Tuesday, February 26, 2019
Internet Addiction Essay
Abstract snarly computing machine exercise is a increase tender issue which is macrocosm debated worldwide. internet Addiction discommode (IAD) ruins lives by ca utilize neurological complications, psychological disturbances, and kind problems. Surveys in the get together States and Europe rich person indicated alarming prevalence place betwixt 1.5 and 8.2% 1. thither argon some(prenominal)(prenominal) reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD 2-5, and virtually reviews 6-8 addressing the interference of IAD. The ingest of this paper is to experience a preferably brief overview of research on IAD and supposititious considerations from a mulish perspective base on historic period of daily fetch with clients suffering from net profit habituation. Furthermore, with this paper we intend to constitute in practical experience in the debate al close the eventual(prenominal) inclusion body of IAD in the nex t version of the Diagnostic and statistical manual(a) of Mental Disorders (DSM). rugged reck unmatchabler implement is a growing social issue which is being debated worldwide. cyberspace Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rate between 1.5 and 8.2% 1. in that location atomic number 18 several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD 2-5, and some reviews 6-8 addressing the preaching of IAD. The aim of this paper is to give a preferably brief overview of research on IAD and theoretical considerations from a practical perspective based on long time of daily work with clients suffering from mesh dependence. Furthermore, with this paper we intend to bring in practical experience in the debate about the eventual inclusion of IAD in the next version of the Diag nostic and Statistical Manual of Mental Disorders (DSM). Keywords Addiction, Computer, net profit, reSTART, interposition.INTRODUCTIONThe idea that involved computer use meets criteria for an habituation, and and then should be included in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th ed. Text Revision 9 was first proposed by Kimberly Young, PhD in her seminal 1996 paper 10. Sincethat time IAD has been extensively studied and is indeed, presently under consideration for inclusion in the DSM-V 11. Meanwhile, both China and entropy Korea have identified net income addiction as a authoritative public health threat and both countries support education, research and give-and-take 12. In the United States, despite a growing body of research, and servement for the disorder avail equal to(p) in out-patient and in-patient heaptings, there has been no formal govern amiable response to the issue of net income addiction. While the debat e goes on about whether or not the DSM-V should designate Internet addiction a mental disorder 12-14 mint flowly suffering from Internet addiction are seeking intercession. Because of our experience we support the inducement of uniform symbolatic criteria and the inclusion of IAD in the DSM-V 11 in order to advance public education, diagnosis and preaching of this important disorder.CLASSIFICATIONThere is ongoing debate about how surpass to classify the demeanour which is characterized by many hours pass in non-work technology-related computer/Internet/video game activities 15. It is accompanied by changes in inclination, soaking up with the Internet and digital media, the in major power to control the sum up of time exhausted interfacing with digital technology, the need for more time or a reinvigorated game to achieve a desired mood, withdrawal presages when not filmd, and a lengthening of the demeanour despite family conflict, a diminishing social keep and adve rse work or academic consequences 2, 16, 17. somewhat researchers and mental health practitioners see immoderate Internet use as a symptom of anformer(a) disorder such as anxiety or first gear rather than a separate entity e.g. 18.Internet addiction could be considered an caprice control disorder (not early(a)wisewise specified). Yet there is a growing consensus that this constellation of symptoms is an addiction e.g. 19. The Ameri end Society of Addiction Medicine (ASAM) recently released a new definition of addiction as a inveterate brain disorder, officially proposing for the first time that addiction is not circumscribed to substance use 20. All addictions, whether chemical or behavioral, share genuine characteristics including salience, compulsive use (loss of control), mood modification and the alleviation of distress, permissiveness and withdrawal, and the continuation despite negative consequences.DIAGNOSTIC CRITERIA FOR IADThe first serious proposal for diagnosti c criteria was advanced in 1996 by Dr. Young, modifying the DSM-IV criteria for pathological gambling 10. Since then variations in both name and criteria have been put forward to capture the problem, which is instantaneously near popularly known as Internet Addiction Disorder. Problematic Internet accustom (PIU) 21, computer addiction, Internet dependence 22, compulsive Internet use, pathological Internet use 23, and many different labels can be found in the literature. Likewise a renewing of often coincide criteria have been proposed and studied, some of which have been validated. However, empirical studies provide an inconsistent