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Monday, November 10, 2014

Should video games be considered a collegiate sport? I say No…

Last week, I was flying home from Germany where I met with my research colleagues at the University of Duisburg-Essen. We held an entire symposium on Internet addiction including cybersex addiction, social media addiction, and Internet gaming addiction – an especially potent addiction in countries such as Korea, China, and Taiwan. Imagine my surprise when, while waiting at the airport to catch my plane, I saw a story on CNN about Robert Morris University in Aurora, Illinois becoming the first school to categorize playing video games as a varsity sport, even offering scholarship funds for the "athletes." The team meets every weekday for practice between 4 and 9 p.m., with an hour break for dinner, and competitions are every Saturday, according to Kurt Melcher, the school's associate athletic director.

That day, I was being interviewed by ABC News for a story on Candy Crush Saga, when I told the reporter about my deep concerns over video games being considered an athletic sport, she followed up with a story, What It's Like to Be a Video Game Athlete on College Scholarship.

Given the research on Internet gaming, in 2013, the American Psychiatric Association included Internet Gaming Addiction in the Diagnostic and Statistical Manual of Mental Disorders as a new condition for further study. Other studies have repeatedly documented that what begins as a recreational activity can easily turn into an addictive problem. For instance, in an effort to curb video game addiction among youth, South Korea's Ministry of Culture, Sports and Tourism has implemented a sort of gaming "curfew" that will block underage users from accessing online computer games after midnight.

Studies have shown video games feed the brain’s reward centers in a similar way that drugs or alcohol produce an appealing “high.” Further studies have shown that gamers quickly lose themselves in these virtual worlds and their behavior has serious consequences. This summer I met Valerie Veatch, the producer and director of the HBO documentary “Love Child,” a film about a South Korean couple who had let their 3-month-old daughter starve to death while they spent up to 12 hours a day playing “Prius Online” at a local internet cafe. At a special preview of the documentary that we both attended, she said, “They were unable to distinguish the virtual world from the real world.”

These problems are not only seen in Korea, China was one of the first countries in the world to label overuse of the Internet a clinical condition and in response the Chinese government has created treatment facilities to detox and cure teenagers of their addictions to online life.

So, should American colleges view video games as an eSport? The problem of video game addiction isn’t as simple as playing too much or really enjoying video games. At the Center for Internet Addiction, a U.S. firm, we see addicted gamers who are more than twice as likely to have ADD/ADHD, get into more physical fights, and have health problems caused by long hours of game play (e.g., hand and wrist pain, poor hygiene, irregular eating habits). Many need treatment to improve their academic performance and return to normal functioning.

We find treatment for video game addicts to be very difficult because addicted gamers need to spend more time and money on video games to feel the same “high,” skipping out on responsibilities like household chores or homework to play games, excessive thinking about game play, trying to play less and failing, and stealing games or money to play. In their eyes, they don’t see this behavior as an addiction.


Although the U.S. is lagging behind countries like South Korea, which boasts more than 100 clinics to treat video game addiction, there should great concern about American colleges deeming video games as sport. It is important that we first understand the impact of these games on our youth. While video games can be fun and entertaining, I continue to hear from families who are struggling because of a child's gaming habits. What may seem like a competitive sport could be masking a deeper problem. 

Wednesday, March 26, 2014

Reflections on the first International Congress on Internet Addiction Disorders - Cultural and Clinical Perspectives

Internet addiction is a global and rapidly evolving disorder. I just returned from the first International Congress on Internet Addiction Disorders held in Milan, Italy. While the ideas are still fresh, I wanted to write about the new and exciting programs being started to address this rapidly evolving problem.

