Internet addiction and problematic Internet use: A systematic review of clinical research

AIM: To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science. METHODS: Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally. RESULTS: The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment. CONCLUSION: A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.     

Multi-dimensional discriminative factors for Internet addiction among adolescents regarding gender and age

Aims:  The aim of the present study was to examine the discriminative effects of sociodemographic, individual, family, peers, and school life factors on Internet addiction in Taiwanese adolescents.
Methods:  A total of 8941 adolescents were recruited and completed the questionnaires. Multi-dimensional discriminative factors for Internet addiction were examined using chi-squared automatic interaction detection for gender and sex.
Results:  Depression and low family monitoring were the discriminative factors for Internet addiction in all four gender- and age-specified groups of adolescents. Low connectedness to school, high family conflict, having friends with habitual alcohol drinking, and living in rural areas also had discriminative effects on adolescent Internet addiction in adolescents of different gender and age.
Conclusions:  Multi-dimensional factors were able to discriminate between those adolescents with and without Internet addiction. It is suggested that parents and health and educational professionals monitor the Internet-using behaviors of adolescents who have the factors discriminating for Internet addiction identified in the present study.     

Internet Sexual Offending: Overview of Potential Contributing Factors and Intervention Strategies

As Internet accessibility and use increase dramatically, more and more people are turning to it for sexual purposes. This growing use of the Internet for sexual purposes indicates that the proportion of Internet sexual offences also will continue to rise dramatically. This article examines the impact of Internet problematic behaviours on the potential for recidivism among online sexual offenders. It argues for specialised treatment for these offenders whilst providing an overview of approaches that are currently used in other areas to treat problematic behaviours and how they could be used in the treatment of Internet sexual offenders.     

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.     

Psychiatric symptoms in adolescents with Internet addiction: Comparison with substance use

Aims:  The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use.
Methods:  A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use.
Results:  It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms.
Conclusions:  This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.     

Neurobiological risk factors for problematic social media use as a specific form of Internet addiction: A narrative review

Problematic social media use (PSMU) is a behavioral addiction, a specific form of problematic Internet use associated with the uncontrolled use of social networks. It is typical mostly for modern adolescents and young adults, which are the first generations fully grown up in the era of total digitalization of society. The modern biopsychosocial model of the formation of behavioral addictions, postulating the impact of a large number of biological, psychological, and social factors on addictive behavior formation, may be quite applicable to PSMU. In this narrative review, we discussed neurobiological risk factors for Internet addiction with a focus on current evidence on the association between PSMU and structural/ functional characteristics of the brain and autonomic nervous system, neurochemical correlations, and genetic features. A review of the literature shows that the vast majority of the mentioned neurobiological studies were focused on computer games addiction and generalized Internet addiction (without taking into account the consumed content). Even though a certain number of neuroimaging studies have been conducted for PSMU, there is practically no research on neuropeptide and genetic associations for PSMU to date. This fact points to the extremely high relevance of such studies.     

Usage de Jeux de hasard et d’argent et d’Internet dans une population de patients en demande de soins en addictologie–Étude multicentrique

BackgroundTransversal grouping of addictions under the heading “Substance related and addictive disorders” in the DSM-5 has led to a common policy on addictions and the promotion of addiction services covering all types of addictions, including behavioral addictions.Material and methodsThe main objective of this study was to describe the prevalence of problem gambling in a population of patients seeking treatment in addictive disorders center. Secondary objectives were: to describe the use of Internet and the prevalence of gaming disorder, sexual addiction and compulsive buying online ; to describe a population of patients consulting in addictive disorders center; to explore associated factors related to problem gambling. A self-questionnaire was built, evaluating the socio-demographic elements, the addiction pathway, problem gambling and Internet use with a focus on video game disorder, sexual addiction and compulsive buying. It was offered to consultants from five addictology centers in Brittany.Results252 patients seeking treatment for addictive disorders were included. Problem gambling was present in 9.9 % of patients. Problem gamblers were more likely to have been asked about their gambling by the addictology team than other patients. The rate of identification of gambling habits, whether in addiction or outside, was generally low. Internet use was 83 %. The prevalence of other online behavioral addictions was low.Discussion and conclusionThe prevalence of problem gambling is almost 4 times higher among addictology consultants, compared to the general population, probably related to addictive comorbidities. The identification of gambling habits concerned a small proportion of the patients included, whether in specialized care or outside. There is significant room for improvement in the identification of problem gambling, in addictology and beyond. It is important to question gambling habits for any reason for addiction consultation and to repeat this identification over time. As the Internet is widely used by addictology consultants, it can represent a key element in care, both in the identification of behavioral addictions and in follow-up.     

