I A

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I A

Kathryn Vercillo

Health and Medical Issues Today

Copyright © 2020 by ABC-CLIO, LLC
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmied, in any form or by any means, electronic,
meanical, photocopying, recording, or otherwise, except for the inclusion
of brief quotations in a review, without prior permission in writing from the
publisher.
Library of Congress Cataloging in Publication Control Number: 2019917717
ISBN: 978-1-4408-6606-7 (print)
978-1-4408-6607-4 (ebook)
24 23 22 21 20 1 2 3 4 5
is book is also available as an eBook.

Greenwood
An Imprint of ABC-CLIO, LLC

ABC-CLIO, LLC
147 Castilian Drive
Santa Barbara, California 93117
www.abc-clio.com
is book is printed on acid-free paper
Manufactured in the United States of America
is book discusses treatments (including types of medication and mental
health therapies), diagnostic tests for various symptoms and mental health
disorders, and organizations. e author has made every effort to present
accurate and up-to-date information. However, the information in this book
is not intended to recommend or endorse particular treatments or
organizations, or substitute for the care or medical advice of a qualified
health professional, or used to alter any medical therapy without a medical
doctor’s advice. Specific situations may require specific therapeutic
approaes not included in this book. For those reasons, we recommend that
readers follow the advice of qualified health-care professionals directly
involved in their care. Readers who suspect they may have specific medical
problems should consult a physician about any suggestions made in this
book.
is book is dedicated to my brother and sister, who not only
are my best friends but also provide me with some of the best
examples in my real life of how to put the devices down and
truly engage with the life that’s right in front of me.
C

Series Foreword

Preface

Acknowledgments

Introduction

Part I: Overview and Baground Information

1 What Is Internet Addiction?

2 Why Is Internet Addiction a Problem?

3 What Makes the Internet So Addictive?

4 Internet Addiction and Relationships

5 Other Forms of Internet Addiction

6 At-Risk Populations

Part II: Issues and Controversies

7 Treatment Options

8 What Is the Underlying Problem?

9 But Aren’t ere Benefits to the Internet?

10 What Are the Implications of New and Emerging Tenologies?

11 Whose Responsibility Is It to Resolve Internet Addiction?

Part III: Scenarios

12 Case Studies

Glossary

Timeline

Sources for Further Information

Index

About the Author

S F

Every day, the public is bombarded with information on developments in

medicine and health care. Whether it is on the latest teniques in treatment
or resear, or on concerns over public health threats, this information
directly affects the lives of people more than almost any other issue.
Although there are many sources for understanding these topics—from Web
sites and blogs to newspapers and magazines—students and ordinary
citizens oen need one resource that makes sense of the complex health and
medical issues affecting their daily lives.
e Health and Medical Issues Today series provides just su a one-stop
resource for obtaining a solid overview of the most controversial areas of
health care in the twenty-first century. Ea volume addresses one topic and
provides a balanced summary of what is known. ese volumes provide an
excellent first step for students and lay people interested in understanding
how health care works in our society today.
Ea volume is broken into several parts to provide readers and
researers with easy access to the information they need:

Part I provides overview apters on baground information—including

apters on su areas as the historical, scientific, medical, social, and
legal issues involved—that a citizen needs to intelligently understand
the topic.
 Part II provides capsule examinations of the most heated contemporary
issues and debates, and analyzes in a balanced manner the viewpoints
held by various advocates in the debates.
Part III provides case studies that show examples of the concepts discussed
in the previous parts.

A selection of reference material, su as a timeline of important events, a

directory of organizations, and a bibliography, serves as the best next step in
learning about the topic at hand.
e Health and Medical Issues Today series strives to provide readers with
all the information needed to begin making sense of some of the most
important debates going on in the world today. e series includes volumes
on su topics as stem-cell resear, obesity, gene therapy, alternative
medicine, organ transplantation, mental health, and more.
P

We as a society increasingly recognize that there are problems, including

those that potentially cause serious harm to our brains, that come along
with this new world of being constantly connected to our screens and
devices. One of the problems is the risk of Internet addiction. is is a
controversial label, whi, as we’ll see in this text, we are still learning how
to define. As fast as studies come out to help us beer understand the issue,
tenologies ange and the effects they have on us ange as well. It’s hard
to keep up, both from a consumer perspective and from a resear point of
view. is book is designed to help people understand what we know so far
about Internet addiction.
is book is wrien for an undergraduate audience studying across
diverse topic areas because it is an issue that will affect people in a variety of
fields from education to neuroscience. is book is also of relevance and
interest to the average reader who wants to learn more about what constant
Internet use is doing to our minds, bodies, and social lives. Parents who are
concerned about raising ildren in this te-heavy world, therapists and
doctors who increasingly see clients who present symptoms related to
Internet addiction, and individuals who are struggling with their own use
may all gain insight and information from reading this book.
e book presumes that, though some argue against it (and we do discuss
that debate), there is su a thing as Internet addiction. It exists on the
spectrum, and the book addresses that spectrum, but primarily it is about
what happens for people who are on the side of the spectrum where full-
blown addiction does occur. roughout Part 1 of the book (Chapters 1–6),
we look at the effects overuse and addiction have on the brain, the types of
content that people frequently find addictive online, and the most at-risk
populations. In Part 2 (Chapters 7–11), we discuss some of the more
controversial aspects of the topic, including treatment options, why some
people don’t consider Internet addiction a true diagnosis because of the
variety of complicating factors, how the Internet can also be a mental health
benefit (not just a detriment), and who might bear some responsibility for
addressing this issue further in the years to come.
If you’ve ever felt like you’re spending more time than you want on your
phone, your gaming system, or your social media, then this book can help
you gain a solid understanding of the basics underlying this issue.
Furthermore, it can get you thinking and talking about ways to maximize
the benefits of the Internet, including emerging tenologies like virtual
reality, while mitigating the harms.
A

I want to thank the people who have paved the way before me with their
resear into this complicated twenty-first-century topic. In particular, I
want to recognize the thought leaders from Silicon Valley, su as Tristan
Harris (formerly of Google), who recognized that their te companies were
making oices that intentionally led users into addiction, and instead of
siing by quietly they raised the flag to make us all aware of the potential
harms this could cause.
I want to thank my publishing team at ABC-CLIO for believing in the
importance of this book and making it happen. In particular, thanks to my
editor Maxine Taylor. I am passionate about exploring mental health issues
that affect people in society today, helping to raise awareness in order to
help people and destigmatize allenges. I am grateful to the publisher for
also sharing this passion.
As always, this book couldn’t have happened without the constant,
ongoing support of my family and friends, who encourage me during the
times when it feels like I don’t know what I’m doing and can’t get the work
done to my own satisfaction.
I

How oen do you e your phone for text messages, emails, and social
media updates? What does it feel like if you forget your phone and find
yourself without it? If the power goes out and you can’t access the Internet,
do you struggle to figure out how to pass the time? You’re not alone. e
pervasiveness of the Internet in recent years offers many benefits to our
society, but it’s also intrusive. e very nature of the anging tenology
has made it so that we are all increasingly a lile bit addicted to the
Internet.
Internet addiction exists on a spectrum, and most of us are somewhere on
that spectrum today. is book primarily covers the extreme end of the
spectrum where full-blown addiction leads to serious problems in life
including job loss, destruction of relationships, and comorbidity with other
mental and physical health problems. It will help you understand what it is
like to live with Internet addiction; how it affects individuals, families, and
communities; and what options there are for treating this emerging issue.
Most of us aren’t at that extreme end of the spectrum. However, it’s a
slippery slope. Understanding the ways in whi the Internet is increasingly
addictive for all people can help you take precautions in your own life in
order to prevent heading down that slope yourself. Knowing the signs and
risks of Internet addiction can allow you to see when someone you love
might need to step ba from their devices for a lile bit. Most important,
gaining a deeper understanding of the issue can help ea of us proceed
more consciously with our Internet use.
No one is suggesting giving up the Internet entirely (although some
people with addiction oose to do so). In today’s world, it’s nearly
impossible to work or socialize without some degree of Internet
connectivity. at’s perfectly fine. However, we can oose to use the
Internet in a focused, intentional way that allows ea of us to make the
most of the tenology instead of leing the tenology get the best of us.
We can recognize warnings of addiction and take appropriate steps to
mitigate the harms in the lives of ourselves and our ildren.
Naturally, in order to understand Internet addiction, we have to define it.
We’ll do that in Chapter 1, looking at some of the official diagnostic criteria
that various professionals use to help clients determine whether or not
they’re dealing with addiction. We’ll also look at some ways that people can
self-identify whether or not their Internet use is becoming a problem.
Finally, in this apter, we will address the important distinction between
addiction and simply being creatures of habit. How do you know if it’s
really addiction? It’s hard to tell where any one person lands on the
spectrum, particularly yourself when you are deep inside of the issue, but
this apter helps gives you a beer perspective on what Internet addiction
really means. At the end of the book, you will also find five case studies that
can help you get a more personal sense of what it is like to live with Internet
addiction.
Chapter 2 digs deep into why it’s a problem to have this type of addiction.
Most of us are so used to the prevalence of online tenology that we don’t
necessarily see it as a serious issue. Sure, we might have a sense that we
could all benefit from a digital detox now and then. However, most of us
don’t bother to take one, and that suggests that we don’t see the real harm at
play here. Gaining a deeper understanding of how serious the issue can get
for some people helps open our eyes to why it’s a problem worthy of
discussion, aention, concern, and treatment. We look at some of the major
mental, physical, and social repercussions of Internet addiction, thiening
our comprehension of why we need to address this issue sooner rather than
later.
Moving on from defining Internet addiction and why it’s a problem, we’ll
take a moment to examine the human brain as it relates to addiction.
Chapter 3 lays out the science of the maer, helping set the groundwork for
understanding what makes the Internet so addictive to the human brain.
Aer we begin to get a grasp on why the brain easily becomes addicted to
this medium, we will tou on the important topic of how the tenology
industry has exploited the brain’s weaknesses specifically to generate
addiction. Companies of all kinds have used what we know from both
psyology and neuroscience to intentionally make the Internet more
addictive. at’s why so many people are affected by this issue today.
Next, we’ll break down the different types of Internet addiction people
commonly face. e Internet is increasingly a social tool, so Chapter 4
covers all of the forms of addiction related to people’s relationships on the
Internet. Social media addiction is one of the most common forms of the
condition, and it comes in many forms including addiction to selfies, likes,
image management, catfishing, and even cyberbullying. Many of society’s
issues, particularly those afflicting the young, relate directly to social media
addiction. Chapter 4 also covers addictions to texting, online dating, and
Internet pornography. e laer is one of the most widely studied forms of
Internet addiction to date.
Although social media and the relational aspect of the Internet are highly
addictive, people can become addicted to this tenology in many other
ways as well. Chapter 5 explores some of the most common nonrelational
Internet addictions starting with online gaming. As with pornography,
Internet gaming is one of the most widely studied forms of Internet
addiction. In fact, it’s the only form to have an official diagnosis at a
professional psyiatric level. Like pornography, it straddles the line
between a social/relational addiction and a solo addiction, whi is why the
apter begins with this topic.
e rest of the issues in this apter are generally solo endeavors.
Compulsive Internet behavior is common, so we’ll look at addictions to
online gambling, sto trading, shopping, and auctions. In recent years,
video streaming tenology has improved dramatically, allowing us to easily
develop an addiction to “binge-wating” television shows, movies, video
clips, and the news. News addiction is a particularly prevalent problem
emerging in society today. Finally, this apter wraps up with a condition
that you may not have heard of but might be able to relate to:
cyberondria. is is a form of hypoondria directly related to the
tendency to sear online for information about potential medical
conditions, becoming increasingly certain that you’re deathly ill because of
what the Internet has to say.
If you have ever stayed up late at night on a site like WebMD, then you
have a sense of what cyberondria can feel like. You also see how easy it
might be to become addicted to any behavior or content online. Virtually
anyone can develop Internet addiction. However, there are certain
populations that are more at risk than others, whi is the topic covered in
Chapter 6. We start with ildren and teens because their developing brains
make them particularly vulnerable to the risk of Internet addiction. en we
explore a variety of other conditions and issues that can put someone at
greater risk than the general population.
At this point, you might be wondering what can be done about this
increasingly prevalent problem in our society. Chapter 7 answers that
question as far as it relates to individuals. We look at the established and
emerging treatment options available to people struggling with Internet
addiction. We explore the concept of harm reduction, discuss the allenges
of withdrawing from the Internet, and look at professional options including
inpatient and outpatient therapy. We also explore self-help options for
people who may not have a full-blown Internet addiction but who want to
cut ba on Internet use, go online with more intention, or utilize teniques
to prevent addiction in the future.
Chapter 8 adds to the conversation begun in Chapter 7, looking at how
addiction and treatment may be complicated by a variety of issues. We look
at an individual’s addiction in general, asking, “Would this person still have
a similar addiction even without access to the Internet?” In other words, “Is
the Internet really the problem or does it only exacerbate the problem?” is
apter also explores comorbidity, whi is Internet addiction among people
with other mental health diagnoses.
Although Chapters 7 and 8 address how to solve the problem at the
individual level, this is really a societal issue. We are all increasingly reliant
on the Internet for both work and play, whi primes more and more people
for potential addictive behavior. Chapter 9 asks the question, “If everyone is
doing it, what is the problem?” More important, it looks at the benefits of
the Internet, particularly as it applies to mental health. Because this book is
about Internet addiction, and not just average use of the Internet, mu of
the content in the earlier apters can lead you to believe that the Internet is
a terrible thing puing us all at risk. is apter helps to balance that out
by looking at how the Internet can and does improve mental health
generally and for specific populations. It includes asking the question, “Can
the Internet help resolve the issue of Internet addiction?”
Chapter 10 takes things to the next level by addressing the increasing
prevalence of Internet tenology across all aspects of our lives. New and
emerging tenology, including smart homes and virtual reality, make it
increasingly likely that Internet addiction will impact more and more people
in new ways that we might not yet be able to foresee. It’s important to start
having the conversations about these tenologies so that we can be
thoughtful about how we introduce them into our lives, particularly among
populations that are at-risk for addiction.
In Chapter 11, we ask the controversial and complicated question about
who is responsible for helping to resolve the Internet addiction issue.
Parents, sools, health professionals, government agencies, and nonprofit
organizations are all working on some level to cope with the effects of
Internet addiction and even to prevent it to some degree. What can ea of
these groups do best? Who bears what level of responsibility to take greater
action? While there aren’t clear-cut answers, this apter aims to provide an
overview of the options in order to start a greater conversation to resolve the
issues.
 By the end of the book, you should have a strong sense of what it means
to have Internet addiction or to love someone who is coping with this
problem. You will understand the issues affecting both individuals and
communities and how, even though full-blown problematic Internet
addiction isn’t a widespread condition, it’s a problem that affects many of us
on a smaller scale. As tenology advances, more people are exposed to the
risk of greater addiction. By examining the treatment options, complicating
factors, and big questions toward the end of the book, perhaps you yourself
will begin to dream up some of the answers that can help all of us with this
issue in the future.
P I

Overview and Baground Information

C 1

What Is Internet Addiction?

D I A

Defining Internet addiction is no simple thing. At what point does regular
use go beyond habitual and into addiction? Who gets to define this issue?
Aer all, we don’t want to pathologize behavior that everyone we know,
including ourselves, engages in to some degree. And yet, we’re seeing signs
of serious Internet addiction across all sectors of our society. ere are
accounts of ildren dying because their parents were so immersed in online
gaming that they neglected to give them proper care. ere are cases in
whi people are so addicted to staying on the Internet that they stop eating,
bathing, or even going to the restroom normally—instead wearing adult
diapers so that they don’t ever have to leave the screen. Prolonged, nonstop
online activity has led some people into full-blown psyosis, in whi they
develop paranoid thinking along with auditory and visual hallucinations
that require inpatient treatment for weeks, or even months, to resolve.
Clearly, there is su a thing as Internet addiction that goes beyond the
regular person’s tendency to perhaps wat one too many Netflix shows in a
row or get lost in the rabbit hole of social media for longer than they prefer.
So how do we define that addiction?
Let’s look first at what it means to have an addiction at all. In general,
addiction is defined as engaging in the compulsive use of a substance or
behavior in spite of negative life consequences (whi may include, but are
not limited to, a negative impact on health, relationships, and finances).
Addiction also has signs of withdrawal, cravings, and increased tolerance.
Let’s consider alcohol addiction, for example. Many people drink beer or
wine on a regular basis. Historically, it was very common for people to have
a “cotail hour” ea day aer work. at’s ongoing, regular, repetitive
behavior. However, that alone doesn’t mean that the person has an
addiction. If the person can’t stop themselves from compulsively drinking
alcohol on a daily basis, then there’s a big red flag that this might be
addiction. If drinking every day impacts their life in a negative way, and
they still can’t or won’t quit, then it’s almost certainly addiction. If they do
try to quit and experience the symptoms of alcohol withdrawal, then there’s
addiction at play.
As you can see, addiction exists on a spectrum. With alcohol, some people
drink regularly, but it doesn’t negatively impact their lives in any significant
way. ey can stop if they oose to do so. Sure, there might be a lile bit of
withdrawal symptoms, but they can manage and get through it. at’s not
addiction, although it clearly exists somewhere on a spectrum from “no
problem” to “addicted.” When the addiction begins to cause repercussions
and the person is mentally or physically unable to stop consuming the
alcohol, it’s addiction. at framework helps us beer understand what it
means to have an addiction in general, whi makes it easier to get a sense
of what Internet addiction might be.
Internet addiction is a term for compulsive Internet use that causes some kind of hindrance to life
but the person continues the behavior in spite of the negative consequences. If they do try to stop,
they experience withdrawal symptoms.