set of criteria to define Internet addiction 24. For an overview see Byun et al. 25. Beard 2 recommends that the following fiver diagnostic criteria are required for a diagnosis of Internet addiction (1) Is preoccupied with the Internet (thinks about previous online natural action or yell next online session) (2) Needs to use the Internet with in creased amounts of time in order to achieve satis featureion (3) Has made unsuccessful efforts to control, cut back, or stop Internet use (4) Is restless, moody, depressed, or irritable when attempting to cut coldcock or stop Internet use (5) Has stayed online longer than originally intended.Additionally, at least one of the following must be present (6) Has jeopardized or run a risked the loss of a significant relationship, job, educational or career opportunity because of the Internet (7) Has lied to family members, therapist, or others to conceal the extent of involvement with the Internet (8) Uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of serve closelylessness, guilt, anxiety, depression) 2. There has been similarly been a variety of assessment tools use in evaluation. Youngs Internet Addiction Test 16, the Problematic Internet Use Questionnaire (PIUQ) developed by Demetrovics, Szeredi, and Pozsa 26 and the Compuls ive Internet Use Scale (CIUS) 27 are all examples of instruments to assess for this disorder.PREVALENCEThe considerable discrepancy of the prevalence rates drawed for IAD (between 0.3% and 38%) 28 may be credited(predicate) to the fact that diagnostic criteria and assessment questionnaires apply for diagnosis vary between countries and studies often use highly selective samples of online surveys 7. In theirreview Weinstein and Lejoyeux 1 herald that surveys in the United States and Europe have indicated prevalence rates change between 1.5% and 8.2%. Other reports place the rates between 6% and 18.5% 29. Some obvious differences with respect to the methodologies, cultural factors, outcomes and assessment tools forming the basis for these prevalence rates notwithstanding, the rates we encountered were generally high and sometimes alarming. 24ETIOLOGYThere are different models available for the development and maintenance of IAD like the cognitive-behavioral model of problematic Internet use 21, the anonymity, convenience and escape (ACE) model 30, the access, affordability, anonymity (Triple-A) locomotive 31, a phases model of pathological Internet use by Grohol 32, and a comprehensive model of the development and maintenance of Internet addiction by Winkler & Drsing 24, which takes into account socio-cultural factors (e.g., demographic factors, access to and acceptance of the Internet), biological vulnerabilities (e.g., genetic factors, abnormalities in neurochemical processes), psychological predispositions (e.g., personality characteristics, negative affects), and specific attributes of the Internet to justify excessive consumement in Internet activities 24.NEUROBIOLOGICAL VULNERABILITIESIt is known that addictions touch off a combination of sites in the brain associated with pleasure, known together as the pay back center or pleasure pathway of the brain 33, 34. When activated, dopamine release is increased, along with opiates and other neurochem icals. Over time, the associated receptors may be affected, producing tolerance or the need for increasing stimulation of the reward center to upgrade a high and the subsequent characteristic behavior patterns needed to repress withdrawal. Internet use may alike lead specifically to dopamine release in the nucleus accumbens 35, 36, one of the reward structures of the brain specifically involved in other addictions 20. An example of the rewarding nature of digital technology use may be captured in the following rehearsal by a 21 year-old male in treatment for IAD I feel technology has brought so much joy into my life. No other activity relaxes me or stimulates me like technology. However, when depression hits, I tend to use technology as a wayof retreating and isolating.REINFORCEMENT/REWARDWhat is so rewarding about Internet and video game use that it could buzz off an addiction? The theory is that digital technology users experience multiple layers of reward when they use vario us computer screenings. The Internet functions on a variable star ratio reinforcement schedule (VRRS), as does gambling 29. Whatever the application (general surfing, pornography, chat inhabit, message boards, social net running(a) sites, video games, email, texting, cloud applications and games, etc.), these activities support unforeseeable and variable reward structures. The reward experienced is intensified when combined with mood enhancing/stimulating content. Examples of this would be pornography (sexual stimulation), video games (e.g. various social rewards, credit with a hero, immersive graphics), dating sites (romantic fantasy), online poker (financial) and special interest chat rooms or message boards (sense of belonging) 29, 37.BIOLOGICAL PREDISPOSITIONThere is increasing reason that there can be a genetic predisposition to habit-forming behaviors 38, 39. The theory is that individuals with this predisposition do not have an adequate consider of dopamine receptors or have an insufficient amount of serotonin/dopamine 2, thereby