Emotionally focused therapy for couples recovering from sexual addiction

Sexual addiction is described as a pathological relationship with sexual behaviors. Similar to addictions to substances, sexual addiction is commonly associated with dependency, tolerance, and withdrawal. The treatment of sexual addiction within the romantic couple relationship is significantly absent from existing literature. The presence of sexual addiction in a romantic relationship can result in lack of trust, feelings of shame, anger or betrayal, and ultimately the deterioration of the relationship. Emotionally focused therapy (EFT) is a couples therapy modality in which both partners are validated and helped by the therapist to develop a secure attachment to one another. This theoretical treatment model addresses recovery from a sexual addiction within the couple relationship through the incorporation of empirically validated addictions literature and EFT techniques. Both partners simultaneously participate in the modified steps of EFT treatment to address underlying needs of each partner. The therapist facilitates the couple's expression of emotions and interaction cycles. The goal of this theoretical model is for the couple to develop a secure attachment to one another and to improve resilient coping within the relationship in order to reduce or eliminate the sexually addictive behaviors.     

Calming the tempest,bridging the gorge: healing in couples ruptured by “sex addiction”

Frequently couples seek marital therapy for the painful impact of one partner's “sex addiction.” Disagreement abounds in both the clinical world and the larger society, about what the designation “sex addiction” actually means. A variety of diagnostic categories are subsumed under it, creating confusion about both its causes and effective treatments. The current paper proposes precise definition and diagnostic language regarding a range of compulsive sexual behaviors. It maps a model for understanding and treating compulsive sexual activity in marital therapy in a stepwise sequence, beginning with careful history taking and diagnostics of both partners, identification of the mutually reinforcing relationship dynamics keeping destructive behaviors in play, processing of underlying psychological and developmental roots of such behaviors, cultivation of empathy and trust, and revitalizing of the couple's sexual relationship. The method is illustrated with a case history.     

The Effect of Stress on Internet Game Addiction Trends in Adults: Mindfulness and Conscientiousness as Mediators

ObjectiveThis study examined the mediating effect of mindfulness and consciousness among five factors on the effect of stress on Internet game addiction tendency. MethodsAn online survey was conducted on 400 men and women between their 20s and 40s across Korea. The scales used in the study were the Internet game addiction scale based on the DSM-5, Perceived Stress Scale, Mindfulness Scale, and Five-Factor Personality Scale. For data analysis, structural equation modeling was conducted, and Sobel verification was carried out to verify the significance of the mediating effects. ResultsThe results of the study are as follows: Stress showed a positive correlation with Internet game addiction tendency, mindfulness mediated the effect of stress on Internet game addiction tendency. ConclusionOf the five personality factors, conscientiousness also mediated the effect of stress on Internet game addiction tendency. This study highlights the need for further research for individuals with game addiction tendency.     

上海市网络成瘾中学生的应对方式与社会支持

背景应激被认为与青少年网络成瘾存在一定的关联,除了事件本身,应对方式和寻求社会支持则是应激过程中的主观过程。目的评价网络成瘾中学生的社会支持系统和应对机制。方法以Beard的网络成瘾诊断标准结合功能受损程度,通过临床访谈得到网络成瘾中学生205人,以问卷调查形式评估他们的应对方式和社会支持。176人有效完成问卷（问卷有效率85.9%）,并且与352例（按照1∶2的比例年龄、性别配对）不满足网络成瘾诊断标准的学生进行比较。结果与非网络成瘾学生相比,网络成瘾学生在应对方式问卷的＂问题解决＂分量表和＂求助＂分量表上的平均分显著较低,而在＂自责＂和＂幻想＂分量表上的平均分较高。网络成瘾组中,社会支持评定量表中的＂支持总分＂、＂主观支持分＂、＂对支持的利用度＂分量表得分显著较低。Logistic回归分析提示网络成瘾与应对方式中使用＂问题解决＂、＂幻想＂、＂自责＂以及在＂对支持的利用＂能力上独立相关。结论在中学生中,网络成瘾与应对方式、社会支持的利用度相关。需要进一步的研究来确定,是否在学生中鼓励他们使用积极的应对方式或者训练他们发展和使用社会支持资源将预防或者改善网络成瘾的消极影响。     

The relationship between autism quotient,anxiety, and internet addiction

This study investigated internet addiction across the broad autism phenotype, and assessed the degree to which internet addiction in individuals with higher autism quotient scores may be mediated by co-morbid depression and anxiety. Ninety participants were given a range of psychometric assessments to determine their level of problematic internet usage (Internet Addiction Test), autism traits (Autism Quotient Scale), depression (Beck Depression Inventory), and anxiety (Speilberger Trait Anxiety Scale). Significant associations were found between both autism, and anxiety, and internet addiction. However, the association between autism traits and internet addiction was moderated by high level for anxiety, such that individuals with high numbers of autism traits showed less evidence of internet addiction if they also displayed high levels of anxiety. It is suggested that the presence of anxiety in these individuals alters the function that internet behavior serves, and makes internet addiction less likely.     