It is a behavioral addiction, whi is in contrast to a substance addiction.

Other behavioral addictions include gambling, shopping, and overeating. To
reiterate then, Internet addiction has three key components:

1. Compulsive Internet behavior (social media, gaming, pornography,

online shopping, TV binges, etc.)
2. Growing tolerance (requiring more time or intensity to aieve the
same pleasure) as well as withdrawal symptoms when not able to
access the Internet
3. Problems caused by the addiction in one or more significant areas of a
person’s life (relationships, finances, health, etc.)

is laer part of the definition is the key thing to pay aention to when
trying to determine if someone has an Internet addiction. Frequent use of
the Internet may not itself be a problem for some people. It becomes an
addiction when the person is unable to reduce or stop usage despite
consequences to key areas of the person’s life. It is even more clearly an
addiction when the person’s tolerance goes up (so they need a bigger “hit” of
the Internet experience to get the same “high”) and/or they have cravings
and withdrawal as a result of trying to reduce Internet use.
For example, a teenager might enjoy online gaming so mu that they do
it every single day aer sool. While it might frustrate parents, it’s not
necessarily a problem. If they aend sool, get decent grades, and have
some friends outside of the online world, then there’s not necessarily an
addiction. Kids like video games, and that’s not necessarily a sign of
addiction in and of itself. But if they are staying up so late that they can’t
get to sool, their grades are dropping, their only social life is through the
game, and they refuse to eat or exercise because they don’t want to get
offline, then there’s likely an issue. If parents take away the Internet and the
ild reacts with aggression or depression, whi can both be reactions to
withdrawal symptoms, then there’s likely an addiction at play.
As you can see, addiction, including Internet addiction, isn’t a clear-cut
thing. Nevertheless, we can start to define it at a basic level when we look at
the following criteria:
 Frequency of behavior, including whether or not that has increased: has
the person started using the Internet more and more over time?
Duration of behavior, both in individual siings and over length of
time: a person who is online for twenty-four hours nonstop likely has
some level of addiction.
Impact of Internet use on physical, psyological, emotional, spiritual,
social, and financial health: what areas of life are affected and to what
degree?
What happens when the person tries—or is forced—to give up the
Internet? Cravings to get ba on the Internet and/or symptoms of
withdrawal are strong indicators of Internet addiction.

Although this basic definition is the most important part of a diagnosis,

it’s worth taking a look at the history of Internet addiction to get a beer
sense of how to define it. It’s also important to consider how the mental
health and medical communities define the condition according to various
diagnostic criteria.

History of Defining Internet Addiction

Children growing up today can’t even imagine a world without the
Internet. In fact, I recently went to a lecture aended by multiple
generations interested in learning about the impact of the Stonewall riots on
gay/trans history. ere were people there (baby boomers) who were
immersed in activist culture in the 1960s, and they shared their anecdotes
with Gen Xers, millennials, and the Gen Z aendees of the talk. is talk
took place in San Francisco, so a key part of the talk was exploring how the
event, whi happened on the East Coast, impacted activism on the West
Coast. People from these older generations shared that although they had
heard of Stonewall at the time of the event, it wasn’t something that made a
lot of waves right away in California. at’s certainly not because people in
California weren’t toued by the issue. Gay rights was a huge issue here.
Instead, it was because, frankly, it took a long time for news to make its way
from one coast to the other. It took time to interview people who were there
(oen by very expensive phone calls or travel), write up those stories,
publish them in newspapers, and then share those news stories with people
across the nation. e riots happened in June, and it wasn’t until October
that California newspapers really seemed to make mention of them.
e millennials and Gen Zers in the audience seemed baffled by this time
lag in communication. If you grew up aer the Internet was a regular part of
life, it’s hard to understand how long it would take for news to rea people.
It’s allenging to think about how few places published information about
an event like Stonewall, how difficult it was to access those resources, and
how unlikely it was to be able to find widely differing opinions about su
an event. If Stonewall happened today, it would instantly be announced on
Twier, we would see images of the event unfolding in real time on
Instagram, and every news outlet, from nie bloggers to big media, would
quily be there to report on the event. In fact, it would be a completely
different experience for everyone involved, and it’s important to highlight
that even people on the opposite coast might feel “involved” because of the
ability to participate to su a high degree thanks to the Internet.
All of this is to say that the Internet has anged our world in ways both
tiny and immense. Even those of us who grew up without access to the
Internet tend to take it for granted that it’s at our fingertips today. Most of
us have some sense of what Internet addiction is, if only because our own
online behavior has grown increasingly compulsive, and sometimes
problematic, over time. ere’s a tendency then to think of Internet
addiction as always kind of being a problem for some people. We may know
that cell phones weren’t available during the Stonewall riots, but when we
picture it, we still kind of mentally think of time moving at the same pace as
it did then. We know the Internet wasn’t always there, but we behave and
tend to think like it was. But when we look ba at the history of the
tenology, and how it has impacted our mental health, we realize that this
is really a twenty-first-century problem.
e term “Internet addiction” did begin making its way into society at the
very end of the twentieth century. One of the earliest professional studies of
the condition began in 1994 when Kimberly Young of the University of
Pisburgh at Bradford used anecdotal evidence of clients to gain more
information about the issue. is was a three-year-long study that was
eventually published in a book called Caught in the Net. is period, right at
the end of the 1990s, marked an increase in awareness about how the
Internet was more and more prevalent and might be more and more of a
problem for some people.
In Mar 1995, a New York Times article appeared called “e Lure and
Addiction of Life OnLine.” is may be the first time in history that the term
“Internet addiction disorder” was used in a major publication. e article
quoted specialists in addiction and compared the issue to other behavioral
addictions, including compulsive gambling, shopping, and exercise. ere
were not any professional criteria for diagnosing the condition. ere was
simply growing awareness of the fact that people were engaging in Internet
behavior in increasingly addictive ways. Our best option was to look at
other forms of addiction to see how Internet behavior compared to those
established issues so that we could begin to understand what it might mean
to be addicted to the Internet.
It’s an interesting sidenote that you can quily and effortlessly pull this
article up online today. When you do, you’ll see that it begins with a note or
disclaimer that reads, “is is a digitized version of an article from The
Times’s print arive, before the start of online publication in 1996.” Even as
people were beginning to define the problem of Internet addiction, su an
established publication hadn’t yet begun to offer an online version of their
work. e world was anging quily, and we were really only starting to
guess at what it might mean for ea of us, particularly those people prone
to addictive behavior.
During this same time period, scientists began working to find a
definition for Internet addiction using measurable criteria. As mentioned,
they used working models of addiction already accepted in the community.
ey looked at both substance and behavioral addiction, because the two
forms of addiction do have many similarities. ey drew more heavily on
information about behavioral addiction, because engaging with the Internet
is a behavior (although, as we will see in Chapter 3, behavioral addiction can
actually trigger emicals in the brain in su a way that it mirrors
substance addiction). Based on the criteria for addiction in general, scientists
in the late 1990s determined that identifying Internet or tenology addicts
required the following traits:

Compulsive behavior
Overuse of the tenology
Problems caused by overuse, including interpersonal and health issues
Time management allenges, particularly due to overuse of the
tenology
Tolerance requiring increased use
Withdrawal when not using the tenology

In other words, a person with an Internet addiction feels compelled to

frequent and increasing use of the tenology despite the fact that it’s
causing problems in one or more areas of their life. ey go online “too
mu,” and they can’t stop even though their health or relationships suffer as
a direct result of the behavior. at basic definition is the definition that
we’ve been working with since the 1990s, and it’s a good working definition
of what Internet addiction is. However, over the years, professionals from
various fields have adapted and supplemented this definition with a more
refined understanding of the condition.

e DSM’s Diagnosis of Internet Addiction

e Diagnostic and Statistical Manual of Mental Disorders (known more
commonly as the DSM) is a guide used by psyologists and other health-
care professionals in the United States to officially diagnose all mental
disorders. e book, whi is wrien by a panel of psyiatrists, is reviewed
regularly, and conditions may be added or removed based on scientific
evaluation and the industry’s evolving understanding of humanity. e first
edition was published by the American Psyological Association (APA) in
1952; it has grown about tenfold in length since then.
ere are certainly pros and cons to the DSM. People have a lot of
concerns about labeling individuals with certain conditions. One of the most
well-known examples of how a DSM diagnosis can be pathologizing and
problematic is the fact that in early editions of the book, homosexuality was
considered a mental disorder, whi of course today we find appalling. is
reflects how the standards of psyiatry, and thus the DSM diagnostic labels,
are naturally directly impacted by social, cultural, and medical beliefs
prevalent in society at the time of the writing. In fact, it took several anges
to the DSM to remove the entry “homosexuality” entirely. In the first edition,
it was its own “disorder.” en the label was anged to “ego-dystonic
homosexuality,” meaning essentially that it was only a disorder if the person
felt like it was a problem. A later edition subsumed homosexuality as a
“problem” quietly under the larger term “sexual orientation disturbance.” It
wasn’t until the 1980s that it was entirely removed from the DSM as
professionals and laypeople alike began to recognize that being gay isn’t a
mental health problem at all.
is is all to say that the DSM is flawed and has been rightly criticized,
but it’s also the standard that mental health professionals adhere to when
giving a clinical diagnosis—whi may be solely for insurance purposes but
can also be a means to guide treatment. So, regardless of what you think of
the DSM and its many flaws, it’s important to realize that the way we
diagnose mental health disorders in America today relies heavily on the
DSM. Moreover, ea edition of the DSM does reflect a wide swath of the
current understanding and resear related to conditions impacting people
in society today. erefore, the DSM editions of the past clearly wouldn’t
have included issues of Internet addiction since the Internet wasn’t even
around in those early days, but as the Internet has grown in prevalence and
more and more issues with it have emerged, the psyiatrists on the
deciding panel of the DSM have had to consider whether or not the problem
rises to the level of a mental health disorder.
 e current edition of the DSM, the DSM-5, does not have a diagnosis
specific to Internet addiction. In fact, the only behavioral addiction that is
found in the DSM is for gambling. is shows us that what general society
recognizes as a problematic behavior—su as compulsive shopping or
overeating—hasn’t necessarily made it into the DSM, yet, because there is a
stringent process for editing the DSM in ea new version and that process
hasn’t always caught up with the realities of the modern world. is isn’t
necessarily a good thing or a bad thing. It’s good that it takes a long time for
psyiatrists to assess a problem to determine what it really means and what
the criteria would be to diagnose it. It’s a good thing that we don’t
immediately pathologize problematic behaviors by giving them a diagnostic
label.
On the other hand, a lot of the treatment options in our society require a
mental health diagnosis. If there is no diagnosis for “overeating” or “Internet
addiction,” then it can be mu harder for people facing those allenges to
find affordable care to help in dealing with the reality of those issues. So,
there are some good reasons for labeling a problem as a disorder in the DSM,
but there is also a lot of caution around adding new terms.
It is worth noting that Internet addiction has sometimes been viewed as
an impulse control disorder. e DSM-3 was the first edition of the manual
that included disorders of impulse control. ose disorders included
kleptomania and pyromania. e defining feature of those disorders is that
there is an impulse and the person fails to resist that impulse, despite the
fact that it harms self or others. e individual struggling with impulse
control will feel tension before giving into the impulse, relief while
completing the act, guilt aer the act, and withdrawal until the tension
builds, and the cycle starts over again. People aempting to quit Internet
addiction may experience this same cycle of feelings. While the Internet
didn’t widely exist during the time of the DSM-3, if it had, then it might
have fallen under the “impulse control disorder” category. at category still
exists today. erefore, a person seeking treatment might be able to work
with professionals using that definition of Internet addiction even though
the specific disorder of Internet addiction isn’t listed in the DSM.
 Internet addiction is a relatively new thing in our society. It has evolved
rapidly with the rise and ange of tenology including not only computers
but also smartphones and other widely accessible devices from tablets to
cloud-based tenologies and voice-activated personal assistants like Alexa.
It’s no surprise that Internet addiction as a whole is not represented in the
DSM, yet. It’s just too new an issue for us to really know how to address it.
at said, there is one aspect of Internet addiction that is mentioned in the
DSM-5, in a section recommending further study. at aspect is Internet
gaming disorder.
One of the things that has to happen in order for people to widely accept
a specific diagnosis with detailed criteria is that studies have to take place to
determine what it means to have this illness. It takes time for those studies
to occur. In terms of the Internet, some behaviors are older than others.
Internet gaming and online pornography are two of the oldest, most
prevalent, most addictive Internet behaviors. erefore, they are the most
widely studied. It’s no surprise that online gaming was the first form of the
condition to receive official DSM aention. It has enough of a history—and
the studies to support the claims—to suggest it’s an issue.
Recent editions of the DSM, in particular, recognize the flaws inherent in
this system of diagnosis. at’s why the book has become increasingly
broader, sometimes opting not to define a condition as a disorder but instead
to recommend more study for future editions. is lends credibility to the
issue as a potential problem, gives professionals some ideas of what to look
for in assessing people for the problem, and lends legitimacy to additional
studies into the issue. at’s where we are currently at with Internet gaming
disorder in the DSM. It’s not an official diagnosis, but it’s emerging as
enough of a problem that the authors recommend further study.

International Classification of Diseases on Internet Addiction

e DSM is the “gold standard” of diagnosis in the United States.
However, people around the world are equally or more likely to turn to a
similar tool: the International Classification of Diseases or ICD. is is a
system maintained by the World Health Organization (WHO) to classify all
different types of health issues, including those related to mental health. It’s
very common for DSM diagnoses and ICD diagnoses to look similar, but
there are also differences between the two. If you want to fully understand a
mental health issue, a good place to start is to look at the similarities and
differences between how it is defined by the DSM and the ICD.
e WHO has been working with the ICD-10 edition since 1992. Since
there weren’t even studies of Internet addiction at the time, it’s no surprise
that it’s not mentioned in that edition. e WHO does publish minor
updates annually, but there hasn’t been a big edition ange since that time,
until recently. e WHO officially accepted ICD-11 in May 2019, and this
new edition’s guidelines will go into full effect in 2022. is new edition, like
the newest version of the DSM, includes the online gaming aspect of Internet
addiction. Unlike the DSM, it’s not “recommended for further study” but is
officially included as a diagnosis.
e ICD says that gaming disorder is a paern of digital or video gaming
(whi these days basically always takes place online) with the following
problematic criteria:

Impaired control over gaming behavior

Giving more and more priority to gaming over other daily activities
and interests
Continuing or escalating negative consequences in life

ICD-11 is conservative in its diagnosis in that it requires symptoms to be

present for at least one year. Some would suggest that six months of nonstop
gaming with continued use despite problems in multiple areas of life could
be considered an addiction. However, the official diagnosis suggests
observation of what happens over the course of a full year before giving
someone this label.

Other Diagnostic Criteria

 Although the DSM-5 doesn’t have an official diagnosis for Internet
addiction and only includes a recommendation for further study of Internet
gaming specifically, it is widely recognized in the medical community and
the society at large that there are many people who are struggling with
compulsive Internet behavior. Likewise, ICD-11 does have an official
diagnosis, but it’s limited to online gaming and doesn’t include other
addictive online behaviors (yet), but this WHO ange is a significant
indicator of increasing global awareness about problematic Internet use.
e DSM is used primarily in the United States and the Western world.
e ICD is used more widely, but it’s not the standard everywhere. It
certainly isn’t the only way that professionals in the mental health field deal
with the realities of problems presented by their patients. In fact,
professionals throughout the world see Internet addiction as a growing
problem. And in some parts of the world, professionals do consider Internet
addiction disorder to be a real (and serious) problem. China, for example,
has identified Internet addiction disorder as its number one health crisis.
One tool used to measure Internet addiction in Chinese adolescents is called
the Chen Internet Addiction Scale (CIAS). It measures compulsive use,
withdrawal, and tolerance as well as problems with time management,
health, and relationships. ese are all the same indicators that we would
use to address behavioral addiction in the United States or Europe, but
they’re applied specifically to concern about Internet use (and although that
includes gaming as a primary focus, it’s not just about online gaming).
Kimberly Young, the psyologist who did the first major study of
Internet addiction beginning in 1994, used a screening tool that asks about
different criteria including being preoccupied with the Internet. It covers
many of the same questions as the CIAS model, including staying on the
Internet longer than planned, trying to quit Internet use, growing tolerance,
and negative impacts on jobs and relationships. In addition, there are
questions about mood anges, lying to others about usage, and using the
Internet as a means of escape. All of these criteria are things that
professionals in the mental health field may look to in order to diagnose
Internet addiction problems among clients.
 ere are also specific tests for certain types of Internet addiction. For
example, World of Warcraft is one of the most widely cited games related to
Internet gaming addiction, and there is a free online test to e for
addiction to that game specifically. e popular version of this test, available
at Wowaholics.com, is adapted from the CAGE questionnaire for identifying
alcohol addiction. It asks four questions, and people who have more than
two “yes” answers are considered addicted. e four questions are whether
you have ever (1) felt that you should cut down use, (2) been annoyed by
people criticizing your game play, (3) felt bad or guilty about playing, and
(4) felt like you have to play first thing in the morning to steady yourself?
Arguably, this is a really limited and perhaps unscientific approa to
diagnosing a World of Warcraft addiction. It may still be a good starting
point for figuring out if you have a possible problem.

