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 Table of Contents  
INVITED VIEWPOINT
Year : 2021  |  Volume : 37  |  Issue : 3  |  Page : 265-268

Do we really understand addictions to internet well enough to be able to manage it in the young population: A viewpoint


Department of Psychiatry, Moti Lal Nehru Medical College; Centre of Behavioural and Cognitive Sciences, University of Allahabad, Allahabad, Uttar Pradesh, India; Institute of Psychiatry, King's College London, London, UK

Date of Submission30-Aug-2021
Date of Acceptance05-Sep-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Dr. Chhitij Srivastava
Department of Psychiatry, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_256_21

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  Abstract 


Behavior addictions, including those to internet and smartphones, stem largely from underlying vulnerabilities. This article describes a framework that takes into consideration these vulnerabilities, the environmental conditions that contribute to addictions, the actual addiction and the secondary effects of addictions. In the author's view, this framework can be used to help come up with a comprehensive and individualized formulation when assessing behavior addictions in the young population thereby helping in tailored management. Some important underlying vulnerabilities include symptoms of attention deficit hyperactivity disorders, anxiety, depression, and trait impulsivity. The modifying effects of the environment on these vulnerabilities need to be understood comprehensively, especially those relating to parenting, schooling, and secondary effects of psychiatric problems in family members. The content of the actual addiction has to be properly understood as it can include a variety of different things such as gaming, social media, shopping, and gambling. Addiction processes including impulsive-compulsive phenomena, withdrawal, and craving have to be factored in the management plan. The secondary effects of addictions including the physical, psychiatric, and those related to exploitation of these children also need to be addressed systematically. The formulation and management plan therefore can possibly include a number of psychiatric disorders, temperamental traits, environmental conditions, and various secondary health aspects of the addiction. The goals of managing behavior addictions related to internet and smartphone usage are predominantly about harm reduction as our lives have become increasingly dependent on the benefits of this smart technology.

Keywords: Behavior addictions, internet addiction, management, young population


How to cite this article:
Srivastava C. Do we really understand addictions to internet well enough to be able to manage it in the young population: A viewpoint. Indian J Soc Psychiatry 2021;37:265-8

How to cite this URL:
Srivastava C. Do we really understand addictions to internet well enough to be able to manage it in the young population: A viewpoint. Indian J Soc Psychiatry [serial online] 2021 [cited 2022 Sep 30];37:265-8. Available from: https://www.indjsp.org/text.asp?2021/37/3/265/327293




  Introduction Top


Problems arising from excessive use of technology are relatively new phenomena that researchers and clinicians are still trying to understand properly. Internet gaming disorder has been included in the DSM-5 criteria as a condition warranting further study while the International Classification of Diseases (ICD)-11 includes it as a formal diagnosis.[1],[2] However, internet addiction per se has not made it to either ICD-11 or DSM-5. Perhaps, this uncertainty reflects the different opinions in the scientific community on the nature of these conditions and our limited understanding, both theoretically and clinically.[3]

A deeper understanding of addictive behaviors shows that they stem from underlying vulnerabilities.[4] Certain activities such as excessive use of smartphones and internet can further worsen these vulnerabilities. The advantage of being able to access information on one's fingertips with a smartphone has to be weighed against the disadvantage of making us impatient when that information is not available. It probably wires the brains to always expect instant rewards and to struggle in situations that need patience and persistence.

To be able to manage behavior addictions, a holistic approach works best that takes into consideration various risk factors that lead to addictions and the multitude of secondary effects of addiction [Table 1].
Table 1: Scheme of management

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  The Preexisting Vulnerability to Addictions Top


Childhood is in itself a vulnerable period because of immature higher brain areas making it difficult for children to inhibit their impulses. Various conditions and childhood traits can further increase one's vulnerability to addictive behaviors.[4] Symptoms of attention deficit hyperactivity disorders (ADHD) are especially relevant.[5] While inattention in these children makes routine tasks a struggle, engaging in tasks that provide multisensory stimulation, novelty and instant rewards is much easier and enjoyable. This naturally draws them toward mobile games. These children are also high on traits such as sensation seeking, risk taking, lack of inhibition, impulsivity, preference for immediate rewards (at the cost of better longer term rewards), and poor emotional control. Apart from mobile games, young children are also increasingly spending time on social media sites. This has assumed even more relevance in the current times with COVID-19 and lockdown causing a lack of social activities that children engaged in previously. Continued exposure to smart technology leads to a conditioning that makes it more difficult for these children to engage in routine tasks. It therefore can make their existing vulnerability worse, thereby becoming a vicious cycle.

Neurotic traits in childhood are also important risk factors for developing behavior addictions to smartphones.[6] Children who are oversensitive have anxiety especially social anxiety, poor emotional vocabulary, low social competence, low self-esteem, poor coping mechanisms are vulnerable. Social media sites provide them an escape from the troubles they face in their daily lives. Early exposure (<11 years) to potentially traumatic events further increases the risk of addictive behaviors [Table 2].[7]
Table 2: The preexisting vulnerability to addictions

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The implications from a thorough understanding of these vulnerabilities are to always focus on the treatment of underlying ADHD, anxiety and depressive symptoms, and trait impulsivity.