having difficulty experiencing normal levels of pleasure in activities that most people would find rewarding. To increase pleasure, these individuals are more likely to seek great than average engagement in behaviors that stimulate an increase in dopamine, efficaciously giving them more reward but placing them at higher risk for addiction.MENTAL HEALTH VULNERABILITIESMany researchers and clinicians have noted that a variety of mental disorders co-occur with IAD. There is debate about which came first, the addiction or the co-occurring disorder 18, 40. The scan by Dong et al. 40 had at least the authorisation to clarify this question, reporting that higher gobs for depression, anxiety, hostility, interpersonal sensitivity, and psychoticism were consequences of IAD. But collectable to the limitations of the study come on research is necessary.THE TREATMENT OF INTERNET ADDICTIONThere is a general consensus that total abstinence from the Internet should not be the goal of the incumbrances and that instead, an abstinence from problematic applications and a controlled and oddmentd Internet practice should be achieved 6. The following paragraphs illustrate the various treatment options for IAD that exist today. Unless studies examining the power of the illustrated treatments are not available, findings on the force of the presented treatments are also provided. Unfortunately, most of the treatment studies were of low methodological quality and used an intra- concourse design. The general leave out of treatment studies notwithstanding, there are treatment guidelines reported by clinicians working in the field of IAD. In her book Internet Addiction Symptoms, Evaluation, and Treatment, Young 41 offers some treatment strategies which are already known from the cognitive-behavioral set about (a) practice opposite time of Internet use (discover patients patterns of Internet use and disrupt these pa tterns by suggesting new schedules), (b) use foreign stoppers (real events or activities prompting the patient to log off), (c) set goals (with regard to the amount of time), (d) abstain from a particular application (that the client is unable to control), (e) use reminder cards (cues that remind the patient of the costs of IAD and benefits of breaking it), (f) develop a personal inventory (shows all the activities that the patient used to engage in or cant find the time referable to IAD), (g) enter a support convocation (compensates for a lack of social support), and (h) engage in family therapy (addresses relational problems in the family) 41. Unfortunately, clinical evidence for the readiness of these strategies is not mentioned.Non-psychological ApproachesSome authors examine pharmacologic interventions for IAD, perhaps repayable to the fact that clinicians use psychopharmacology to treat IAD despite the lack of treatment studies addressing the efficacy of pharmacological treatments. In particular, selective serotonin-reuptake inhibitors (SSRIs) have been used because of the co-morbid psychiatric symptoms of IAD (e.g. depression and anxiety) for which SSRIs have been found to be advantageously 42-46. Escitalopram (a SSRI) was used by DellOsso et al. 47 to treat 14 subjects with impulsive-compulsive Internet usage disorder. Internet usage decrease importantly from a mean of 36.8 hours/ calendar week to a baseline of 16.5 hours/week. In another(prenominal) study Han, Hwang, and Renshaw 48 used bupropion (a non-tricyclic antidepressant) and found a decrease of craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex after a six week period of bupropion sustained release treatment. Methylphenidate (a psycho stimulant drug) was used by Han et al. 49 to treat 62 Internet video game-playing children diagnosed with attention-deficit hyperactivity disorder.After octette weeks of treatmen t, the YIAS-K gain and Internet usage times were significantly reduced and the authors cautiously suggest that methylphenidate dexterity be evaluated as a possible treatment of IAD. According to a study by Shapira et al. 50, mood stabilizers might also improve the symptoms of IAD. In addition to these studies, there are some instance reports of patients treated with escitalopram 45, citalopram (SSRI)- quetiapine (antipsychotic) combination 43 and naltrexone (an opioid receptor antagonist) 51. A few authors mentioned that visible exercise could compensate the decrease of the dopamine level due to reduced online usage 52. In addition, sports exercise prescriptions used in the course of cognitive behavioral group therapy may enhance the rig of the intervention for IAD 53. mental ApproachesMotivational interviewing (MI) is a client-centered yet directive method for enhancing intrinsic indigence to change by exploring and resolving client ambivalence 54. It was developed to help individuals give up habit-forming behaviors and learn new behavioral skills, using techniques such as open-ended questions, reflective listening, affirmation, and summarization to help individuals demo their concerns about change 55. Unfortunately, there are currently no studies addressing the efficacy of MI in treating IAD, but MI seems to be moderately telling in the areas of alcohol, drug addiction, and diet/exercise problems 56. Peukert et al. 7 suggest that interventions with family members