Self-Identification of a Problem Even If It Doesn’t Meet Medical

Criteria
An individual does not have to be officially diagnosed with a behavioral
addiction to suffer the consequences of that addiction. Many people today
recognize that their Internet use is problematic for them and would like to
ange their behavior. Whether that use rises to the level of addiction or not
is less important than the desire to ange.
While plenty of individuals see a potential problem, addiction is oen
something that people in a person’s life will point out to them. Parents,
spouses, and bosses may make comments about the person’s frequent use.
ey may do so in jest, but if it happens oen enough, it might be a sign
that something could be wrong. If someone expresses direct and clear
concern or frustration, it’s at least worth taking a look at to determine
whether or not there’s a problem.
If you are concerned that you or someone you care about might have a
problem with Internet addiction, then Kevin Roberts might be a good
resource to help you identify whether or not there is an issue. Roberts is a
recovering video game addict and a nationally recognized expert and author
on the issue of online gaming addiction. He runs support groups to help
others. According to him, someone with four or more of the following traits
may have a problem with Internet addiction. is list is specifically for
Internet gaming issues, but it can be used to consider whether any Internet
use is becoming problematic. e traits are as follows:

More than two hours per day of use on four or more days per week
Changes in sleep
Continued use despite consequences
Cravings to use; this goes beyond simple desire and feels like a
biological imperative
Eating at the computer
Emotional disturbance if tenology is taken away
Glorifying gaming/Internet use
Inability to see negative consequences
Increasing usage
Losing tra of time
Lying about online activities
Mood swings
Obsessing about being online when not online
Persistent inability to reduce use
Physical issues
Poor sool/work performance
Using real money to buy things inside of games/apps
Withdrawal symptoms
Withdrawing from others and from other interests to use

Roberts also notes that people vulnerable to addiction experience

“normal” Internet usage as all encompassing. Whereas most of us feel a lile
boost of energy when we e social media, a person with an addiction to
it will become so focused on social media that they fail to engage with
important people and activities in order to aend to their online interaction.
ey stop thinking about other things in life because they’re obsessed with
the Internet. ey justify their Internet use when it’s obvious to others that
they are making excuses for behavior that has started to cause real problems
in their lives.
Roberts’s list of criteria is one of the best starting places for self-
identification of a problem. You can also draw from the descriptions in the
DSM and ICD for some guidance. Ultimately, though, the very best place to
e is your own gut. Deep inside, we always know when there is a
problem. We certainly have a lot of defense meanisms in place that allow
us to hide addiction from ourselves, but somewhere inside us the compass is
pointing to our true north, and if we can tap into it, then we can get a sense
when things just aren’t right. e ironic thing about Internet addiction is
that it does a great job of distracting us and numbing us to our internal
compass, so it becomes easy to avoid sensing that there’s a problem. e
addiction itself takes over our aention. at’s why it helps to get an outside
opinion, whether from a friend or from a professional, and to use that
opinion to e in with yourself about whether or not there might be an
issue.

Addiction versus Habit

One of the questions that come up, particularly when people self-evaluate
for Internet addiction, is whether the behavior is a true addiction or merely
a habit. e best way to think of this is that the behavior exists on a
spectrum. A habit, when performed oen enough, mindlessly, and to the
detriment of the individual, is an addiction. At the opposite end of the
spectrum is a habit that someone is aware of and ooses mindfully as a
desired behavior. For example, brushing your teeth is a habit that most
people have. Someone who brushes their teeth compulsively, fiy or more
times per day, has a problem that might be called an addiction (or an
impulse control disorder or an obsessive compulsive behavior). Most habits
lie somewhere in the middle of the spectrum, with many behaviors leaning
toward addictive in the sense that they create some kind of discomfort or
problem for the individual struggling with the issue.
 Related to this issue is the issue of cravings and withdrawal. ere is a
spectrum to consider in this area as well. Desire and wanting to engage with
the Internet lie at the habit side of the spectrum. When you began to feel a
need to engage, or a deeper craving, then you’re moving toward addiction.
When you have a craving, it feels like your survival depends on responding
to the craving. is is related to withdrawal in addiction, where not using
the Internet leads to deep, intensifying cravings to use.
e world is definitely anging regarding what constitutes acceptable
habitual behavior with the Internet. Look at books from 2010 and earlier,
and you’ll see many references to the rarity of staying up all night online or
eing email during a business meeting. At the time, these were not
common behaviors and were warning signs of addiction. Now everyone has
their phone out all of the time; it is not at all unusual for phones to be in use
during meetings and dinner dates. Many people keep their phones by their
bedside and not only e them first thing in the morning but also e
them if they wake up in the night. In some cases, this is a habit, and it’s
supported by our society. In other cases, the use can become problematic,
and it moves toward the addiction end of the spectrum.
It can be hard to tell when a habit has started to control us to the point
that it becomes an addiction. However, you can oose to ange your
behavior regardless of where it lies on the spectrum. If you have a habit that
you don’t think is serving you, it’s worth considering ways to ange it. If
that habit is increasingly causing you problems in work, time management,
relationships, physical heath, and/or mental health and you find yourself
unable to reduce usage in spite of these problems, then you are leaning more
and more toward addiction. People with bad habits may be able to reduce
use on their own, while people with more severe addictions may seek help
for the problem.

H   C T

One of the things that make it really difficult to define Internet addiction
today is the fact that there is a blurring of lines between all of our different
forms of tenology. Is it still “Internet addiction” if what you’re doing
compulsively is texting on your cell phone without logging on to the
Internet? What if what you’re addicted to is your Fitbit that tras health
and exercise information? As fast as we can study one form of “Internet”
addiction, some new potentially addictive tenology pops up, and we have
to figure out whether it even falls into the same category.

Defining the Tenology at We Become Addicted To

Historically, cell phone addiction was studied separately from Internet
addiction. Today, most cell phones do connect to the Internet. In fact, these
days everything from our cars to our refrigerators are high te, and many
of them are connected online. e tenology is anging faster that we can
account for as we study Internet addiction.
Mark Griffiths of Noingham Trent University prefers the term
“tenology addiction.” He defines this as a behavioral addiction (meaning a
nonsubstance addiction) that involves interaction between a human and a
maine. Some people will say that this definition is too broad. Others may
say that in a world where artificial intelligence (AI) is increasingly an
everyday reality, it may become too difficult to even define the difference
between a human and a maine. So, tenology addiction may be too broad
a word or it may be too narrow, but it gives us one way of encompassing the
many different devices that now relate to some degree to Internet addiction.
Another phrase has been coined by Dr. Larry Rosen, a resear
psyologist and expert in the psyology of tenology. He’s the author of a
book titled iDisorder, whi is a term he uses to define an enmeshed
relationship with tenology. He says that user-friendly tenologies create
a sense of dependence, obsession, and stress that simultaneously encourages
our overreliance on them while causing problems for our mental health. He
specifically explores how daily use of media and tenology leads to anges
in the human brain’s ability to process information and relate to others in
the world. He considers both gadgets and websites to be culprits in an
iDisorder. So, “iDisorder” is another term that we could use in place of
Internet addiction to define the addiction to anging tenologies related to
the Internet.
“Cyberaddiction” is yet another term that is commonly used instead of
“Internet addiction.” is term gives many people the sense that the issue
isn’t limited to the Internet, per se, but instead to the behaviors associated
with using cell phones, computers, and other related tenologies. “Cyber” is
loosely defined as things that relate to computers, virtual reality, and
information tenology. erefore, it encompasses “the Internet” but it’s not
limited to it, making it a broader definition than Internet addiction alone.
We could debate for hours (and some people have) about the correct name
for the addiction to these different devices and activities. In this book, we
use the term “Internet addiction” to describe more than just addiction to the
Internet but also to other tenology-based activities su as Fitbit
monitoring and text messaging.

Changes in the Tenology

Not only has tenology anged a lot in recent years, but it also keeps
anging more and more frequently. Looking ba across time, we can see
that it took about two decades aer the invention of the telephone for a
majority of society to start using the device. In contrast, cell phones were
introduced in 1985 and became popular ten years later (although it took
another ten years for the number of cell phones to surpass the number of
landlines in the United States).
Cell phone adoption was faster than that of landlines but not nearly as
fast as the tenologies to come. Both the World Wide Web and instant
messaging needed only four years for widespread adoption and blogging
about three; it took even less than that for social media to take hold. ings
are anging quily, becoming more readily available to ea of us, and we
may not know how to integrate the tenology into our lives in a healthy
way.
A few key things have anged in tenology that make it potentially
more addictive than ever before. We can gain some perspective on these
features by looking at the evolution of video games. ink ba to the first
interactive home video game systems, su as Atari. Kids would gather
together around the maine, and they may get very immersed in it for a
time, but the activity was self-limiting. ere were only a handful of games.
e games were limited to a maximum of two players at a time. e goal
was to “beat the game,” and once you completed all of the levels of the game,
it wasn’t very fun to keep on playing it. In other words, kids would naturally
lose interest, and because they were in a room together, they would
eventually stop playing the games to do other things with ea other su as
ki a ball around outside.
When gaming systems went online, it was a completely different story.
Computers could connect to one another, meaning that kids could sit in their
own rooms, in separate homes, and compete. ey would go head to head,
whi meant that they were competing against ea other, instead of trying
to “beat the game.” It was no longer just “you take a turn, then I take a turn.”
is increased interactivity created new options for game play that pumped
up adrenaline and prolonged the amount of time people would play any
given game.
With the creation of massive multiplayer online role-playing games
(MMORPGs), the anges were magnified. You can play with many people,
at any hour of the day or night, working with teammates to compete against
others. You can constantly level up; there is no “beating the game” because
there is always something more to do in the fantasy world created there.
is evolution from Atari is a terrific example of how our tenology has
goen faster, more interactive, and more pervasive. e games are more
realistic, they happen in real time, and they are mu more immersive. It is
mu easier to lose ourselves in a twenty-first-century game than in Atari’s
Donkey Kong or Frogger.
We see this same trend with other devices. Social media, for example,
connects us to constantly anging information from people we know and
strangers all around the world. We could never have looked at a pager every
few minutes throughout the day because there simply wasn’t anything there
to engage with, but it is not uncommon for people to e their social
media accounts or look for new text messages on their phones many, many
times throughout an hour.
It is almost impossible to keep up with what it means to be overusing
tenology to the point of addiction when the tenology itself is anging
so mu. e 1994 Internet addiction study by Kimberly Young (who
founded the Center for Internet Addiction the following year) found that
people engaged in “interactive applications” were most prone to addiction.
At that time, interactive meant participating in at rooms and news groups.
Engaging with other people in this way was found to be more addictive than
simply “surfing the web.” In the twenty-first century, the number of
opportunities for interactive communication has increased dramatically. It
follows that the potential for addiction has also increased.
is has developed alongside the anges in mobile tenology. At one
time in recent history, mu aention was given to the addictive potential of
computers, without as mu focus on that of cell phones. e content itself
was what was viewed as addictive, and the limited tenology of older cell
phones limited that content. Smartphones today are capable of accessing all
of the content—and more, and more quily—as twentieth-century
computers. As su, studying cell phone addiction and computer addiction
separately no longer makes mu sense.
e advances in mobile tenology also mean a ange in addictive
potential. When accessing the Internet meant that you had to sit at a desktop
computer, you were naturally limited in how mu time you could spend
online. (at’s not even to mention the fact that you used to have to pay per
minute for Internet use, so you were financially restricted as well.)
Eventually, you had to get up from the desktop and go out into the world.
(is was well before the days when Amazon delivery could instantly bring
almost anything that you needed right to your doorstep.) Even when cell
phones first began connecting to the Internet, they were somewhat self-
limiting. e service wasn’t great, so you couldn’t connect everywhere, and
you oen paid exorbitant fees for Internet usage. Now that Internet-
connected cell phones work so well, so quily, so affordably, almost
everywhere, we can easily spend all of our waking hours online.
C 2

Why Is Internet Addiction a Problem?

Most of us use the Internet every day for a wide variety of functions. It is
just a feature of life. So, what makes it a problem? Chronic Internet use of
the kind that has become an addiction has a significant number of negative
long-term effects, not the least of whi is that resear indicates that it
actually anges the structure of the brain. We will look at the brain in more
depth in Chapter 3, but for now let’s focus on the most common problematic
issues associated with Internet addiction. ese are the negative effects that
people experience when they have full-blown Internet addiction and that
other people may experience to a lesser degree when overusing their
devices.

A
Anxiety might be the most common ronic condition experienced by
people with Internet addiction. Even people who aren’t truly addicted to the
Internet oen experience low levels of anxiety related to their devices. For
example, many of us have experienced “disconnectivity anxiety,” whi
refers to feelings of fear, stress, anger, and frustration caused by the
unexpected inability to connect to our phones or the Internet. is may
happen when you accidentally leave your phone at home, when traveling in
areas without consistent reception, or when the power goes out for a period
of time. You may begin to worry about the messages that you’re missing,
feel lost as to what to do with yourself during the downtime, or think that
you feel the vibration of a phone alert when the phone isn’t even on you.
is laer condition is widely known as phantom vibration syndrome, and
some studies indicate that as many as 75 percent of cell phone users have
experienced it. ese things might be mildly frustrating, or they might cause
full-blown anxiety. It can happen even when we consciously decide to take a
break from our devices. As anxiety increases, we may break our “digital
fast” in order to soothe the feelings.
Disconnectivity is only one form of anxiety that people can experience
due to Internet addiction. You can get anxiety when you don’t get a
message, su as when you text someone and they don’t immediately
respond (especially if you can see that they’ve read the message). You can
get anxiety when you post a photo and people don’t respond to it in the way
that you want. You can get anxiety when you’ve commented on someone’s
content and then worry about how they’re going to take what you’ve said.
ere are many specific triggers for anxiety on the Internet.
Anxiety is aracterized by excessive worry and the feeling that you can’t
control your worries. e more time you spend online, the worse your
anxiety may get. It may manifest in emotional or physical health symptoms
including insomnia, fatigue, trouble concentrating, irritability, ainess, and
restlessness. Some people develop panic aas, whi include trouble
breathing, racing heart, sweating and shaking, and other physical symptoms
accompanied by a feeling of dread or danger. People with Internet addiction
may experience panic aas related to specific triggers online. For example,
someone might start to panic when receiving negative comments on a blog
post they’ve just made.
ere also might be a more widespread feeling of generalized anxiety in
our society related to the anges that tenology has placed on our social
norms and the fact that we don’t have clear etiquee for those anges.
Professor and author Jarice Hanson suggests that tenology is causing our
lives to ange so mu, and so quily, that none of us are certain what the
new social norms are surrounding our behavior, particularly as it relates to
use of tenology. Consider, for example, that ildren today might take
offense to a text message sent by a parent that includes punctuation;
punctuation is considered aggressive to this younger generation, something
that older folks might not be aware of. So, when a parent discovers this, they
may start to get anxiety about how to handle the next text message to their
ild. How many times have you had to correct a misunderstanding because
what was said online or through text was taken the wrong way? With so
many underlying issues affecting our society, it’s hard not to feel some
anxiety when engaging on the Internet.
We may also feel like tenology is taking over our lives, and we want to
return to a “simpler time,” but we also feel like there’s no turning ba from
the onslaught of gadgets. All of this leads to ronic anxiety related to an
inability to adjust to a rapidly anging world. is can manifest in anxiety
triggered by device updates that ange things around, trying to learn a new
app, or otherwise engaging in a new activity that feels like one more
overwhelming thing that you have to learn.
Anxiety is arguably increasing year upon year in our society. In 2017, the
American Psyiatric Association (APA) found that two-thirds of those
polled were either somewhat or extremely anxious specifically about health
and safety and at least one-third were just anxious in general. e following
year, the APA repeated the study, and results indicated that anxiety had
already increased by 5 percent. Of all those studied, millennials were the
ones most likely to report anxiety. Of course, there could be many different
causes for this increase in anxiety. However, we can’t ignore the likelihood
that Internet connectivity could be one major cause. is is further
supported by the fact that studies show that anxiety is more common in
wealthy countries, whi, of course, are also the most Internet connected.
People with Internet addiction are highly likely to suffer from anxiety. It
can oen be a ien-and-egg situation because people with anxiety are
also at risk of developing Internet addiction. e addiction is a form of
escape that can seem to help soothe the symptoms of anxiety. However, the
behavior worsens the anxiety, requiring more need for soothing. Regardless
of whi came first—the anxiety or the addiction—they reinforce ea other.