Editorial Perspective: Missing the forest for the trees – how the focus on digital addiction and gaming diverted attention away from wider online risks

Despite the many ways in which Internet-related technologies can affect psychology, research into the Internet’s mental health consequences has disproportionately focussed on the narrow topics of online addiction and the closely related Internet gaming disorder. Over two decades into the online revolution, the Internet is being blamed for dramatic transformations, including a rise in extremism, social polarization and weakened democracies. In trying to understand how these shifts could have happened, or how they might be contained, society looks to mental health experts – after all, it is the interaction between technology and human psychology that is encouraging certain behaviours online and discouraging others. The field, however, has precious little to offer by way of explanations. To no small degree, this is due to the tendency to approach online psychological problems primarily through the addiction framework. The result has been to blind us to other important traits and phenomena that are playing out online and on social media, including impulsivity, aggression, inattention, narcissism and the psychological meaning of living in a postprivacy world. The article covers historical aspects of how the addiction model came to dominate the field; some insufficiently heeded early warning signals about other online ills and the big price society is paying today for this approach. We end with a call for a significant broadening of the focus of research when it comes to online psychopathology.     

Sex addiction: therapist perspectives

Sexual addiction may be defined as sexual behaviour that is “compulsive and yet continues despite adverse consequences”. Knowledge and understanding of sexual addiction has been impaired by the use of multiple labels, definitions, and assessment procedures, hence the present study investigated therapist perspectives and experiences of assessing and treating the condition. Interviews were conducted with nine psychosexual therapists and subjected to interpretive phenomenological analysis. Three superordinate themes emerged from the analysis. These were distress, risk, and treatment. The distress theme included three sub-themes: stress and coping; suicidal ideation; and partner experience. Three sub-themes formed the risk theme: physical safety; disease, dysfunctions, and pregnancy; and co-addiction. The treatment theme contained three sub-themes: awareness; assessment and diagnosis; and successful therapy. Findings have important implications for the diagnosis and treatment of sexual addiction. Future research should investigate these themes further and introduce interventions to support the safety and well-being of sexual addiction clients.     

Brain activities associated with gaming urge of online gaming addiction

The aim of this study was to identify the neural substrates of online gaming addiction through evaluation of the brain areas associated with the cue-induced gaming urge. Ten participants with online gaming addiction and 10 control subjects without online gaming addiction were tested. They were presented with gaming pictures and the paired mosaic pictures while undergoing functional magnetic resonance imaging (fMRI) scanning. The contrast in blood-oxygen-level dependent (BOLD) signals when viewing gaming pictures and when viewing mosaic pictures was calculated with the SPM2 software to evaluate the brain activations. Right orbitofrontal cortex, right nucleus accumbens, bilateral anterior cingulate and medial frontal cortex, right dorsolateral prefrontal cortex, and right caudate nucleus were activated in the addicted group in contrast to the control group. The activation of the region-of-interest (ROI) defined by the above brain areas was positively correlated with self-reported gaming urge and recalling of gaming experience provoked by the WOW pictures. The results demonstrate that the neural substrate of cue-induced gaming urge/craving in online gaming addiction is similar to that of the cue-induced craving in substance dependence. The above-mentioned brain regions have been reported to contribute to the craving in substance dependence, and here we show that the same areas were involved in online gaming urge/craving. Thus, the results suggest that the gaming urge/craving in online gaming addiction and craving in substance dependence might share the same neurobiological mechanism.     

The association between harmful alcohol use and Internet addiction among college students: Comparison of personality

Aims:  This study aimed to (i) evaluate the association between Internet addiction and harmful alcohol use, and (ii) evaluate the associated personality characteristics of Internet addiction as well as harmful alcohol use.
Methods:  A total of 2453 college students were invited to complete the Chen Internet Addiction Scale, Behavior Inhibition System and Behavior Approach System Scale(BIS/BAS scale), and the Alcohol Use Disorders Identification Test from May 2005 to May 2006.
Results:  The results demonstrated Internet addiction was associated with harmful alcohol use among college students. College students with Internet addiction had higher scores on the BIS and BAS fun-seeking subscales. However, college students with harmful alcohol use had higher scores on the BAS drive and fun-seeking subscales, and lower scores on the BIS subscale.
Conclusions:  Internet addiction is associated with harmful alcohol use. Furthermore, fun seeking was the shared characteristic of these two problem behaviors and might contribute to the association. However, further studies are necessary to evaluate the underlying mechanisms accounting for the association between Internet addiction and harmful alcohol use.     

