Mary E. Varghese • Carlos Fayard

Caught In the Net: Recognizing Internet Addiction in Youth

Special Issue

Behavioral Addictions

Thirteen-year-old Ryan1 is excited to receive his first computer and begins spending much of his time learning to use it. His parents dismiss his interest as a phase, but his computer time steadily increases until he is regularly using it more than 10 hours a day. He consumes caffeine drinks in order to stay up late to visit chat rooms and play games. He has difficulty waking up for school and regularly forgets to shower. His teachers notice increasing problems with his hygiene and attention in class, and his grades significantly decline. He skips family gatherings to spend more time on the computer and loses touch with his friends. He is eventually dropped from his baseball team for skipping practices. However, he is not bothered, as his problems and stress seem to disappear the moment he gets online. He has formed several online friendships and spends his time in school ruminating on what he will do the next time he is online. When his parents try to reduce his computer time, he becomes uncharacteristically aggressive, making threats and throwing tantrums. They finally get him to agree to give up his computer for two weeks, but after that time, he immediately reverts to his old ways.2

The Nature of Internet Addiction

The use of technology has exploded over the past few decades as access to high-speed Internet has become more widely available. The educational and social benefits are many: wider access to educational knowledge, increased work efficiency, and ability to stay connected to social networks. However, a growing number of experts, including Kimberley Young, founder of the Center for Internet Addiction; and David Greenfield, founder of The Center for Technology and Internet Addiction, have voiced concern that some computer users are becoming dependent on the Internet to the point that their behaviors resemble that of full-blown addiction.3 Internet addiction refers to a pathological use of computers or technology that is characterized by intrusive urges to engage in online behaviors to an extent that contributes to significant impairments in daily life (e.g., relationships, school, physical health). Internet addiction can take many forms, such as excessive gaming, problematic online gambling, preoccupation with online sexual content, compulsive use of social media or chat rooms, and excessive and compulsive e-mailing or texting. Emerging research shows that brain activation patterns found in individuals who are addicted to the Internet are similar to those found in individuals with chemical addictions.4 Griffiths5 observed the following elements, based on the six core factors seen in addiction disorders, to be present in Internet addiction:

  1. Salience. The Internet takes priority over other domains (e.g., family, work) in an individual’s life. (As indicated in the above example, the desire to use the Internet dominates Ryan’s thinking [e.g., constantly thinking about being online when offline], feelings [e.g., experiencing cravings], and behavior [e.g., reduced social activity].)
  2. Mood modification. Internet use becomes a coping strategy for relieving negative moods or stress. Users may experience a “high” or a sense of euphoric numbing. (Ryan uses the Internet to cope with the problems caused by his excessive computer use.)
  3. Tolerance. Users increase their time online in order to extend or intensify mood-altering effects. (Ryan increasingly wants to spend more time online.)
  4. Withdrawal. Users experience negative symptoms (e.g., moodiness, irritability) when their Internet use is eliminated or suddenly reduced. (Ryan shows uncharacteristic aggressiveness when his parents try to set boundaries on his computer use.)
  5. Conflict. Excessive Internet use begins to impair users’ physical, social, educational, and occupational functioning; causing them to experience a loss of control. (Ryan’s grades fall, he is dropped from his team, and becomes estranged from family and friends.)
  6. Relapse. Problematic behavioral patterns return after a period of abstinence or control. (Ryan immediately relapses when reunited with his computer.)

Prevalence of Internet Addiction

Students are a group who are particularly at risk for developing Internet addiction. Researchers have found evidence of Internet addiction among adolescents and young adult students all over the world, with prevalence rates differing by country. For instance, estimates range from 4 percent for U.S. high school students6 to 10.7 percent of adolescents in South Korea7 and 13 percent among UK university students.8

Adolescents and young adults are thought to be especially vulnerable to this form of addiction, as Internet use may become a strategy for coping with developmental stressors common to their age group, such as identity formation and the establishment of intimate relationships. Students may turn to the online world to escape from difficult developmental tasks because online relationships are anonymous and allow the individual to take on any persona desired.9 However, reliance on such behaviors can result in a preference for online versus face-to-face interactions, leading to excessive Internet use and problematic psychological and social outcomes.10