or other relatives like Community Reinforcement and Family Training 57 could be useful in enhancing the motivation of an addict to cut back on Internet use, although the reviewers follow that control studies with relatives do not exist to date. Reality therapy (RT) is supposed to come on individuals to choose to improve theirlives by committing to change their behavior. It includes sessions to show clients that addiction is a choice and to give them training in time management it also i ntroduces alternative activities to the problematic behavior 58.According to Kim 58, RT is a core addiction recovery tool that offers a wide variety of uses as a treatment for addictive disorders such as drugs, sex, food, and works as well for the Internet. In his RT group counseling political platform treatment study, Kim 59 found that the treatment broadcast effectively reduced addiction level and ameliorate egotism of 25 Internet-addicted university students in Korea. Twohig and Crosby 60 used an Acceptance & Commitment Therapy (ACT) protocol including several exercises adjusted to better fit the issues with which the sample struggles to treat six openhanded males suffering from problematic Internet pornography viewing. The treatment resulted in an 85% reduction in viewing at post-treatment with results being maintained at the three month follow-up (83% reduction in viewing pornography). Widyanto and Griffith 8 report that most of the treatments employed so far had utilized a cognitive-behavioral approach. The case for using cognitive-behavioral therapy (CBT) is justified due to the good results in the treatment of other behavioral addictions/impulse-control disorders, such as pathological gambling, compulsive shopping, bulimia nervosa, and satiate eating-disorders 61.Wlfling 5 described a predominantly behavioral group treatment including identification of sustaining conditions, establishing of intrinsic motivation to reduce the amount of time being online, learning alternative behaviors, engagement in new social real-life contacts, psycho-education and delineation therapy, but unfortunately clinical evidence for the efficacy of these strategies is not mentioned. In her study, Young 62 used CBT to treat 114 clients suffering from IAD and found that participants were better able to manage their presenting problems post-treatment, showing improved motivation to stop abusing the Internet, improved ability to control their computer use, improved ability to function in offline relationships, improved ability to abstain from sexually explicit online material, improved ability to engage in offline activities, and improved ability to achieve sobriety from problematic applications. Cao, Su and Gao 63 investigated the effect of group CBT on 29 middle school students with IAD and found that IAD scads of the experimental group were lower than of the control groupafter treatment.The authors also reported improvement in psychological function. Thirty-eight adolescents with IAD were treated with CBT intentional particularly for addicted adolescents by Li and Dai 64. They found that CBT has good effectuate on the adolescents with IAD (CIAS scores in the therapy group were significant lower than that in the control group). In the experimental group the scores of depression, anxiety, compulsiveness, self-blame, illusion, and retreat were significantly decreased after treatment. Zhu, Jin, and Zhong 65 compared CBT and electro acupuncture (EA) plus CBT assigning forty-seven patients with IAD to one of the two groups respectively. The authors found that CBT alone or combined with EA can significantly reduce the score of IAD and anxiety on a self-rating scale and improve self-conscious health status in patients with IAD, but the effect obtained by the combined therapy was better.Multimodal TreatmentsA multimodal treatment approach is characterized by the implementation of several different types of treatment in some cases even from different disciplines such as pharmacology, psychotherapy and family counseling simultaneously or sequentially. Orzack and Orzack 66 mentioned that treatments for IAD need to be multidisciplinary including CBT, psychotropic medication, family therapy, and case managers, because of the complexity of these patients problems. In their treatment study, Du, Jiang, and Vance 67 found that multimodal school-based group CBT (including parent training, teacher education, and group CBT) was effective for a dolescents with IAD (n = 23), particularly in amend emotional state and regulation ability, behavioral and self-management style. The effect of another multimodal intervention consisting of solution-focused brief therapy (SFBT), family therapy, and CT was investigated among 52 adolescents with IAD in China. After three months of treatment, the scores on an IAD scale (IAD-DQ), the scores on the SCL-90, and the amount of time spent online decreased significantly 68.Orzack et al. 69 used a psychoeducational program, which combines psychodynamic and cognitive-behavioral theoretical perspectives, using a combination of Readiness to Change (RtC), CBT and MI interventions to treat a group of 35 men involved in problematic Internet-enabled sexual behavior (IESB). In this group treatment, the quality of life increased and the level of depressive