addiction to the use of virtual reality or virtual, immersive environments. Currently, interactive virtual media (such as social networks) are referred to as virtual reality,[29] whereas future virtual reality refers to computer-simulated, immersive environments or worlds. Experts warn about the dangers of virtual reality, and compare the use of virtual reality (both in its current and future form) to the use of drugs, bringing with these comparisons the concern that, like drugs, users could possibly become addicted to virtual reality.[citation needed]

Risk factorsEdit

 
Video game and Internet addiction.

Social factorsEdit

Interpersonal difficulties

It is argued that interpersonal difficulties such as introversion, social problems,[30] and poor face-to-face communication skills,[31] often lead to internet addiction. Internet-based relationships offer a safe alternative for people with aforementioned difficulties to escape from the potential rejections and anxieties of interpersonal real-life contact.[32]

A lack of social support

Individuals who lack sufficient social connection and social support are found to run a higher risk of Internet addiction. They resort to virtual relationships and support to alleviate their loneliness.[33][34] As a matter of fact, the most prevalent applications among Internet addicts are chat rooms, interactive games, instant messaging, or social media.[32] Some empirical studies reveal that conflict between parents and children and not living with mother significantly associated with IA after one year.[35] Protective factors such as quality communication between parents and children[36] and positive youth development[37] are demonstrated, in turn, to reduce the risk of IA.

Psychological factorsEdit

Prior addictive or psychiatric history are found to influence the likelihood of being addicted to the Internet.[35][38] Some individuals with prior psychiatric problems such as depression and anxiety turn to compulsive behaviors to avoid the unpleasant emotions and situation of their psychiatric problems and regard being addicted to the Internet a safer alternative to substance addictive tendency. But it is generally unclear from existing research which is the cause and which is the effect partially due to the fact that comorbidity is common among Internet addicts.

The most common co-morbidities that have been linked to IAD are major depression and Attention Deficit Disorder (ADHD). The rate of ADHD and IAD associating is as high as 51.6%.[39]

Internet addicts with no previous significant addictive or psychiatric history are argued to develop an addiction to the some of the features of Internet use: anonymity, easy accessibility, and its interactive nature.[32]

Biological factorsEdit

Most recent research has focused on the biological causes of Internet addiction. For a systematic review of the kind, please refer to the 2017 Springer book edited by Christian Montag and Martin Reuter: Internet Addiction: Neuroscientific Approaches and Therapeutical Implications Including Smartphone Addiction (3nd edition).

Other factorsEdit

Parental educational level, age at first use of the Internet, and the frequency of using social networking sites and gaming sites are found to be positively associated with excessive Internet use among adolescents in some European countries, as well as in the USA.[9][40]

DiagnosisEdit

Diagnosis of Internet addiction disorder is empirically difficult. Various screening instruments have been employed to detect Internet addiction disorder. Current diagnoses are faced with multiple obstacles.

DifficultiesEdit

Given the newness of the Internet and the inconsistent definition of Internet addiction disorder, practical diagnosis is far from clearcut. With the first research initiated by Kimberly S. Young in 1996, the scientific study of Internet addiction has merely existed for 20 years.[41] A few obstacles are present in creating an applicable diagnostic method for Internet addiction disorder.

  • Wide and extensive use of the Internet: Diagnosing Internet addiction is often more complex than substance addiction as internet use has largely evolved into be an integral or necessary part of human lives. The addictive or problematic use of the internet is thus easily masked or justified.[32] Also, the Internet is largely a pro-social, interactive, and information-driven medium, while other established addiction behaviors such as gambling are often seen as a single, anti-social behavior that has very little socially redeeming value. Many so-called Internet addicts do not suffer from the same damage to health and relationships that are common to established addictions.[42]
  • High comorbidity: Internet addiction is often accompanied by other psychiatric disorders such as personality disorder and mental retardation.[32][43][44][45][46] It is found that Internet addiction is accompanied by other DSM-IV diagnosis 86% of the time.[47] In one study conducted in South Korea, 30% of the identified Internet addicts have accompanying symptoms such as anxiety or depression and another 30% have a second disorder such as attention deficit hyperactivity disorder (ADHD).[48] Another study in South Korea found an average of 1.5 other diagnoses among adolescent internet addicts.[47] Further, it is noted in the United States that many patients only resort to medical help when experiencing difficulties they attribute to other disorders.[32][47] For many individuals, overuse or inappropriate use of the Internet is a manifestation of their depression, social anxiety disorders, impulse control disorders, or pathological gambling.[49] It generally remains unclear from existing literature whether other psychiatric disorders is the cause or manifest of Internet addiction.

