In the mid ’90s, back in the infancy of the internet age, a psychologist named Kimberly Young heard a disturbing story. A friend’s husband had become obsessed with AOL chat rooms and, at a time when internet providers charged by the hour, was spending up to 60 nonwork hours a week on AOL. Not only was that taking a toll on the couple’s finances, but it soon became clear that the husband was going online to meet women. He didn’t stop, and the marriage didn’t survive.
Young, who’d studied computers as an undergraduate, began to wonder if others were getting similarly hooked on the temptations available on the internet. Using criteria for a gambling addiction, she posted a small survey online, substituting the word internet for gambling. Stories poured in about the connection between internet overuse and ruined marriages, devastating debt, lost jobs, teenagers who’d stopped sleeping, and college students who'd dropped out.
Then an assistant professor at the University of Pittsburgh, Young soon expanded her survey into a study that she submitted to the annual meeting of the American Psychological Association, suggesting that a new breed of addicts could be emerging. Her research ignited a controversy that remains to this day.
Young’s internet overusers, she’d insisted, showed all the hallmarks of a substance or behavioral addiction. Maybe they weren’t smoking cocaine or blacking out after drinking, but they couldn’t resist this new kind of craving. They lied about how much they used it, they thought about it when they weren’t on it, and they felt loads better when they were. They’d put in 40 to 80 extra online hours a week binging on games, porn sites, online stock trading and gambling, and falling into online affairs. Attempting to control their use, they’d unplug their modems and hide their monitors, only to give in to their need for an online fix and assemble their connections again. She thought this behavior, which she branded “internet addiction disorder,” warranted its own clinical classification.
Twenty years later, the debate over whether the internet is addictive is still going on. Young and other proponents of the diagnosis say it’s not a vice for most, and that those of us who use the internet for work or reasonable periods of escape aren’t at risk for addiction. Instead, potential addicts lose themselves in salacious and addictive online content, even as their real lives fray.
Today’s conversation about the psychological impact of the internet is expanding beyond the question of addiction, with researchers warning that we’ve entered a state of internet immersion that’s fundamentally affecting how we relate to each other and the quality of consciousness we bring to the rest of our lives. Now that people can go online on phones, watches, tablets, and laptops, they’re melding more than ever with the internet. They can sleep with it at their bedsides, eat with it by their plates, and sit with it on the toilet. It can hike with them in parks, fly with them on planes, and follow them underground into subways. Via search engines and social media, the ever-present internet now relentlessly curates itself to offer clients what they most want to see and hear, pinging its new possibilities at them day and night.
For more and more therapists, regardless of how they feel about internet addiction as a diagnosis, understanding clients’ attachment to their digital devices and advising them about healthy use is becoming an unavoidable part of practice. Practitioners around the world are now finding themselves in need of resources to explore our relationship to technology—an issue that’s been percolating in the minds of experts for decades, but is still hotly debated throughout our field.
Is It Addictive After All?
According to the Substance Abuse and Mental Health Services Association’s nationwide drug and alcohol abuse survey, the subset of the US population addicted to substances is currently about eight percent. Proponents of an internet addiction diagnosis cite studies suggesting similar rates of true addiction for US internet users—around 8 to 12 percent. The World Health Organization has officially recognized that the internet can be addicting for some, and the governments of South Korea and China—countries that lead the world in connectivity and high-speed internet access—are concerned enough to fund research, diagnosis and treatment, and public education campaigns. Australia and some European countries have followed suit in their own ways.
After considering the studies of internet overuse published since the last iteration of the DSM, the APA stopped short of calling it an addiction in 2013’s DSM-5, instead adding internet gaming disorder as a topic for further study. It also replaced the nomenclature of “substance-related disorders” with “substance-related and addictive disorders,” widening the addiction category to include behavioral addictions like gambling disorder and internet gaming disorder.
Despite the APA’s decision, counselors in US schools have been working on internet addiction protocols, and a fair number of college campuses share internet-addiction resources with students and faculty. The diagnosis is relatively high among college students, with a few studies suggesting some correlation between internet addiction and majoring in a hard science. The American Counseling Association provides resources for school counselors to assess students routinely for internet addiction and to intervene accordingly.
“You can’t really have an internet addiction unless you’re spending an excessive amount of time online,” says David Greenfield, who runs the Center for Internet and Technology Addiction in West Hartford, Conn. “It de facto requires you to elevate the dopamine levels by excessive use.”
Greenfield points to mounting evidence of this neurochemical reaction. “We have numerous neuroimaging studies that have shown activation in the nucleus accumbens, and the central segmental area of the prefrontal cortex. They light up the same dopaminergic pathways as cocaine or other drugs or alcohol. All addictions light up that mesolimbic reward circuitry in the mid-brain, it doesn’t really matter what the activating drug is.”
“If Everybody’s Doing It, How Can It Be an Addiction?”
Thousands of people have been treated for internet addiction concerns over the last couple of decades, but vocal critics of the diagnosis like John Grohol, who runs the website Psych Central, remain unconvinced. On the editorial board of the journal Computers in Human Behavior, Grohol spends a lot of time reviewing and interpreting research to offer up-to-date advice on his site. He insists that none of the recent research has swayed his opinion that there’s no such thing as internet addiction.