C S D

Anxiety might be the most prevalent problem facing people with Internet
addiction. But ronic sleep deprivation might be the most problematic of
all. Sleep is critical to mental and physical well-being, and yet a large
portion of the population today fails to get enough sleep. Screen time at
night, including alerts throughout the night, is a primary contributor to this
problem.
Although losing sleep to screen time is one reason for sleep deprivation
due to te, it’s not the only one. More insidious is the difficulty or inability
to sleep because prolonged use of devices has le your brain too awake. is
especially happens in gaming, last-minute auction bidding, and other
Internet behaviors that increase adrenaline and initiate the fight-or-flight
response in the body. is reaction gets the body pumping, making it
difficult to fall asleep because you have a hyperaroused nervous system. It’s
like trying to fall asleep aer wating a really scary movie.
It gets worse if you keep those stress response levels high over a period of
time, whi is not what was intended for the body to do. Over time, a
steadily high level of adrenaline can lead to symptoms similar to that seen in
bipolar mania—rapid spee and extreme excitability followed by a crash
into depression that is oen accompanied by sleep loss. So, someone with an
Internet addiction to adrenaline-increasing activities su as gaming
negatively trains their brain to stay in stress mode, leading to a variety of
different issues, not the least of whi is trouble sleeping.
Although those activities are the most problematic, any online use,
particularly later in the day, may affect sleep. e blue light emied from
our gadgets has been shown to disrupt our sleep cycles. It can ange our
circadian rhythm, throw off our melatonin, and make it hard for the body to
fall asleep at night. e later you use the devices in the day, the more likely
it is to affect your sleep.
Sleep problems become a vicious cycle. People give up sleep to be online,
and this leads to reduced ability to make good decisions, so they are even
more likely to give up sleep even as they need it more. And sleep problems
lead to all sorts of other problems including mood anges, trouble
concentrating, problems with memory, difficulty completing tasks at sool
and work, and myriad physical health issues.

L  D  IP R

Although people have an increasingly large number of “friends” (or “fans”
or “followers”) through social media, the number and quality of face-to-face
interpersonal relationships have decreased as tenology has risen. People
with Internet addiction oen find it difficult to interact with people in real
life, substituting online relationships for real ones.
Sherry Turkle, a somewhat controversial expert in the psyology of
tenology, describes this phenomenon well in her book Alone Together,
whi relates her findings of studies of the social use of robots. She explains
that robots were once considered to be “beer than nothing.” For example, if
an elderly person has to be home alone all day, it is beer to have an
interactive robot than to have nothing to interact with at all. However, as
time has gone on, and tenology has invaded every part of our society,
many people are now experiencing robots as “beer than everything.” e
elderly person now might rather have the unfailing, consistent response
from a programmed robot than to be forced to engage with the complicated
behavior and emotions of real-life family members.
Relationships based on tenology are naturally one-sided. is is true
even in cases where it might seem like you’re interacting with others—
through social media, email, text messages, gaming guilds, and the like.
Although there is tenically another person on the other side of that screen,
mu of what we read into their messages happens in our own minds. We
can’t see their body language, experience their immediate response, or deal
with them through honest, authentic interaction. erefore, we fill in the
blanks in our own minds. We are mostly just having a relationship with
ourselves and our own projections.
is isn’t always the case. Some people are actually able to enhance the
authenticity and depth of their in-person connections by addressing
allenging conversations online first, where they may have more time to
give a thoughtful response, and then bringing the conversation into the real
world. However, that’s increasingly rare. More and more oen, people use
online communication to avoid depth while still maintaining a feeling of
connectedness to others.
is is a self-reinforcing behavior; the more time you spend focused on
online relationships, the more difficult it is to interact with people in the
“real world” and the more likely the person will ramp up their online
activity in response. We seek to stave off the feelings of loneliness by
busying the brain with more pseudointeractions, at the expense of authentic,
but messy, connections.
In cases of Internet addiction, there may be a desire to be alone in order to
keep the addiction secret. People addicted to online shopping or
pornography may spend more and more time home alone to engage in the
behavior. ey may feel intruded upon when others enter their space, and
they may feel irritation or anger when the “real world” interrupts their
online activities. is desire for alone time feeds into the loneliness.
Loneliness leads to more loneliness. Johann Hari, writing about
disconnection in society, says that the longer we experience loneliness, the
more we tend to socially shut down and the more likely we are to become
suspicious of activities that would break the loneliness. We get wrapped up
in our own minds, and we become hypervigilant toward others intruding on
our mental space. He suggests that there’s a biological imperative at work
here; being alone, we sense that nobody is looking out for us, so we start to
constantly look out for threats from others. In other words, what we
desperately need is to connect with others to break the loneliness, but the
loneliness itself causes us to fear others to the point that we don’t want to
connect. e more disconnected we become, the more we engage in
behavior that disconnects us further.
e Internet can reinforce this loneliness. On the one hand, we may
replace real-life connections with watered-down online versions to soothe
some of that loneliness. On the other hand, we may subconsciously seek out
the kind of online activity that confirms our worst suspicions about people.
For example, we may begin to binge-wat online episodes of true crime,
seeing evil lurking in every corner. Or we may engage in negative,
destructive, ba-and-forth social media exanges that fuel our beliefs that
people are out to get us or that no one understands us.
Loneliness is not just an emotional issue; it can also have physical health
consequences. Johann Hari reports on resear that has found that feeling
lonely increases your cortisol levels. Acute loneliness can cause you as mu
of a stress response as geing physically aaed by someone can.
Prolonged stress in the body leads to many different health issues.
Loneliness is an increasingly widespread problem. Recently, many health
professionals are even naming it as an epidemic. Studies have shown that
many people don’t feel like they have even one close friend, that loneliness
is increasing rapidly over time, and that it leads to a large number of other
problems for individuals and society as a whole. People with Internet
addiction frequently experience loneliness, and the Internet usually only
makes it worse over time. is isn’t to say that it can’t offer some sense of
connection for isolated people, a benefit we’ll look at in Chapter 9, but it is
more oen a problem and is a negative effect for those who do develop
addiction.

P A   S L

As we have come to spend more and more time on our devices, we have
started to spend less time on physical activity. Kids who used to spend time
together at parks, or even at least walking around the mall, are now
“gathering” through the screen. A sedentary lifestyle oen causes fatigue
and may result in obesity, the laer of whi is correlated with a large
number of health problems including heart disease and diabetes.
Obesity isn’t just a result of the la of exercise, either, but may also be
caused or worsened by certain online activities. Dr. Doan, an MD with a
PhD in neuroscience, and a recovered video game addict himself, explains in
his interview with Niolas Kardaras for the book Glow Kids that Internet
and gaming activity can alter cortisol levels, whi can lead to problems
with obesity. He explains that extra cortisol dysregulates the hypothalamic
pituitary adrenal (HPA) axis, and this dysregulation can lead to weight gain.
So, if you’re siing on the Internet, you are gaining weight not only because
of la of exercise but also because the Internet activities themselves are
making you fat.
Obesity isn’t the only health issue associated with a sedentary lifestyle.
Additional issues include the following:

Hormonal imbalances
Increased inflammation
Mental health issues including depression
Muscle atrophy
Problems with blood circulation leading to various heart health issues
Reduced immune system leading to various illnesses including higher
risk of certain cancers
Weakened bones including risk of osteoporosis

An excessively sedentary lifestyle can lead to physical and mental health

problems that actually put people at risk for early death. erefore, those
with an Internet addiction that leads to increasing sedentary behavior are
facing some potentially serious consequences.

O C P H I

Even people who remain active are at risk of health issues from the
ronic use of devices. Many different parts of our bodies can experience
aes and pains not only as a result of siing at the computer but also
because of the nature of the repetitive activities that we engage in there.
Staring at a screen all day leads to eye strain. Poor posture while using
laptops, desktop computers, and handheld devices creates ba pain and
other aes in the body. Near-constant typing and swiping can lead to
repetitive stress injuries including carpal tunnel syndrome. People with
Internet addiction will continue to use their devices despite the pain.
For example, Kevin Roberts has shared his own story of how excessive
gaming caused him to experience lower ba pain. He ignored the initial
pain, upon whi he began to experience a shooting pain down his leg that
was so bad that it limited his mobility. At the same time, he started geing
pain in his right wrist, the one that clied constantly on the computer
mouse. Instead of taking a break, he started wearing a wrist guard so that he
could continue puing that strain on his body. His addiction caused him to
ignore his health issues in favor of staying online.
Dr. Dean Fisherman, a iropractor in Florida, created the term “text
ne” to describe pain in the ne, shoulders, and ba associated with poor
posture due to compulsive text messaging. He first called it “forward head
posture,” but the term “text ne” stu, and he opened the text ne
Institute. It was intended to treat mostly teenagers, but these days people of
all ages are experiencing text ne.
Another similar term that people have used is “texting thumb.” e term
is used to describe a repetitive stress injury that typically results in pain at
the base of thumb without anything broken, torn, or necessarily even
inflamed in the area. e problem has been going on as long as we’ve had
devices; in early decades it was called Blaberry thumb and Nintendo
thumb, and it is comparable to “writer’s cramp” from the days when people
actually wrote longhand with pens. Today it is caused by the variety of
things we do on our phones including not just texting but also swiping and
scrolling.
People who spend significant amounts of time on their devices, especially
those engaging in prolonged hours of gaming, oen have an increased level
of adrenaline. e body was designed to experience this fight-or-flight
hormone for only short bursts of time in order to get us out of dangerous
situations. Geing that adrenaline rush without ever moving around can
cause a variety of problems, including physical ones; even very young
people may get hemorrhoids as a result.
More important, keeping stress levels elevated for so long creates a wide
range of different issues in the body. e constant adrenaline rush leads to
high blood pressure and high olesterol. Stress can decrease thyroid
function, insulin production, sex hormones, and growth hormones.
As mentioned before, many Internet activities lead to extra cortisol, whi
dysregulates the HPA axis. is not only leads to weight gain but also causes
hormonal issues. Adults spending too mu time online may suddenly find
themselves with adult acne. Infection can become more common as well.
Your whole body gets thrown out of wha, and there is no telling what
physical conditions may ensue as a result.
People struggling with an Internet addiction may experience a variety of
other health issues that they don’t necessarily immediately recognize as
linked to their Internet use. Professionals in the medical field would do well
to become increasingly aware of these potential problems so that they can
help identify Internet overuse as a possible cause.

F L  C  L

One of the vaguer, but very distressing, feelings that people report with
Internet addiction is a growing sense that they are losing control over their
own lives. Some of this comes from the addictive behavior itself; they want
to stop or reduce use but feel unable to do so, whi leads to a sense of
having no control over the self. As with any addict, Internet addicts may tell
themselves again and again that they’ll “stop using tomorrow,” and then
when tomorrow comes and they turn the Internet on again, they feel guilt,
shame, and a spiraling loss of control.
Oen Internet use leads to a sense of control in the moment, whi can
reinforce this feeling. Playing a game in whi you are skilled gives you a
sense of mastery and control. Perfecting your image on social media makes
you feel like you have control over how others see you through that annel.
An addict may engage in these behaviors with increasing frequency to avoid
the discomfort of not feeling in control in “real life.” e more time spent
online, the less control one feels in the real world.
Additionally, out there in the real world, there may be the feeling that
you have to “keep up with the Joneses” in terms of tenology. e long
lines outside of the Apple store for the latest iPhone are just one example. If
you don’t have the newest app, know the latest news sourced from online, or
have access to the newest device, you may feel inferior. Trying to keep up
increases that feeling that you have no control over where life is going.
e addict spends more and more time online in an effort to “keep up,”
but it’s absolutely impossible when so mu new information flies at you
every second of the day. On YouTube alone, people upload more than five
hundred hours of new content per minute. You could wat YouTube every
minute of every day and never cat up. e addict who feels lost if they
don’t know all of the latest stuff is never going to cat up; trying to only
makes the feeling worse.

D, A,  I R  S

Depression is a widespread problem in our society, and it’s even worse for
people with Internet addiction. e National Institute of Mental Health
estimates that more than 6 percent, or 16.2 million, of the adults in the
United States have had at least one major depressive episode. e problem
affects more females than males and is most common among young adults
aged eighteen to twenty-five. Of the adults afflicted, more than ten million
had severe impairment due to their depression. e number is even higher
for teens; more than three million U.S. teens aged twelve to seventeen have
experienced major depression, whi is more than 12 percent of the teens in
the country. More than two million had serious impairment. Girls are more
than three times as likely as boys to experience depression.
Depression and suicide aren’t inextricably linked, but there’s a strong
correlation between the two. Suicide rates have climbed steadily in the
United States in recent years. e Centers for Disease Control reports that
the suicide rate increased by 24 percent between 1999 and 2014. e rate
increased steadily between 1999 and 2006, and then the rate doubled aer
that. It may be no coincidence that the steady rise corresponds to the timing
of computers and cell phones entering mainstream culture; the later years of
even more rapid increase corresponds with increased prevalence of cell
phones and the early days of social media.
Numerous studies have been done exploring the link between Internet use
and depression. Facebook-linked depression has been a particular area of
study interest. A 2014 study called “Facebook’s Emotional Consequences”
found that people expect to feel beer aer using Facebook, and yet they
typically don’t find it meaningful and end up feeling bad about using it so
mu. Its addictive nature leads us to continue using in spite of this feeling.
One reason we do this is related to the way that it affects dopamine levels in
the brain, something we’ll look at in more depth in Chapter 3. Essentially,
ea time that we e our email, texts, or social media, we get a lile
dopamine hit, whi feels really good. Our brains experience euphoric recall;
they remember that this behavior caused the dopamine to rise. As a result,
we continue to predict that engaging in the same addictive behavior will
produce that feeling, even though we are no longer satisfied by the behavior.
It’s a problem called affective forecasting error; we think we’ll feel good,
then we don’t, and that feels especially bad.
ere are many reasons that Internet addiction is correlated with
depression. e brain emistry is one of them. Another is social
comparison, a problem particularly linked with social media use. A 2015
University of Houston study conducted by Mai-Ly Steers specifically found
that Facebook use increases the frequency of users comparing themselves to
others, whi in turn leads to depression. ink about it; how many times
has it seemed like everyone else on social media is doing beer than you are
and how has that made you feel? Even if you don’t struggle with an Internet
addiction, the experience can have negative consequences on self-esteem
and mood. If you do have an Internet addiction, the consequences are worse.
 e problem is exacerbated when we experience negative online
interactions, su as cyberbullying or rude comments. No maer how many
positive things are in our social media feeds, we are drawn to focus on the
negative. at’s because negative feedba pings a specific part of the brain
that seems to strike us more powerfully than positive interaction does. With
so many frequent opportunities for that negative feedba, it’s no wonder
that social media can lead us to feel badly about ourselves. is can become,
or can worsen, depression.
Before there was Facebook, the big social media giant was MySpace, and
it, too, was studied for links with depression. One study conducted through
the Victoria University of Wellington in New Zealand discovered that one in
six MySpace users were at risk for depression and even suicide. ese people
were expressing negative thoughts through the site. e study wasn’t
complete enough to know whether MySpace itself was causing any
depression or if it simply served as a place for people who were already
depressed to express those thoughts, but it was an important early study on
the link between depression and users of social media.
Sharing our feelings of depression online can have both positive and
negative effects. For some people, opening up about depression reduces the
stigma of the condition. A positive response from the online community,
combined with support, can help people rebuild self-esteem, seek treatment,
and take steps toward healing from depression. On the other hand, a
negative response can cause immeasurable detriment. Furthermore, one can
get trapped in the cycle of negative commentary online; in depression, the
mind ruminates on the negative, and some people use social media as a
space to ruminate out loud. Others may join in; they say that misery loves
company aer all. e result is more rumination, whi frequently
exacerbates depression symptoms.
Some researers have suggested that generations growing up with
constant online access are more likely to experience levels of depression,
although it will take time for studies to confirm or debunk this theory. One
interesting study highlighted by Niolas Kardaras was a two-decade
longitudinal study completed by the German Psyological Association and
the University of Tubingen, in whi it was found that we as a group are
steadily losing our increasing sensory awareness, at a rate of about 1 percent
per year. e more stimulation we get, the more we lose aention to it. is
study ended in 1980, long before the excessive stimulation of pervasive
gadgets always at our fingertips. Kardaras links this with a term he uses,
called “digitally induced adolescent malaise”; we all feel duller because of
this overstimulation. While the result isn’t necessarily clinical depression, it
can produce many of the same symptoms as depression.
Dr. Dimitri Christakis describes the same phenomenon in the world of
highly stimulating video games. He posits that a growing person’s brain can
get habituated to the qui responses and high levels of alertness that are
necessary to excel at the game and that keeping the brain at that pace can
lead the youth to feel like the nongaming world is understimulating,
underwhelming, and possibly even depressing.
One thing that is important to consider is whether an individual
experiences depression first or the addiction first. In some cases, depression
itself can lead to excessive, addictive use of the Internet; the opposite can
also be true. It’s a self-reinforcing cycle. In Part 2 of this book, we’ll look
more closely at comorbidity and the allenge of deciphering whi issue
came first. As we can already see in this apter, many of the issues
associated with Internet addiction are ien-and-egg situations that can be
hard to parse out because of the constant use of the Internet in today’s
society.
For now, let’s look at the reasons that Internet addiction is correlated with
depression. We’ve already discussed brain anges as well as a negative self-
image caused by making social comparisons. As we know, Internet addiction
also leads to sleep problems, and disrupted sleep can be a factor in
depression. Exposure to negative content is also a depression risk factor;
whether it’s violence, frustrating news commentary, or negative body image,
the content we see online can contribute to an increasingly hopeless view of
the world. Finally, there is a strong link between Internet addiction and
loneliness as well as a link between loneliness and depression. Ea problem
reinforces the other, exacerbating the risk of depression among people with
Internet addiction.