Despite the advocacy of categorizing Internet addiction as an established illness,[47][50] neither DSM-IV (1995) nor DSM-V (2013) considers Internet addiction as a mental disorder.[51] It is worth noting, though, a subcategory of IAD, Internet gaming disorder is listed in DSM-V as a condition that requires more research in order to be considered as a full disorder in May 2013.[4][51][52] The WHO's draft 11th Revision of the International Classification of Diseases (ICD-11) scheduled for publication in 2018 also include gaming disorder.[53] There is still considerable controversy over whether IAD should be included in the DSM-V and recognized as a mental disease in general.[54]

Screening instrumentsEdit

DSM-based instruments

Most of the criteria utilized by research are adaptations of listed mental disorders (e.g., pathological gambling) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) handbook.[13]

Dr. Ivan K. Goldberg, who first broached the concept of Internet addiction, adopted a few criteria for IAD on the basis of DSM-IV, including “hoping to increase time on the network” and “dreaming about the network.”[13] By adapting the DSM-IV criteria for pathological gambling, Dr. Kimberly S. Young (1998) proposed one of the first integrated sets of criteria, Diagnostic Questionnaire (YDQ), to detect Internet addiction. A person who fulfills any five of the eight adapted criteria would be regarded as Internet addicted:[2][55][56]

  1. Preoccupation with the Internet;
  2. A need for increased time spent online to achieve the same amount of satisfaction;
  3. Repeated efforts to curtail Internet use;
  4. Irritability, depression, or mood lability when Internet use is limited;
  5. Staying online longer than anticipated;
  6. Putting a job or relationship in jeopardy to use the Internet;
  7. Lying to others about how much time is spent online; and
  8. Using the Internet as a means of regulating mood.

While Young's YDQ assessment for IA has the advantage of simplicity and ease of use, Keith W. Beard and Eve M. Wolf (2001) further asserted that all of the first five (in the order above) and at least one of the final three criteria (in the order above) be met to delineate Internet addiction in order for a more appropriate and objective assessment.[57]

Young further extended her 8-question YDQ assessment to the now most widely used Internet Addiction Test (IAT),[2][58][59] which consists of 20 items with each on a 5-point Likert scale. Questions included on the IAT expand upon Young's earlier 8-question assessment in greater detail and include questions such as "Do you become defensive or secretive when anyone asks you what you do online?" and "Do you find yourself anticipating when you go online again?". A complete list of questions can be found in Dr. Kimberly S. Young's 1998 book Caught in the Net: How to Recognize the Signs of Internet Addiction and A Winning Strategy for Recovery and Drs. Laura Widyanto and Mary McMurran's 2004 article titled The Psychometric Properties of the Internet Addiction Test. The Test score ranges from 20 to 100 and a higher value indicates a more problematic use of the Internet:

  • 20–39 = average Internet users,
  • 40–69 = potentially problematic Internet users, and
  • 70–100 = problematic Internet users.

Over time, a considerable number of screening instruments have been developed to diagnose Internet addiction, including the Internet Addiction Test (IAT),[2] the Internet-Related Addictive Behavior Inventory (IRABI),[60] the Chinese Internet Addiction Inventory (CIAI),[61] the Korean Internet Addiction Self-Assessment Scale (KS Scale),[62] the Compulsive Internet Use Scale (CIUS),[63] the Generalized Problematic Internet Use Scale (GPIUS),[64] the Internet Consequences Scale (ICONS),[65] and the Problematic Internet Use Scale (PIUS).[66] Among others, the Internet Addiction Test (IAT) by Young (1998) exhibits good internal reliability and validity and has been used and validated worldwide as a screening instrument.[67][68][69]

Although the various screening methods are developed from diverse contexts, four dimensions manifest themselves across all instruments:[47][70]

  • Excessive use: compulsive Internet use and excessive online time-use;
  • Withdrawal symptoms: withdrawal symptoms including feelings such as depression and anger, given restricted Internet use;
  • Tolerance: the need for better equipment, increased internet use, and more applications/software;
  • Negative repercussions: Internet use caused negative consequences in various aspects, including problematic performance in social, academic, or work domains.

