Concerned Coping in the Contemporary Age: Process Addiction and Internet Use Disorder
We are all seeking a way to handle the stress and pace of this new contemporary age. Internet access and use has become a normal part of daily life in the developed world. What is actually more abnormal, is for an individual to not have access to internet at all times. Internet use is now crucial for education, employment, and entertainment. The question is: has an industry sought to increase intelligence and broaden connections, created in an inadvertent ripple that destroys relationships, increases psychiatric symptoms, and a pattern of attachment to a fantasy world? “Every time there's a new tool, whether it's internet or cell phones or anything else, all these things can be used for good or evil. Technology is neutral; it depends on how it's used. The internet is becoming the town square for the global village of tomorrow” (Smolan, n.d.). With the increased portability of devices and devotion to technology, we have come to live in a virtual and screen filled world. The repetitive and excessive use of the internet from some individuals has become a concern due to the potential of overuse and misuse. In this essay, I will provide a summary of the research surrounding process addiction and internet use disorder, and my response will focus on probability that internet gaming is in fact a disorder, especially with further research.
Process & Behavioural Addiction
Process Addiction, also known as behavioural addiction, is a term used to explain specific repetitive patterns of behaviours. This term has been rising to fame since the addition of Gambling Disorder—previously Pathological Gambling—into the Diagnostic and Statistical Manual of Psychiatric Disorders (DMS). Process Addiction is still not a diagnosis, and like the term addiction, is often used colloquially. The possible future diagnosis of Process Addiction would likely be an umbrella diagnosis, with specifiers such as gaming, sex, shopping, or exercise (American Psychiatric Association, p. 481, 2013).
Northrup et. al. (2015) uses Wilson and Johnson’s description of Process Addiction as “the systematic behaviours mimicking the disease of addiction.” (as cited in Northrup et. all, p.342). This description captures the current theory that behaviours or processes can be analyzed through an addiction model. The progression of the use of a behaviour is very similar to substance addiction: weekly or daily use; excessive amounts of time using, getting, or recovering from the effects of use; use causing social problems or causing the person to reduce or give up important activities in school, work, or home; and experience of withdrawal symptoms from use (Dennis et. al., p.22, 2006).
Internet Use Disorder
The excessive use of the internet resulting in negative personal, social, and potential health related consequences, is the explanation most commonly given when discussing Internet Addiction. There are some proposed criteria for Internet Gaming Disorder, and sources agree that process addiction criteria, including sex, shopping, or internet, would likely be the same or extremely similar to that of Substance Use Disorder and, particularly, Gambling Disorder.
Northrup et. al. highlights a very interesting argument the has come up with much of the research surrounding process, and specifically, internet addiction: Internet is means of access, or a medium. The question here is whether the individual is addicted to the internet or the games/websites they are accessing on the internet (p. 343, 2015). This brings forth the question about the framework we are attempting to provide for a specific diagnosis. What the American Psychiatric Association has done is include Internet Gaming Disorder as a potential disorder to be included in the “Substance-Related and Addictive Disorders” chapter of the DSM (2013). Such a decision acknowledges the severity of concern regarding internet use, misuse, and abuse, all the while focusing on both internet—the medium—and gaming—the addictive application—accessed online.
In revising the DSM-IV chapter “Substance-Related Disorder” to the now “Substance-Related and Addictive Disorders” chapter in the DSM-V, the American Psychiatric Association has acknowledged Gambling Disorder as the only non-substance addictive disorder (2013). This leap created an opportunity for other process and behavioural addictions to possibly be grouped and explained in this chapter as well.
In Section III of the DSM, “Conditions for Further Study,” the American Psychiatric Association has decided that Internet Gaming Disorder and “behavioural syndromes” such as sex, exercise, or shopping addiction have “insufficient peer-reviewed evidence to establish diagnostic criteria” (p. 481, 2013). The push for Internet Gaming and other behavioural addictions to be further researched, is parallel to the original reasoning for the addition of addictive disorders to the substance-related Disorder chapter: “diagnostic criteria [of gambling disorder] echoed that of addiction, including tolerance, withdrawal, maladaptive functioning, and repeated unsuccessful attempts to stop” (Carlisle et. al., p. 171, 2016). What this has done, has shown that even without a chemical substance, our minds and bodies may react in similar ways to behavioural patterns as they provide the same emotional reward as a drug.
Response
I agree with the American Psychiatric Association that the sites, games, or applications accessed through the internet could be addictive. A person could exhibit a digression consistent with that of drug addiction. However, context, historical period, and social evolution are crucial aspects in this discussion.
It is important to remember the social implications of using and not using technology for the younger generations, along with the necessity of internet use for employment, education, and social relevance. It should also be made a point that our society has evolved in a way that increases the need to connect online. There is a requirement to use the internet daily and this has offered individuals a taste of a way out of a life they may struggle in, just like substances. What the increased need for use and domestic evolution of technology has allowed is the requirement to use, to turn into the want to use, into the need to use.
