Understanding Internet Addiction

The idea that we can become addicted to Internet-related activities wasn’t always taken as seriously as it is today. While it’s not officially recognized as a disorder in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the prevalence of Internet Addiction (IA), also commonly referred to as Internet Addiction Disorder (IAD), has become a legitimate concern.

It’s important to note that simply using the Internet frequently — to watch YouTube videos, shop online, or scroll social media — doesn’t mean you’re suffering from Internet Addiction. Concerns should only arise when excessive use of the Internet begins to negatively impact your daily life. Our guide provides a comprehensive definition of Internet Addiction, as well as its common causes, effects, and treatments.

While Internet Addiction is not currently acknowledged as a formal disorder by that name, “Digital Addiction” (or addiction to digital technology) was officially recognized by the World Health Organization as a worldwide concern in 2020, when this problem became even more widespread due to the COVID-19 pandemic.16

Formal recognition is a step in the right direction, but currently, there are no standardized criteria for characterizing repetitive behavior (like that seen in IA) as an addiction.1 However, the DSM-5 and the World Health Organization’s International Classification of Disease, 11th Edition (ICD-11) both attempt to address the issue of whether the definition of addiction should be expanded to include forms of behavior alongside psychoactive substances, such as alcohol and other drugs.

For example, in the DSM-5, gambling disorder (GD), formally defined as pathological gambling, was moved from the impulse control disorders section to the “Substance-Related and Addictive Disorders” chapter. Mounting empirical evidence showing parallels between compulsive gambling and substance use prompted the move. There was insufficient evidence, however, relating to behaviors such as sexual activity, Internet use, compulsive spending, and stealing to also categorize them as addictions.1

Substance use disorders (SUDs) and behavioral addictions are characterized by the ongoing inability to control the frequency of an activity, even when that activity comes with negative consequences.2 Both include urges, cravings, and a perceived inability to stop. They also appear to share a genetic component; for instance, researchers have found compulsive gamblers to share some of the same gene mutations as those with alcohol use disorder.2

Behavioral addictions related to gambling, Internet use, and online gaming appear to be more common among adolescents and young adults. As advancements in technology continue to accelerate, this increases the need for more current, longitudinal studies surrounding Internet- and technology-based behavioral addictions.

Without an official classification as a psychiatric disorder, calling an unhealthy amount of Internet usage an addiction could be considered controversial, making it more challenging to diagnose and treat this increasingly prevalent issue.3 The term addiction is most readily associated with psychoactive substances, but as behavioral and impulse-related disorders continue to rise, a broader definition has become necessary.

Like many other forms of addiction, Internet Addiction can be defined, generally, as a lack of control that negatively impacts the life of the addicted person. Broadly speaking, Internet-focused addictive behaviors present as:3

• An intense preoccupation with using the Internet
• Difficulty managing time on the Internet
• Irritation resulting from disruption of online activity
• Decreased real-world social interaction due to spending time online
• Experiencing anxiety or discomfort when the Internet is unavailable
• Increasing Internet use over intended amounts

Technically, the Internet is just the vehicle through which we access online activities and services. And what we often label as Internet Addiction is one of the many manifestations of this overarching affliction. Those struggling with IA will typically engage in some combination of behaviors included in the following categories:3

• Play (online forms of gaming or gambling)
• Work (accessing online resources, downloading software, emailing, website hosting)
• Socializing (social networking sites, group chats, online dating)
• Entertainment (film databases, pornography, music)
• Consumables (groceries, clothing, items)
• Other web-based activities and services

The wide range of activities available on the Internet makes it a highly diverse and stimulating environment. In turn, this hearty selection of stimuli makes the fundamental concept of Internet Addiction more difficult to grasp. This raises the question: Do we become addicted to our individual experiences or to the medium itself?

This isn’t the only question that remains unanswered; the impact of smartphone technology on our Internet usage is still yet to be definitively determined. Additionally, it’s unclear whether or not IA is actually an expression of another underlying psychological disorder.