P  W  S P

So far, the consequences of Internet addiction that we’ve discussed may
be experienced to some degree by anyone using the Internet. Now, let’s talk
about a specific criterion of addiction. Internet addiction means that you
continue use despite negative consequences. So, what consequences may
those be? e biggest may be a failure to meet responsibilities. Students may
fail out of sool, while adults may experience job loss and therefore debt
and other financial consequences due to excessive Internet use.
One reason for this is that it becomes “easier” to simply stay online. e
longer you’re online, the harder it can feel to go deal with the real world.
Interacting with people through social media means that you don’t have to
deal face-to-face with their criticisms, demands, or emotions; most of the
interaction happens in your own mind through interpreting what they’ve
wrien, and you can always turn the device off (or swit to a different
online activity) if you really don’t want to deal with them.
Additionally, Internet usage oen allows us to experience mastery that
isn’t as easy to come by in daily life. For example, it is easier to level up in a
video game than to get a promotion at work. Even if you fail in the game,
you simply have to restart, whereas failing at a job means that you have to
process the experience and work through it before moving forward again.
All of this can lead “real life” to feel too hard in comparison with life
online. e longer you spend online, the more likely you are to have reduced
skills in interacting with others, coping with failure, dealing with situations
that require tact and patience, and so on. Furthermore, Internet addiction
frequently leads to elevated stress levels and more impulsive responses,
whi in turn can lead to behavior, su as aggression, that isn’t taken well
in sool or the workplace. Staying up late to engage with the Internet
causes sleep disruption that makes it difficult to get up in the morning to get
things done.
 All of this leads to a tendency to skip class or to stay home from work. It
means showing up late to important events and meeting, if you show up at
all. It means that when you do show up, you feel uncomfortable and aren’t a
team player. Students may fail classes, or they may squeak by but be unable
to get college recommendations from teaers. Adults may get demoted or
fired or find it difficult to seek new gainful employment. Instead, they get
online to stop feeling the bad feeling, and this worsens the situation.

I  T

Being late is just one time-related issue that can become a problem in
Internet addiction. It is also possible to completely lose sense of time. Of
course, this further impinges on your life when it comes to work or sool,
and it also impacts your social relationships. Worse, it can cause a distortion
in your sense of reality, since the daily world is structured around time.
is issue has been most closely studied in relationship to online gaming
addictions. Jarice Hanson writes, for example, “Games can be dysfunctional
… when they offer a sense of time and space that is so different from reality
that the user loses control of how long he or she plays a game.” e game’s
sense of time is different from real-life time, and addicted users get confused.
is same author goes further to say that the way we view time in a
digital world may have social consequences beyond yet what we can
currently understand, noting that when you look at a clo face, you can see
time passing, whereas when you look at a digital clo, you can see only
that moment in time. is leaves us feeling disconnected from any sort of
history. e immediacy of the news cycle may exacerbate this as well.
Everything is made to feel so important in the moment that we are losing
our grasp on the fact that this moment is just one blip in the big arc of
history. Internet addiction makes it feel like right now is the only thing that
maers.
Tenology is now moving so mu faster than humans can move.
Everything online is happening in “real time,” and this is actually beyond the
processing time that our brains require to keep up. is results in a feeling
like we’re never going to cat up. It leaves most of us wanting “more time.”
We feel constantly rushed, under the pressure of su a fast pace, and this
makes us impatient and aggressive. e addict has no sense of patience
because they have no sense of time.

P A  B C

As we’ll discuss in more detail in Chapter 3, behavioral addiction
including Internet addiction causes structural anges to the brain. is can
result in many and varied issues including the loss of willpower, decreased
aention span, a la of long-term goals, risk-taking behavior, and memory
loss. Larry Rosen reports that people who are online ten or more hours per
day, whi is very common in Internet addiction (and increasingly common
among regular users), have a significantly smaller amount of gray maer
than people who spend two hours or less online daily.
We outsource a lot of our memory now—knowing that we can access all
information on our devices at any time. However, memory is use-it-or-lose-
it. Memory exercises strengthen the brain and increase our gray maer.
Repetitive passive activities including Internet use may deplete the gray
maer. e addict is at risk of losing their memory.
We learn best when focused and paying aention to what we want to
remember, whi isn’t done as easily if we are multitasking. We tend to try
to multitask with the Internet, either by using multiple devices/screens at
once or by using the Internet while doing other things in the real world.
What we call multitasking is really more likely to be “swittasking”—
moving our focus from one thing to the other and ba again. Resear
indicates that it takes a significant amount of time to be able to refocus and
aend again to the new task. More than this, there are long-term impacts of
frequent swittasking; the brain gets so used to distraction that it can’t
sele down to focus, and this leads to ongoing problems with concentration.
Multitasking has also been correlated with a decreased ability to identify
human emotions. e Internet addict is at risk of decreased concentration
and an inability to connect emotionally to others.
 is doesn’t necessarily mean that humans can’t handle distractions.
Rather, we need to have a balance between distractions and focus, and
people with Internet addiction tend to be very imbalanced in this area. An
important thing to understand is that we have two types of aention: top-
down and boom-up. When we aend to something with our top-down
aention, the experience is one of focus. We set goals and direct where our
aention will go in order to meet those goals. In contrast, boom-up
aention is when something distracts us; the constant alerts from phones
and computers are boom-up aention grabbers that, when not balanced
with top-down aention, can lead to decreased aention in our lives overall.
All of this occurs as anges in the brain occur. e brain also anges in
ways that increase risk-taking behavior and decrease impulse control. When
we have an addiction to the Internet, we can’t pull ourselves away from it,
no maer how dangerous it may be to focus on a device. We hear the ping
of the cell phone while we’re driving, leing us know that we have a text
message, and we take our eyes off of the road to see what it says, although
we know how dangerous this can be. e urge to aend to the device
overrules our ability to think rationally about the risk. e more time we
spend on Internet-addicted activities, the more it affects our brain and the
more likely we are to take su risks.

R P
Internet addiction can lead to problems in all of our relationships, due
largely to how the addict treats the people in their life but also to the
anging relational behavior of someone who spends the majority of their
time in a virtual world.
ere are several extreme cases of people being so wrapped up in their
virtual worlds that it causes devastating impact to others, especially
ildren. One well-known case is that of an Arkansas woman and her
boyfriend who were so focused on playing the online game EverQuest that
they forgot their three-year-old ild in the car and the ild died. Less
extreme, but more common, are examples of parents distracted by Internet
use in ways that can be devastating to the parent-ild relationship. A
parent may play online games with their kids as a way to bond but then
become frustrated and angry when the ild can’t “keep up” in a game,
eroding the relationship that they are aempting to build.
One very serious potential problem that hasn’t yet been sufficiently
studied is the prevalence of infants who are not geing their mu-needed
eye contact with their mom (or the primary caregivers) because she is busy
on her phone or computer while breastfeeding. at bonding time is critical
to feelings of security in the world. It forms our first aaments, whi
imprint on us and affect all of our future relationships. We simply don’t
know what it’s doing to an entire generation that might not be experiencing
that bonding to the degree kids did in the past. Toddlers and older ildren
are also laing in parents’ aention because that aention is divided
between devices. What is this doing to our ability to form relationships? We
don’t know, but it might not be good.
Something we do know is that people with full-blown Internet addiction
will oen oose to engage with their devices instead of with the people in
their everyday lives. is leads to hurt feelings, communication problems,
and the potential for more serious long-term consequences in our
relationships. People who are wrapped up in an online activity may become
irritable with those who interrupt them; they get snappish and angry when
parents, ildren, and spouses want their aention. At the extreme end, this
leads to things like “gaming widows”—partners (of any gender and
orientation) who feel like they are living as single parents because their
spouses spend more time gaming than being with their families, a situation
that has led some to divorce. ere are support groups for loved ones of
people with Internet addiction to help them with feelings of frustration,
abandonment, disappointment, hurt, and anger.
One of the specific behaviors of Internet addiction that can devastate
relationships is lying. Teens lie about the frequency of their use as well as
the content that they engage with online. While some of this is normal as
teens learn to differentiate from their family units and become individuals, it
can lead to (or point to) problems in the ongoing trust in the parent-ild
relationship.
Partners/spouses also lie to one another about their usage; this is typically
more about content than frequency. Lying about who you’re contacting
online and the information exanged in the online relationship can be
symptomatic of a problem in the relationship but can in turn also lead to
relationship problems. Lying about, or being secretive around, Internet use
provokes an increase in jealousy and a breakdown in trust. Partners may
also lie about financial issues related to online gambling and shopping
activity. In general, it is mu easier to lie about behavioral addictions, like
problems with Internet usage, than it is to lie about substance addictions,
and the lying can eat away at a relationship for a long time before it is
addressed. Sometimes the relationship cannot be repaired.
In general, we as a society oen fail to give enough aention to the
people whom we are face to face with because instead of communicating
with them, we are looking at our devices. How many times have you been
speaking with someone and their engagement dropped as they glanced at a
phone screen? Our relationships are built in large part on our nonverbal
communication, showing other people that we are listening and that we care
about them through the aention we give them as they speak. People may
think that they can glance surreptitiously at their phone and not interrupt
the flow of face-to-face conversations, but the reality is that they are oen
responding without actually listening and truly communicating. e
relationship becomes shallow and transactional rather than deep and
relational.
ere is also the problem that the more we engage with online
relationships, the less inclined we may be to engage in face-to-face social
interaction at all. is relates to the aforementioned problem of loneliness
but is worth repeating here, because it’s a relationship problem caused or
exacerbated by Internet addiction. People with an addiction to the Internet
may stop connecting with people in the real world, skip face-to-face
interactions, develop social phobia, and simply stop “showing up” for their
friends and family. is clearly creates a negative impact on the
relationships.

W S  T

e problem isn’t just in the use of the tenology but can also come
when we try not to use the tenology. As an addiction, it can lead to
withdrawal symptoms su as craving and anxiety. If you’ve ever
accidentally le your phone at home when going out, you might have felt
some of those feelings—anxiety, wondering what you’re missing, reaing
for the phone even though it’s not there, sensing phantom vibrations, or
simply feeling “a lile weird.”
In Internet addiction, withdrawal can present as physical symptoms.
Withdrawal can lead to cravings, and a craving goes beyond a desire to the
point where your body actually physically thinks it needs the Internet. Some
of the things that a person might experience when their use is limited
include the following:

Agitation
Anger
Anxiety
Headae
Light-headedness
Rapid heartbeat
Shortness of breath
Tense muscles

e other side of the withdrawal coin in addiction is tolerance. is

basically means that you need increasing amounts of a drug to get high. In
the case of Internet addiction, you may need more and more time online to
get a good feeling from the experience or you may need increasingly
exciting online content or both.
P
As with any addiction, the problems that people experience from Internet
addiction exist on a spectrum. Oen people begin with very few side effects,
but the more intense and prolonged the addiction, the worse those side
effects are. People who get into extreme Internet addiction can experience
heightened states of distress more commonly associated with drug
addiction. For example, it is not unheard of for people to go into psyosis as
a result of Internet addiction.
Psyosis is most likely to occur in Internet gaming addiction. Immersion
in gaming, particularly highly realistic fantasy gaming for prolonged periods
of time without rest, can lead to a break with reality so that the gamer
ceases to know whether or not they’re in the game. In psyological terms,
the gamer may experience derealization (whi is an inability to know what
is real) and/or depersonalization (whi is when the person doesn’t feel real
anymore). As mentioned previously, sleep deprivation can lead to HPA axis
dysregulation, and one of the more serious symptoms of that is psyotic
breakdown. is dysregulation is exacerbated by Internet use in a cycle.
Psyosis can occur during withdrawal from the Internet. For example, in
2012, two doctors reported on the case of a fieen-year-old boy with
Internet addiction whose parents removed the Internet. Within a few days,
the boy had developed several psyotic symptoms including paranoia that
his parents had stolen his passwords and were trying to learn secrets about
him because they wanted to hurt him.
In that case, the ild was treated with psyiatric medication. In other
instances, removing devices and seing up a safe space during withdrawal
have been shown to be enough to resolve psyosis. Because this is su an
extreme reaction to Internet addiction, it hasn’t been studied completely
enough to know the best method of treatment. We will look further at
treatment options in Chapter 7.
C 3

What Makes the Internet So Addictive?

Addiction happens in the brain. It looks like it’s happening on the outside, in
the insertion of a needle into an arm, in the glazed-over eyes of the Internet
addict who hasn’t le the screen for thirty-six hours. However, the behavior
is just the tip of the iceberg; the addiction is going on between the ears.
erefore, in order to understand what makes the Internet so addictive, we
have to understand a lile bit about the human brain.
Brain imaging studies have emerged in the past few decades, leading to
an increasingly more in-depth understanding of the way that our brain
works and of what addiction looks like in the brain. It is important to note,
before delving into the resear, though, that for all that we now know
about the human brain, there is still so mu to learn. e tenology for
brain study is new, plus Internet tenology is new and anging, so we
simply don’t have the information that we need to be able to accurately say
exactly what the long-term effects are on the brain with regard to daily use
of Internet devices. at said, we do have a good idea about the initial
effects and the relationship of Internet activity to behavioral addiction
within the brain. We have early studies, and we are learning more and more
ea year.
One of the most powerful things that resear has uncovered so far is that
if you look at the brain scans of people addicted to tenology, and you
compare those with the brain scans of people addicted to drugs, you will be
unable to tell a difference. e addiction looks the same in the brain
regardless of the substance or behavior. is has led some neuroscientists
and other professionals to use terms for the Internet su as “electronic
heroin” or “electronic cocaine.” is underlines the fact that despite
contradictory arguments about whether or not Internet addiction is “real” or
“problematic,” brain resear strongly shows that you can indeed get
addicted to the Internet.

N: D   R S

e brain is a complex thing, and it takes years of study to really get a
grasp on how it works. So, we’re only going to examine parts of it as they
relate specifically to addiction. In doing so, we have to begin with the
neurotransmiers. ese are basically the communicators, or messengers, in
the brain. ey transmit information from one part to another, oen from
neuron to neuron. is information is critical to our survival; it tells the
brain to perform certain important tasks su as eating and sleeping.
Addictive behavior manipulates these neurotransmiers, causing disruption
in the brain. You might not care so mu about eating or sleeping because
your brain isn’t communicating the importance of that anymore. It’s been
hijaed by the drug. e drug could be the Internet.
Dopamine is perhaps the most important neurotransmier at play when it
comes to Internet addiction. It plays a really critical role in Internet usage in
general and Internet addiction specifically. Dopamine is a natural drug in
the brain, oen called “the feel good emical.” Whenever we experience
something that feels good, the brain releases dopamine. at dopamine goes
directly to the nucleus accumbens, a cluster of nerve cells oen called the
“brain’s pleasure center.” ese neurotransmiers communicate, “Ah, yes,
that feels great.” Here’s basically what happens:

Something makes you feel good.

is sends a signal to the ventral tegmental area of the brain.
at travels to the nucleus accumbens to tell you that you feel really,
really good.
en your hippocampus records that feel-good experience as a
memory.
e amygdala creates a condition response that makes you want to do
that again.