We find all if not most of our entertainment now on the internet, and nothing is stopping us from constant gratification whether through gaming, pornography, shopping, or hearts and likes. What the virtual world allows is strikingly similar to the escape and psychological reward offered by drug use; Internet Gaming offers both an escape from reality into a fantasy reality, along with reward from winning or doing well in the game, and connection with other players.
The DSM-V suggests that Internet Gaming Disorder is the “persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more)” of the proposed criteria (p. 795, 2013). After reading this definition, I compared it to both Gambling Disorder and the other Specific Substance Use Disorders’ descriptions, which were all paraphrases of each other. The common denominator includes these key words: “clinically significant impairment or distress” caused by several of the, also markedly similar, criteria (p. 523, 2013).
Nine criteria have been projected for Internet Gaming Disorder, and these are near identical to the criteria of Gambling Disorder, just with gambling substituted with internet. These criteria are also in line with the four pillars of drug addiction: 1) preoccupation with use or “impaired control,” 2) use has jeopardized or resulted in loss of important relationships or activities or “social impairment,” 3) continued use despite knowledge of psychological problems or “risky use,” and 4) experience of withdrawal symptoms and tolerance or “pharmacological criteria” (American Psychiatric Association, p. 483-484, 2013). The presence of these four underpinnings of addiction in the criteria and literature of what could be Internet Gaming Disorder, really shows the connection between engaging in behavioural patterns that result in activation of the brain’s reward system in the same ways that drugs do. The similarities speak for themselves, but I believe it is important to understand that what one may deem as excessive use of internet itself is not necessarily an addiction.
The argument can be made that “conceptualizing excessive behaviours within the addiction model can be a simplification of an individual’s psychological function” (Billieux et. al., p. 460, 2014). An analysis of any behaviour, that is not associated to drug use, through a substance-use disorder criteria lens, could allow for anything to be considered an addiction or addictive. One would not be able to argue that the recurrent use, large amounts of time spent, and possible problems caused or reduction of activities at school, work or home of a diabetic testing their sugars multiple times a day as an addiction. Even if such a person was compulsively testing out of anxiety or fear, this sort of behaviour, if extreme, would more likely be classified as an anxiety disorder or obsessive-compulsive behaviour.
It is important to recognize the context of the behaviours and that the behaviours need to be causing significant and negative social, personal, and health—both psychological and physical—consequences in an individual’s life to be considered an addiction. I believe further research will show, like Gambling Disorder, that Internet Gaming Disorder is in fact an addiction.
Conclusion
Although this may only seem like a future problem, it truly is important for all that use technology, as we could potentially be exposed to patterns of behaviour akin to addiction without really understanding or knowing why. The difference with Internet Gaming Disorder and Substance Use Disorders is the lethality of the drug-of-choice; in one case it is online gaming, whereas in the other it could be fentanyl or cocaine. The idea of “overdose” in a process addiction would not present the same, and help may not be sought prior to an increased severity of the addiction to whatever behaviour this may be. It is scary to think that the public at large could be experiencing these types of process addictions, behind closed doors, without anyone ever knowing, and without individuals ever getting help.
What further research may also require is the inclusion of a specific differentiation for what amount of internet use is required to be considered an addiction. The line with substance abuse is dependence or necessity to use just to function, not because a person necessarily wants to be using alcohol or drugs. Where is the line with internet use? Could we accept the argument that addiction, whether substance or process, is simply just a coping mechanism that has been too heavily relied on? My question to researchers interested in treatment options for those with internet gaming addiction is this: will abstinence even be an option in a future dictated by technology? The internet is the way we connect to others, and the way of the future: what preventions are there for us?
References
American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.), 481-589. Washington, DC: American Psychiatric Publishing.
Carlisle, K. L., Carlisle, R. M., Polychronopoulos, G. B., Goodman-Scott, E., & Kirk-Jenkins, A. (2016). Exploring Internet Addiction as a Process Addiction. Journal of Mental Health Counseling, 38(2), 170–182. https://doi-org.roxy.nipissingu.ca/10.17744/mehc.38.2.07
Dennis, M. L., Feeney, T., Stevens, L. H. (2006). Global Appraisal of Individual Needs–Short Screener (GAIN-SS): Administration and Scoring Manual for the GAINSS Version 2.0.1. Bloomington, IL: Chestnut Health Systems. Retrieved on [insert date] from http://www.chestnut.org/LI/gain/GAIN_SS/index.html.
Northrup, J. C., Lapierre, C., Kirk, J., & Rae, C. (2015). The Internet Process Addiction Test: Screening for Addictions to Processes Facilitated by the Internet. Behavioral Sciences (2076-328X), 5(3), 341–352. https://doi-org.roxy.nipissingu.ca/10.3390/bs5030341
Smolan, R. (n.d.). BrainyQuote.com. Retrieved March 2, 2019, from BrainyQuote.com Web site: https://www.brainyquote.com/quotes/rick_smolan_705112