  Environmental Conditions that Contribute to Addictions Top


There are recommendations on screen time usage in the early years of life based on the recognition that formative years are also the most vulnerable.[8] However, the COVID-19 pandemic has made it almost impossible to follow any recommendations given the switch to online schooling. The pandemic and the lockdown have also meant that the usual social and play outlets for children are no longer available. Besides, giving a smartphone to children appears to be a much easier way to parent than spending time with them. This proxy parenting deprives them of the valuable opportunities for human interaction and exposes their young vulnerable brains to technology very early in life. This exposure is often unsupervised by parents who themselves spend excessive time on their own smartphones thus providing social reinforcement. By the time parents realize the problem, the child has a lot of other secondary issues. Some parents themselves have psychiatric, drug, and alcohol-related problems which further confer risks at many levels. Apart from the increased genetic risk, it also significantly affects their parenting abilities [Table 3].
Table 3: Environmental conditions that further predispose

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The implications from this understanding are to always focus on parenting issues, schooling, and the psychiatric problems in family members.


  The Actual Addiction Top


Behavior addictions just like drug addictions have to be understood in terms of their content. They could involve gaming, social media, shopping, gambling, or even work and education. The motives behind a particular addictive behavior are especially important to be understood. Gaming, for example, is a heterogenous entity and motives behind pursuing different gaming activities can differ significantly.[4] Games can be offline or online, solitary, or competitive, can involve teamwork, and can be extremely immersive with real world-like qualities. The rewards can be in the form of an instant high or more long term like perceived skill development, sense of achievement, enhancing imagination, and socialization (in some online games). These games can offer a perceived sense of control over one's life and escape from the struggles in actual life. Once the motives behind a particular activity are well understood, strategies can be devised to replace it with other activities that are healthier but motivate the person in similar ways. For example, if an adolescent engages in online gaming where he also likes to interact with others, social skills training may be a useful management strategy to enable him/her to socialize in the real world rather than virtual.

It is important to understand the process of any addiction starting from occasional use to becoming addictive. The initial excessive use tends to be driven by impulsivity where rewards are important. However, with time, the driving force shifts from rewards to avoidance of withdrawal symptoms. Addictions can therefore be seen as impulsive-compulsive disorders which informs their management from a phenomenological perspective.[9]

The implications from this understanding are to focus on understanding the process and content of addiction. Management strategies should focus on dealing with withdrawal and craving by promoting alternative interests and working on social competence [Table 4]. Promoting alternative interests make use of experience-dependent neuroplasticity.
Table 4: Managing the actual addiction

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  Secondary Effects of Addiction Top


It is also important to understand the secondary effects of behavior addictions in planning management strategies [Table 5]. These effects are physical, psychiatric, and related to exploitation of these children through their interactions with strangers on social media sites.
Table 5: Secondary effects of addiction

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  Summary of Management Approach Top


The above model that looks into the various aspects of behavior addictions is a useful approach to formulate the problem and plan management for these children and adolescents [Figure 1]. It is extremely important to understand that when we manage behavior addictions, we are essentially managing a number of possible psychiatric disorders, temperamental traits, environmental conditions, and various secondary health aspects of the addiction. While with substance use disorder, one may think about complete abstinence as the goal of treatment, managing behavior addictions is predominantly about harm reduction. This stems from the basic understanding that the use of smart technology only becomes a problem when it is used excessively and that it remains an asset when used appropriately. In the coming future, it is likely that our lives will become even more dependent on the benefits of this smart technology. It is therefore extremely important that we tread this path carefully and maintain a very fine balance.
Figure 1: Formulation of behavior addictions

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Text Revision. Washington, DC: American Psychiatric Association; 2013.  Back to cited text no. 1
    
2.
World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD-11): New Release. Geneva, Switzerland: World Health Assembly; 2019. Available from: https://www.who.int/news-room/detail/25-05-2019-world-health-assembly-update. [Last accessed on 2019 May 26].  Back to cited text no. 2
    
3.
Petry NM, Zajac K, Ginley MK. Behavioral addictions as mental disorders: To be or not to be? Annu Rev Clin Psychol 2018;14:399-423.  Back to cited text no. 3
    
4.
Belisle J, Dixon MR. Behavior and substance addictions in children: A behavioral model and potential solutions. Pediatr Clin North Am 2020;67:589-602.  Back to cited text no. 4
    
5.
Wang BQ, Yao NQ, Zhou X, Liu J, Lv ZT. The association between attention deficit/hyperactivity disorder and internet addiction: A systematic review and meta-analysis. BMC Psychiatry 2017;17:260.  Back to cited text no. 5
    
6.
Marciano L, Camerini AL, Schulz PJ. Neuroticism in the digital age: A meta-analysis. Comput Human Behav Rep 2020;2:100026.  Back to cited text no. 6
    
7.
Carliner H, Keyes KM, McLaughlin KA, Meyers JL, Dunn EC, Martins SS. Childhood trauma and illicit drug use in adolescence: A population-based national comorbidity survey replication-adolescent supplement study. J Am Acad Child Adolesc Psychiatry 2016;55:701-8.  Back to cited text no. 7
    
8.
Chauhan N, Patra S, Bhargava R, Srivastava C, Gujar KV, Gupta N, et al. Exposure to smartphone and screen media in children and adolescents and COVID-19 pandemic. J Indian Assoc Child Adolesc Ment Health 2021;17:219-29.  Back to cited text no. 8
    
9.
Cuzen NL, Stein DJ. Behavioral addiction: The nexus of impulsivity and compulsivity. In: Rosenberg KP, Feder LC, editors. Behavioral Addictions Criteria, Evidence, and Treatment. 1st ed. New York: Academic Press of Elsevier; 2014. p. 19-34.  Back to cited text no. 9
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
The Preexisting ...
Environmental Co...
The Actual Addiction
Secondary Effect...
Summary of Manag...
The Preexisting ...
Environmental Co...
References
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