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Plasticity is the normal ongoing state of the nervous system throughout the life span.

– Alvaro Pascual-Leone, Neuroscientist, Harvard Medical School.



Connectivity becomes a craving; when we receive a text or email, our nervous system responds by giving us a shot of dopamine. We are stimulated by connectivity itself. We learn to require it, even as it depletes us.

– Sherry Turkle, Alone Together, p.237.



Specialized MRI brain scans showed changes in the white matter of the brain—the part that contains nerve fibres—in those classed as being web addicts, compared with non-addicts. This could imply that Internet Addiction Disorder has similarities with substance addiction and impulse control disorders.

The Wall Street Journal, 16 January, 2012.



Addiction is a misguided search for self-love and spiritual fulfillment.

– Charlotte Davis Kasl, Women, Sex, and Addiction, p.19.



I think using the internet in certain ways can be quite absorbing, but I don't know that it's any different from an addiction to playing the violin and bowling. […] There is absolutely no evidence that spending time online, exchanging email with family and friends, is the least bit harmful. We know that people who are depressed or anxious are likely to go online for escape and that doing so helps them.

– Sara Kershaw, professor of computer science and human-computer interaction at Carnegie Mellon University.



The idea of addiction, with its one solution that we know we won’t take, makes us feel hopeless. We have to find a way to live with seductive technology and make it work for our purposes.

– Sherry Turkle, Alone Together, p.294.


The internet is changing us

When we overuse the internet – and it has been estimated that 1.5% to 8.2% of the general population have a problematic web dependency – we train our brains to think in a very distracted, superficial way. As masterfully outlined by Nicholas Carr in The Shallows, pervasive information technology and the internet have significantly contributed to a contemporary psychological state that is ever more adept at scanning and skimming, but at a cost. We are losing our familiarity with the deeper modes of thinking – which require attentiveness, concentration and an ability to tune out distractions, to allow for contemplation, and reflection. The new normal is to have a networked smart phone constantly at the ready, removing our need to remember anything, a mediated encouragement of rapid sampling of small bits of information from limitless, unaccountable sources.


Neurological perspective: brain training

In recent decades, neuroscientists and psychologists have not only confirmed the plasticity of the human brain and its neurological activity, but have also discovered how profoundly the use of media can influence the formation of neural circuitry.

In his book Affective Neuroscience: The Foundations of Human and Animal Emotions, the neuroscientist, Jaak Panksepp describes a neurochemically compelled behaviour that exists in all mammals: a “seeking drive.” Panksepp’s laboratory research shows that when we get thrilled about an idea, (from making a new connection intellectually, or divining a meaning, etc), there is physical evidence of stimulation to the lateral hypothalamus of the brain. He calls these “seeking circuits.” However, in the context of internet use, when we receive an email, message or search result, these same circuits are firing continuously and are caught in a short-term memory loop “where each stimulation evoke[s] a reinvigorated search strategy.” His implication is that one online search endlessly provokes another search, causing our “seeking drive” to be short circuited – as opposed to allowing a more natural transition into neurological regions more conducive to contemplation, idea gestation and development.

Related research has been done by the psychologist Kent Berridge into what he calls the “panting appetite,” in which the audio ping announcing the arrival of a new email or message serves as an irresistible Pavlovian reward cue for heavily-mediated users. Another relevant insight has come from Dr Paul Howard Jones, who has outlined how uncertain rewards are particularly effective at stimulating midbrain dopamine, and so the unpredictability of when a new email message will arrive only serves to enhance its poignancy at triggering neurological pleasure.

Usage habits also play a role – as our devices become more portable, usable and personal, our behaviour with them becomes more intimate. Staring at a small, bright screen while in bed has been shown to disrupt the pineal gland’s ability to naturally produce melatonin – which in turn disturbs sleep. As sleep is necessary to consolidate memory and learning, our mobile devices have a very real ability to significantly disrupt our mental well-being.


The psychiatric perspective

Problematic overuse of the internet has been discussed in the psychiatric community since the 1990s, though the idea that it is uniquely distinct from established disorders such as obsession, depression, or compulsion remains controversial – therefore, there is no standardized definition, diagnosis or treatment.

The psychiatric addiction treatment field generally defines addiction as a form of mental illness broadly categorized as two types: substance addictions and process addictions. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (better known as the DSM-IV), a widely influential manual published by the American Psychiatric Association defines “Substance dependence” as “a cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.” The DSM-IV distinguishes between substance dependence and substance abuse. The main difference is one of degree of substance use, possibly related to the presence or absence of factors of predisposition – the physiological component of addiction, as manifested in regards to tolerance, withdrawal, loss of control, and the nature of the adverse results. Addictive substances traditionally include alcohol, tobacco, and illegal and prescription drugs.

