August 3, 2008

Debate Starts on Internet Addiction

By Alonzo Weston, St. Joseph News-Press, Mo.

Aug. 3--If an Oregon psychiatrist has his way, excessive Internet surfing, text messaging and e-mailing would be considered a mental illness. And it would be one officially recognized and included in the Diagnostic and Statistical Manual of Mental Disorders (DSMV), the psychoanalyst's bible.

But some local mental health providers disagree. They say they haven't seen any actual cases of Internet addiction. And what can be considered Internet addiction is already covered in the DSM manual under compulsive disorders.

Internet addiction simply doesn't compare to substance abuse or other addictions, said Bernie Storms, director for the Family Guidance Center for Behavioral Healthcare addiction treatment services.

"I haven't seen anything that tells me it alters the brain chemistry," she said. "I haven't seen anything that tells me there are real physiological negative ramification from using the Internet.

"I don't think it probably deserves its own subcategory," said Dr. James Jura, psychiatrist at the Heartland Health mental health unit. "It's more in like the impulse control category, like kleptomania or people who set fires ... non-specified, and that's kind of a catch-all. TV addiction fits in there, too."

Dr. Jerald Block, an Oregon Health and Science University psychiatrist, opened the discussion on Internet addiction as an official diagnosis in a recent editorial of the American Journal of Psychiatry. He bolstered his position by claiming that 86 percent of Internet addicts already have an official mental illness diagnosis. And unless a therapist is trained to screen for it, the condition is likely to go undetected.

"Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of three subtypes: excessive gaming, sexual preoccupations and e-mail text-messaging," Dr. Block said in the article. He added that all three variants of Internet addiction share the same components of other addictions such as excessive use, withdrawal, tolerance and negative repercussions.

"These compulsive behaviors can have very serious health and social consequences ranging from fatigue, depression, social isolation and poor work performance," explained Mr. Block from the Oregon Health and Science University Web site. "In some very extreme cases, those addicted to Internet use have suffered cardiopulmonary-related deaths."

Dr. Block cites an Internet addiction study in South Korea that was done after a series of cardio-pulmonary related deaths in Internet cafes. South Korea considers Internet addiction one of its most serious public health issues, he said. And 2006 South Korean government data estimates that about 210,000 South Korean children from 6 to 19 years old are Internet addicts who require treatment.

"About 80 percent of those needing treatment may need psychotropic medications and perhaps 20 to 24 percent require hospitalization," Dr. Block said.

He added that data is lacking on prevalence of the condition in the United States. One of the reasons is that unlike in the United States, Asian therapists are taught to screen for Internet addiction.

"Unlike in Asia, where Internet cafes are frequently used, in the United States games and virtual sex are accessed at home," he said. "Attempts to measure the phenomenon are clouded by shame, denial and minimization."

Dr. Shirley Taylor, a Heartland Health Counseling Services psychologist, agrees with Dr. Block's recommendation that Internet addiction be listed in the DSMV. She said the diagnosis fits some individuals.

I have seen individuals who get anxious if they can't check their e-mails hourly. I don't necessarily call that an addiction, maybe a dependency," she said. "They may be the same people who previously (before the Internet) made contact via telephone to others many times a day."

Dr. Taylor said she hasn't treated anyone for Internet addiction. But she has treated men for Internet porn addiction.

"As the Internet becomes even more commonplace and affordable, more people will have the opportunity to develop an addiction to viewing the Internet," she said.

Ms. Storms said she doesn't doubt that excessive Internet use can be a problem for relationships. She sees it as a trend among younger people who would rather communicate through MySpace and text messaging rather than in person. That could create face-to-face communication problems in the future, she said.

"I have heard that it can also become quite problematic, particularly when pornography is involved, and it's a substitute for intimacy because the individual who is involved in a relationship, because they have his real intimate connection with the other person," she said.

"My personal belief is if you spend 20 hours behind a computer and not interacting or talking to people, you're not going to develop the nonverbal communication skills that is so much in the interaction between people," Dr. Jura added. "I think people can stunt their ability to interact appropriately with other people."

Dr. Jura said that on the other hand, Internet communication can be beneficial for some people who suffer from social phobia and other avoidance disorders. It can promote a connectedness that will encourage the person to venture out in public.

"But doing those things at home without pushing yourself to leave actually worsens it for the folk who are on that (path)," he said.

Dr. Jura said for persons who feel they spend too much time on the Internet and are seeking help, there are treatments. But treatment differs depending on the underlying causes.

A mix of medication and therapy is prescribed for those with underlying conditions of depression and anxiety and those with porn addictions bordering on paraphelias.

"But if there wasn't any of that stuff there, and if it was really troublesome to them, you could do one or two things. You could do psychotherapy to help set limits and then probably consider some medication for impulse control disorders," he said.

Ms. Storms said you can't treat Internet addiction like other addictions such as drugs and alcohol, even gambling, which has been proven to affect certain brain neurotransmitters. She also believes that the term "addiction" is thrown around too loosely.

"I don't have anything to back this up, but personally I believe a lot of people blame addiction for a lot of society's ills," she said. "Internet addiction and pornography addiction and texting addiction and that stuff is really taking it a bit too far in my opinion."

Alonzo Weston can be reached at [email protected]


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