Dopamine itself is a bit addictive; we always want to feel good, so the

more dopamine we get, the more we want to have. e brain is always
seeking out things that will give it a dopamine release. e more dopamine
we get from an activity, the more likely it is that the activity will become
addictive. If you know that something feels good, you are going to keep
going ba to that same activity to try to get that food feeling.
One of the things that the brain especially loves is the feeling of novelty.
Our brains are wired to take pleasure in new, unexpected things. When we
experience something new, particularly something that feels especially good,
our brains surge with dopamine. erefore, we seek out novelty. e brain’s
reward center activates when we hit the japot by finding that novel thing.
is relates to addiction generally in that people will constantly seek out
new, beer, more interesting triggers for that feel-good dopamine release. It
relates specifically to Internet addiction because the Internet offers constant
potential for something new. With just a qui cli of the mouse, you can
see something that you have never seen before. e Internet is designed to
offer instant gratification, whi is exactly what the brain loves—give me
more of that dopamine, and give it to me now!
Resear has found that intermient rewards are mu more satisfying to
the brain than rewards delivered on a regular sedule. ink about it; if you
know that every fih bite of food will taste amazing, then your brain will
habituate to that. You’ll tune out to the first four bites and feel mildly
excited by bite five. However, if you have no idea whi bite of food is the
one that will taste good, then you’ll always be hopeful for it, and when that
exciting flavor does hit your mouth, it will be that mu more exciting. Now
apply that to the Internet; you never really know whether the next web link,
article, cat video, or social media post will be the one that excites your brain.
at itself makes the sear for something pleasurable even more enjoyable
to the brain. at enjoyment is so addictive. Remember a few years ba
when the Shiba Inu Puppy Cam was all the rage? You could tune in day or
night and peek in real time at what the growing puppies were doing. Oen,
they weren’t doing anything. Sometimes they weren’t even on the screen.
But every now and then you’d tune in, and they’d be there acting super
adorable and, you would feel great. You’d keep coming ba.
We see intermient rewards (also called a variable-ratio reward sedule)
in online video games. Even a game as simple as Minecraft, whi has a
lower potential for addiction than real-time strategy games, offers the
dopamine high of intermient rewards. In the game, you aempt to find
gold, but there is a moment right before your virtual piaxe strikes down
when you don’t know whether or not the gold will be there. When it is, you
feel great, and dopamine releases. If it’s not there, you have that mu
stronger of an urge to try again. You were almost about to get that great
dopamine surge, and then it didn’t happen. Why would you stop now⁈
Niolas Kardaras calls that hit of dopamine a “brain orgasm.” He has
found through studies of brain imaging that Internet behaviors are as
capable of stimulating the pleasure center as sexual activity is. is is
potentially more dangerous than it seems at first glance. To understand, we
have to look at evolution. Ba in a time when we had to forage for our
food, the brain released dopamine when we found and ate that food so that
dopamine pleasure spike was really a key part of our survival. We wanted to
feel good again, whi motivated us to go out and look for more food.
erefore, natural dopamine is tied up with the circuits in the brain that
relate to food, to sex, and essentially to survival.
 Of course, most of us don’t have to forage for our food today. We get
instant gratification rewards all day long from various stimuli including the
Internet. However, this confuses the body. Dopamine is naturally highest in
the body when we seek food, sex, and safety. erefore, when dopamine
levels are high, the body thinks that is what is happening. e brain’s
reward system gets confused, actually beginning to believe that the
behaviors (su as Internet searing or online gaming) are crucial to
survival. e more frequently we indulge in the behavior, the longer those
dopamine levels stay elevated and the more confused the body gets. e
brain knows that it wants to feel good, and it knows that the addictive drug
or behavior makes it feel that way. It thinks you will die without it.
is has the potential to increase addiction because cravings continue to
intensify despite constantly elevated levels of dopamine. Moreover, it is
possible that the dopamine we get from natural sources (like food and sex)
can get dulled. We are so used to the dopamine high from tenology that
this “regular” dopamine doesn’t feel good enough. erefore, we seek more
and more dopamine through tenology in order to keep feeling good. It is
as if we were going in there and tinkering with our brains, telling the brain
that food and sex aren’t that important to survival anymore, but the Internet
is. Pause for a moment, and think about the consequences of that for the
entire species, let alone the individual.
ere are four different dopamine pathways in the brain, three of whi
relate to different aspects of reward. e mesocortical pathway is linked
with cognitive and emotional abilities as well as memory, aention, and our
ability to learn. e nigrostriatal pathway is all about movement and
sensory stimulation. And the mesolimbic pathway is the pleasure-seeking
and reward-desiring section. e laer is the one most associated with
addiction. However, all of these areas may be affected by anges in
dopamine levels.
If you’re having trouble following this, Kevin Roberts gives a great
analogy, describing the brain like a complicated highway system. He writes,
“Addiction floods some roads with increased traffic, while allowing other
roads to fall into disuse and disrepair.” e pathways are different highways
in this system, and the desire to get the reward is so strong that your brain
will try different pathways to get there. e neurotransmiers, including
dopamine, are the cars that you take to get from one place to another. You
are on a highway to pleasure, and you’re driving your car as fast and wildly
as you can to get there.
Dopamine is only one of several important neurotransmiers in the brain.
You have probably also heard of serotonin. People with depression oen
have emical imbalances particularly in terms of the serotonin levels.
Serotonin is your brain’s biggest mood stabilizer. It also plays a role in your
systems for sleep, food, and sexual desire.
Mu of the resear into the neuroemistry of addiction has focused on
dopamine, so we currently have less understanding about the way that
addiction relates to serotonin and some of the other transmiers. One thing
we do know for sure is that the nucleus accumbens (that pleasure center in
the brain) consists of two of the major neurotransmiers: dopamine and
serotonin. erefore, we can guess that when addiction messes with that
reward center in the brain, it includes serotonin effects. We also know that
serotonin is directly linked to our mood, so some of the consequences of
Internet addiction discussed in the previous apter (depression, irritability,
etc.) may be linked with serotonin anges in the brain caused by the
additive behavior.
Here’s something else that’s interesting: if serotonin is low, then the
effects of dopamine motivation are greater. In other words, if you have low
serotonin, then you’re more likely to seek out the things that give you a feel-
good hit of dopamine. is makes sense; low serotonin means feeling
depressed or low in mood, and you don’t want to feel that way, so your
brain makes up for it by seeking out that dopamine hit. e reason this is
important is because whether or not the Internet affects serotonin levels, we
do know from early resear that people who start out with low serotonin
are more at risk of developing Internet addiction. ey’re more motivated
than others to seek the dopamine hit that the Internet may provide.
One study published in the 2011 issue of Neuropsychopharmacology
explored the role of serotonin in gambling addiction, whi we know is a
behavioral addiction similar to Internet addiction. e study looked
specifically at “loss asing,” whi refers to the gambler’s addicted behavior
to try to cover their losses by gambling even more. ey found that there
was a relationship between serotonin and the willingness to loss ase,
noting specifically that serotonin plays a complex, lile-understood role, in
impulse control not the least of whi is that it plays a part in mediating
how we learn about negative events. So, if serotonin is off, then we don’t
make the best oices about things that are affecting us negatively. Combine
that with seeking the dopamine hit, and the whole system is primed for
addiction.
Another neurotransmier that’s been linked with potential Internet
addiction harm is gamma-aminobutyric acid (GABA). Among other things,
GABA communicates to help control vision and motor function. More
important, it plays a crucial role in inhibiting neuron activity in order to
reduce stress and increase relaxation, whi in turn can lead to a more
balanced mood, beer sleep, and even pain relief. In order to feel “right,” you
need to have the right GABA activity. Resear indicates that Internet use
messes with that.
A small study presented by Hyung Suk Seo, MD, professor of
neuroradiology at Korea University, found that people diagnosed with
Internet addiction had more GABA activity than those without addiction.
is further means that GABA levels were off in terms of the ratio to other
activity in the brain. Increased GABA can lead to problems with both
cognitive and emotional processing, as well as to addiction side effects su
as fatigue and anxiety.
Finally, let’s talk about norepinephrine. is neurotransmier plays a role
that’s similar to adrenaline, activating the body’s “fight, flight, or freeze”
response. When your body thinks that it’s in danger, you experience anges
in heart rate, breathing, body temperature, and your ability to process
sensory stimuli. is can affect your movement (thus, you fight or flee or
sometimes freeze). It can also affect your mood, sleep, appetite, and so forth.
Basically, your body goes into a state of focusing entirely on geing to
safety, so it doesn’t care as mu about those other things.
 ere’s an interesting history when it comes to the resear around
norepinephrine and addiction. Ba in the 1960s and 1970s, researers were
sure that it played a key role in addiction. However, those early experiments
were limited, and researers couldn’t quite tell whether it was
norepinephrine or dopamine at play. By the 1980s, almost all of the resear
began to focus on dopamine. at is why we have so mu information
today about the role that dopamine plays in addiction but mu less
information about the role of the other neurotransmiers including
norepinephrine.
More recent studies are beginning to try to fill in this gap, and they do
indicate that norepinephrine is worth studying if we want to know more
about addiction. ey’re also shedding more light on the original confusing
studies between norepinephrine and dopamine. e truth is, although we are
learning more and more about the roles of ea individual neurotransmier,
the brain exists as a thing in its entirety. It’s not just the individual parts that
maer but also the way that those parts interact with one another. Some of
the dopamine pathways, including the mesolimbic pathway, are modulated
in part by norepinephrine. If one part gets affected, then so do the other
parts. So, although we don’t have all of the answers, we do know that
addiction happens in the brain, and within the brain it happens in large part
among the communication systems of whi the neurotransmiers play the
biggest role. And studies indicate that the Internet is messing with the brain.
To what degree and whether this is good, bad, or neutral is up for debate,
and perhaps only time will tell.

T F L  P C

If you look at physical models of the brain, then you will see that it
contains four paired lobes (one in the right hemisphere and one in the le):
occipital, temporal, parietal, and frontal. Ea lobe is responsible for certain
body functions. For example, the occipital lobe relates to vision. e frontal
lobe is responsible for voluntary movement and cognitive functions. is is
the part of the brain that helps us with “higher-level” functioning su as
problem-solving, planning, and regulating our emotions. Our memories and
personality are formed here. It also plays a part in the actions we oose,
su as running, and in managing aention including selective aention
abilities (what to pay aention to and what to ignore).
e frontal lobe, as the name suggests, is located at the front of the brain.
And right at the front of the frontal lobe is the prefrontal cortex. e human
brain develops ba to front, so this is the last part of the brain to fully
develop. And it’s the most complex part of the human brain in terms of
allowing us adults to do the things that other mammals—or even ildren—
can’t quite grasp. Aention, planning, prioritizing, impulse control behavior,
emotional control, and adjusting to complicated and varying situations are
all things that we are able to do thanks to the prefrontal cortex.
Brain injuries oen affect the prefrontal cortex. ey can ange a
person’s ability to perform executive functions, so someone who could
normally plan things very well and stay organized can’t do so anymore aer
a traumatic brain injury. ey may get emotionally dysregulated, have
trouble controlling themselves, and even experience complete personality
anges. Clearly, this is an important part of the brain.
Like so mu else when it comes to Internet addiction, it’s hard to tell
cause and effect here. Resear indicates that people who have problems in
their prefrontal cortex are more likely to be at risk for Internet addiction.
Other resear has found that regular, ongoing addictive behavior has a
negative impact on the brain, inhibiting the abilities of the prefrontal cortex.
is part of the brain may literally shrink with addictive Internet use. Since
this is the part of the brain that regulates impulse control, the more damaged
it gets, the less able we are to make logical, long-term solutions. In other
words, addiction begets more addictive behavior; you can’t oose the
actions that end addiction when your brain is wired to respond to impulsive
drives that get triggered in addiction.
Did you cat what we said there just a few sentences ago? It bears
repeating: this part of the brain may literally shrink with addictive Internet
use. Multiple studies have found that the brain actually shrinks, possibly as
mu as 20 percent, losing more and more area with longer duration of the
addiction. We lose parts of our brain when we engage in addictive Internet
behavior. e frontal lobe decreases in size. Studies have also found brain
shrinkage in the striatum and the insula, areas related to appropriate social
behavior and developing empathy and compassion. People with Internet
addiction are literally losing their minds in ways that affect their ability to
participate healthily in our society. Notably, the studies into this are young,
and there’s some debate about them within the scientific community.
However, enough information has been released that a large percentage of
reputable researers believe that Internet addiction can lead to brain
shrinkage.

G M  W M

When we talk about parts of the brain like the prefrontal cortex, we’re
talking about gray maer. When we talk about the brain shrinking due to
Internet addiction, it’s the gray maer that shrinks. But the brain consists of
both gray maer and white maer, and both may be affected by Internet
addiction. e gray maer is the bulk of what we see when we look at a
human brain—the wrinkled, pinkish-gray tissue consisting of cell bodies,
dendrites, and nerve synapses. But these gray maer tissues are connected
by bundles of axons called white maer. White maer exists in the brain
and the spinal cord; although there’s some gray maer in the spinal cord, it’s
mostly white maer there.
One important thing to know about when it comes to white maer is the
role of myelin, an insulating layer that wraps around the white maer. It’s a
protective part of the body. Among other functions, it helps to make those
axons more efficient, allowing brains to do more and to do so more quily.
As the brain develops, learning experiences are solidified with myelin. For
example, when a ild first learns to read, the areas of the brain that are
used in reading get increased myelin, and (barring some tragic brain event)
the ild will then forever know how to read. Myelination is what we’re
talking about when we talk about something being “hardwired in the brain.”
It’s an amazing process, and it doesn’t stop when we hit puberty; a healthy
brain can continue growing and myelinating for about five decades. With
myelin, we learn; without it, we are vulnerable to a series of problems
including an inability to focus, pay aention, feel empathy, and even discern
reality.
But there are many different things in our environment that reduce the
healthiness of the brain and impact its ability to keep growing white maer.
A range of things—from toxins to stress—can cause problems with this part
of our brains, limiting our ability to hardwire learning. One of the things
that can cause su problems is overstimulation. ink about how
overstimulating the Internet is. Naturally, it’s going to affect our white
maer. is is a particular issue for younger brains that go through key
developmental periods in whi myelin-strengthening is not only at its peak
but also at its most vulnerable.
China-based resear indicates a direct link between Internet addiction
and myelin. People diagnosed with Internet addiction disorder in one study
had problems with myelin in the areas of the brain that are related to
decision-making, emotional generation, executive aention, and the ability
to store and retrieve information. e white maer carries information from
one part of the brain to the other so that the whole brain can operate
properly. When it’s depleted, the connections don’t work as well. For
example, your brain doesn’t properly connect the lower emotional impulses
and the higher cognitive management, so you might not be as capable of
thinking before you act.
is resear supports what other brain studies have found about
addiction in general. It anges the brain.

N
You have probably heard about neuroplasticity before. Also called brain
plasticity or neuroelasticity, it refers to the brain’s ability to ange and
grow over time. It’s truly an amazing thing. When someone experiences a
brain injury, they may be unable to do certain things because that part of
the brain is hindered, but through therapy they can create new neural
pathways that allow them to resume function. e brain can learn again.
ere are two types of neuroplasticity: synaptic and cellular. Synaptic
neuroplasticity is a ange in the strength of the connection across the
junction from one brain cell to the next (synapse). Cellular neuroplasticity is
a ange in the number of brain cells that are talking to one another.
Synaptic neuroplasticity is lifelong (an old dog can learn new tris), but
cellular neuroplasticity primarily happens early in life. About 90 percent of
our cellular structure is set by the age of six and the rest through to age
twenty-five.
In fact, we get an overabundance of brain cells when we’re babies. We
grow really fast. We can learn mu faster as ildren than we can as adults.
We get a lot of brain cells really fast, and then the cells go through a pruning
process; what you don’t use you lose, and what you do use grows and
strengthens. erefore, it’s especially important to pay aention to what we
are and aren’t feeding into our brains while the brain is still in that pruning
process. at said, because of neuroplasticity, habitual behaviors can ange
the brain at any point in time.
Neuroplasticity means that if we do something regularly, it will ange
the brain. It may ange some of the cells. It will certainly ange the
synaptic connections. e behavior we engage in every day shapes the brain.
Now think about some of our common online behavior, things that we have
all goen just a lile bit too comfortable with since the Internet became so
prevalent in our worlds. Let your mind wander for a moment to all of the
things you did or saw online in the past week: social media posts you
scrolled past in less than one second, comments you read in a few seconds or
wrote in under a minute, memes that quily made you laugh before you
rapidly forwarded them to someone else, stories you browsed while
multitasking, and … the list goes on. All of those are very short, addictive
behaviors that are teaing our neural pathways to skim, stay shallow, see
information and pass it along but not retain it, and quily jump from
thought to thought.
 If that’s what we’re teaing our neural pathways, at what expense are
we doing so? Remember, the habits we do every day create those pathways.
When we stop doing them, the pathways start to fade. We’re teaing our
brain those qui-fix activities at the expense of deep thought, focused
aention, and memory retention.
is is your brain on the Internet.