Grohol likes to point out that New York psychiatrist Ivan Goldberg, the man who first proposed the idea of internet addiction, invented the term in a post on his website in 1995 to parody how the DSM can medicalize any excessive human behavior. But colleagues, not getting the joke, wrote to Goldberg, admitting to having the disorder and asking for help. Hundreds of self-diagnosing internet addicts soon began using the term on sites across the web to describe their problem, and the label and self-identification spread.
According to Grohol, “The whole idea that people are addicted to this tool, this technology that we all take advantage of today, like running water and electricity—it’s just hard for me to wrap my mind around. And apparently it’s hard for researchers to wrap their minds around as well.” He cautions that not only do online shopping, stock trading, online porn, and social media not fit together under a research category, but to place them under the umbrella category of internet addictions is to lose their distinctions for treatment. And he says issues aside from internet use are usually in play.
“When therapists see a couple in counseling and the husband is complaining that the wife is always on the phone and Facebooking and Instagramming, it’s not because the wife is addicted to the internet: it’s because the two of them haven’t worked out their relationship boundaries of ‘when we’re talking, let’s respect each other and put down the phones.’ There’s no value in labeling that as an internet addiction. It doesn’t help you conceptualize the problem or lead you to solutions or treatments for the problem.”
What Digital Detoxes Can Do
Linda Graham is a marriage and family therapist who gives workshops on digital dependence and detoxes. She believes that for many clients, phones are a useful tool for avoiding emotionally challenging issues. She cites a couple who came in because they were arguing too much. In their first session, both kept their phones out on the couch. Says Graham, “So I asked them how much time they spend talking together without their phones on.”
Shocked to learn the answer was zero, Graham got them to turn their phones off for 10 minutes a day and set them in another room. Almost immediately, other issues started floating to the surface, and each began to share how often the other had seemed to avoid or criticize them. In the second session, when Graham asked them to take it up a notch and block out 30 phone-free minutes a day and a chunk of time on the weekends, things got even harder. How could they shut off the phone that long? What if their son had an emergency? The wife thought maybe she didn’t need to be so constantly available to their child, but her husband disagreed. More unaddressed differences in parenting philosophies followed.
Because they were working through their reliance on their phones, the general topic of addiction was suddenly before them as well. The wife said that when her husband drank at parties, he became angry, rude, and abusive. When pressed to face this behavior and asked to cut back, he refused, arguing, “This is who I am. Don’t ask me to change.” That refusal extended to the phone. He was suddenly unwilling to put it away to spend device-free time with his wife, and he ultimately withdrew from therapy while she kept on. “In a sense,” says Graham, “part of her continuing engagement with therapy was due to her willingness to spend time off her devices and confront her issues, while he was unable to separate his phone use from his defended way of being.”
Because issues around our relationship to our devices—including the problems they often mask—consistently come up in practice, Graham suggests detoxes for all her clients. “People need to detox enough so their brains are strong enough again to override the impulse to respond to every ping of the phone. They can begin to make choices about how much time they should be away from the phones in their homes—perhaps setting limits like ‘not in the kitchen, not in the dining room, not in the car, not before you go to bed.’”
She’ll encourage clients to try being without their phones for short spurts and replacing the dopamine hit with other, nondigital experiences, like being in nature, talking with a friend, making a meal, playing with a puppy, reading a book. “It isn’t about doing nothing and being bored,” she says: “It’s about cultivating interests that don’t require the internet.”
Doubling Down on Resistance
We all get a certain kind of relief and release from giving ourselves over to an internet-based life. Constant access to the web can offer an alternative to the tedium in our days, help us dodge our worries, and most of all, distract us from our insecurities and uncertainties. In fact, clients’ attachments to their online life can be a means of resisting full engagement in therapy. If cases aren’t coming along, if clients aren’t truly present in session, this new, digital avenue of resistance might be one of the primary culprits.
Graham is concerned that some therapists may be too put off by the internet-addiction debate or so uneasy evaluating its use without prompting from the client that they ignore the issue of internet use altogether. “Therapy needs to be a safe place for people to talk about issues that impact their lives, and this is one of those issues,” she says. “But many clinicians in our field still believe that they need permission to bring internet use into the therapeutic spotlight.”
Where does this permission need to come from? From peers, Graham argues. “Rather than waiting to follow the lead of the professional organizations, we can take the lead from each other.” Ultimately, she says, “Cyberculture is making it easier and easier to avoid the hard personal issues in life.” But therapists occupy a special place in this new internet order. Their offices provide the opportunity for something increasingly rare in the whirlwind of daily life—a space for meaningful, face-to-face conversations, where feelings, instead of being mollified by online distractions, can be felt. For a growing number of clients, the therapeutic interaction may be one of the few touchstones of what internet video gamers call RL—the messy state of real life.
This blog is excerpted from "Loving Our Devices," by Lauren Dockett. The full version is available in the July/August 2017 issue, Left to Our Own Devices: Is It Time for Therapists to Be Concerned?
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