The relationship between optimal parenting,Internet addiction and motives for social networking in adolescence

This paper presents a cross-sectional study of a large, high-school Greek student sample (N=1971) with the aim to examine adolescent motives for participating in social networking (SN) for a possible link with parenting style and cognitions related to Internet addiction disorder (IAD). Exploratory statistics demonstrate a shift from the prominence of online gaming to social networking for this age group. A regression model provides with the best linear combination of independent variables useful in predicting participation in SN. Results also include a validated model of negative correlation between optimal parenting on the one hand and motives for SN participation and IAD on the other. Examining cognitions linked to SN may assist in a better understanding of underlying adolescent wishes and problems. Future research may focus in the patterns unveiled among those adolescents turning to SN for the gratification of basic unmet psychological needs. The debate on the exact nature of IAD would benefit from the inclusion of SN as a possible online activity where addictive phenomena may occur.     

L’addiction aux smartphones : validation française de l’échelle Internet Addiction Test-version smartphone (IAT-smartphone) et caractéristiques psychopathologiques associées

IntroductionSince their first appearance in 1992 smartphones have improved constantly, and their use, combined with the rapid spread of the Internet, has increased dramatically. The recent emergence of this technology raises new issues, at both individual and societal levels. Several studies have investigated the physical and psychological harm that may be caused by smartphones. The issue of excessive smartphone use as an addictive disorder is frequently raised and debated, although it is not acknowledged in international classifications. In France, there is no validated assessment tool for smartphone addiction. Therefore, the aims of this research were: to validate a French translation of the Internet Addiction Test-smartphone version (IAT-smartphone); to study the links between smartphone addiction, Internet addiction, depression, anxiety and impulsivity.MethodTwo hundred and sixteen participants from the general population were included in the study (January to February 2016), which was available online using Sphinx software. We assessed smartphone addiction (French version of the Internet Addiction Scale – smartphone version, IAT-smartphone), specificity of smartphone use (time spent, types of activity), Internet addiction (Internet Addiction Test, IAT), impulsivity (UPPS Impulsiveness Behavior Scale), and anxiety and depression (Hospital Anxiety and Depression scale, HAD). We tested the construct validity of the IAT-smartphone (exploratory factor analysis, internal consistency, non-parametric correlation tests for convergent validity). We also carried out multiple linear regressions to determine the factors associated with IAT-smartphone.ResultsMean age was 32.4 ± 12.2 years; 75.5% of the participants were women. The IAT-smartphone had a one-factor structure (explaining 42 % of the variance), excellent internal consistency (α = 0.93) and satisfactory convergent validity. Smartphone addiction was associated with Internet addiction (ρ = 0.85), depression (ρ = 0.31), anxiety (ρ = 0.14), and some impulsivity subscales, including “negative urgency” (ρ = 0.20; P < 0.01), “positive urgency” (ρ = 0.20; P < 0.01), and “lack of perseverance” (ρ = 0.16; P < 0.05). Age was negatively associated with the IAT-S total score (ρ = −0.25; P < 0.001), and there was a non-significant difference between the IAT-S total scores of men and women (29.3 ± 10.2 vs. 32.7 ± 12.4; P = 0.06). Multiple linear regression showed that age, anxiety, depression, average time spent on the smartphone, impulsivity and Internet addiction explained 71.4 % of the variance of IAT-smartphone scores. However, this score dropped to 13.2 % when Internet addiction was removed from the model. This variable alone explained 70.8 % of the IAT-smartphone scores.ConclusionThe French version of the IAT-smartphone is a reliable and valid questionnaire to assess smartphone addiction. This addiction appears to be strongly linked to anxiety, depression and impulsivity. The strong association between smartphone addiction and Internet addiction suggests that smartphone addiction is one of the many forms of Internet addiction. In fact, smartphones may not be the object of the addiction but rather a medium facilitating Internet access as it makes it possible to connect anywhere anytime. This raises the issue of the potential role of smartphones in speeding up and facilitating the development of Internet addiction.     

Cyberspace Betrayal: Attachment in an Era of Virtual Connection

Electronic technology has yielded new forms of relationship bonding as well as unique aspects of betrayal and ruptures in attachment. Four key characteristics of betrayal that differentiate online from offline experience will be identified. The inherent ambiguities in defining online sexual infidelity will point to a need to professionally define the parameters of internet betrayal in light of the ever expanding electronic revolution.