By Delaney Ruston, M.D.
Many people use the word addiction casually to describe something they do often and somewhat compulsively. We hear people say things like, “I’m addicted to chocolate or I’m addicted to my cell phone.” Clinical addiction is a different matter. A clinical diagnosis is defined by:
Negative consequences: problems with relationships, work, school, and more
Tolerance: wanting to engage with the substance more and more to get the same affect
Withdrawal: feelings of anxiousness, physical symptoms and more when away from it
Unable to stop: Serious difficulties with trying to cut down or stop
The issue around the term “addiction” as it relates to the internet is confusing. Internet Gaming Disorder as a diagnosis is currently being considered for official recognition by the American Association of Psychiatry (APA). This is based on studies that show psychologic and physiologic patterns similar to those exhibited by a person with a drug addiction. For example, MRI studies of the brains of people engaged in excessive video game use look very similar to people addicted to drugs like cocaine.
Meanwhile, the idea of internet addiction is not currently being considered by the APA as a diagnosable addiction. In part this is because a person can do many things on the internet such as participate in social media, browse, research, and play games and so it is unclear what the internet addiction is to. That said, if you refer back to the signs of addiction above, people clearly exhibit symptoms of addiction in their use of internet.
If you are concerned about addiction in yourself or someone else, or you want to teach your kids about this issue, take a look at these two questionnaires below that screen for problematic use. Each has been validated by research. Even if a person has no signs of addiction, I think it is a great idea to do these surveys with your family as a way to open a conversation around addiction.
Questionnaires for problematic use:
1. Video Game Addiction Questionnaire
Survey developed by Dr. Paul Gentile
Over time, have you been spending much more time thinking about playing video games, learning about video-game playing, or planning the next opportunity to play?
Do you need to spend more and more time and/or money on video games in order to feel the same amount of excitement?
Have you tried to play video games less often or for shorter periods of time, but are unsuccessful?
Do you become restless or irritable when attempting to cut down or stop playing video games?
Have you played video games as a way of escaping from problems or bad feelings?
Have you ever lied to family or friends about how much time you play video games?
Have you ever stolen a video game from a store or a friend, or have you ever stolen money to buy a video game?
Do you sometimes skip household chores in order to spend more time playing video games?
Do you sometimes skip doing homework in order to spend more time playing video games?
Have you ever done poorly on a school assignment or test because you spent too much time playing video games?
Have you ever needed friends or family to give you extra money because you spent too much money on video game equipment, software, or game/Internet fees?
Total your "Yes", "Sometimes", and "No" answers.
Kids are considered to be pathological gamers if they responded with a “Yes" or “Sometimes" to at least 6 of these 11 questions.
2. The Internet Addiction Test (IAT)
The Internet Addiction Test (IAT) is the first validated measure of Internet Addiction described in the IAT Manual to measure internet use in terms of mild, moderate, to severe levels of addiction. This questionnaire can be found at http://netaddiction.com/internet-addiction-test.
Based upon the following five-point scale, select the response that best represents the frequency of the behavior described in the following 20-item questionnaire.
0 = Not Applicable
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Often
5 = Always
___How often do you find that you stay online longer than you intended?
___How often do you neglect household chores to spend more time online?
___How often do you prefer the excitement of the internet to intimacy with your partner?
___How often do you form new relationships with fellow online users?
___How often do others in your life complain to you about the amount of time you spend online?
___How often do your grades or school work suffer because of the amount of time you spend online?
___How often do you check your e-mail before something else that you need to do?
___How often does your job performance or productivity suffer because of the Internet?
___How often do you become defensive or secretive when anyone asks you what you do online?
___How often do you block out disturbing thoughts about your life with soothing thoughts of the Internet?
___How often do you find yourself anticipating when you will go online again?
___How often do you fear that life without the Internet would be boring, empty, and joyless?
___How often do you snap, yell, or act annoyed if someone bothers you while you are online?
___How often do you lose sleep due to late-night log-ins?
___How often do you feel preoccupied with the Internet when off-line, or fantasize about being online?
___How often do you find yourself saying “just a few more minutes” when online?
___How often do you try to cut down the amount of time you spend online and fail?
___How often do you try to hide how long you’ve been online?
___How often do you choose to spend more time online over going out with others?
___How often do you feel depressed, moody, or nervous when you are off-line, which goes away once you are back online?
After all the questions have been answered, add the numbers for each response to obtain a final score. The higher the score, the greater the level of addiction and creation of problems resultant from such Internet usage. The severity impairment index is as follows:
NONE 0 - 30 points
MILD 31- 49 points: You are an average online user. You may surf the web a bit too long at times, but you have control over your usage.
MODERATE 50 -79 points: You are experiencing occasional or frequent problems because of the Internet. You should consider their full impact on your life.
SEVERE 80 – 100 points: Your Internet usage is causing significant problems in your life. You should evaluate the impact of the Internet on your life and address the problems directly caused by your Internet usage.
Read about addiction and curbing screen time here:
Think your kid (or you) could be a screen zombie? Take the 'Screenagers' test—Los Angeles Times
Learning How to Exert Self-Control—New York Times
Compulsive Texting Associated with Poorer School Performance Among Girls—American Psychological Association
Compulsive Texting Takes Toll on Teenagers—New York Times
Teaching Self-Control Tips—Provides evidence-based information about parenting and child development.
Internet Gaming Order in the DSM 5 — In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Internet Gaming Disorder is identified in Section III as a condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.
Here are some Programs and Centers for treating Cases of Addiction:
reSTART—The nation's first center specializing in the treatment of problematic internet, video game and technology use.
Outback Therapeutic Expeditions—A wilderness therapy program for teens.
Problematic & Risky Internet Use Screening Scale—An assessment specifically tailored to adolescents and young adults.
Bradford Regional Medical Center—Counseling and treatment for adults 18 years of age and older.
The Center for Internet & Technology Addiction—Founded by Dr. David Greenfield, one of the world's latest voices on internet, computer and digital media behavior.