More recently, researchers Mark D. Griffiths (2000) and Dr. Jason C. Northrup and colleagues (2015) claim that Internet per se is simply the medium and that the people are in effect addicted to processes facilitated by the Internet.[70][71] Based on Young's Internet Addiction Test (IAT),[2] Northrup and associates further decompose the internet addiction measure into four addictive processes: Online video game playing, online social networking, online sexual activity, and web surfing.[70] The Internet Process Addiction Test (IPAT)[70] is created to measure the processes to which individuals are addicted.

Screening methods that heavily rely on DSM criteria have been accused of lacking consensus by some studies, finding that screening results generated from prior measures rooted in DSM criteria are inconsistent with each other.[10] As a consequence of studies being conducted in divergent contexts, studies constantly modify scales for their own purposes, thereby imposing a further challenge to the standardization in assessing Internet addiction disorder.[13]

Single-question instruments

Some scholars and practitioners also attempt to define Internet addiction by a single question, typically the time-use of the Internet.[48][72] The extent to which Internet use can cause negative health consequences is, however, not clear from such a measure.[13] The latter of which is critical to whether IAD should be defined as a mental disorder.

ClassificationEdit

As many scholars have pointed out, the Internet serves merely as a medium through which tasks of divergent nature can be accomplished.[70][71] Treating disparate addictive behaviors under the same umbrella term is highly problematic.[73]

Dr. Kimberly S. Young (1999) asserts that Internet addiction is a broad term which can be decomposed into several subtypes of behavior and impulse control problems, namely,[74]

  • Cybersexual addiction: compulsive use of adult websites for cybersex and cyberporn;
  • Cyber-relationship addiction: Over-involvement in online relationships;
  • Net compulsions: Obsessive online gambling, shopping or day-trading;
  • Information overload: Compulsive web surfing or database searches;
  • Computer addiction: Obsessive computer game playing.

For a more detailed description of related disorders please refer to the Related Disorder section above.

Treatment: therapiesEdit

Current interventions and strategies used as treatments for Internet addiction stem from those practiced in substance abuse disorder. In the absence of "methodologically adequate research", treatment programs are not well corroborated.[75] Psychosocial treatment is the approach most often applied.[54] In practice, rehab centers usually devise a combination of multiple therapies.[61]

Psychosocial TreatmentEdit

Cognitive-Behavioral Therapy

The cognitive-behavioral therapy with Internet addicts (CBT-IA) is developed in analogy to therapies for impulse control disorder.[32][76]

Several key aspects are embedded in this therapy:[77][78]

  • Learning time management strategies;
  • Recognizing the benefits and potential harms of the Internet;
  • Increasing self-awareness and awareness of others and one’s surroundings;
  • Identifying “triggers” of Internet “binge behavior,” such as particular Internet applications, emotional states, maladaptive cognitions, and life events;
  • Learning to manage emotions and control impulses related to accessing the Internet, such as muscles or breathing relaxation training;
  • Improving interpersonal communication and interaction skills;
  • Improving coping styles; and
  • Cultivating interests in alternative activities.

Three phases are implemented in the CBT-IA therapy:[32][76]

  1. Behavior modification to control Internet use: Examine both computer behavior and non-computer behavior and manage Internet addicts' time online and offline;
  2. Cognitive restructuring to challenge and modify cognitive distortions: Identify, challenge, and modify the rationalizations that justify excessive Internet use;
  3. Harm reduction therapy to address co-morbid issues: Address any co-morbid factors associated with Internet addiction, sustain recovery, and prevent relapse.

Symptom management of CBT-IA treatment has been found to sustain 6 months post-treatment.[32]

RESTORE RECOVERYTM is a training program that aims to standardize the CBT-IA application and assist practitioners' practice in assessing and treating Internet addiction disorder.