symptoms decreasedafter 16 (weekly) treatment sessions, but the level of problematic Internet use failed to decrease significantly 69. Internet add iction related symptom scores significantly decreased after a group of 23 middle school students with IAD were treated with Behavioral Therapy (BT) or CT, detoxification treatment, psychosocial rehabilitation, personality mold and parent training 70.Therefore, the authors concluded that psychotherapy, in particular CT and BT were effective in treating middle school students with IAD. Shek, Tang, and Lo 71 described a multi-level counseling program designed for young people with IAD based on the responses of 59 clients. Findings of this study suggest this multi-level counseling program (including counseling, MI, family perspective, case work and group work) is lustrous to help young people with IAD. Internet addiction symptom scores significantly decreased, but the program failed to increase psychological well-being significantly. A six-week group counseling program (including CBT, social competence training, training of obstinance strategies and training of communication skills) was shown to be effective on 24 Internet-addicted college students in China 72. The authors reported that the adapted CIAS-R scores of the experimental group were significantly lower than those of the control group post-treatment.The reSTART ProgramThe authors of this article are currently, or have been, affiliated with the reSTART Internet Addiction recuperation Program 73 in Fall City, Washington. The reSTART program is an inpatient Internet addiction recovery program which integrates technology detoxification (no technology for 45 to 90 days), drug and alcohol treatment, 12 step work, cognitive behavioral therapy (CBT), experiential adventure based therapy, Acceptance and Commitment therapy (ACT), brain enhancing interventions, animal support therapy, motivational interviewing (MI), mindfulness based relapse prevention (MBRP), Mindfulness based stress reduction (MBSR), interpersonal group psychotherapy, individual psychotherapy, individualized treatments for co-occurring disor ders, psycho- educational groups (life visioning, addiction education, communication and assertiveness training, social skills, life skills, Life balance plan), aftercare treatments (monitoring of technology use, ongoing psychotherapy and group work), and continuing care (outpatient treatment) in an individualized, holistic approach.The firstresults from an ongoing OQ45.2 74 study (a self-reported measurement of subjective discomfort, interpersonal relationships and social role performance assessed on a weekly basis) of the short-term impact on 19 adults who complete the 45+ days program showed an improved score after treatment. Seventy-four percent of participants showed significant clinical improvement, 21% of participants showed no reliable change, and 5% deteriorated. The results have to be regarded as preliminary due to the small study sample, the self-report measurement and the lack of a control group. Despite these limitations, there is evidence that the program is responsibl e for most of the improvements demonstrated.CONCLUSIONAs can be seen from this brief review, the field of Internet addiction is advancing rapidly even without its official recognition as a separate and distinct behavioral addiction and with continuing departure over diagnostic criteria. The ongoing debate whether IAD should be classified as an (behavioral) addiction, an impulse-control disorder or even an obsessive compulsive disorder cannot be satisfactorily resolved in this paper. But the symptoms we observed in clinical practice show a great deal of overlap with the symptoms ordinarily associated with (behavioral) addictions. Also it remains unclear to this day whether the underlying mechanisms responsible for the addictive behavior are the same in different types of IAD (e.g., online sexual addiction, online gaming, and excessive surfing).From our practical perspective the different shapes of IAD fit in one category, due to various Internet specific commonalities (e.g., anonym ity, riskless interaction), commonalities in the underlying behavior (e.g., avoidance, fear, pleasure, entertainment) and overlapping symptoms (e.g., the increased amount of time spent online, preoccupation and other signs of addiction). Nevertheless more research has to be done to substantiate our clinical impression. Despite several methodological limitations, the strength of this work in parity to other reviews in the international body of literature addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD 2-5, and to reviews 6-8 addressing the treatment of IAD, is that it connects theoretical considerations with the clinical practice of interdisciplinary mental health experts working for years in the field of Internet addiction.Furthermore, the current work gives a goodoverview of the current state of research in the field of internet addiction treatment. Despite the limitations stated above this work gives a brief overview of the current sta te of research on IAD from a practical perspective and can therefore be seen as an important and helpful paper for further research as well as for clinical practice in particular.
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