CMAJ 1997;157:785
© 1997 Canadian Medical Association (unless otherwise indicated)
Can users get addicted to the Internet?
Debate about the possibility of Internet addiction has long been part of cyberspace culture. In the past year, however, the notion has moved from the realm of online joke to serious study.
CMAJ was the first professional journal to publish an article on the subject (OReilly M. Internet addiction: a new disorder enters the medical lexicon. CMAJ 1996;154:1882-3). Since then the issue of Internet addiction disorder (IAD) has been raised in forums as diverse as the New England Journal of Medicine and Ann Landers' syndicated column. Because I wrote the original CMAJ article, I'm only too aware of the interest IAD has generated. I'm still fielding a dozen or more reprint requests a month from researchers, students and physicians around the world.
Dr. Kimberly Young, a psychologist at the University of Pittsburgh, was one of the first researchers to examine the disorder. She established the Centre for Online Addiction and is about to release a book on the subject.
"Last summer, my paper was the only one on IAD presented at the American Psychological Association [meeting]," she said. "This year there is an entire symposium on the topic." As well, treatment centres have opened in Massachusetts and Illinois, where 2 hospitals have introduced services related to computer and Internet addiction in their recovery units.
When she first studied the issue, Young reviewed the model for substance abuse outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th edition). By substituting the word "Internet" in that model, she established standard criteria for Internet addiction. Using this information she identified and studied 400 cases involving people who met at least 3 of the 7 criteria. From this she has documented the social and emotional consequences of IAD.
Her paper, "Internet addiction: the emergence of a new clinical disorder," concluded that IAD exists and, given the explosive growth in Internet usage, the problem will likely get worse.
"Internet addiction or, as I refer to it clinically, pathological Internet use, has similar characteristics to pathological gambling or substance dependence," Young said. "Loss of control, cravings and withdrawal symptoms, social isolation, marital discord, academic failure, excessive financial debt, job termination -- these are just some of the consequences documented in my research."
Other research is emerging. A Marquette University report on Internet use determined that 89% of survey participants exhibited addiction-like behaviour at some point. Over half the respondents felt their work had suffered because of Internet use and 7% said it had caused trouble at work or school.
That survey was based on responses from self-selected Internet users, but the findings correspond with data from other researchers. Among its highlights: 37% of respondents reported they routinely cut short sleep to spend more time online, 58% had been told by others that they spend too much time online, 30% reported having tried and failed to reduce Internet usage, and 12% said most of their friends are people met via the Internet.
According to Young, Internet users should be wary if:
- They have made unsuccessful attempts to cut down on Internet use, or don't want to cut down.
- They lie about the amount of time they spend on the Internet or try to hide the amount.
- They have lost interest in other recreational or social activities.
- They experience depression or other withdrawal symptoms when not online.
"The significance and reality of this disorder is evident in the increased research interest and the formation of treatment centres to address this issue clinically," Young said. "Although its existence [has been debated], clinicians and academicians are moving rapidly to address the reality that addictive use of the Internet is causing problems within the family, at school and at work."
Young often gets requests for information from physicians and other professionals worried about patients. She has also helped police and lawyers deal with cases of child neglect or divorce in which the problems may have been fuelled
by IAD.
Young is now turning her research toward early detection of at-risk Internet users. She is also examining the roles different personality dynamics and prior psychiatric history play in the development of Internet-related problems.
Physicians interested in the issue can get more information from Young's home page, www.pitt.edu/~ksy/. Information about her survey is available from www.pitt.edu/~ksy/survey.htm, while details about the Marquette University report can be found at www.ccsnet.com/prep/pap/pap8b/638b012p.txt.
Does a problem exist?
Young says people who give affirmative answers to at least 3 of the following questions may have an Internet-related disorder:
- Are you spending more time on the Internet to get the same level of satisfaction?
- Do you experience withdrawal symptoms such as depression when not online?
- Do your Internet sessions last longer than planned?
- Do you spend a lot of time on Internet-related activities such as buying Internet books and trying new software?
- Despite adverse effects such as family problems, do you continue to use the Internet?
- Have attempts to cut down or stop failed?
- Are you giving up social or job-related activities to spend more time on the Internet?
Physicians wanting to subscribe to the Internet Addiction Support Group (IASG) email list should send a message to listserv@netcom.com that reads "subscribe i-a-s-g" in the message area. -- © Michael OReilly
Highlights from CMA Online
The online version of the CMA Publications Catalogue (www.cma.ca/catalog [French: www.cma.ca/catalog/index_f.htm]) has been redesigned to make it more appealing to physicians. The online catalogue, which lists dozens of books available by specialty, has new graphically enhanced point-and-click menus that make it both appealing and user friendly. Orders can be placed directly with an electronic order form. It also provides updates about new releases and special offers. -- Dawna Ramsay
Cool site
www-medlib.med.utah.edu/WebPath/webpath.html
The University of Utah's WebPath: The Internet Pathology Laboratory for Medical Education offers an excellent example of the Internet's educational potential. Originally launched as a teaching tool for medical students, its scope has been broadened to allow practising physicians to learn. It is an electronic lab that provides more than 1800 images, with text and tutorials, which demonstrate gross and microscopic pathologic findings associated with human disease. The main menu directs the user into several areas, including general pathology, organ-system pathology and laboratory exercises where case-based problems are presented. Surgical residents may want to review the tutorial on breast cancer, which includes a discussion of risk factors and other issues. The text is accompanied by high-quality images of normal and diseased tissue which download surprisingly quickly. I wish I'd had this material before my fellowship exams! Family doctors could benefit from the tutorials on AIDS, diabetes and osteoporosis. There is also a fascinating section on firearms, which includes forensic lab methods and some gruesome photos. For those wishing to sharpen exam skills there is a collection of more than 1500 multiple-choice questions, plus 30 case-based laboratory exercises. The university offers CME credits upon successful completion of some of the exercises. Plans for the future include additional tutorials and exam questions, and the addition of radiologic images. Javascript programming, which allows for a more interactive experience, is already available with the multiple-choice questions. The site was created by Dr. Edward Klatt, a professor of pathology at the University of Utah, eklatt@msscc.med.utah.educ. -- Dr. Robert Patterson, robpatterson@msn.com
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