In addition to substance dependence/abuse, the DSM-IV covers “Impulse-Control Disorders” which includes pathological behavioural or activity addictions such as eating, gambling, spending, working, exercising, and sexual activity compulsions. And so following the DSM-IV manual, like obsessive television viewing, internet addiction has been diagnosed and treated as an “impulse control disorder not otherwise specified,” essentially a process addiction. However, there is also a growing consensus in the psychiatric and neuro-scientific communities towards a more formal and distinct recognition of internet addiction.


Internet Addiction Disorder

The concept of ‘Internet Addiction Disorder,’ or IAD, was largely popularized by Dr Kimberly Young of the University of Pittsburgh, who founded The Centre for Online Addiction in 1998, and also developed an online internet addiction test which became an early, popular psychometric measure of web user pathology. She defines IAD as a distinct clinical disorder: “Internet addicts suffer from emotional problems such as depression and anxiety-related disorders and often use the fantasy world of the internet to psychologically escape unpleasant feelings or stressful situations.”

Dr. Young’s research has revealed that the most common mental health co-morbiduaries of pathological internet use are primarily depression and bi-polar disorder in its depressive swing, but also include alcoholism, chemical dependency, compulsive gambling, or chronic overeating. She has linked the disorder to negative social, psychological and occupational consequences such as job loss, marriage breakdown, financial debt, and academic failure: broadly, a desire to avoid reality.

Numerous definitions for Internet Addiction, and more generally ‘problematic computer overuse’, have been proposed over the last 20 years, including the following by Dr. K. W. Beard: “an individual is addicted when an individual’s psychological state, which includes both mental and emotional states, as well as their scholastic, occupational, and social interactions, is impaired by the overuse of the medium.” Among those who believe the disorder is best clinically treated as a compulsion rather than as an addiction is David Greenfield, of the Centre for Internet and Technology Addiction and the author of Virtual Addiction, who has researched how online experiences seem to have unique psychological properties which induce dissociation, time distortion, and instant gratification.


Contemporary Diagnosis

Growing attention has been granted to a detailed diagnostic criteria proposed in 2010 by a team lead by Dr Ran Tao, based at an addiction treatment centre in Beijing, and backed by a large sample group. Let us briefly detail their diagnosis methodology, which is broken down into four criteria related to symptoms, impairment, duration, and exclusion of unrelated disorders:

1. Symptom criterion (7 of 8 must be present): Preoccupation, withdrawal, tolerance, lack of control, continued excessive use despite knowledge of negative effects/affects, loss of interests excluding internet, use of the internet to escape or relieve a dysphoric mood, and hiding from friends and relatives.

2. Impairment criterion. Clinically significant functional and psychosocial impairments.

3. Course criterion. The duration of addiction has lasted at least three months, with at least six hours of non-essential internet usage per day.

4. Exclusion criterion. Dependency cannot otherwise be attributed to a psychotic disorder.


The addict’s experience

There is a profound stigma and shame to addiction. Indeed, it would seem that addiction and shame are so intertwined that It is hard to understand where one starts and the other ends. An addicted person experiences a loss of control and has a compulsion to use despite adverse consequences. Addiction leaves the addict feeling powerless, isolated, confused, and unworthy, and similar emotional sensations can also be experienced by the addicted person’s loved ones and family members.


Controversy

In public opinion the psychiatric community has long courted controversy, in recent decades mostly caused by its close and financially lucrative relationship to the pharmaceutical industry, which has resulted in the invention of new disorders such as Attention Deficit disorder, (also known as Attention Deficit and Hyperactivity disorder or 'ADHD'), and the widespread prescription of psychostimulant drugs to adults, children and even pets. Curiously, the first generation of children – whose brains are in a sensitive developing state – widely prescribed psychostimulant drugs such as Methylphenidate (Ritalin, MPH, MPD), which increase the levels of dopamine and norepinephrine in the brain through reuptake inhibition of the respective monoamine transporters (in a similar fashion to cocaine) is now the very same online generation who have assumed the mantle of contemporary media barons.

The labelling and treatment of problematic internet usage as an addiction has been fiercely opposed by some professionals working in the information technology industries. Sara Kiesler, a professor of computer science and human-computer interaction at Carnegie Mellon University, has also been vocal in her opposition, going so far as to call internet addiction a self-correctable “fad illness”, less serious than television addiction. According to Kiesler, calling problematic internet usage an addiction “demeans really serious illnesses, which are things like addiction to gambling, where you steal your family's money to pay for your gambling debts, drug addictions, cigarette addictions. These are physiological addictions.” Bold statements to make as a non-professional psychologist, that may relate more to the positivistic, industrialist ambitions of her chosen discipline.

In the contemporary medical community, addiction treatment has become far more complex and nuanced than “the one solution” of abstinence supported by conventional psychiatry and ‘Twelve-Step’ programs, based on the incurable disease model of “Once an addict, always an addict.” The problematic issues associated with online networked media are likely one or two steps beyond the conventional, North American model of addiction, with its binary framework of problem-solution, substance abuse-abstinence. The ever-growing integral importance of the internet denotes that a more nuanced approach to our current cyborgian state is likely to be required.

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