Risk Factors for Developing Internet Addiction

Emerging research points to genetic risk factors for Internet addiction. One study found that individuals exhibiting problematic Internet usage were also more likely to be carriers of a particular gene mutation that plays a predictive role in nicotine addiction.11 In terms of personality factors, shyness, social anxiety, low self-esteem, lack of a strong sense of self, loneliness, and introversion have been seen as significant predictors of problematic Internet use.12 Additionally, individuals with deficits in social skills are more likely to prefer online social interactions to face-to-face interactions.13 Such individuals may become attached to the Internet because online relationships produce less anxiety than face-to-face relationships; however, as use becomes excessive, individuals may not develop the social skills necessary to form satisfying offline relationships.

Having other psychological problems also appears to be a risk factor for problematic Internet use. Research indicates that nearly 80 percent of individuals who have Internet addiction also suffer from other psychological disorders,14 such as depression and anxiety,15 social phobia,16 ADHD,17 and other addiction or impulse-control disorders.18 Thus, Internet use can become a form of self-medication; distressing experiences in offline life are soothed or numbed by Internet use that provides a “high” or sense of escape. Problems in the environment, such as poor parent-child relationships, also render individuals more susceptible to problematic and excessive Internet use.19

Research indicates that problematic Internet use contributes to negative consequences in virtually all domains of functioning. Excessive Internet use appears to change the structure of the developing adolescent brain, particularly in areas associated with cognitive and behavioral control.20 Excessive time spent using the Internet also has physical repercussions such as insomnia,21 back pain, sight problems,22 and poor hygiene.23 Pathological Inte­r­net users also experience negative psychological effects, such as losing interest in activities that they used to enjoy and developing distorted thoughts about themselves and the world (e.g., that they are effective only on the Internet and that the online world is the only place where they are respected and safe).24 These factors contribute to poor functioning across academic and interpersonal domains. One study indicated that problematic Internet use is negatively correlated with high grades,25 likely because the inordinate amount of time spent online interferes with study habits, sleep, and concentration. The Internet begins to take precedence over other life roles, causing the user to neglect other relationships,26 resulting in detrimental effects on families and friendships. (See Box 1.)

Evidenced-based Prevention and Intervention Programs

Efforts to prevent addiction can be enacted in family, church, and educational spheres. Children and adolescents who lack rewarding or nurturing relationships and who have poor social skills and difficulty making friends are more susceptible to turning to virtual interactions to meet their need for attention and friendship. Those at a higher risk may remain invisible because they tend to be quiet, shy, socially awkward, depressed, and isolated. Finding these marginalized individuals, nurturing them, coaching them, and actively seeing that they are included can be saving. One of the most severely shy clients I (CF) ever worked with told me that his life was “saved” by an outgoing peer in graduate school who took him under his wing and would not take “no” for an answer whenever a social opportunity arose. This shows that building strong bonds with parents, youth ministers, and teachers can provide the most basic form of prevention for addiction.

The next step in prevention is increasing awareness of the problem. Administrators and school counselors can raise awareness during in-service staff programs and parent-teacher meetings by distributing information regarding the basics of Internet addiction, warning signs (see Figure 1), and local resources. Because inadequate social skills and lack of a strong sense of self appear to be risk factors for Internet addiction, Young27 suggests that the adoption of a broad prevention approach such as Life Skills Training (which has been successful in prevention of tobacco use among adolescents by enhancing social and personal competence) may also be effective for preventing Internet addiction.28 On university campuses, residence-hall directors can offer educational programs, similar to drug and alcohol prevention programs, that educate students regarding the warning signs and risk factors of Internet addiction. Seminars can also be conducted to educate faculty, counseling staff, and administrators about Internet addiction and how to recognize it in their students. Schools can help educate parents about preventing Internet addiction by sharing tips on proper monitoring of Internet use, including setting boundaries for when and for how long the computer is used, and by frequently encouraging participation in activities that are incompatible with Internet use.29 In church communities, ministers have a particularly important role to play in prevention and can use similar techniques to raise awareness among families and reach out to youth in whom they recognize warning signs.