Individuals who spend an excessive amount of time online shopping, for example, differ psychologically from those addicted to pornography — these are distinct behaviors rooted in different types of gratification or fulfillment. For instance, those addicted to pornography are seeking sexual stimulation, while those addicted to online dating or social media could be seeking romantic fantasy, a sense of belonging, or acceptance.3 12

This means that, ultimately, examining compulsive Internet use too broadly could result in crucial behavioral nuances getting overlooked. It’s also important to note how rapidly the Internet has evolved in the past couple of decades (particularly with smartphones) — we still don’t know the long-term effects of IA or how it may evolve over time.

For now, gaining a more thorough understanding of Internet Addiction requires a close examination of the activities most commonly associated with it.

Like most behavioral disorders, Internet Addiction is a complex issue with no single, specific cause. However, researchers have identified various contributing factors that may increase the likelihood of developing an addiction to the Internet. While the exact cause of Internet addiction remains unclear, it’s important to address these contributing factors to better understand and prevent this growing problem.

Self-image

A few studies report no direct connection between social media addiction and life satisfaction; however, research has linked excessive use of social media to low self-esteem and higher levels of narcissism.9 One explanation for this, based on the ‘‘social compensation’’ hypothesis, is that individuals with low self-esteem, low life satisfaction, and few offline relationships tend to compensate by using social media platforms, like Facebook, to enhance their self-image and increase their sense of popularity or acceptance.9

Some studies have shown a correlation between increased Instagram use and levels of narcissism. And one large-scale study of 23,592 social media users (Facebook, Instagram, and Twitter) showed that social media addiction is linked to three primary factors: being female, high in narcissism, and low in self-esteem.9 Researchers recently found that narcissism comes from insecurity, which could lead individuals with those personality traits to continuously seek validation and acceptance from others via social media (and potentially become addicted).14

Neurobiology

The use of magnetic resonance imaging (MRI), electroencephalography (EEG), and positron emission tomography (PET) has helped researchers understand how brain function applies to Internet Addiction. However, there’s very little information regarding the specific molecules in the brain involved in IA.10 To give us a rough idea of which parts of the brain and which neurotransmitters might be involved in Internet Addiction, a range of self-report surveys have been used.

According to questionnaire data, higher levels of fear, sadness, and anger were strongly associated with problematic Internet usage, while higher scores pertaining to positive emotional systems were associated with the opposite. Survey participants with higher sadness scores appeared to use the Internet as a substitute for socializing and were, therefore, more likely to be addicted to the Internet.10 It’s also possible, though, that excessive use of the Internet could lead to higher levels of sadness over time.

Excessive Internet use was observed in participants with anxiety, as indicated by their high fear scores. Negative outcomes related to Internet use were also reported by individuals who scored low in seeking (curiosity or openness toward new experiences). This suggests that low seeking scores may be associated with excessive Internet use or indicate a preference for interacting with inanimate objects. Researchers identified a low care score as one of the best predictors of excessive Internet use.10

Reward and control

Multiple brain imaging studies have shown that excessive online gaming can affect regions of the brain responsible for reward, impulse control, and sensory-motor coordination. And additional studies have suggested that persistent gaming can affect dopamine levels in ways similar to drug use.11

Dopamine is a neurotransmitter in your brain that plays a crucial part in your body as its “reward center”; it’s involved in your movement, memory, mood, ability to learn, attention, behavior, motivation, and more.17 Addiction increases your brain’s dopamine levels and the rate at which these increases occur. The faster the increase, the more intense the reinforcing effects — this leads to an increased motivation to partake in the addictive behavior. But, as the behavior continues, your brain makes less dopamine in response to it, leading to needing more and more to achieve the same feeling.18

Specifically, structural studies have revealed alterations in the volume of the ventral striatum (a critical component of the brain’s motor and reward systems). The neural mechanisms underlying video game addiction are similar to those of substance use disorder. However, there’s still insufficient evidence to conclude that it can be diagnosed and treated the same way. Treatment studies using functional magnetic resonance imaging (fMRI), however, have shown a reduction in brain activity associated with compulsive gaming.11

Many researchers and mental health practitioners view Internet Addiction as a symptom of another disorder (like anxiety or depression) as opposed to a separate diagnosable affliction. But there’s also a strong argument that Internet Addiction merits an individual label, especially given the array of symptoms associated with it:12