Y B I S  B K I

As you can see, your brain is designed in su a manner that it is
supersensitive to the potential for addiction. Some people are more at risk
than others due to their own natural brain emistry and brain structure.
Someone with damage to their prefrontal cortex or with naturally low
serotonin levels may be at more risk of addiction than someone without
those things. But all brains are at risk. And the people who are selling us this
tenology are well aware of that risk. In fact, they are in the business of
exploiting it.
e companies that develop the devices, the apps, the websites, and the
advertising all benefit when you spend more time on those things. ey
want you to become addicted. In fact, there are countless stories of some of
the biggest names in tenology making sure to limit their own ildren’s
exposure to tenology precisely because they’re so aware of how addictive
it is designed to be.
Several industry insiders have pointed out the similarity of apps and
devices to slot maines. It’s no casual comment. Some of the designers
behind these tools have specifically studied the psyology of slot maines
and then adapted their teniques to computers and smartphones. ey prey
upon the brain’s desire for intermient reward by creating tools that provide
exactly that. ey do it so that they can make money. When they show up to
the table to ask for more venture capital, they have to show that more and
more people are using their product, that they’re using it for longer, and that
they keep coming ba to use it more and more. So, if you find yourself
eing a particular app or site more oen over time, staying on it longer,
and talking to others who are doing the same, it’s likely because it was
designed that way. In fact, there are people who have full-time jobs
specifically to aid in addictive design; although some companies use creative
names that hide that this is what they’re doing, more and more are offering
job positions for “demand engineers” or “aention engineering” positions.
People get paid, oen mightily so, to demand your aention.
Tenology author Nir Eyal spent several years studying how different
companies were geing people addicted and distilled it down to a four-step
process he calls the hooked model. rough this model, companies are able
to repeatedly get customers ba again and again without expensive or
aggressive advertising, and they do so by manipulating people’s existing
habits. e four steps are as follows:

1. e trigger, whi may be external or internal. For example, you get an

external trigger when your phone notifies you that you have a new
message on an app that you just downloaded. Ea time you get a
notification, it triggers you to e the app. You feel good when you
get a good experience on the app, so you start to associate the app with
good feelings. en whenever you feel bad, whi is an internal trigger,
you turn to the app to feel beer. It hooks you with both external and
internal triggers.
2. e action, whi is the thing that you do (eventually out of habit) in
an effort to get the reward that you associate with the trigger. You open
the app, you cli the link, you hit the like, and you enter the giveaway.
3. e intermient reward, whi Eyal calls the variable reward. is is
the part where you may or may not get that dopamine hit. You’re
eagerly anticipating it. Tenology and media companies exploit this
part of the model more than anything else. ey have studied that your
brain doesn’t like predictable rewards, but rather it likes intermient
ones, and they have designed their products accordingly. In fact, you’ll
find that you oen get more rewards in the beginning than later
because once your brain is addicted, you don’t need as many rewards.
 So, for example, a game might offer you lots of bonuses and coins in
the early levels and fewer as you get to higher levels.
4. e investment, whi is what you’ve given to the tool that makes you
even more likely to get and stay addicted to it. Why do you think so
many of today’s products give you a bonus to share with your friends?
It’s not just because the company will get one more follower that way.
It’s because when you share, you’ve invested, and therefore, you
yourself are more likely to grow your own addiction. Depending on the
product or tool, you might invest time, energy, money, social capital, or
data. For example, investing the time to learn the new features on a
favorite app makes you even more likely to keep using that app.

is is just one model of how the addictive nature of tenology works,
but it points to the fact that companies are all aware of your brain’s
addictive nature. ey want to take advantage of it because they benefit
when you become addicted. In a well-known 2017 episode of Bill Maher’s
Real Time, cited in Cal Newport’s book Digital Minimalism, Maher directly
compares “the tycoons of social media” to tobacco farmers. Historically, Big
Tobacco exploited addiction, particularly in ildren, to sell their products,
and Maher, among others, argues that social media giants (and other leaders
in tenology and media) are doing exactly the same thing. ey know it’s
addictive, they know it’s anging our brains and affecting our health and
relationships, and they are exploiting it anyway because they want to sell
their product.
Consider, for example, how we have already goen so used to predictive
text and targeted advertising. When you go to type something into Google,
it fills in possible responses for you. Whenever you are online, you see ads
that are targeted just to you. ese things can prey upon your existing
addictive tendencies. For example, if you sear for a dating app, you’ll
suddenly start seeing all sorts of ads for dating or about being single. is
can lead you to follow more and more links and download more and more
similar apps. Companies do this on purpose.
C 4

Internet Addiction and Relationships

We have already looked at how Internet addiction can affect relationships.

Now it’s time to look at different types of Internet addiction, and it is
interesting to learn that many of these addictions are themselves related to
online relationships.
ere are two broad types of Internet addiction: general and specific.
People with general Internet addiction are simply addicted to the act of
spending time on their devices, without too mu focus on any specific
content. Most people, though, have a specific addiction, whi means that
they are only addicted to very specific content.
A lot of content online involves or simulates human relationships, so it’s
of very lile surprise that a lot of specific addictions relate to that content.
is also makes sense with human psyology and culture. We are social
creatures. Our entire being is primed to exist in relationship with others. We
seek approval from others, we want to fit in with them, and we oen define
ourselves in relation to others. For beer or worse (and in the case of
addiction, it’s oen for worse), we increasingly utilize tenology to
facilitate, enhance, or even simulate our need for social connection and
inclusivity. All of the specific addictions in this apter relate to
relationships and include addictions to social media, texting, and compulsive
use of dating apps. Pornography addiction, whi is one of the most widely
studied forms of Internet addiction, also falls into this category.

S M A

One of the most common types of Internet addiction is addiction to the
use of social media. is is due in part to the content itself; the relationships
online are compelling enough to garner our aention. However, the design
of the sites is what really makes them addictive, and social media designers
have been tweaking that design steadily to increase addictive qualities. e
sites want people coming ba frequently, and they create incentives to do
so, whi can lead to or exacerbate addictive use.
Social media launed ba in the late 1990s, but it didn’t become widely
used until the convergence of broadband Internet and smartphones. More
and more people were geing online, and they were doing it more oen
since the Internet was now at their fingertips, and this opened the door to
truly connecting those people. Facebook launed in 2004; Instagram
launed in 2010.
Ba in the early days of social media, including the beginning of
Facebook, the purpose—and the reason that people spent time on the device
—was to connect with other people that they already knew in real life.
People spent time on the site as a novelty, because it was fun and somewhat
social, but it didn’t dominate their aention. Over the years, Facebook has
added countless tools designed to exploit the brain’s addictive nature.
Take, for example, the “like” buon. Do you remember ba in the early
days when it wasn’t there at all? e buon actually wasn’t introduced until
2009, five years aer the company launed. Why did Facebook add that
buon? Author and social psyologist Adam Alter posits that it marks the
turning point in how Facebook has anged to become more addictive,
because it shied the platform from one in whi you passively perused
updates to one in whi you were an interactive participant. is exploits
several of those addictive features that the human brain loves including the
following:

Once you’ve hit the like buon, you’re more invested in the
interaction. erefore, you’re more likely to come ba to the site,
spend more time there, and share it more with others.
You never know when you post whether people are going to hit the like
for you or not. is satisfies the brain’s love for intermient rewards.
e more you post, the more likely it is that you’ll get some likes, so
you start posting more and eing more frequently on your likes
status.
Humans want social approval. e like tells us, at least in theory, that
people approve of us. at feels good, so we want to keep doing it.

At least two of the people on the original team that designed the
Facebook like buon (project manager Leah Pearlman and engineer Justin
Rosenstein) have come out publicly to explain how addictive it is and that it
was designed to be so. So, make no mistake, of all of the content out there on
the Internet today, social media is among the most addictive, in large part
because businesses have spent a lot of time, money, and energy to make it
so.
But what exactly is a social media addiction? Essentially, it means that
you keep using social media with increasing frequency even though the
rewards that you get from it are diminishing and/or there are negative
consequences in other areas of your life. For example, if you find yourself
spending time connecting with people on social media at the expense of
your face-to-face relationships, that can be a sign of an addiction. You aren’t
geing as mu from that online interaction as you could from face-to-face
connection, plus your real-life connections begin to suffer, and yet you can’t
stop yourself.
Of course, it’s allenging to tell when use has become abuse. In trying to
determine whether someone has a social media addiction, it’s common to
use a question-based assessment. One example comes from psyologists
Mark Griffiths and Daria Kuss, who work out of Noingham Trent
University to study the impact of tenology on behavior. ey offer the
following six questions for basic assessment:

1. When you are not online, do you think about using social media?
2. Do you experience increasing urges to use social media over time?
3. Is social media a way that you try to forget about your problems?
4. Do you continue to use social media even aer you’ve decided you
want to stop?
5. Do you become restless or upset when you are unable to use social
media?
6. Has there been a negative impact on your relationships, work, or sool
because of your use of social media?

People who answer yes to a majority of those questions might have an

addiction to social media. Moreover, if you’re experiencing consequences
and have withdrawal and tolerance to social media use, then there’s
probably a problem.
In a 2017 paper wrien by Griffiths and Kuss, the authors lay out some
important conclusions about social media and its potential for addiction.
ey emphasize that you can utilize social media without becoming
addicted to it, but that social networking is a way of being that you can
easily become addicted to. ey note that within social media addiction,
there are specific addictions that include Facebook addiction as well as
specific disordered thoughts and behavior including nomophobia (fear of
being without a smartphone) and FOMO (fear of missing out).
In this paper, the authors also lay out some helpful models for defining
social media addiction:

Biopsychosocial model.is is built upon our understanding of

addictive substances and extends to addictive behaviors. Addiction is
viewed in terms of mood anges, preoccupation with use, problems in
 other areas of life resulting from addiction, and withdrawal, tolerance,
and relapse.
Cognitive behavioral model. A person has maladaptive beliefs that are
“exacerbated through a number of external issues,” and this leads to
social media addiction.
Social skills model. A person has difficulty with face-to-face social
interaction and turns to social media as a substitute, leading to
addiction.
Socio-cognitive model. A person has a good experience with social
media, then expects to continue to have that experience, and begins to
use the sites excessively in sear of that despite not always geing
what they want out of it.

ese are different lenses for looking at social media addiction (and
Internet addiction more generally) that lead us ba to the brain and the
psyology of humans. People who are interested in working professionally
with Internet addicts, su as counselors, can utilize these different models
for helping to both assess and understand a person’s addiction to social
media. rough psyoeducation, they can help their clients beer
understand the issue as well.
As mentioned, an individual may have a general social media addiction,
or they may have a very specific addiction to one aspect of social media use.
is can be an addiction to only one specific platform. For example,
someone may be able to take or leave Instagram but have an addiction to
Twier. Another person may have a Facebook addiction but not use any
other social media at all. e specific platform isn’t the only thing that
people can become addicted to though; it’s also possible to develop an
addiction for certain activities on one or more sites.
For example, you can become addicted to the act of taking and posting
selfies or to the act of catfishing others.

Selfies
 Selfie addiction sounds a lile bit ridiculous if you’ve never encountered
someone who struggles with this problem. However, it’s quite a serious issue
for a small group of people. Some people will take hundreds of photos of one
pose just to make sure that they have the best one to post on social media.
Aer posting, they look obsessively at the comments people are making, and
their mood and self-esteem can be greatly impacted by what they see there.
ey’ll delete a photo within minutes if it hasn’t goen the qui, positive
reception that they expected, and they can feel terrible about themselves for
hours aerward as a result.
Instead of, or in addition to, taking many photos, a person with a selfie
addiction might spend hours tweaking one photo just to get it right. ey’ll
use different apps and filters to perfect the lighting, erase their perceived
flaws, and enhance certain traits in order to appear exactly as they want to
appear. It becomes an obsession, and this obsession leads to addiction. ey
keep taking and tweaking more and more photos, looking for the perfect
one, never quite satisfied. Every once in a while, they’ll get the image or
response to an image that feels great, and it’ll offer that big hit of dopamine,
and then the cycle starts again.
Selfie addiction is oen inextricably linked with self-image issues. When
you’re constantly trying to tweak your appearance for the perfect photo, it’s
hard to be satisfied with the way you look in real life. As you zoom in on the
screen, you see all of your (real or perceived) flaws magnified. is can lead
to, or exist in combination with, body dysmorphic disorder, a mental health
condition in whi the person obsesses over their flaws, grooms and
exercises excessively, avoids mirrors, constantly works to ange their
appearance, and obviously has negative self-esteem. Whether or not a selfie
addiction gets to that extreme, someone with this addiction is at risk of
basing too mu of their self-worth on their image to the point that it causes
problems with both physical and mental health.
As we’ve seen, a aracteristic of addiction is that it causes problems in a
key area of your life. In the case of selfie addiction, the person might spend
so mu time trying to get their images to look a certain way that they don’t
actually do the things they desire to do. In extreme cases, the individual
might live an entirely fake life. For example, they might invest in thousands
of dollars of props to make it look like they’re at the bea in their photos.
Meanwhile, they’re really never leaving the house. ey’re spending so
mu time and energy on that online image that they can’t even afford a
bea vacation.
at’s an extreme example, of course. In most cases, the person will
actually aend the events in the photos. However, they may not be enjoying
them or participating fully, because they are obsessed with geing the right
photos to post later. Let’s say that a man focuses so mu on his appearance
and the right photos at a mixer that he fails to do the networking that would
land him a job that he really wants. is is an example of someone whose
real life is negatively impacted by his selfie addiction.
Selfie addiction can also negatively impact real-life relationships. ere is
a 2018 Taco Bell commercial that captures this perfectly. Most commonly
known as “Sunset Heart Hands,” it features an “Instagram boyfriend” whose
primary role in his relationship seems to be to take cute photos of his
girlfriend to post on Instagram. en he discovers a new Taco Bell item, so
his hands are full, and he can’t take the photos. She starts insistently
repeating the phrase, “Sunset Heart Hands,” because she desperately wants
him to take the all-so-oen-posted image of her fingers forming a heart that
frames the sunset. She gets increasingly agitated; he says, “Let’s just enjoy
the moment,” and she snaps. Of course, this is an ad for Taco Bell and it’s
not exactly a selfie, but it dramatizes an increasingly common problem—the
couple selfie that becomes more important than just being together in the
moment. e addict becomes so obsessed with documenting their
relationship together online that the actual relationship suffers. is brings
us directly into a different, but related (and oen intertwined), social media
addiction: an addiction to curating the “perfect” life.

e Self-Curated “Perfect” Life

is type of addiction goes beyond the selfie to include an addiction to
posting pictures of your room or home, pets, clothing, ildren and family,
vacations, and so forth. In addiction you don’t merely want to record and
share some your favorite things from your life; you want to make
everything look perfect in your online world. is can impact your real life.
For example, are you ignoring that your dog is completely stressed out by
the outfit you’ve put him in and the camera always in his face? Or have you
failed to notice that your ild never actually gets to enjoy the experience of
feeding the dus because you’re so consumed with geing her to pose
properly for the du-feeding picture? As with “Sunset Heart Hands,” these
small things add up day aer day to eat away at your relationships and
diminish the quality of your actual life experience.
As with selfie addiction, the addiction can be to taking multiple photos,
tweaking photos, and/or seeing the response that those photos receive on
your social media platforms. e addict may pay constant aention to the
number of followers they have from day to day, feeling devastated when
they lose some and elated when they gain a few. ey may get a huge surge
of dopamine when one of their images gets reposted by a bigger account,
validating the idea that their life is “perfect.” However, the addict oen feels
like a fraud, because they know that there’s a mess cropped out of the image
and that nothing is perfect at all. is can lead to a cycle of trying to perfect
the next image even more to try to escape being “found out.”
is belief that you’re a fraud is a condition oen called imposter
syndrome. And this can lead you to feel depressed about your own life while
simultaneously making you feel like you have to keep up with this perfect
online arade. is experience also exacerbates any pain that you already
experience about unrealized dreams you may have; it looks like everyone
else is living the life that you want to have. You don’t want to feel that pain,
so you desire an escape, and social media offers the perfect, terrible escape
so you become more and more addicted.
Internet marketer Morra Aarons-Mele writes about this in her book
Hiding in the Bathroom: An Introvert’s Roadmap to Getting Out There
(When You’d Rather Stay Home) when she criticizes what she calls
“aievement porn.” She talks about how aievement has been fetishized
thanks in large part to social media images of the peak experiences of life.
For example, a pregnant mother might feel like she has to contort herself
into the perfect glowing yoga pose on a cliff side in her second trimester to
get the perfect image of her “perfect pregnancy.” So, even something as
natural as pregnancy becomes a subject for aievement in photos. e
person suffering from an addiction to this is constantly performing for the
camera, seeking validation through images. She may eventually start to feel
like she doesn’t even know what’s true about herself anymore. is sense of
being out of tou with your inner self can wreak havoc on your mental
health.
Relative to this, someone addicted to curating the perfect online life oen
grapples with the feeling that they don’t measure up to the other people that
they see online. Human beings have a natural tendency to compare
ourselves to others. To the addict, it may always look like someone else’s
house is beer decorated, their closet filled with cuter purases, their food
prepared more perfectly, and their friends happier in photos. If you suffer
from this, then you keep trying to make your life look that same way, but
you never quite feel like you measure up. You can become increasingly
dissatisfied with your own (normal) life because it doesn’t mat what you
see in pictures. And yet, you can’t seem to stop yourself from looking. You
have to know what other people’s pictures look like. You may become
particularly obsessed with specific influencers or feeds, feeling jealous of
them as you strive to mat their following. is leads us to another type of
social media addiction: stalking others.

Addiction to Other People’s Content

Social media has stoked the human drive toward voyeurism. Although
frequently associated with sexuality, voyeurism more generally means that
you take pleasure in wating someone else, particularly when they’re doing
something private, dangerous, or scandalous. Social media has put
everyone’s private lives out there for all of us to see. Wating what
someone is eating for dinner has become a very regular part of our everyday
lives, and that is one of the more mundane things we get to glimpse ea
day. Some people share every waking moment of their lives on social media,
and other people can get addicted to following those lives online.
An addiction to someone else’s content can develop into stalking
behavior. Stalking encompasses a broad spectrum of things that range from
quietly obsessing over the person and following them online without
contacting them to full-blown, in-real-life following them and causing them
fear if not actual harm. Of course, most people with an addiction to other
people’s content don’t become dangerous real-life stalkers, but given the
right (or rather wrong) brain emistry and environmental factors, it can
happen. Alternatively, someone with unhealthy stalking tendencies can now
easily find and follow their object of desire online and become addicted to
traing them in that way.
is type of social media addiction may manifest as becoming an online
“superfan” of one or more people, usually celebrities or online influencers.
e addict begins to feel like they are part of the person’s life because they
see everything that the other person is doing. ey think that they truly
know the person. And they may come to think that they have a relationship
with that person, feeling hurt or offended when the person doesn’t post in a
timely manner, respond to a comment, or follow ba the addict’s account.
e superfan may comment on every single post, tag the object of their
addiction in all of their own images, and follow link aer link aer link to
try to learn more about the person’s life. ey may contact the person
through direct messaging, and if that fails, try to connect with the person’s
other online friends and followers.
As mentioned, all of the addictions discussed in this apter relate to
people’s relationships, and that is particularly true with this type of social
media addiction. Another way that it can manifest is through online
addiction to the content of someone you know in real life. e most
prevalent example is in the case of breakups; the relationship ends, but one
or both partners become addicted to stalking the other on social media as a
way to maintain something of the relationship. Other types of addiction,
besides to an ex’s content, could be to the content of their new partner or to
the content of someone they have a crush on and want to get involved with.
It’s one thing to Google a potential new partner to learn some basic things
about them; it’s another entirely to fall down the rabbit hole of reading
every old post they ever made on social media and trying to analyze it for
clues about where your own relationship might go.
Yet another way that this form of addiction can show up is when you
become addicted to eing your partner’s accounts. Jealousy as it relates
to social media is a significant problem in many modern relationships. e
more you look at your partner’s online activity, the more your mind whirls
and the more you try to soothe it with even more information, blowing it up
into a full-blown addiction by stalking their social media accounts.

