Internet Addiction: A Public Health Crisis?

There are concerns that large numbers of people have become "Internet addicts" and that the Internet is dehumanizing us. Despite the credibility of some of the people who raise these concerns, the evidence is anything but conclusive.
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The growing use of the Internet in everyday life has raised concerns that large numbers of people have become "Internet addicts" and that the Internet is dehumanizing us. Despite the credibility of some of the people who raise these concerns, the evidence is anything but conclusive.

For example, Elias Aboujaoude, the psychiatrist who heads the OCD clinic at Stanford University, claims in a book published earlier this year that there are "alarming rates of online pathological behavior ... while the Internet is a force for good in many arenas, it also has the power to interfere with our home lives, our romantic relationships, our careers, our parenting abilities--and our very concept of who we are."

No doubt the Internet is changing the way we work and interact with friends and family. No doubt it is changing the way in which we get information. No doubt many people have "second" lives on line where they build virtual communities, go shopping, make friends, have sex, and fight wars.

Certainly some of this Internet use is problematic, interfering with work, meeting family responsibilities, or engaging in flesh and blood relationships. But it also makes it possible to be more efficient and effective, to be better informed, to participate in political life easily, and to have relationships that would otherwise be impossible due to constraints of time and distance.

How, then, should we react to alarms about Internet addiction? Is it really a "21st century epidemic," stealthily destroying relationships, increasing the prevalence of mental disorders, and breeding a generation of people who are impulsive, unable to concentrate, and loathe to do the hard work it takes to build knowledge, skills, and meaningful relationships? Or, on balance, do the personal, vocational, and political changes made possible by the Internet enhance rather than destroy human potential?

Let's look at the evidence.

•"Internet addiction" is not currently a formal diagnosis. Some credible professionals have made a case that it should become one in the Diagnostic and Statistical Manual (DSM-V) that will be issued by the APA in 2013, but their proposal has been rejected.

•There are preliminary research findings of some correlations between 'excessive internet use' and symptoms of depression and anxiety disorders such as obsessive-compulsive disorder (OCD) and attention deficit disorder (ADD). But evidence that use of the Internet causes these symptoms, rather than the other way around is scarce. Grounds to believe in causal connections between Internet use and mental illness will have to wait for further research.

•The only nationally representative epidemiologic study of 'problematic internet use' in the U.S., which was led by Dr. Aboujaoude and is the empirical basis of his claim that there are "alarming rates of pathological online behavior" reports that the 4-13 percent of those studied acknowledged "markers consistent with problematic Internet use" but that the prevalence of diagnosable problematic Internet use was less than 1 percent.

• A large portion of studies on internet addiction come from countries like Taiwan, China and South Korea, which have some of the highest broadband use in the world. The South Korean government has declared Internet addiction a "public health crisis," and China has over 300 dedicated treatment centers.

•There is also research that suggests that using the Internet may enhance social ties and mental health. For example, a study done at Carnegie Mellon University indicates that use of the Internet to get information about one's health increases depression to some extent but that use of the Internet for social purposes decreases depression. Another study, done at the University of Sydney, found that the Internet could result in improvements in social relations and declines in depression. Still another study found that the relationship between Internet use and loneliness was "spurious."

Current research regarding the impact of Internet use on mental health and human life is inconclusive. That leaves everyone free to speculate about dread, or wonderful, consequences of the growth of the Internet.

But it is a striking fact of history that every generation of mature adults has worried about the decline of discipline and morality in the younger generation. In its time, the invention of writing probably struck terror in the hearts of those who revered the oral tradition.

Let's be very careful about indicting a generation of multitaskers and new technology that undoubtedly has its risks but also has great benefits.

That does not mean that we should ignore the fact that some individuals feel irresistibly driven to use the Internet in ways that undermine their personal or vocational lives. They probably need help. Unfortunately, evidence-based treatment for problematic Internet use is not well established and existing sources of help are not yet widely available, a fact that is not likely to change while funding for mental health services is on the chopping block. But, if you think you or someone you care about needs help, call 1-800-273-TALK, the national mental health information and referral service.

This blog posting is co-authored by Simone G. Seol, an MPH candidate at the Mailman School of Public Health at Columbia University.

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