“The Doctor’s Opinion”
Reviewed by Dr. Amanda Giordano, PhD.
Internet and technology addiction is the compulsive and self-destructive use of the internet, digital media, and smart devices. Addiction develops through the repeated triggered release of dopamine in the brain, which over time can lead to structural changes in the brain that compromise our ability to focus, prioritize, regulate our mood, and relate to others. We may develop an addiction to social media, streaming video or audio content, pornography, dating apps, games, online research, online shopping, news, or any other digital activity that becomes compulsive and problematic.
The first researcher to investigate this addiction was the psychologist Kimberly S. Young, who in 1998 adapted the diagnostic criteria for pathological gambling to suggest eight criteria for identifying internet addiction:
- Demonstrating preoccupation with the internet;
- Using the internet for [progressively] longer amounts of time to achieve satisfaction;
- Unsuccessful attempts to control or cut back internet use;
- Experiencing withdrawal symptoms when the internet cannot be accessed (for example, restlessness, depression, irritability);
- Using the internet longer than intended;
- Jeopardized relationships, educational pursuits, or career opportunities due to internet use;
- Deceiving others about amounts of time spent online; and
- Using internet to escape dysphoric moods or problems in life.
According to Young, endorsing five or more criteria is indicative of internet addiction.1 Since Young first published her research, much more work has been done on the subject. While there is still an open discussion in the scientific community regarding how to define, qualify, and study internet addiction, there is widespread consensus that the problematic and compulsive use of the internet, digital media, and smart devices has been rising over the past two decades, and that this behavior is associated with a variety of mental, emotional, physical, interpersonal, and professional problems.
Perhaps most significantly, people who meet the diagnostic criteria for internet and technology addiction have been shown to experience structural changes in the brain very similar to the changes experienced in the brains of individuals with drug or alcohol addictions. In particular, internet and technology addiction is associated with reduced gray matter in the prefrontal cortex, the anterior cingulate cortex, the ventral tegmental area, the nucleus accumbens, the caudate nucleus, the putamen, the thalamus, and the amygdala. These changes compromise our inhibitory control, conscious decision-making and reasoning, voluntary top–down attentional control, modeling and prediction of the behavior of others, emotional processing, behavior monitoring and modulation, reward expectation, executive function, and cognitive function.2,3,4,5 In addition, changes in the brain’s white matter further affect our sensory, cognitive, and emotional regulation abilities, our reward pathways, and the formation, maintenance, and retrieval of our working memory.5,6
These findings are cause for serious concern. While some might minimize the impact of internet and technology addiction in comparison to chemical substances, the truth is that internet and technology addiction changes our brains in a manner similar to the effects produced by an addiction to alcohol, heroin, or other chemical substances. A variety of studies have shown that access to television and video games reduces the amount of pain medication needed by hospital patients.9,10,11
Of course, the effects of internet and technology addiction are not only reflected in the structure of our brains, but in our lives as well. Internet and technology addiction is strongly associated with increased impulsivity,5 ADHD, anxiety, and depression.12 In addition, it is associated with psychological inflexibility, avoidance behaviors, substance abuse, higher incidences of interpersonal problems, emotional instability, borderline personality symptoms, low self-esteem, and low emotional intelligence.13 In addition to these mental and emotional problems, internet and technology addiction is also linked to a higher risk of obesity and cardiometabolic disease,14 poorer sleep quality, increased fatigue, and symptoms of insomnia,15,16 all of which are correlated to a higher mortality rate.17,18 Perhaps most tragically of all, individuals with internet addiction have much higher rates of suicidal ideation, planning, and attempts—roughly three times the average.19
In 1935, several alcoholics gathered together for mutual aid and founded what would later become known as Alcoholics Anonymous, a community that has since blossomed to over one hundred thousand groups in 180 countries around the world with an estimated 2.1 million members. In the book Alcoholics Anonymous, published in 1939, the renowned doctor William Silkworth contributed to an introductory chapter titled “The Doctor’s Opinion.” In it, he wrote:
“In late 1934 I attended a patient who, though he had been a competent businessman of good earning capacity, was an alcoholic of a type I had come to regard as hopeless. In the course of his third treatment he acquired certain ideas concerning a possible means of recovery. As part of his rehabilitation he commenced to present his conceptions to other alcoholics, impressing upon them that they must do likewise with still others. This has become the basis of a rapidly growing fellowship of these [people] and their families. This man and over one hundred others appear to have recovered. I personally know scores of cases who were of the type with whom other methods had failed completely. These facts appear to be of extreme medical importance… We feel, after many years of experience, that we have found nothing which has contributed more to the rehabilitation of these [alcoholics] than the altruistic movement now growing up among them.” 20
A recent meta-analysis conducted by Stanford researchers evaluating 35 studies—involving the work of 145 scientists and the outcomes of 10,565 participants—determined that participation in Alcoholics Anonymous was nearly always found to be more effective than other therapies in achieving continuous abstinence from alcoholism.21 The AA model has been successfully adapted to help people suffering from a variety of addictions, including heroine, cocaine, marijuana, nicotine, sex, pornography, and food, among others.
