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What is internet addiction? It depends on whom you ask

Internet addiction centers across the country are treating a condition that has no formal definition. haggismac/Flickr
Internet addiction centers across the country are treating a condition that has no formal definition. haggismac/Flickr

By J.R. Williams
As recovery centers admit teens, adults, experts call for consensus

Dr. Hilarie Cash and her colleagues at reSTART, a Washington treatment program for technology addicts, have their sights set on a lush, 32-acre property overlooking the Cascade Range.

ReSTART already cares for adults, but they’re opening a new facility exclusively for juveniles — mostly boys with severe addictions to online games. Cash, the organization’s clinical director, said they have applications in hand and are “scrambling” to open.

“There are parents drumming their fingers waiting to get more information to do this,” she said.

With two houses on the property, they’ll admit as many as 16 children. Some may stay for as long as a year to complete schoolwork, relearn life skills and interact with nature.

ReSTART, formed in 2009, is one of many centers across the country treating internet-related addictions, a condition that is not defined in the authoritative guide to mental disorders. Citing a lack of research to support including a general term, The American Psychiatric Association added in 2013 the more closely studied Internet Gaming Disorder as a “condition of interest” warranting further review. That disorder is receiving renewed attention amid calls for additional research and consensus on what constitutes broader internet addiction.

The technology education nonprofit Common Sense Media recently devoted an exhaustive report on the subject, saying that the “tension” families face over media and technology was one basis for exploring the issue in depth. But while media use can easily rise to problematic levels, experts say our kids need to clear a high bar to be considered addicts.

The average child with an X-Box or a World of Warcraft account won’t qualify for IGD. ReSTART sees people who show traditional signs of addiction: unsuccessful attempts to stop or cut back on gaming, pornography or gambling; deception; and missed educational, career or relationship opportunities due to their behavior. In one testimonial on YouTube, a man in recovery describes how he spent nearly every waking moment playing online games, stopping only when he was too exhausted to stay awake.

While that’s a severe case, it’s easy for parents to see gray areas given how intently children use their devices. That’s why experts want to see consensus on official criteria for a broader diagnosis. The Common Sense media report found a “considerable debate about whether internet addiction is a real phenomenon or not” and noted the lack of studies focused on children.

“We know what we’re looking for, but I might want to include a sign or a symptom that someone else might not think of, and might not want to include,” Cash said. “That’s the kind of thing that’s indicative of how young the field is. It will be kind of hard for it to get full status and full legitimacy until we can at least do that.”

Dr. Kimberly Young, who founded the Center for Internet Addiction in 1995, said the additional research work is well underway, and that “the recent model for why people have developed internet addiction, e.g., poor coping styles, are excellent new areas of research that support the condition.”

Researchers know there are startling similarities between internet and drug addicts. In both cases, the elevation of neurochemicals such as dopamine give the user a sense of pleasure or relief, leading to a tolerance of ever-higher levels of those chemicals, leading to increased use, negative consequences and a cycle of abuse.

"This is trickier. As a consequence of being trickier, it's more prone to relapse."

The first step for an addict at ReSTART is detox, which can take about three weeks, Cash said. While withdrawal for a gaming addict doesn’t have the same physical dangers as chemical addiction, the psychological effects are similar, she said. Overwhelmingly, clients need treatment for addictions to gaming, pornography or gambling. Social media issues are typically tied to the greater problem: An obsession with gaming might also include too much time spent on the live-gaming broadcast service Twitch.

For the new adolescent center, Cash said they’re planning a more intensive family involvement and working to equip parents on how to handle things at home, in addition to an active schedule of healthy activities. That complements Common Sense Media’s recommendations of “fostering awareness of media and self,” which includes designated screen-free times and the importance of face-to-face conversation.

“A balanced approach provides opportunities to exercise self-regulation, enhance social competence, and combat loneliness, each of which makes individuals less likely to use media pathologically,” their report says. “Balance does not mean eliminating media use; it doesn’t necessarily mean reducing media use. Balance is about respecting quality of life, both online and offline.”

Unlike traditional addiction treatment focused on abstinence, children must still interact with computers once they leave ReSTART’s care. They develop a life balance plan while in the program to detail how they will interact with technology in the future and for how long.

“We will be asking them to think that through and make commitments on how they will use computers, but it makes this addiction more difficult,” Cash said. “This is trickier. As a consequence of being trickier, it’s more prone to relapse, more difficult to maintain a delicate balance of use of technology — which is just sitting down in front of a computer — triggering the desire to go back to the old thing. So it’s hard.”

To identify someone who may need help, look at outcomes, Young said.

“Like anything, it is a productive tool, or is it harmful?” she said. “If someone is using for work productively, I would not call that a problem or addiction, but if someone is using it in a harmful way that they are fired from a job or lose a relationship, the consequence speaks volumes.”

J.R. Williams

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