In terms of intervention, support and faith are crucial in the recovery effort. In treating addiction as a spiritual disorder, the 12-step program for chemical addictions emphasizes accepting one’s own powerlessness and the need for God’s divine intervention to lead the individual struggling with addiction away from the path of abuse.30 Step 2 states, “Came to believe that a Power greater than ourselves could restore us to sanity.”31 This is not to say that one can “pray an addiction away,” as wonderful and powerful prayer is. Rather, it speaks to the human need to quench the deepest thirsting that cannot be satisfied by whatever addictive behaviors compulsively and repetitively seek to fulfill. Jesus invited, “‘Let anyone who is thirsty come to me and drink’” (John 7:37, NIV).32 Coming to Jesus means coming to be loved and accepted so that “‘rivers of living water will flow from within’” (John 7:38, NIV). Teachers, clergy, family, and friends can play an important role in helping individuals recognize the extent of damage their excessive Internet use has been causing in their lives and guiding them to the appropriate help.

Once an individual is motivated for recovery, behavioral modification can be implemented with the support of loved ones or a professional therapist. This can include setting a timer for usage, matching time spent online with in-person social interactions, and increasing scheduling of non-computer-related activities. If modification attempts are unsuccessful or if the person is suffering from an underlying psychological disorder such as depression, professional counseling may be warranted. Emerging research supports the use of cognitive-behavioral therapies (CBT) as an effective treatment for Internet addiction.33 CBT highlights how underlying distorted thoughts about oneself and the world (e.g., I am weak when I am offline, but online I am somebody.) are linked to problematic and compulsive behavior and teaches skills for changing those thoughts and behaviors. For many, social skills training, building self-esteem, and treating co-morbid psychological disorders will also be a focus of treatment, as these factors likely are contributing to the addiction.

For adolescents, a combination of individual and family therapy is recommended34 and can even be implemented in school settings. In family approaches, the psychotherapist meets with individual members of the family and then meets regularly with the entire family to support the target individual (the one presenting with Internet addiction); everyone is made partly responsible for the problem, rather than blaming one family member. In a recent study of Chinese adolescents with Internet addiction, a six-session family therapy that focused on building parent-adolescent communication skills and training parents to address their child’s psychological needs (e.g., autonomy, interaction, achievement) was effective in significantly reducing Internet addiction behaviors.35 Joining 12-step programs (such as Internet and Tech Addiction Anonymous, http://www.netaddictionanon.org/) or support groups can also be tools for recovery. Rather than abstinence, learning to manage and regain control over Internet use, as well as treating underlying problems leading to compulsive use, are principles in effective recovery.

Conclusion

While in the process of writing this article, I (CF) was visiting a beautiful valley deep in Argentina’s countryside. Yet, something felt wrong—my cell phone had neither signal nor access to the Internet. Really?! For those in my generation, this experience may only be a minor inconvenience, as I was quickly able to return to the Andes and enjoy God’s creation. However, for those in my generation (MV), this experience may be an inkling of something much more pervasive. Internet addiction is a phenomenon that is quickly but silently invading homes and afflicting youth. It is thus a growing concern for parents and educators.

Most people rely on the Internet for daily tasks and enjoy using it for personal benefits, and thus the Internet itself is not the enemy. However, for vulnerable individuals who are lonely, shy, have low self-esteem, inadequate relationships, and who may be struggling with depression or anxiety, the Internet can become a tool for escape and relief. Unknowingly, addiction can develop as the user’s dependency on the Internet to meet social and emotional needs increases. For individuals with an addiction, the Internet becomes the organizing principle of their lives, thus pulling them farther away from the natural order and human experiences God intended.

