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Abstract Problematic computer use is a growing social issue which is being debated worldwide. Internet 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 rates between 1. There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD , and some reviews  addressing the treatment 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 years of daily work with clients suffering from Internet addiction.
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 Diagnostic and Statistical Manual of Mental Disorders DSM. Meanwhile, both China and South Korea have identified Internet addiction as a significant public health threat and both countries support education, research and treatment [ 12 ]. In the United States, despite a growing body of research, and treatment for the disorder available in out-patient and in-patient settings, there has been no formal governmental response to the issue of Internet addiction.
While the debate goes on about whether or not the DSM-V should designate Internet addiction a mental disorder [ 12 - 14 ] people currently suffering from Internet addiction are seeking treatment. Because of our experience we support the development of uniform diagnostic criteria and the inclusion of IAD in the DSM-V [ 11 ] in order to advance public education, diagnosis and treatment of this important disorder. It is accompanied by changes in mood, preoccupation with the Internet and digital media, the inability to control the amount of time spent interfacing with digital technology, the need for more time or a new game to achieve a desired mood, withdrawal symptoms when not engaged, and a continuation of the behavior despite family conflict, a diminishing social life and adverse work or academic consequences [ 2 , 16 , 17 ].
Some researchers and mental health practitioners see excessive Internet use as a symptom of another disorder such as anxiety or depression rather than a separate entity [e. Internet addiction could be considered an Impulse control disorder not otherwise specified. Yet there is a growing consensus that this constellation of symptoms is an addiction [e. The American Society of Addiction Medicine ASAM recently released a new definition of addiction as a chronic brain disorder, officially proposing for the first time that addiction is not limited to substance use [ 20 ].
All addictions, whether chemical or behavioral, share certain characteristics including salience, compulsive use loss of control , mood modification and the alleviation of distress, tolerance and withdrawal, and the continuation despite negative consequences.
Since then variations in both name and criteria have been put forward to capture the problem, which is now most popularly known as Internet Addiction Disorder.
Problematic Internet Use PIU [ 21 ], computer addiction, Internet dependence [ 22 ], compulsive Internet use, pathological Internet use [ 23 ], and many other labels can be found in the literature. Likewise a variety of often overlapping 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. Beard [ 2 ] recommends that the following five diagnostic criteria are required for a diagnosis of Internet addiction: 1 Is preoccupied with the Internet thinks about previous online activity or anticipate next online session ; 2 Needs to use the Internet with increased amounts of time in order to achieve satisfaction; 3 Has made unsuccessful efforts to control, cut back, or stop Internet use; 4 Is restless, moody, depressed, or irritable when attempting to cut down 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 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.
There has been also been a variety of assessment tools used in evaluation. In their review Weinstein and Lejoyeux [ 1 ] report that surveys in the United States and Europe have indicated prevalence rates varying between 1. When activated, dopamine release is increased, along with opiates and other neurochemicals.
Internet use may also 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 ]. No other activity relaxes me or stimulates me like technology. However, when depression hits, I tend to use technology as a way of retreating and isolating.
The theory is that digital technology users experience multiple layers of reward when they use various computer applications. Whatever the application general surfing, pornography, chat rooms, message boards, social networking sites, video games, email, texting, cloud applications and games, etc.
Examples of this would be pornography sexual stimulation , video games e. To increase pleasure, these individuals are more likely to seek greater than average engagement in behaviors that stimulate an increase in dopamine, effectively giving them more reward but placing them at higher risk for addiction. There is debate about which came first, the addiction or the co-occurring disorder [ 18 , 40 ].
The study by Dong et al. But due to the limitations of the study further research is necessary. The following paragraphs illustrate the various treatment options for IAD that exist today.
Unless studies examining the efficacy of the illustrated treatments are not available, findings on the efficacy of the presented treatments are also provided.
Unfortunately, most of the treatment studies were of low methodological quality and used an intra-group design. The general lack of treatment studies notwithstanding, there are treatment guidelines reported by clinicians working in the field of IAD.
Unfortunately, clinical evidence for the efficacy of these strategies is not mentioned. Non-psychological Approaches Some authors examine pharmacological interventions for IAD, perhaps due to the fact that clinicians use psychopharmacology to treat IAD despite the lack of treatment studies addressing the efficacy of pharmacological treatments.
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