IN-Patient Treatment for Internet Addiction?

Last week, Mashable.com reported, "First U. S. Rehab Center for Internet Addiction Opens Its Doors." In the story, the case of a 19-year-old male who "could not remove himself from World of Warcraft," a popular online multi-player war game, was used to segue to an essay on inpatient treatment for Internet addiction. This prompted a rather provocative question from a reader: "I'm not sure I buy it. I spent two years in grad school reading books 16 hours a day and not going out in the 'real world.' Should I have ponied up $15k for some 'education' rehab?"

The “treatment” provided the 19-year-old is treatment for what is referred to as a “process addiction,” something akin to gambling or sex “addiction.” As with any addiction, a diagnosis can only be made when several diagnostic criteria have been met…and as the article reports, these have yet to be quantified in the Diagnostic and Statistical Manual of Mental Diseases for Internet addiction. Generally, the “non-scientific” diagnostic criteria for addiction include: (1) compulsive behavior that is (2) chronic and (3) continues in spite of known associated negative consequences, and (4) attempts at changing the behavior result in relapse (meaning a return to the compulsive behavior). With gambling and sexual addictions, which not only meet these criteria, but result in demonstrable chemical changes in the brain, a key element in discerning why process addictions are considered by many to be true “addictions" even though the individual does not consume a psychoactive substance (see "Gamblers's Brains") is met.

Clearly the jury is still out on this with many behaviorally oriented practitioners seeing process addiction as being more the result of “cognition and/or learned behavior” than “organic and/or physical processes." That said, there are demonstrable chemical changes (able to be documented with PET scans) that occur when addicted individuals are presented non-substance related stimuli. This means that the reward pathway in the brain is activated by behavior in a similar fashion to when psychoactive substances--or anticipation of their use--are administered (see Drugs Alter the Brain's Reward Pathway). In the case of the experienced user, it is the anticipation of the chemical that results in these chemical changes in the brain; in the gambler—and perhaps the video gamer cited in the article—it is the behavior that results in the stimulation of the chemical rewards that translate into “addiction,” i.e., “compulsion,” “chronicity,” and “relapse.”

Although one may have spent 16-hours a day reading and studying when in grad schools, the reasons for doing so were different than those of the 19-year old “addicted” to War Craft. In addition, once an individual completed his or her degree—the reason those hours were spent studying—the “studying behavior" changed without negative consequences, i.e., “withdrawal.” True, the student may have learned to enjoy this studying behavior/pattern and may continue that behavior to this day, but likely in a significantly different way, not to mention that the change was not marked by repeated failures to realize the change. In short there is a difference between engaging in a behavior because you “cannot not” stop and continuing a behavior because it is a means to a desired end. Eating is a good example of this.

Compulsive eaters, a.k.a., "food addicts," cannot not eat—or cannot not binge and purge, etc. Their treatment does not have the same goal, however, as treatment for a cocaine or alcohol dependency—abstinence, although some still argue that abstinence is not necessary as a condition of change when treating substance use disorders, but this is a topic for another discussion. The objective of treatment for this individual is to establish a new and different “relationship with food,” a constructive rather than destructive relationship. Whereas one can live without alcohol or heroin, one cannot live without food, hence, the objective of treatment for the two similar disorders is different. What is not clear in the cited Mashable article is if the objective of the treatment is abstinence from the Internet or learning to use it constructively; I suspect that the objective is similar to that in treating gambling…abstinence.

In short, I am not sure, yet, where I stand on the need for in-patient treatment or 12-step groups for Internet Addicted individuals. I do embrace the argument that “treatment” in the form of counseling and behaviorally oriented skills training can be useful, but then I believe that most people can benefit from “counseling’ where the focus is either overcoming obstacles that preclude success in a particular area of one’s life and/or learning new skills that allow one to move towards realizing a stated goal.

I suspect that as we learn more about dependence (a.k.a. addiction) we will learn that there are behavioral stimuli that initiate the same physiological and neurological responses seen in individuals addicted to psychoactive substances. I have watched the addictions field progress far in the last 35 years and it is likely that we have but "merely opened the book" on what there is to be known. There is compelling information to argue that "Internet addiction" is a real disorder, but documenting that--and more importantly--identifying the best course of treatment remains to be seen.

What do you think? Leave a comment.