Research36 shows that problematic Internet use can have long-lasting negative consequences, including changes to the developing brain and severe impairment in academic and social functioning. Parents and educators are encouraged to be watchful for signs of addiction in their young people. Because Internet use becomes pathological when it takes the person away from real life, young people’s faith and relationship with God can be pivotal in helping them recognize how their behaviors are diverting them from God’s calling. With ongoing support from loved ones and professionals, Internet addicts can learn to accept the need for divine intervention in reorganizing their priorities so that the Internet becomes a tool that is used in a healthful manner. 0


This article has been peer reviewed.

Mary E. Varghese

Mary E. Varghese, Ph.D., is a postdoctoral psychology fellow specializing in health psychology at the Northport Veterans Affairs Medical Center in Northport, New York. She completed her pre-doctoral internship at Loma Linda University School of Medicine in Loma Linda, California, and her doctorate in Counseling Psychology at Purdue University in West Lafayette, Indiana. Dr. Varghese’s doctoral dissertation examined attachment in spiritual relationships, and she has previously published research on personality factors and problematic Internet use.

Carlos Fayard

Carlos Fayard, Ph.D., is Associate Professor of Psychiatry at Loma Linda University School of Medicine. He is also Chair of the Psychiatry and Religion Program, Director of the World Health Organization Collaborating Center, and Director of the Clinical Psychology Internship Program. Dr. Fayard is an Associate Director of the Health Ministries Department, General Conference of Seventh-day Adventists, and the Co-editor of A Christian Worldview and Mental Health: A Seventh-day Adventist Perspective, and Vida Abundante: La Psicológia Positiva Desde una Cosmovision Biblica. He serves as a consultant to the Plan of Action for Mental Health 2014-2020 from the Pan American Health Organization and has been recognized with the “Guadalupe” and “Amar es Entregarse” awards by the San Bernardino Diocese of the Catholic Church for his contributions to the community.

