Ask the Expert: Can You Be Addicted to the Internet?

A psychiatry professor tells us how to know if your Internet behavior is normal, and what to do if it isn’t.

Internet addiction

Don’t let this be you. Internet addiction photo via Shutterstock

For many of us, the average work day means eight or more hours in front of a computer. As if that’s not enough, we often go home and check email, Facebook, and Twitter over and over again. This behavior is constant, but is it an addiction? We asked Dr. Ronald Pies, a clinical professor of psychiatry at Tufts University Medical School for an answer.

Q: Is Internet addiction a real condition?

A: The whole notion of “Internet addiction” is very controversial within the mental health field, even though it’s clear that many people use electronic media in ways that greatly interfere with important aspects of their life. But is this really an addiction?

If someone shows a maladaptive or injurious pattern of Internet use—and I have in mind any sort of electronic device or medium—is this really a disease or disorder in its own right, or is it an underlying problem such as depression, bipolar disorder, obsessive-compulsive disorder, or severe social anxiety? These are complicated questions, and I don’t believe we have the necessary research to answer them conclusively. What we do know is that many persons diagnosed with Internet addiction appear to suffer from other psychological problems.

How do I know if I have it?

Psychiatry’s latest diagnostic manual, the DSM-5, considered and then rejected Internet addiction as a validated diagnosis. Nevertheless, in the section of DSM-5 titled “Conditions For Further Study”, the syndrome known as “Internet Gaming Disorder” (IGD) is described. Basically, IGD is described as “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress.” Often, persons who fit this description have little or no control over their Internet use. They also seem to show tolerance and withdrawal symptoms analogous to those seen with addictive chemicals. For example, they may need to engage in more and more online gaming in order to satisfy their craving (tolerance), and may experience anxiety or depressed mood when they are unable to engage in Internet gaming (withdrawal).

That said, it is not clear if the same physiological abnormalities underlie IGD or other forms of excessive Internet use and substance-based addictions. We don’t have enough research to answer that, but so far, there is little evidence that IGD produces dangerous withdrawal symptoms—such as seizures or delirium—as often occur during alcohol or [drug] withdrawal. There are, however, occasional case reports of persons sitting at the computer for so many hours that they actually develop life-threatening blood clots!

There is great interest in the role of the brain chemicals dopamine and serotonin. One hypothesis is that all these conditions involve excessive release of dopamine in the brain, which seems to drive the brain’s reward system. The idea is that some people―for biological or psychological reasons—seem to need this dopamine “buzz” in order to “rev up” their under-active reward system. We need more research to confirm this hypothesis, however.

How can I treat it?

Many persons with IGD (or other forms of excessive internet use) go for long periods without food or sleep, and are unable to meet their obligations at school, work, or at home. These people often require professional help—for example, the reSTART Internet Addiction Recovery Program in Washington state—but I am skeptical that we have the necessary research to know what the best treatment is for these various Internet-related problems.

For anyone who believes he or she is experiencing IGD or something similar, I would recommend speaking first with your family physician, and then considering a general psychiatric evaluation to rule out underlying problems that may explain the excessive Internet use. Many such underlying problems—such as an anxiety or mood disorder—may respond well to some form of talk therapy, or, in more severe cases, to medication.