Motivational Interviewing

The motivational interviewing approach is developed based on therapies for alcohol abusers.[32][78] This therapy is a directive, patient-centered counseling style for eliciting behavior change through helping patients explore and resolve ambivalence with a respectful therapeutic manner. It does not, however, provide patients with solutions or problem solving until patients' decision to change behaviors.[77]

Several key elements are embedded in this therapy:[32]

  • Asking open-ended questions;
  • Giving affirmations;
  • Reflective listening.

Other psychosocial treatment therapies include reality therapy, Naikan cognitive psychotherapy, group therapy, family therapy, and multimodal psychotherapy.[77]

Transcutaneous Electrical Nerve StimulationEdit

Scholars have also evaluated the effect of 2/100-Hz transcutaneous electrical nerve stimulation (TENS) on Internet addicts. Two Chinese studies found that 2/100- Hz TENS, which adjusts the release of central neurotransmitter, can effectively reduce the online time of adolescent Internet addicts and mitigate IA syndrome.[79][80]

Pharmacologic TherapyEdit

As we have discovered, IAD may be associated with a co-morbidity. So it's no surprise that treating a related disorder will also help in the treatment of IAD. When addicts were treated with certain anti-depressants it reduced time online by 65% and also reduced cravings of being online. The anti-depressants that have been most successful are selective serotonin reuptake inhibitors such as ecitalopram and a heterocyclic atypical anti-depressant called buproprion. A psychostimulant, methylphenidate has also shown beneficial effects as well.[81]

PrevalenceEdit

Research-based Prevalence Rate of Internet Addiction
Country or Region Rate or Population Sample Year Instrument
Global 6%[58] A meta-analysis-based estimate 1994 - 2012 YDQ & IAT
Asia
Asia 20%[82]
China 10.4%[83] 10158 adolescents 2016 IAT
Hong Kong 17 - 26.7%[84] Over 3000 high school students 2009 - 2015 IAT
Taiwan 13.8%[85] 1708 high school students n.a. YDQ
South Korea 2.1%[47] An estimate based on Korean population aged 6–19 years 2006
Japan 2.0%[86] 853 adolescents aged 12–15 years 2014 IAT
Europe
Europe 4.4%[87] 11956 adolescents in 11 European countries 2009 - 2010 YDQ
Germany 1.5 million[88] An estimate based on German population n.a.
Spain 16.3%[89] 40955 school adolescents aged 12–17 years 2016 PIUS-a
Norway 0.7%[90] 3399 individuals aged 16–74 years 2007 YDQ
UK 18.3%[91] 371 college students n.a. PIUS
North America
USA 0.3-0.7%[92] 2513 Adults 2004 Non-standard

Different samples, methodologies, and screening instruments are employed across studies and therefore one should take caution interpreting and comparing the above-listed figures.

TerminologyEdit

The notion of "Internet Addictive Disorder" was initially conjured up by Dr. Ivan K. Goldberg in 1995 as a joke to parody the complexity and rigidity of American Psychiatric Association's (APA) "Diagnostic and Statistical Manual of Mental Disorders (DSM)." In his first narration, Internet addictive disorder was described as having the symptoms of "important social or occupational activities that are given up or reduced because of Internet use," "fantasies or dreams about the Internet," and "voluntary or involuntary typing movements of the fingers."[93]

The definition of Internet addiction disorder has troubled researchers ever since its inception. In general, no standardized definition has been provided despite that the phenomenon has received extensive public and scholar recognition.[8][13] Below are some of the commonly used definitions.