In continuation of this tradition, Internet and Technology Addicts Anonymous applies the proven model of Alcoholics Anonymous to help those who are suffering from an addiction to internet and technology find long-term freedom from their self-destructive behaviors. We share our experience, strength, and hope with each other through group meetings and one-on-one relationships, and we work a recovery program based on the Twelve Steps of Alcoholics Anonymous. ITAA is free and open to all who wish to join, and we welcome anyone who thinks they may have a problem to visit one of our meetings.
- Internet Addiction: The Emergence of a New Clinical Disorder (1998)
In this paper, Kimberly S. Young first proposed diagnostic criteria for internet addiction.
- Internet Communication Disorder and the structure of the human brain: initial insights on WeChat addiction (2018)
The tendency toward an addiction to social networks is associated with a lower volume of gray matter in the subgenual anterior cingulate cortex, which is an essential area for regulatory control in addiction behaviors.
- Electrophysiological activity is associated with vulnerability of Internet addiction in non-clinical population (2018)
People with a greater probability of developing an internet addiction are more likely to present a functional reduction in the frontal lobe region.
- Structural gray matter differences in Problematic Usage of the Internet: a systematic review and meta-analysis (2021)
Problematic Usage of the Internet (PUI) is linked to reduced gray matter in the brain compared to controls. In particular, gray matter reductions occur in the dorsolateral prefrontal cortex and anterior cingulate cortex in PUI, regions implicated in reward processing and top-down inhibitory control.
- Altered Gray Matter Volume and White Matter Integrity in College Students with Mobile Phone Dependence (2016)
Addictive smartphone usage is associated with decreased gray matter volume in various areas of the brain, as well as changes in the white matter in the hippocampus, and these changes are similar to those experienced by people with drug addictions and gambling addictions. Additionally, people exhibiting addictive smartphone usage have higher levels of impulsivity, which is the strongest predictor of a wide variety of addictive behaviors.
- Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study (2012)
People with Internet Addiction Disorder demonstrate widespread changes in major white matter pathways.
- Prefrontal control and Internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2014)
When exposed to internet-related cues, the brain of an internet-addicted individual reacts with craving in the same way that the brain of a substance-dependent individual reacts to substance-related stimuli. There is also growing evidence that persons with internet addiction exhibit impulse control problems similar to those with substance use disorders.
- Activation of the ventral and dorsal striatum during cue reactivity in Internet gaming disorder (2016)
A study of young men with Internet gaming disorder found differential ventral versus dorsal striatal brain responses to gaming cues that were similar to those of persons unable to control their substance use.
- Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study (2019)
Virtual reality gaming helped reduce pain for victims of severe burns by almost 50%.
- Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial (2019)
Watching virtual reality media content significantly reduced pain in hospitalized patients.
- Analgesic effect of watching TV during venipuncture (2006)
Watching television during venipuncture reduced pain levels in children by 75%.
- Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don’t Know (2 ed.) (2017)
Internet addiction is strongly associated with alcohol abuse, ADHD, anxiety, and depression.
- Internet addiction in young adults: A meta-analysis and systematic review (2022)
Internet addiction is associated with interpersonal problems, depression, anxiety, perceived stress, difficulties in resilience, and traits such as psychological inflexibility, experiential avoidance and emotional instability, reduced extraversion, borderline personality symptoms, very low self-concept and emotional intelligence levels, reduced inhibition in risky online behaviors, and low quality of life in physical, psychological, social and environmental aspects. Moreover, the severity of internet addiction is associated not only with a higher rate of mental health problems, but also with a greater severity of their symptoms.
- Associations of leisure screen time with cardiometabolic biomarkers in college-aged adults (2020)
Increases in leisure screen time was associated with a higher risk of obesity and cardiometabolic disease in young adults.
- Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal (2017)
Higher binge viewing frequency was associated with a poorer sleep quality, increased fatigue, and other symptoms of insomnia, whereas regular television viewing was not.
- Internet gaming addiction, problematic use of the internet, and sleep problems: a systematic review (2014)
Problematic internet use is associated with sleep problems such as insomnia, short sleep duration, and poor sleep quality.
- Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents (2016)
Being overweight or obese was associated with increased all-cause mortality.
- Insomnia with Short Sleep Duration and Mortality: The Penn State Cohort (2010)
Persistent insomnia is linked to higher mortality rates.
- Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies (2018)
Individuals with internet addiction had significantly higher rates of suicidal ideation, planning, and attempts, as well as greater severity of suicidal ideation.
- The Doctor’s Opinion, Alcoholics Anonymous (1939)
Note: This passage has been edited to be gender inclusive.
- Alcoholics Anonymous and other 12-step programs for alcohol use disorder (2020)
A recent meta-analysis evaluating 35 studies—involving the work of 145 scientists and the outcomes of 10,565 participants—determined that participation in Alcoholics Anonymous was nearly always found to be more effective than other therapies in achieving continuous abstinence from alcoholism.
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