Internet Addiction: Causes, Disorders, and Global Impact

Introduction

From education to entertainment and business to communication, the Internet has touched upon every aspect of our lives. Paradoxical as it might seem, the Internet — widely touted as a broad socializing medium — is silently causing social isolation among some of its users. The explosive growth of the Internet makes it a high priority to intervene appropriately in order to limit its destabilizing influence on young people. Increasing awareness about the potential negative effects of the Internet, including gaming, gambling, and pornography, is the first step in controlling the development of aggressive and addictive behaviors.

The Internet has revolutionized the lives of millions of people around the world over the last two decades. It has brought a paradigm shift in our access to information, communication, and entertainment, and has opened a whole new dimension for businesses. It has become the most important medium for educational research. On the darker side, however, is the proposed addition of "internet addiction" as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This concern assumes real significance as worldwide statistics indicate increasing Internet usage, particularly among young people. Recent statistics show that youth in the USA and UK spend up to 16.7 hours and 20 hours respectively per week on the Internet. The figure is far worse for Korea, where 6- to 19-year-olds spend around 23 hours per week online (Reid, 2008). Gambling, pornography, and socializing through online chatting are identified as some of the main addictive platforms of the Internet. As alarming as it may seem, Internet-based Massively Multiplayer Online Role-Playing Games (MMORPGs) are identified as a major addiction affecting 8.5% of American youth gamers, 12% of British gamers, and are the number one concern for young people in China (Reid, 2008). Could the Internet be addictive? Could it be a destructive tool? A brief overview of the current research will help highlight these growing concerns.

Internet Addiction Disorder

Addictive behavior in general is defined as a "compulsive, uncontrollable dependence on a substance, habit, or practice to such a degree that cessation causes severe emotional, mental, or physiological reactions" (Byun et al., 2009). The four main components associated with compulsive and impulsive disorders — namely, excessive use, withdrawal, tolerance, and negative repercussions — are clearly observed in a subset of Internet users. This has prompted psychiatrists and behavioral analysts to recommend the inclusion of "internet addiction disorder" in the DSM-V (Block, 2008).

Excessive Internet use is a commonly observed trend among young gamers. A study by Nicholas Yee (2006) revealed some striking findings. Conducted over a four-year period from 2000 to 2003, the study analyzed 30,000 online MMORPG players. Statistical analysis of the survey revealed several noteworthy patterns. Gaming, which had previously been identified primarily with teenagers, was found to be more prevalent across a wider age spectrum. The average age of participants was 26.57 years. The study also revealed that around 8% of subjects spent more than 40 hours per week on online interactive gaming — equivalent to a standard working week — and there was no correlation between age and time spent, meaning all age groups were equally vulnerable to gaming addiction. Seventy percent of participants spent more than 10 consecutive hours gaming, while 50% self-reported addiction to their online game (Yee, 2006).

The study also identified withdrawal symptoms among participants. As one participant described, "There are serious withdrawal pangs, anxiety, and a feeling of being lost and not quite knowing what next to do with yourself." Based on a five-point Likert scale used in the study, 15% of subjects agreed that they were very angry and irritable upon withdrawal, and 30% strongly agreed that they continued to participate in gaming even when frustrated and not genuinely enjoying the experience — a clear indication of addiction and withdrawal avoidance (Yee, 2006).

It is estimated that around 9 million Americans are afflicted by computer and Internet addiction disorders, which seriously affects their social, educational, and work lives (Byun et al., 2009). A national telephone survey of 2,513 people was conducted to gauge the extent of problematic Internet usage in the United States. Participants were interviewed using questions derived from established diagnostic criteria for impulse control and substance abuse disorders. Some question sets were specifically formulated to gather information on unintended prolonged usage, withdrawal issues, and interference with normal social relationships. From interviews lasting an average of approximately 11.3 minutes, it was inferred that at least 3.7% to 13% of respondents had problematic levels of Internet usage that interfered with their regular lives. The study authors concluded that "potential markers of problematic Internet use seem present in a sizable proportion of adults" (Aboujaoude et al., 2006).

Internet Game Addiction: A Growing Crisis in China and South Korea

While Internet addiction is present among a subset of users worldwide, the problem is particularly acute in developing economies in Asia. In China and South Korea, addiction to Internet gaming has reached crisis proportions and has resulted in fatalities. A series of cardiopulmonary deaths at Internet cafes prompted the South Korean government to investigate the issue of Internet addiction among children and adolescents. The report from the 2006 investigation revealed staggering statistics: approximately 2.1% of 6- to 19-year-olds were found to be seriously addicted, with 80% of those cases requiring psychotropic medications and 20% to 24% reportedly requiring hospitalization. Government sources believe that a further 1.2 million school-age children may require counseling and immediate interventional services. These findings have spurred government action, and there are now approximately 193 hospitals throughout South Korea listed for internet addiction disorder treatment, staffed by more than 1,043 trained counselors (Block, 2008).

China is experiencing a similar problem at a larger scale due to its enormous population. As Dr. Tao Ran, director of the Beijing Military Central Hospital, recently reported, more than 13.7% of adolescent Internet users — approximately 10 million teenagers — are afflicted by internet addiction disorder (Block, 2008). One recent study compared Internet usage between Chinese and American students. Conducted by Zhang et al. (2008), the study selected 314 students in total: 171 from a U.S. university and 143 from a public university in northern China. Participants completed questionnaires covering demographic data, 10 internet addiction symptoms, and a 28-item survey instrument designed to measure addiction on a five-point Likert scale. Results were assessed across five parameters of Internet addiction: social escape, secretive behavior, negative outcomes, virtual intimacy, and obsessive-compulsive behavior. Univariate statistical analysis revealed that Chinese students scored significantly higher across all five dimensions of Internet addiction. Final analysis found that 20 Chinese students (14%) were heavily addicted compared to 7 U.S. students (4%). Additionally, 92 Chinese students (64%) and 40 U.S. students (23%) were classified as mildly addicted. The study concluded that Internet addiction was more prevalent among Chinese students (Zhang et al., 2008).

A recent Italian study administered the Italian version of the Internet Addiction Test (IAT) to 236 subjects who were actively participating in Internet chat rooms. The subjects were diverse in terms of age and occupation. Analysis of the data revealed that younger users are at greater risk for problematic Internet use or addiction, and that the Internet was being used as a compensatory measure for a perceived poor quality of social life. The study also found that habitual nighttime Internet use had a significant negative impact on overall quality of life (Ferraro et al., 2007).

Conclusion

The Internet age has completely changed our way of living and has touched upon every aspect of our lives, from education and entertainment to communication and commerce. Paradoxical as it might seem, the Internet — widely touted as a broad socializing medium — is silently causing social isolation among some of its users. In countries like South Korea and China, increasing numbers of adolescents are addicted to online gaming portals, seriously damaging their personal and social lives. Internet addiction-related deaths in these countries have forced governments to adopt new regulatory approaches to managing Internet use. Studies demonstrating a positive correlation between Internet usage and pre-existing behavioral anomalies suggest a new perspective on the problem.

It is essential that researchers examine increasing Internet use from a causative perspective, as this would help identify underlying behavioral issues and support the design of appropriate rehabilitative measures. Resistance to treatment and high relapse rates make internet addiction a serious public health concern. Creating awareness about this growing problem, combined with active parental supervision and governmental regulatory measures, represents an ideal interventional approach. The explosive growth of the Internet makes it a high priority to intervene appropriately in order to limit its destabilizing influence on young people.

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