NOTES AND REFERENCES

  1. Name is a pseudonym.
  2. Daniel L. King et al., “Cognitive‐behavioral Approaches to Outpatient Treatment of Internet Addiction in Children and Adolescents,” Journal of Clinical Psychology 68:11 (November 2012):1185-1195.
  3. Kimberly Young, “Internet Addiction: Diagnosis and Treatment Considerations,” Journal of Contemporary Psychotherapy 39:4 (December 2009):241-246.
  4. Chih‐Hung Ko et al., “Brain Correlates of Craving for Online Gaming Under Cue Exposure in Subjects With Internet Gaming Addiction and in Remitted Subjects,” Addiction Biology 18:3 (May 2013):559-569.
  5. Mark Griffiths, “Internet Addiction—Time to Be Taken Seriously?” Addiction Research and Theory 8:5 (2000):413-418.
  6. Timothy C. Liu et al., “Problematic Internet Use and Health in Adolescents: Data From a High School Survey in Connecticut,” The Journal of Clinical Psychiatry 72:6 (June 2011):836.
  7. Soo Kyung Park, Jae Yop Kim, and Choon Bum Cho, “Prevalence of Internet Addiction and Correlations With Family Factors Among South Korean Adolescents,” Adolescence 43:172 (2007):895-909.
  8. Katie Niemz, Mark Griffiths, and Phil Banyard, “Prevalence of Pathological Internet Use Among University Students and Correlations with Self-esteem, the General Health Questionnaire (GHQ), and Disinhibition,” CyberPsychology & Behavior 8:6 (December 2005):562-570.
  9. Mark Griffiths, “Internet Addiction: Does It Really Exist?” Psychology and the Internet: Intrapersonal, Interpersonal, and Transpersonal Implications (1998):61-75.
  10. Scott E. Caplan, “Preference for Online Social Interaction: A Theory of Problematic Internet Use and Psychosocial Well-being,” Communication Research 30:6 (December 2003):625-648.
  11. Christian Montag et al., “The Role of the CHRNA4 Gene in Internet Addiction: A Case-control Study,” Journal of Addiction Medicine 6:3 (September 2012):191-195.
  12. Scott Caplan, Dmitri Williams, and Nick Yee, “Problematic Internet Use and Psychosocial Well-being Among MMO Players,” Computers in Human Behavior 25:6 (November 2009):1312-1319.
  13. Scott E. Caplan, “A Social Skill Account of Problematic Internet Use,” Journal of Communication 55:4 (December 2005):721-736.
  14. Jerald J. Block, “Issues for DSM-V: Internet Addiction,” American Journal of Psychiatry 165:3 (March 2008):306, 307.
  15. Ho-Kyung Kim and Keith E. Davis, “Toward a Comprehensive Theory of Problematic Internet Use: Evaluating the Role of Self-esteem, Anxiety, Flow, and the Self-rated Importance of Internet Activities,” Computers in Human Behavior 25:2 (March 2009):490-500.
  16. Chih-Hung Ko et al., “Psychiatric Comorbidity of Internet Addiction in College Students: An Interview Study,” CNS Spectrums 13:2 (February 2008):147-153.
  17. Nathan A. Shapira et al., “Psychiatric Features of Individuals With Problematic Internet Use,” Journal of Affective Disorders 57:1 (January-March 2000):267-272.
  18. Chih-Hung Ko et al., “Predictive Values of Psychiatric Symptoms for Internet Addiction in Adolescents: A Two-year Prospective Study,” Archives of Pediatrics and Adolescent Medicine 163:10 (October 2009):937-943.
  19. Ömer Şenormanci et al., “Attachment and Family Functioning in Patients With Internet Addiction,” General Hospital Psychiatry 36:2 (March-April 2014):129-132.
  20. Min-Hyeon Park et al., “Preliminary Study of Internet Addiction and Cognitive Function in Adolescents Based on IQ Tests,” Psychiatry Research 190:2-3 (December 2011):275-281.
  21. Niemz et al., “Prevalence of Pathological Internet Use Among University Students and Correlations with Self-esteem, the General Health Questionnaire (GHQ), and Disinhibition,” op. cit.
  22. Griffiths, “Internet Addiction: Does It Really Exist?” op. cit.
  23. Ibid.
  24. Richard A. Davis, “A Cognitive-behavioral Model of Pathological Internet Use,” Computers in Human Behavior 17:2 (March 2001):187-195.
  25. Caplan, “A Social Skill Account of Problematic Internet Use,” op. cit.
  26. Şenormanci et al., “Attachment and Family Functioning in Patients With Internet Addiction,” op. cit.
  27. Young, “Internet Addiction: Diagnosis and Treatment Considerations,” op. cit.
  28. Terrell W. Zollinger et al., “Impact of the Life Skills Training Curriculum on Middle School Students’ Tobacco Use in Marion County, Indiana, 1997-2000,” Journal of School Health 73:9 (December 2003):338-346.
  29. Chien-Hsin Lin, Shong-Lin Lin, and Chin-Pi Wu, “The Effects of Parental Monitoring and Leisure Boredom on Adolescents’ Internet Addiction,” Adolescence 44:176 (December 2009):993-1004.
  30. “The Twelve Steps”: http://www.12step.org/the-12-steps/. Accessed Feb- ruary 1, 2016.
  31. Ibid.
  32. Scripture quotations credited to NIV are from The Holy Bible, New International Version. Holy Bible, New International Version®, NIV® Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.® Used by permission. All rights reserved worldwide.
  33. Kimberly S. Young, “Cognitive Behavior Therapy With Internet Addicts: Treatment Outcomes and Implications,” CyberPsychology & Behavior 10:5 (October 2007):671-679.
  34. Davis, “A Cognitive-Behavioral Model of Pathological Internet Use,” op. cit.
  35. Qin-Xue Liu et al., “Multi-family Group Therapy for Adolescent Internet Addiction: Exploring the Underlying Mechanisms,” Addictive Behaviors 42 (March 2015):1-8.
  36. Chennan Liu, Minli Liao, and Douglas C. Smith, “An Empirical Review of Internet Addiction Outcome Studies in China,” Research on Social Work Practice 22:3 (May 2012):282-292.