Is Internet Addiction a Viable Mental Health Issue ?

Late at night a neighbor signs out of social media, checks emails again, goes online to “relax” at a site he keeps secret from his family before powering down the computer and the tablet. He checks Smartphone messages again, and then switches to a Smartphone app that is designed to help with sleep. He continues to wonder if he, his wife, his children, his friends are internet “addicts.” He checks Google and finds that they have many of the symptoms of addiction such as preoccupation with internet use, loss of interest in other activities, deceit, problems with work, school and family relationships [1]. Then he finds an article by an addiction “expert” who says Internet addiction does not exist.


Introduction
Late at night a neighbor signs out of social media, checks emails again, goes online to "relax" at a site he keeps secret from his family before powering down the computer and the tablet.He checks Smartphone messages again, and then switches to a Smartphone app that is designed to help with sleep.He continues to wonder if he, his wife, his children, his friends are internet "addicts." He checks Google and finds that they have many of the symptoms of addiction such as preoccupation with internet use, loss of interest in other activities, deceit, problems with work, school and family relationships [1].Then he finds an article by an addiction "expert" who says Internet addiction does not exist.
Confusion!!!! Anyone in recovery from an internet addiction will present a passionate and vivid description of the personal and relationship costs and challenges of recovery [2].
The American Psychological Association recognizes addiction as a complex brain disease that can take over a person's life.People with addictions continue with addictive behaviors even when they are problematic.Family members often get upset with each other for spending too much time on pornography, gambling websites and social media.Yet they do not stop and continue to have further conflict in their lives.(American Psychological Association, nd)

Background
In her book, Internet Addiction, Dr. Kimberly Young and her colleagues cover the emergence and progression of internet addiction through studies in Russia, China, Taiwan, and the USA.She explores symptoms of the various internet addictions.She described in depth the deaths that occurred for several internet gaming addicts [3].

Professional Observations
Collectively most internet addicts are of average to above average intelligence.They range from functioning well in their education and careers to almost exclusive addictive behavior, rendering them virtually non-functional.As with most addicts, they usually present with other obsessions/compulsions.These behaviours often cause problems in their families.Many internet addicts are technologically astute.A few have histories of breaking the law [4].

Internet addiction and therapy
The modern-day therapist is likely to encounter at least one of the following: 1. "Internet Gaming Disorder"-The only addiction recognized by the DSM-5 is as a condition recommended for further study [1].

Internet gaming addiction
In the writer's experience, the typical Internet Gaming Addict is male-high school to young adult age.He often has an "avatar, " an internet gaming identity.He frequents many gaming sites and spends much/most of the day gaming with people all over the world.Very often he is unmotivated to recover from his addiction and is in therapy at the insistence of parents.He enjoys "teaching" the therapist about technology.He is "intolerant" if the therapist does not have the latest "apps" and devices.
The writer has found that the therapist must have good ego strength, as gaming addicts tend to be quite arrogant and judgmental [2].
What motivates the gaming addict to begin recovery?Perhaps "hitting rock bottom, " when he realizes that his non-addicted peers are ahead of him educationally and career wise.Or perhaps he is tired of his addiction but is not able to go "cold turkey by himself." He often begins the process of recovery by trying an online type 12step program [5].He may find other recovering people and share their "strength, hope and love [6].He continues to enjoy "teaching" his therapist about online recovery programs and give liberal suggestions as to how to treat other patients with the same addiction.This can be seen as subtle Cognitive Behavior Therapy and reinforcement of healthy behavior of the recovering addict [7].
The therapist must not compete with the gaming addict but rather establish a team in which the addict is the "star player." Reading "between the lines, " one can see that treating a gaming addict requires the therapist to have a good sense of humor as well as the aforementioned strong ego [2].

Internet gambling addiction
Internet Gambling attracts both males and females.Often, they have been very respectable, responsible adults who started becoming active on internet gambling websites as diversions from the routines of modern life.As the diversions progress to addiction, they hide initially; but eventually behaviors become noticeable and problematic.They neglect their responsibilities and household duties and their children; they get in trouble at work.They progress from being solvent to borrowing money, becoming delinquent in mortgage and credit card payments [8].Gambling addicts often come to therapy at the insistence of their spouses.Or internet gambling addicts who are motivated to stop will sometimes "confess" or stop hiding their debt.It is common for them to go to great lengths to be "caught" by their spouse after significant financial losses.A common ploy is for the gambler to arrange for creditors to contact his/her spouse.Others will have lost everything and everyone and come to therapy because they have hit "rock bottom." Motivational interviewing (MI) [9] works well with gamblers.Gamblers Anonymous [10] is a well-accepted adjunct to Cognitive Behavioral Therapy (CBT) [7].Psychodynamic therapy when the addiction is accompanied by deep-seated issues can be effective [4].

Internet pornography (Porn)
Most often a male, the porn addict is usually referred by his significant other.The typical scenario is that he was a great spouse and father.Now he is on devices 24/7, neglects household responsibilities, is disinterested in family and in her."I caught him watching porn, but he assures me that he just does it to relax." Relaxation is a common rationalization used by porn addicts, in fact by addicts in general [11].
He reluctantly agrees to couples or sex therapy, but often it becomes evident right away that he is unmotivated.He "plays the therapy game." After rapport has been established, he may be gently confronted individually with the idea that he is addicted.He may deny, minimize, rationalize [12].He may request that the therapist not disclose to his wife.It is, of course, suggested that there should be no secrets between them and that she will ultimately figure it out.When and if he does disclose, she is not surprised.She then devours information on porn addiction [13].
Motivational Interviewing [9] will often allow the porn addict to view his addiction realistically and provide the motivated addict with the impetus to begin recovery.Solution focused therapy can help with the shame and guilt of recovery as he is assured that he is not the problem, but that "the problem is the problem" [14][15][16].
It is recommended that he start by taking all porn off his computer, acquire a new computer, go to an online recovery meeting or to a 12step group (Sex Addicts Anonymous (SA) and continue with individual, group, and/or couples therapy.Identification with recovering addicts assists with ongoing recovery [16].
The spouse/partner often initially takes responsibility, e.g., "If only I were more desirable, etc, he would not need to use pornography." Support through 12-step programs such as S-Anon [17] for individuals in relationships with pornography addiction as well as individual and couples therapy can be effective [16].