Cultural Approaches

The panel of speakers and attendees were amazing. They showed the deeply global nature of Internet addiction with each country developing its own methods representative of what worked best for their own circumstances. For instance, in Korea, they are a leader in this field as they are the first to have established a comprehensive Master Plan to prevent and treat Internet addiction. Developed by multiple Ministries of the Korean Government, they provide testing for risk of Internet addiction among adolescents, specialized re-education programs for those at risk, and hundreds of specialized inpatient treatment programs across the country. In Japan and Germany, they utilize Internet fasting camps for children identified at risk, also backed by government support. In China, they utilize military-style boot camps for re-education as depicted in the new documentary, Web Junkies. In Italy, Milan and Rome developed the first inpatient programs with alternative treatments in theater therapy to tap into the emotions of an Internet addict and they explore avatar therapy (in vivo) with peer group training and support. In France, they do not talk as much about pathological Internet addiction but in general focus on early education on technology use for all families. This way, they focus on what parents should do at home when introducing technology for a child. In the U.S., unfortunately, we are lagging behind with respect to prevention and treatment. We do no formally recognize the disorder in the DSM, we only have a handful of specialized treatment programs, we have some digital detox camps but nothing to the scale of Korea, and we do not implement policies for early childhood prevention as they do in France.

This was very enlightening to me, as the only American at the Congress to see how other cultures were addressing what is seen as a significant mental health issue.  There was considerable discussion on how to define Internet addiction. Is it its own disorder? Is it always co-morbidly related to clinical syndromes such as depression and anxiety? How do social problems influence the development of this condition as Internet addicts are highly isolated? What is the relationship with Autism and Asperger’s Syndrome, as these disorders were seen across cultures as a significant risk factor with Internet addiction disorders?

Age of Onset

There was also significant debate on the age of onset for the disorder. How young is too young for children to be introduced to technology? While all the countries represented recognized the benefits of technology use and adaptation among children and adolescents for careers and future job performance, it was asked if technology should also come with warning signs for parents. For instance, in Japan, middle school children were identified to be the most at risk and this launched a greater discussion on what parents need to know at home to address potential Internet addiction disorders.

This is not a new discussion. When I was in Australia this past summer for a Media Addiction conference at Macquarie University in Sydney, this debate of how young is too young also was discussed (and again, to no clear answer). In my own consulting work, throughout the U.S., I have toured several adolescent clinics seeing a growing number of young people with an addiction to technology and visited school systems struggling with how to address the growing problem of students becoming addicted to the very technology that they are required to use. The problem hits home domestically too.

Types of Internet Addicts

The Congress also debated if there were different types of Internet addicts. Were there differences in terms of addicts related to how much time they spent online or what applications they were involved with? For instance, a child who was addicted to video games may be experiencing a developmental phase the he will grow out of into adulthood, whereas an older adult male who suffers from sex addiction is now hooked on online pornography and has long-standing problems with relationships, depression, and substance abuse. Would these two patients be classified the same or are these different types of addicts, one being more phased developmentally and the other more chronic and pervasive?

Also, how does what someone becomes addicted to impact the course of treatment? For instance, in Italy, they use Theater Therapy for young people to act out their avatars for addicted gamers. This has been very effective. But, how does this translate to an older adult who may be addicted to online pornography? Also, how does culture impact treatment?  While Korea has a comprehensive Master Plan (and actually, it was just repurposed as the Master Plan II to address smartphone use), would this be possible in American to implement? My view at the Congress was “no” as our U.S. government does view Internet/technology addiction as a problem. Again, most people did not understand why this is as many other countries are rapidly addressing what they see as a significant mental health concern.

The Role of Government

This led to an important discussion on the role of government involvement and policy. If the government is not supportive of initiatives on Internet addiction prevention, education, or treatment, than it seems that little can be done to properly address the condition. In Korea, they had statistics that showed the effectiveness of their Master Plan in Prevention and Treatment but they also were one of the few countries with widespread government support for the development of their national programs.

Best Practices

In closing, the Congress struggled with the best practices in this emerging field. The issues involved with Internet Addiction Disorders were complex. The issues cited were developmental, clinical, social, cultural, and familial. Developmentally, what was the impact of technology overuse on children? Clinically, what were the best treatment approaches to resolve Internet addiction, especially with the reliance of mobile devices in our daily and work lives? Socially, what were the long-term effects of an over-reliance on technologies that seem to disconnect us more than connect us, especially among children who are using this at younger ages? Culturally, did Internet addiction disorders manifest themselves differently based on ethnic and cultural backgrounds requiring various forms of treatment and prevention? From the family perspective, how should parents learn to integrated technology for their children and what resources were available to help them manage this at home and at school?