In 1998, Dr. Jonathan J. Kandell defined Internet addiction as "a psychological dependence on the Internet, regardless of the type of activity once logged on."[94]

English psychologist Mark D. Griffiths (1998) conceived Internet addiction as a subtype of broader technology addiction, and also a subtype of behavioral addictions.[95]

SocietyEdit

Internet and Technology Addicts AnonymousEdit

Internet and Technology Addicts Anonymous (ITAA), founded in 2009, is a 12-step program supporting users coping with digital distractions such as computers and smartphones.[96] There are face to face meetings in some US cities. English-speaking telephone and online meetings take place over a conference line most days of the week, at varying times that allow people worldwide to attend. Like 12 step fellowships such as Overeaters Anonymous, Workaholics Anonymous, or Sex and Love Addicts Anonymous, most members find that they can't choose to not use technology at all. ITAA members come up with their own definitions of abstinence or problem behaviors, such as not using the computer or internet at certain hours or locations or not going to certain websites or categories of websites that have proven problematic in the past. Meetings provide a source of live support for people who are trying to build connections with people outside the computer, to share struggles and victories, and to learn to better function in life once less of it is spent on problematic technology use.

NoSurfEdit

The NoSurf Reddit community [97] maintains a list of resources and strategies helpful for people trying to decrease their internet usage. This includes lists of software programs that people use to control which sites they visit and when, as well as a discussion group that takes place on Discord.

Public concernEdit

Internet addiction has raised great public concern in Asia and some countries consider Internet addiction as one of the major issues that threatens public health, in particular among adolescents.[47][77]

ChinaEdit

Internet addiction is commonly referred to as "electronic opium"[98] or "electronic heroin" in China.[99] The government of the People's Republic of China is the first country to formally classify Internet addiction a clinical disorder by recognizing Clinical Diagnostic Criteria for Internet Addiction in 2008.[100][101] The government has enacted several policies to regulate adolescents' Internet use, including limiting daily gaming time to 3 hours and requiring users' identification in online video games.[102]

South KoreaEdit

Being almost universally connected to the Internet and boasting online gaming as a professional sport, South Korea deems Internet addiction one of the most serious social issues[103] and describes it as a "national crisis".[104] Nearly 80% of the South Korean population have smartphones. According to government data, about 2 million of the country's population (less than 50 million) have Internet addiction problem, and approximately 68,000 10-19-year-old teenagers are addicted to the Internet, accounting for roughly 10 percent of the teenage population.[105] Even the very young generation are faced with the same problem: Approximately 40% of South Korean children between age 3 to 5 are using smartphones over three times per week. According to experts, if children are constantly stimulated by smartphones during infancy period, their brain will struggle to balance growth and the risk of Internet addiction.[106]

And because of the Internet addiction, so many tragedies happened in South Korea: A mother, tired of playing online games, killed her 3-year-old son. A couple, obsessed with online child-raising games, left their young daughter die of malnutrition. A 15-year-old teenager killed his mother for not letting himself play online games and then committed suicide.[107] One Internet gaming addict stabbed his sister after playing violent games. Another addict killed one and injured seven others.[104]

In response, the South Korea government has launched the first Internet prevention center in the world, the Jump Up Internet Rescue School, where the most severely addicted teens are treated with full governmental financial aid.[104] As of 2007, the government has built a network of 140 Internet-addiction counseling centers besides treatment programs at around 100 hospitals.[108] Typically, counselor- and instructor-led music therapy and equine therapy and other real-life group activities including military-style obstacle courses and therapeutic workshops on pottery and drumming are used to divert IAs' attention and interest from screens.[104][108]

In 2011, the Korean government introduced the "Shutdown law", also known as the "Cinderella Act", to prevent children under 16 years old from playing online games from midnight (12:00) to 6 a.m.[105]

Mistreatment in ChinaEdit

In the absence of guidance from China’s Health Ministry and a clear definition of Internet addiction, dubious treatment clinics have sprouted up in the country.[48] As part of the treatment, some clinics and camps impose corporal punishment upon patients of Internet addiction and some conducted electroconvulsive therapy (ECT) against patients, the latter of which has caused wide public concern and controversy.[48][109] A few salient mistreatment practices have been well-documented by news reports:

Involuntary confinementEdit

One of the most commonly resorted treatments for Internet-addicted adolescents in China is inpatient care, either in a legal or illegal camp. It is reported that children were sent to "correction" against their will. Some are seized and tied by staff of the camp, some are drugged by their parents, and some are tricked into treatment.[101][110][111][112]

Corporal punishmentEdit

In many camps and clinics, corporal punishment is frequently used to "correct" Internet addiction disorder. The types of corporal punishment practiced include, but not limited to, kilometers-long hikes, intense squats, standing, starving, and confinement.[48][113][114][115] After a physical-abuse-caused death case of an adolescent Internet-addict was reported in 2009, the Chinese government has officially inhibited physical violence to "wean" teens from the Internet.[116] But multiple abuse and death cases of Internet addicts have been reported after the ban.