Internet shopping addict
An affluent woman is the most frequent internet shopping addict.She is often "happily" married.She may have been very involved with her children who have launched their lives and careers.She may find herself lonely and without purpose.She enlists the help of friends and neighbours to have packages delivered to their addresses.She has her own credit card(s); she has places where she hides her purchases.She is organized, often categorizing and placing items in a plethora of storage containers, with labels and pictures of contents [18].
When admitting to herself that it has become a problem, she may become motivated but feels unable to stop on her own.She often sets it up so that her spouse will "catch her." Common ploys are arranging to be away from home when he is there to receive purchases, manipulating others into telling of her addictive purchases, etc. [19].
CBT [7] and solution-focused therapy [18] works well when she is motivated to recover.She often attends a 12-step group [20].Sometimes she finds another woman in recovery, and they use their organizational skills to begin a new healthy business venture.Or she may venture out on her own.Or her children may present her with grandchildren.She must check to be sure that purchasing for her grandchildren does not trigger her addiction.

Internet love addiction
Most often a woman, but men can become addicted to love and, in some cases, both can become stalkers.Their lives often appear "perfect, " and they are embarrassed to admit even to themselves that they are dissatisfied.Usually they start quite accidentally.They are doing legitimate computer work, and a "pop up" suggesting that their need for love can be met on various websites piques their curiosity.They meet other love addicts or individuals wanting to take advantage of them.They often establish torrid online and in-person affairs, while having a "normal" marriage/committed relationships.Sometimes a person with whom they have an online affair will threaten to disclose.This can become shocking and threatening to the internet love addict [21].
When the love addict becomes motivated to stop and realizes it is difficult, she will often seek individual therapy.Often the family learns of the addiction and recovery many years later.A combination of CBT [7] with Mindfulness being a major component, hypnosis, EMDR and/or psychodynamics can be effective [3].

Internet social media addiction
While social media participation currently is the norm, it becomes an addiction when it takes on a "life of its own, " becoming allconsuming, with neglect of many/most/all responsibilities.
There are two types of internet social media addictions.One is teen addiction seen in both male and females.They are preoccupied with posts, sneaking a look during class or between classes; they cut classes so that they can post.They are obsessively preoccupied with incoming and outgoing posts 24-7.They engage in bullying, risqué behavior and endless social media contacts.Teen social media addicts neglect academics, social and family interactions and use personal contacts only to enhance social media interactions.They experience anxiety about receiving and sending posts as normal.The impact of teen social media addiction is often poor academic performance and unhealthy virtual and personal interactions.
Therapy seems ludicrous to teen social media addicts, unless they are impacted by bullying, stalking, etc. Social media addiction is seen as normal.They may be diagnosed as depressed, ADHD, ODD, CD.They are challenging; they do not want to address their addiction [22].
Long-term impact is yet to be seen but should be aggressively examined.Often, when motivated, Motivational Interviewing [9] as well as CBT [7] can help to get through their defenses and begin recovery.
The other social media addict is usually a woman.She may have difficulty establishing and maintaining real-life friendships.She is often unfulfilled in her life.She spends many/most hours online checking out the activities of others, as well as interacting with "virtual" friends, interacting less with "real live " friends" and family members.She often brags about making numerous virtual friends.She ignores her family [23].
Very seldom will the social media addict come for therapy.She believes that her virtual friends are her therapists.Her children, however, will often present as the identified patients, acting out because they are not well parented.
The social media addict is probably the most difficult to treat.If she can be encouraged to establish a meaningful life and to support her children and spouse/significant other, she can begin recovery.
Narrative therapy [24] can be helpful to let the recovering addict create a meaningful life.When she changes her internet involvement to an online 12-step program [5] work and therapy, she can use her energies to continue a viable recovery.

Conclusion
Ongoing research and clinical experience strongly suggest that Internet Addiction does indeed exist [4,7,12].Research further suggests that addictive behaviors and substances use/abuse have similar impacts on the brain [23].
Currently, addiction is considered by some to be a perjorative term.Therefore, the term, Internet Use Disorder, is considered more acceptable than Internet Addiction.Whatever it is called, internet addiction continues to be an ongoing issue.
As an aside, a 60-Minutes program addressed how companies present internet activities in a way that promotes addiction, much like the old beer and cigarette ads.It reaffirms that brain chemistry can trigger internet addiction and can be manipulated to do so [12,13].
Technology presents many opportunities for enhancing the quality of life yet, as with any activities, can be taken to extremes and become addictions.Questions to be explored: Is there a genetic component?Is there an addictive personality type?How can one with an "addictive personality" prevent addiction?Should the term, internet use disorder, rather than addiction, be used?While each type of addiction presents with slightly unique issues, internet addicts have much in common.Their challenges are great.The impact of their addictions on themselves and their families and perhaps on society is ever-reaching.Yet, when they become motivated and commit to recovery and sobriety, the quality of their lives and that of their families, can become better than ever.Ed Theresa Appell, MS.