Conclusions

Overall, the Congress was an important step in the field of Internet and technology addictions. It seems we are all doing something in our respective countries to address an emerging problem. No matter the terms we use, although, I agree that terminology is highly important, it is clear that this has become a global condition and that we are all experiencing problems with integrating technology into our lives.
Future initiatives based on the Congress are determining: 1] Defining Internet addiction (be it problematic Internet use, pathological Internet use, technology addiction, or other terms, we need to define a clear set of standardized criteria). 2] Consider how co-morbid psychiatric syndromes and personality traits play a role in the development of Internet addiction disorders. 3] Consider how age of onset (and age in general with the introduction of technology) influences childhood development and what parents and families need to know for prevention and what resources are available to them as well as to schools. 4] Conduct outcome studies to investigate the best practices in treating Internet addiction disorders among adolescents and adults. Finally, 5] Examine the role of culture in the development of Internet addiction disorders and how public health policies through government and healthcare systems can enable more effective responses for providing resources, prevention, education, and treatment. 

For more information, please visit the International Congress on Internet Addiction Disorders website.


  





Tuesday, January 21, 2014

#internetaddiction: Prescriptions for Maintaining a Healthy Digital Diet in 2014

Internet addiction had a big year in 2013. The U.S. saw its first hospital-based inpatient clinic to treat Internet addiction open. The American Psychiatric Association who publishes the bible of American psychiatric medicine, the Diagnostic and Statistical Manual for Mental Disorders included Internet Gaming Addiction under section 3 as a condition for further study. Internet addiction had been registered as a condition by the World Health Organization and now new digital detox camps have sprung up in China, Korea, Australia, the UK, and Japan to treat what has become a recognized disorder.

The media covered news of my new inpatient clinic at the Bradford Regional Medical Center. It actually trended on national and international news. Time Magazine ran a cover story on Candy Crush Saga addiction and outlets such as CNBC, ABCNEWS.com, and several other magazines ran year-end reviews asking how people in general – not addicts – can achieve a digital diet in 2014.
The issue of Internet addiction hit a psychological nerve. People weren’t just talking about addicts but they were taking a deeper look at their own behavior – asking if we have all become way too dependent on our gadgets and digital devices. After each interview, it became clear to me that the lines between what is healthy technology use and what is addiction were now blurred.

Prescriptions for 2014
The debate is no longer if Internet addiction is a clinical disorder. It is. The debate is about how much technology is too much. We rely it on almost like breathing.
Yes, we can accomplish great things using technology. We have an app for anything and everything! What is there not to like? We have a convenient and portable tool that performs almost any functional and practical task. Again, when does it become too much?
How do we become good consumers of technology without becoming consumed by it? To help us all become a little more balanced, I developed three key prescriptions for maintaining a healthy digital diet.

Prescription #1: SLOWDOWN
New research shows that workaholics are twice as likely to develop Internet addiction. This is staggering. Think about it, we work constantly because we can. Technology allows us to work 24/7 during the evenings, weekends, and on vacations. We never have time to fully rest. Every meeting and every place I go there are people on their devices. That’s okay, but we need to slowdown and not work so hard. I know that sounds crazy, but we need to take breaks from work and when we do, we need to fully rest. Just because we can check our social media at any hour, doesn’t mean that we should. Unplug and stay committed to that for specific periods of times, especially when you are at home with your family or on vacation. Take weekends away from your smartphone and limit your overall use. Studies show that people going a few days of technology-free life enjoy their time more, feel happier, less stressed, and more focused on their primary relationships.

Prescription #2: MAINTAIN FACE-TO-FACE CONTACT
The cover story in the January 2014 issue of The Monitor, the major trade publication of the American Psychological Association was titled Friends Wanted: New research by psychologists uncovers the health risks of loneliness and the benefits of strong social connections. In short, the story shared new research on the impact of loneliness and how a lack of social support will cause physical and psychological problems. Sadly, loneliness is a problem I often hear about from Internet addicts. I have repeatedly found that lonely people are more likely to become addicted to the Internet only to become more socially isolated. It is a vicious cycle. Even if they spend all their time on social media, they are still physically alone. This behavior is compounded by those with social difficulties or phobias who turn to the Internet as a safe way to communicate without face-to-face contact – yet they never learn how to overcome their fears of dealing with people.
If all your needs are fulfilled online, there is little chance that you will explore beyond it. Some people fell disconnected or left out because they don’t know how to approach or contact others socially. Many fear being rejected so they don’t attempt to make friends or develop relationships. They would rather ‘talk’ with people online. This isn’t really talking as it is typing, minus Skype or webcams, we type.