• Changes in mood
• Preoccupation with the Internet and digital media
• Inability to control the amount of time spent using technology
• Need for more time or a new game to achieve a desired mood
• Withdrawal symptoms when not engaged
• Family conflict
• Diminishing social life
• Adverse work or academic consequences
• Continuation of behavior despite negative outcomes

The Internet, just like gambling, operates on a variable ratio reinforcement schedule (VRRS), meaning that whatever the application — pornography, chat rooms, social media, video games, email, texting, and so on — these activities create unpredictable and variable reward structures.12 Mood-enhancing or stimulating content (like social media notifications or updates) can intensify this sense of reward, contributing to our adoption of unhealthy, dependent behaviors.12

The first potential parameters for identifying “Internet overuse” were based on criteria for diagnosing psychoactive substance addiction and were introduced over 20 years ago by Dr. Ivan K. Goldberg.13 Since then, several other research groups have contributed to our understanding of what constitutes an addiction to the Internet.

Generally, Internet Addiction can be identified by a reduction of previously important occupational, social, or recreational activities in favor of spending time on the Internet. Other potential diagnostic elements include:13

• Internet overuse associated with negative life or productivity outcomes
• Tolerance (the need to progressively acquire better equipment or increase time spent on the Internet to achieve similar satisfaction)
• Withdrawal (depressed feelings, increased tension, or anger resulting from nonuse of the Internet)
• Preoccupation (obsessive thoughts regarding what is happening on the Internet; dreams or fantasies about the Internet)
• Negative social and emotional consequences (lying, arguments, fatigue, poor school or work performance, social isolation)
• Failing repeatedly to resist the urge to use the Internet (loss of self-control)
• Frequently spending more time online than intended (inability to use moderation)

Because the behavioral patterns found in substance use disorder and IA appear to be similar, diagnostic systems for Internet-related activities should continue to advance with further research. As researchers develop these systems, identify diagnostic criteria, and generate new approaches to treatment and prevention, they should also consider relevance and impact in terms of public health.

It’s widely believed that the goal of interventions should not be complete abstinence from the Internet.12 It’d be nearly impossible to fully abstain from the Internet with it so ingrained in our modern daily lives — work, school, communicating, and checking daily news or weather. Instead, those undergoing treatment should aim to abstain from problematic applications, cultivate a sense of control, and achieve a healthy balance in terms of Internet usage.

Pharmacological interventions, specifically selective serotonin reuptake inhibitors (SSRIs), have been used to treat Internet Addiction, but only when comorbid psychiatric symptoms are present. A variety of approaches based on cognitive-behavioral therapy (CBT) techniques have also been used:12

• Identifying the pattern of Internet use, then disrupting it by adopting a new schedule
• Using external stoppers — real events or activities that might prompt logging off
• Setting goals regarding the amount of time spent online
• Abstaining from particularly tempting applications
• Using reminder cards or other cost and benefit cues
• Maintaining a personal inventory of all online activities
• Joining a support group
• Engaging in individual, group, or family therapy

While some research points to the prognosis of IA being generally positive if appropriate, individualized treatments are applied, the overall efficacy of these interventions is not yet supported by enough clinical or empirical evidence. And even though the symptoms of IA overlap with those of many behavioral addictions, the debate over diagnostic criteria, classification, and treatment will likely continue until researchers conduct further studies.12

Internet Addiction is defined as a lack of control over Internet usage that can negatively impact your personal life. It can appear in the form of various online activities, including social media, gaming, online shopping, pornography, and gambling. While there’s insufficient evidence to officially categorize excessive Internet use as an addiction, the behavioral patterns and consequences associated with it resemble those observed in other forms of behavioral addiction and substance use disorders (often characterized by an inability to control the frequency of an activity, even when it comes with negative consequences).

There are multiple contributing factors to Internet Addiction, including emotional triggers and changes in neurochemistry. Studies have shown a positive relationship between social media use and narcissism, as well as a link between excessive Internet use and negative emotions such as fear, sadness, and anger. Some research also links excessive online gaming to changes in the brain's reward and control systems, similar to substance use.

However, there is still insufficient evidence to diagnose and treat Internet Addiction the same way as a substance use disorder. Despite behavioral patterns in substance use and Internet addiction being similar, we still need to cultivate a deeper understanding of the psychological motivations behind addictive behaviors to properly diagnose IA.