Among Internet addiction rehab centers that use corporal punishment in treatment, Yuzhang Academy in Nanchang, Jiangxi Province, is the most heavily discussed. In 2017, the Academy was accused of using severe corporal punishment against students, the majority of which are Internet addicts. Former students claimed that the Academy hit problematic students with iron rulers, "whip them with finger-thick steel cables", and lock students in small cells week long.[117][118] Several suicidal cases emerged under the great pressure.[119]

In November 2017, the Academy stopped operating after extensive media exposure and police intervention.[120]

Electroconvulsive therapyEdit

In China, electroconvulsive therapy (ECT) is legally used for schizophrenia and mood disorders. Its off-label practices in treating adolescent Internet addicts has raised great public concern and stigmatized the legal use of ECT.[121]

The most reported and controversial clinic treating Internet addiction disorder is perhaps the Linyi Psychiatric Hospital in Shandong Province.[48] Its center for Internet addiction treatment was established in 2006 by Yongxin Yang.[122] Various interviews of Yongxin Yang confirm that Yang has created a special therapy, xingnao ("brain-waking") therapy, to treat Internet addiction. As part of the therapy, electroconvulsive therapy is implemented with currents of 1-5 milliampere.[123] As Yang put it, the electroconvulsive therapy only involves sending a small current through the brain and will not harm the recipient.[124] As a psychiatric hospital, patients are deprived of personal liberty and are subject to electroconvulsive treatment at the will of hospital staffs.[109] And before admission, parents have to sign contracts in which they deliver their guardianship of kids partially to the hospital and acknowledge that their kids will receive ECT.[109] Frequently, ECT is employed as a punishment method upon patients who breaks any of the center's rules, including "eating chocolate, locking the bathroom door, taking pills before a meal and sitting on Yang's chair without permission".[109] It is reported in a CCTV-12 segment that a DX-IIA electroconvulsive therapy machine is utilized to correct Internet addiction. The machine was, later on, revealed to be illegal, inapplicable to minor[125][126] and can cause great pain and muscle spasm to recipients.[48] Many former patients in the hospital later on stood out and reported that the ECT they received in the hospital was extremely painful, tore up their head,[111] and even caused incontinence.[122][127]An Interview of the Internet addiction treatment center in Linyi Psychiatric Hospital is accessible via the following link.Since neither the safety nor the effectiveness of the method was clear, the Chinese Ministry of Health banned electroconvulsive therapy in treating Internet addiction disorder in 2009.[124][128]

DrugEdit

In Yang's clinic, patients are forced to take psychiatric medication[110] in addition to Jiewangyin, a type of medication invented by himself. Neither the effectiveness nor applicability of the medication has been assessed, however.

Physical abuse and deathEdit

At clinics and rehab centers, at least 12 cases of physical abuse have been revealed by media in the recent years including 7 deaths.[129][130]

In 2009, a 15-year-old, Senshan Deng, was found dead 8 hours after being sent to an Internet-addiction center in Nanning, Guangxi Province. It is reported that the teenager was beaten by his trainers during his stay in the center.[101]

In 2009, another 14-year-old teenager, Liang Pu, was taken to hospital with water in the lungs and kidney failure after a similar attack in Sichuan Province.[116]

In 2014, a 19-year-old, Lingling Guo, died in an Internet-addiction center with multiple injuries on head and neck in Zhengzhou, Henan Province.[101]

In 2016, after escaping from an Internet addiction rehab center, a 16-year-old girl tied and starved her mother to death in revenge of the being sent to treatment in Heilongjiang Province.[101]

In August 2017, an 18-year-old Internet addict, Li Ao, was found dead with 20 external scars and bruises two days after his parents sent him to a military-style boot camp in Fuyang city, Anhui Province.[131]

See alsoEdit

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Further readingEdit