This is a time to talk instead of type and make more face-to-face contact. In 2014, take time to develop personal interests that you may not have had time to before. Get involved in activities you enjoy and that will put you in a position to meet, work, and socialize with others. Get involved with campus activities, volunteering, or working for a cause that you believe in. This will help you to meet people with similar interests and values. Join a gym and exercise to increase your energy and help you to feel better about yourself. The bottom line is the less time you are tied to your gadgets, the more time you will have to develop face-to-face relationships with others.

Prescription #3: LESS SELFIES, MORE MEMORIES
Normally, I don’t get too fussy over selfies. I wish I took more at times because selfies always look like the person is having fun. But, I am writing about technology addiction so I am limiting my focus to the growing narcissism among Internet users who constantly post selfies. Interestingly, Oxford Dictionary’s word of the year for 2013 was “selfie”—a recently invented word for self-photography from smartphones. Sharing too much of oneself, and getting constant feedback for it, is likely to give a person a heightened focus on themselves, leading to negative introspection, low self-esteem, and a host of other issues.

Studies show that those seeking reassurance and approval through selfies consistently take themselves out of social interaction. The concern lies when people are using selfies to create a persona that will be approved of, i.e., how many Facebook or social media clicks, ‘likes,’ and approvals they get. Facebook and other types of social media create a feedback loop, and some people take more pictures to feed their self-esteem, which can become more important than simply documenting the experience.

Taking selfies is fine but keep it in perspective. Don’t post away your entire life, keep some things private. Instead of taking selfies, enjoy the moment. One new study showed that selfies are making our memories worse. The study conducted by Fairfeld University in Connecticut showed that people are losing their memories due to all this digital picture taking and sharing. Researchers hypothesized that “we are less likely to remember information if we think we can retrieve it later.” It seems that we are counting on our technology to keep our memories and we collect photos almost as if they’re trophies, or evidence, but that’s not the same thing as trying to capture the experience.
As we grow more dependent on technology, it is important to keep a check on reality and remember that there is a world outside of ours gadgets. While instant communication is rewarding in many ways, we must not forget the downsides to this phenomenon, and strive to keep a balanced outlook on life. Read more at http://netaddiction.com

Monday, December 02, 2013

How to assess Internet Addiction in the New Inpatient Treatment Center

We opened the first inpatient treatment center for Internet Addiction in September, 2013 at the Bradford Regional Medical Center in Bradford, Pa (http://www.brmc.com/internetaddiction). Diagnosis of Internet addiction is often complex.  Unlike chemical dependency, the Internet offers several direct benefits as a technological advancement in our society and not a device to be criticized as addictive.  Individuals can conduct research, perform business transactions, access libraries, communicate, and make vacation plans. Books have been written outlining the psychological as well as functional benefits of the Internet in our lives.  By comparison, alcohol or drugs are not an integral or necessary part of our personal and professional lives nor do they offer any direct benefit.  With so many practical uses of the Internet signs of addiction can easily be masked or justified.  Further, clinical assessments are often very comprehensive and cover relevant disorders for psychiatric conditions and addictive disorders. However, given its newness, symptoms of Internet addiction may not always be revealed in an initial clinical interview. While self-referrals for Internet addiction are becoming more common, often the client does not present with complaints of Internet or mobile addiction.  People may initially present with signs of clinical depression, bi-polar disorder, anxiety, or obsessive-compulsive tendencies, and hide signs of Internet addiction on clinical interview. 
When we assess clients for admissions to the inpatient unit, we follow a clear assessment tool as , diagnosing Internet addiction can be challenging.  Given the dependence we have on technology, detecting and diagnosing Internet addiction is difficult as its legitimate business and personal use often mask addictive behavior.  The best method to clinically detect compulsive use of the Internet is to compare it against criteria for other established addictions.  Early studies likened Internet addiction to addictive syndromes similar to impulse-control disorders on the Axis I Scale in the DSM (APA, 1994) and utilized various forms of DSM-IV based criteria to define the disorder. Of the all the references in the DSM, Pathological Gambling was viewed as most akin to this phenomenon. In my work trying to classify the problem, I develop the Internet Addiction Diagnostic Questionnaire (IADQ) as a screen tool (Young, 1998a). The questionnaire quickly gained significant popularity. It is now widely cited in the academic literature and used in a multitude of studies and clinics as a screening tool. The IADQ assesses clients with the following questions:
1.      Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?
2.      Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
3.      Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?
4.      Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
5.      Do you stay online longer than originally intended?
6.      Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
7.      Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?
8.      Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?  
Answers should evaluate non-essential Internet usage such as for non-business or academically related use.  Endorsing five or more of the questions over a six-month period is considered addictive or dependent Internet use, although more recent studies that empirically tested the IADQ found that using 3 or 4 criteria where just as robust in diagnosing Internet addiction as using 5 or more and suggested that the cutoff score of 5 criteria might be overly stringent (Dowling & Quirk, 2009). I err on the side of caution and stick to the 5 criteria that I had originally developed. Associated features of the disorder may be present such as ordinarily excessive Internet use, neglect of routine duties or life responsibilities, social isolation, and being secretive about online activities or a sudden demand for privacy when online. While the IADQ provides a means to screen for Internet addiction, these warning signs can often be masked by cultural norms that encourage and reinforce technology use.  Even if a client meets all of the criteria, signs of abuse can be rationalized as, “I need this for my job” “I need this for school”. 
Using the IADQ (see http://www.netaddiction.com for details on the development of the test), we screen patients for Internet addiction. We are able to properly assess the presence of the disorder, and combined with a thorough psychiatric exam and medical history, we determine the basis for admissions criteria. If you are looking for more information on the inpatient unit or further details on how to apply to the program, please visit http://www.brmc.com/internetaddiction or http://netaddiction.com.  

Thursday, October 03, 2013

Inpatient Care for Internet Addiction: Is it Necessary?

Is Internet Addiction real? That is the question I am often asked. Of course it is, I reply, but I can see how many people still question if we can truly become addicted to technology.
It is not technology itself that causes the problem but it is in how we have come to use technology in our lives. Look around any airport, school yard, or mall - everyone is staring at their screens.  We have become socially removed. What is the impact of this technology when it does become excessive or compulsive?
In my 20 years of researching Internet Addiction, I have become the world’s leading expert. I say this because it is humbling and not in any arrogant way. I see how my research and academic studies have been applied by researchers all over the globe. I have consulted with hundreds of clinics about Internet addiction recovery and given many workshops to therapists. I say with that authority, Internet addiction is a real problem.
We debate this in America while other countries such as China and Korea have established treatment centers to deal with the problem for years. We lag behind other countries who have established clinics and university-wide studies in an effort to combat a distressing new problem in our culture.
Internet Addiction is real. Treatment is often necessary. It does not stand alone, most often those who suffer from Internet addiction also suffer from other clinical problems such as depression, anxiety, substance abuse, or social anxiety or phobia.
In September of 2013, I opened the nation’s first inpatient treatment center at the Bradford Regional Medical Center in Bradford, Pa. It is part of Behavioral Health Services Dual Diagnosis Program and we have received calls from all over the world. It says to me how widespread the problem is and how many people are hiding their addiction to technology.
Based on the calls alone, it seems people have such a serious problem with their online use that they have struggled for years in outpatient counseling being seen by therapists who either dismissed the behavior as normal or weren’t sure how to address.
Inpatient counseling is intended for the serious cases of Internet addiction. Treatment focuses on daily individual therapy and 72-hour medically-supervised digital detox is required.
“Do I believe that inpatient care is necessary for Internet addiction?” “Yes,” I exclaim. “Inpatient care is necessary!”

Addiction is addiction. Americans have lagged behind other countries in treating people who may suffer from this problem. We are BRMC are proud to be the first inpatient program in the U.S. to offer such help. While the DSM-5 has only just included Internet Gaming Addiction in Section 3 for conditions that need further research in this last revision, my prediction is that in the years to come, more research will happen, and future DSM revisions will then include Internet Addiction as real condition.   

Wednesday, September 25, 2013

FAQs Answered on the New Inpatient Internet Addiction Recovery Program at BRMC

I have received several calls from people looking for referrals to the new inpatient program on Internet Addictioin recovery at the Bradford Regional Medical Center. Here are some answers:
What are your recovery principles?
At BRMC, we offer unique and specialized treatment methods for Internet addiction recovery. We view the Internet as a productive tool and unlike other addiction rehab that use traditional abstinence models, we focus on healthy choices that you can make about your own Internet use. We teach you how to go on a digital diet so that you can learn to use technology in responsible ways that add to your life. Family support and involvement is also strongly encouraged.

How can someone get help?
The first step is to determine if there is a problem. A licensed psychologist or social worker trained in identification and treatment of Internet addiction can effectively perform an assessment to determine what level of care is most appropriate. Please call 1-800-446-2583 to speak to a professional.

Who can refer someone to the program?
We welcome referrals from psychiatrists, psychologists, social workers, case managers, Employee Assistance Programs (EAPs), insurance companies, managed care organizations, MH/MRs, children & youth, probation, friends, family members, self-referrals, and clergy. Referrals are confidential and can be made by anyone. BRMC does not discriminate in accepting patients based on ethnic or national origin, race, religion, disability, age or gender. If you would like further information, please call 1-800-446-2583.

Will my insurance company pay for services?
Unfortunately, Internet addiction is not a recognized disorder covered by insurance. We do provide additional Payment Information on our program and details on methods of payment.

Who has to know about my hospitalization?
Only the people you authorize will know about your hospitalization and these people will receive only the information that is necessary for them to continue your care or to give you support once you are discharged.
How long will I stay?
Your time in the hospital depends on what your individual needs are. This is a 10-day program but additional time can be accommodated depending on your therapeutic need. Your individualized treatment plan focuses on what can be accomplished in the shortest periods of time. With this as a foundation for progress, you can continue treatment in an outpatient setting.

Call 24 Hours a Day – 1-800-446-2583

Saturday, September 07, 2013

New Internet Addiction Inpatient Treatment and Recovery Program at BRMC

By now the news has been released that we have opened the new Internet Addiction Treatment and Recovery Program at the Bradford Regional Medical Center in Bradford, PA. We are excited to be part of this historic event, as the first program of its kind in the U.S. It is heart-felt for me to see my life's work become a reality and to hopefully build a program that will help many in need.

Internet Addiction
Contact us 1-800-446-2583
116 Interstate Parkway
Bradford, PA 16701
The Internet Addiction Program is a part of the Behavioral Health Services Dual Diagnosis Unit at Bradford Regional Medical Center in Bradford, PA. The Internet Addiction Treatment and Recovery Program offers counseling and treatment for adults 18 years of age and older, the program is for those who have been unsuccessful overcoming the excessive use of the internet and electronic gaming on their own. The program involves a voluntary ten-day stay within a secure and dedicated patient unit. Internet addiction is any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. Internet Addiction has been called internet dependency and internet compulsiveness. By any name, it is a compulsive behavior that completely dominates the addicts’ life. Internet addicts make the internet a priority more important than family, friends, and work. The internet becomes the organizing principle of addicts’ lives. They are willing to sacrifice what they cherish most in order to preserve and continue their behavior.

We are committed to helping patients develop a healthier lifestyle free from addiction and abuse of electronic media.

The service is the first hospital based recovery program in the United States, and offers the first ever Digital Device Treatment Program in the nation.Our expert clinicians understand technology related behavioral addictions. They work with individuals, couples, and families to help them better understand and recover from an internet, video gaming or technology related behavioral addiction.
This inpatient program provides individual, group and family therapy through a unique, individualized treatment plan, of which aftercare planning, family and referral involvement are key components. Patients will be treated by a multidisciplinary team including psychiatrists, licensed psychologists, certified addiction counselors, psychiatric nurses, social workers, mental health therapists, case managers and support staff.
For seeking admissions to the program, please call the number above to receive our application.