Fear of Missing Out

Many of the people who develop a social media addiction, particularly an

addiction to other people’s content, are driven by a fear of missing out
(FOMO). is is the feeling that other people are online doing something
interesting and that if you fail to get online as well, then you’re going to be
excluded from the fun. e term was originally coined by MTV who had
found that even though 66 percent of young people found it exhausting to
constantly be online, 58 percent worried that they were missing out on
something if they didn’t e in.
FOMO itself predicts addictive use; the more prone you are to the feeling,
the more likely you’ll engage in addictive behavior. It’s a cyclical problem;
more use leads to greater FOMO. FOMO has been associated with lower
feelings of life satisfaction, well-being, and general mood and with increased
likelihood of engaging in risky online behavior. FOMO can affect anyone,
but it’s particularly a problem for young users, who are in a stage of life
when acceptance and inclusion with peers is at a high point.
People who are driven to use social media out of FOMO are more likely
than others to develop addictive behavior. Author Larry Rosen explains that
there are two major reasons people will compulsively use tenology;
FOMO being one of them. e other reason would be that they really love
the experience. People who are driven by pleasure may still develop
addictive behavior, but the pain of not using the device is worse for people
who are driven by fear (or FOMO).
Author Morra Aarons-Mele emphasizes that FOMO can be a particular
problem for people with introverted personalities. e introvert doesn’t
necessarily want to be out there in the world doing the things that people
are sharing on social media. However, they may feel like they should be, like
they are missing out on opportunities for growth, because of those introvert
tendencies. Social media is a way to e in and feel connected to
experiences without having to get out there.
In fact, social media relies on FOMO as a marketing strategy. e creators
of social media want you to fear that you are missing out so that you’ll keep
eing ba in to the app. e more time you spend there, the more money
they make. erefore, they exploit your fear to keep you active on the site.
Coming ba again and again becomes an addiction.
It is important to note that FOMO affects people of all ages. e quirky
MTV-coined term oen makes people think it only applies to teens. It can
also make it seem like it’s a problem that isn’t that big of a deal. However, it
can impact people’s lives in deep and lasting ways. In her book I Can’t Help
Myself, advice columnist and author Meredith Goldstein wrote about how
FOMO has affected the lives of the people she knows who are in their
twenties and thirties. She shares that these people are overwhelmingly
miserable in their day-to-day lives. ey oen feel like the slightest thing is
the end of the world. She aributes this catastrophizing to FOMO. She
explains that the plethora of opportunities available makes them feel that
every single decision could be the wrong one. It relates to FOMO because,
thanks to social media, they “know the specifics of every lost opportunity.”
For example, aer a decision to move to New York instead of Los Angeles, a
person might enviously see all of the beautiful lives being lived out in Los
Angeles and mistakenly feel like they made the wrong oice. ere is a
constant reminder of the road not taken, and it can make the FOMO-
motivated addict feel like all of their oices were the wrong ones.
Catfishing
Catfishing is the act of pretending to be someone else online in order to
lure one or more people into a relationship with your fake persona.
Catfishing can become addictive behavior for the person doing the
catfishing, and it can naturally be intertwined with the addiction to curating
a perfect life. A catfish can also exploit the social media addiction of others
to secure victims.
A person addicted to catfishing might spend hours ea day honing their
fake profile. ese days, most people can tell if a social media page or
website looks a lile bit fishy. If you want to really tri someone, you have
to make it look good. On Facebook, for example, this means that you flesh
out the page with photos taken at different places. e catfish steals someone
else’s photos, so they spend time searing online for suitable images and
then tweaking them to add them to their profiles.
e catfish will not only fill out the profile. ey have to make the
interaction on the page look real. ey add a variety of friends,
communicating with these people regularly to generate comments on the
page. In some cases, the catfish cras full fake profiles of people to friend the
original page to make it look even more realistic. e MTV reality television
show Catfish has countless examples of people doing this.
is is all in addition to the time spent actually doing the catfishing.
at’s time spent finding people to catfish, searing the profile for
information to prey upon, aing and sharing messages and photos, and
further developing the relationship. People catfish for a number of reasons
including the following:

Low self-esteem. ey want to make friends online but don’t feel like
the people they want to know would like them the way that they really
are.
Desire to connect with someone they know in real life. For example,
they want a romantic relationship with their best friend but are afraid
 to say so, so they make a fake profile to start the relationship as
someone else.
Reconnecting with someone they know but aren’t in touch with
anymore. For example, creating a fake profile to continue talking with
an ex.
Conning people out of money. Some catfishers are con artists who get
money or other material goods from the people whom they catfish.

Any of these reasons for becoming a catfish in the first place can become
addictive. You can become addicted to being the fake person that you’ve
created. You can become addicted to the relationships you’ve created. You
can become addicted to the “high” of geing away with it.
Why would someone fall prey to a catfish? Sometimes, it’s as simple as
really believing the best in people and assuming that everyone is who they
say they are. However, it’s oen driven by something else. Loneliness,
periods of grief and self-doubt, and low self-esteem of the victim are all
possible reasons that someone would be susceptible to catfishing. Another
key reason is that the victim already has a social media addiction. ey
spend so mu time online already that they don’t sense the warning signs
of a stranger interacting with them there.
e way that the catfish interacts with the person can also worsen the
victim’s social media addiction. e catfish feeds the victim positive
thoughts and feelings of validation, so of course the victim wants to hop
online frequently to find out if they have a message that will give them that
dopamine high.

Cyberbullying/Trolling
Just like someone can become addicted to the act of catfishing, it’s
possible to become addicted to other negative online behaviors including
cyberbullying and trolling. Cyberbullying is persistent bullying of one or
more people that takes place through apps, text, and social media. Trolling is
when someone purposely posts inflammatory comments online in order to
get a group riled up and engaging negatively. Both have similar roots and
can become addictive for similar reasons.
People bully or troll others in large part because it gives them feelings of
power and control. People who engage in these behaviors oen have low
self-esteem, symptoms of anxiety and/or depression, or problems at home or
are in some way discontent with themselves and their lives. Instead of
resolving those issues, they make themselves feel bigger and beer by
diminishing others. Although this can play out in real life, it’s mu easier
to bully or troll people online than it is in person. You can do it
anonymously, without many real-life consequences, and still derive the faux
pleasure of feeling like you’ve done something powerful. If you’ve made
someone cry because of your bullying online, then you’ve caused a reaction,
whi can give you a sense of control. Likewise, if you are able to generate a
huge online fight about a topic through trolling, you’ve essentially
controlled an entire crowd of people.
at feeling of power becomes addictive. e addict wants more of it to
keep feeling powerful and in control. e Internet moves fast, and people’s
aention doesn’t sti for long. In order to keep feeling powerful, the addict
has to increase the frequency and intensity of their actions.
In a comprehensive Vice Motherboard article about whether or not
trolling is addictive, writer Virginia Pelley describes a troller pseudonymed
Dave who argued obsessively with people online under both his real name
and several fake names, increasingly ruining his relationships with people in
real life and even threatening his job security. For him, what was addictive
was that he got to feel like he was right about things as he laid his
arguments out for the world to see. He stopped caring about the real effects
his arguments were having on people, including his own sister and
ildhood friends, because he was addicted to trolling.
George Caspar is a former Internet troll who shares his story in an e-book
that describes how all of his troll behavior was motivated by shame. In a
blog post about the book, he says that he has a shame-based personality,
whi is also an addictive personality, because in an effort not to feel shame,
he tries to escape through behavior that becomes addictive. He highlights
that the troll (and one could argue also the cyberbully) oen particularly
loves to shame their targets, and the reason is because they themselves feel
so mu shame. is doesn’t justify the behavior but can explain some of the
motivation behind these harmful online activities and furthermore highlight
how they can become so addictive.
It’s important to note that the victims of these acts may be prone to social
media addiction, but they may also become addicted to the activities that
victimize them. For example, someone who is being bullied online may feel
terrible when they go online, but they can’t stop themselves because they
feel desperate to know what others are saying about them. Resear
indicates that, at least for teens, the more time spent online, the more likely
the risk of geing cyberbullied. So, the Internet addict is at greater risk than
the average person.
Resear also shows that teens who experience cyberbullying are at
greater risk of other addictions including substance misuse. Cyberbullying
causes a number of problems and mental health issues; it’s linked with
depression, anxiety, and eating disorders as well as low self-esteem and self-
harming behavior. ese problems all put people at greater risk of addiction.
is may manifest as addiction to social media specifically, Internet use
generally, and/or to other behaviors or substances.

T A
Not all relationship-related online addictions are to social media. Texting
is another huge culprit. You don’t even have to be connected to the Internet
to text with people, although oentimes you are. ese days, it’s hard to
even define texting as separate from other forms of messaging. I have
friends whom I know in real life who “text” me not only to my phone
number but also through Facebook messenger and Instagram direct
messages. e tenology anges quily; I used to at privately with
people on GChat and AOL, but I no longer use those applications. Snapat
and WeChat are two other major places where people “text” or send one-to-
one messages to ea other. So, for the purposes of this book, we’ll loosely
define a texting addiction as an addiction to sharing one-on-one private
messages through any phone, computer, or other similar device.
Texting, even with someone you don’t know, feels more personal than
publicly commenting on social media. You’re doing it privately (although
sometimes in group texts), so it’s got the sense of a new level of intimacy.
is makes you feel more connected to the person on the other end of the
message. erefore, you place a higher value on their response. You text and
your brain immediately starts to get excited for the response, seeking the
dopamine hit of the reward of hearing from them. Sometimes you don’t get
the hit; you cra a carefully composed text message and get ba just “ok” or
“cool.” at’s not at all satisfying to the brain, so you immediately want to
text again to see if you’ll get a beer reward.
Of course, just because you text frequently doesn’t mean that you
necessarily have an addiction. Dr. Kelly Lister-Landman did an interesting
study into texting addiction, whi found that teens differ by gender when it
comes to texting addiction. Although boys and girls exanged the same
number of texts, the girls were significantly more likely to develop an
addiction. In this study, addiction was aracterized by trying to cut ba on
use but feeling unable to, geing frustrated by the behavior, and feeling
defensive about their use. e boys weren’t likely to have those problems,
and although they texted oen because of social norms, they could basically
take it or leave it. In contrast, the girls had emotional aaments, and
emotional consequences, associated with compulsive texting.
Many of the tools that we use to text offer addictive features. For example,
there’s the typing indicator; you can see that someone else is typing but
hasn’t yet sent the message because your device either tells you directly
“typing” or shows you through symbols su as an ellipsis. You get anxious
and excited for the response. Your brain is ready for that potential hit.
Likewise, some services allow you to see that someone has read your
message. How do you feel when someone reads what you wrote but hasn’t
yet responded? Do a million questions start going through your mind? Do
you wonder what they’re thinking and what you did “wrong” that made it
so that they haven’t responded yet? Does your worry cause you to want to
text again?
Pairing text messaging with notifications can exacerbate addiction. In
psyology, there’s a well-recognized concept called classical conditioning. If
you know the story about how Pavlov’s dogs would salivate at the ringing
of the bell, then you know about classical conditioning. Basically, you pair
two things together (the dog hears the bell and then gets the food that he
salivates over) and eventually just the first thing triggers the response (the
dog hears the bell and begins salivating even if there’s no food). Your text
messages are probably paired with one or more triggers—a ping, a vibration,
a notification number on the screen. You hear or see it, and you immediately
start to have the feelings associated with the addiction. ese days, you can
oose from any number of different sounds to pair with your text messages,
assigning different sounds to different people that you text with, and this
increases your level of investment in the texting relationship so that you’re
even more easily triggered by those specific sounds.
Texting addiction can lead to physical problems—like text ne or texting
thumb. It can lead to problems associated with la of sleep due to waking
up in the night to text. Texting during class can lead to problems at sool;
excessive or inappropriate texting at work can threaten your job. It’s hard to
say what amount of texts constitutes a problem, so it’s important to consider
the effects texting has on your social life, activities that you’re passionate
about, health and work performance, and so forth.

A  U  D A

Ba in 1995, Mat.com launed the first-ever commercial dating
website. e people who paired up on Mat ba then could never even
have envisioned what online dating would look like in the twenty-first
century. ere are hundreds of different dating sites and dating apps, some
general and many nie. You can satisfy just about every interest you could
possibly desire and connect with someone else who desires the same.
“Connecting” with another person is as simple as swiping a finger across
your phone. And with that prevalence and ease comes the increased
likelihood of addiction.
e reasons, motivations, and problems associated with an addiction to
dating apps are similar to those associated with other relationship-oriented
Internet addictions including social media addictions. In fact, it’s oen
directly tied in with other addictions. For example, you might have some
selfie addiction or addiction to curating the perfect image as you try to
present yourself to be the perfect dating material on different sites. You
could become addicted to the “likes,” constantly eing how many people
are swiping positively for you. You might become addicted to looking at
potential partners but never actually following through on dates. You could
become addicted to the one-on-one messaging, including texting and sexting
addiction. Or you could become addicted to short whirlwind relationships
that you ultimately find unsatisfying, so you go ba to your online
connections.
In terms of harm, addiction to dating apps is most likely to cause
problems in your current relationships. If you’re in a relationship and
“eating” with dating apps, then that’s an obvious trigger for problems. If
you’re single, then you might neglect your friendships and family in favor of
your online dating world. Many dating apps are free, but some cost money,
and of course going out on the dates costs money, so you might also develop
negative consequences in your financial life as a result of dating app
addiction. It can even lead to physical problems; just like there is texting
thumb, there’s also so-called Tinder Finger, whi is pain in the index (or
swiping) finger from constant, repetitive swiping on dating apps.
e problem of dating app addictions seems to be more prevalent than
one might guess. One Mat survey, reported on by VICE in 2017, found that
one out of six single people feel addicted to the process of seeking out a
partner online. Men are far more likely to feel addicted to it than women
are, but women are more likely to report that the whole process makes them
feel fatigued and even depressed. Dating app addiction may correlate with
increased depression, anxiety, self-image issues, and low self-esteem.
O P A
Pornography addiction isn’t necessarily the same as social media
addiction, but it falls under the same umbrella in the sense that it is an
online addictive behavior directly related to and impacting relationships
with others. Compulsive behavior focused on online pornography is also
known by the term “cybersexual addiction.” We can see that it’s on a
spectrum with other social media addiction when we look at the similar
term “cyber-relational addiction.” is laer term refers to addiction to
online relationships at the expense of relationships in real life, whi
describes any of the different types of addictions described in this apter so
far.
Along with gaming, pornographic content is considered one of the most
potentially addictive content types available online. It is also one of the most
widely studied behaviors of Internet addiction. It takes time for enough
scientific studies to be done to really fully understand a mental health issue
su as addiction; porn was one of the first popular content types on the
Internet, so it has a long history available for study (or comparatively long
anyway).
As su, this is a ri topic that really requires a full book to completely
review and understand—and there are several of those books out there for
people who are interested in the topic. Instead of digging that deep into it,
we’ll use what we already know about addiction in general, and Internet
addiction specifically, to get a general grasp of online porn addictions.
Specifically, let’s recognize that porn has existed a lot longer than the
Internet has and to take a look at what makes it mu more likely to develop
an online porn addiction than addiction to other types of porn.
is has to do directly with the tenology itself, in particular the
advances in that tenology. Remember the story earlier in this book about
how early games like those on the Atari system were naturally self-limiting
in terms of addiction? No maer how exciting a single game was, it
eventually got boring. And there were only so many games, so eventually
you stopped playing Atari and did something else. Older versions of
pornography are similar; you can only look through a single magazine so
many times before the excitement is gone. Plus, the magazine is only a still
image, so you have to utilize your imagination, stimulating other parts of
your brain beyond just those that get addicted. e VHS tape or DVD porn
movie uses a lile bit less of your imagination, and it’s a lile bit more
addictive, but eventually you’ve memorized it, and it no longer excites you.
But fast forward to pornography on the Internet today: there is virtually
endless content of all types and varieties, and you can easily cli from one
to the next within seconds. You don’t have to use your imagination at all
because the Internet feeds you far more scenarios than you could imagine
on your own. You passively consume the content, there’s more and more of
it, and you can easily see how this becomes mu more addictive than the
days when you had to covertly enter an adult bookstore to find the video
that you’d wat for the next few weeks.
It’s easy to see how online pornography feeds the brain’s desire for
intermient reward. You cli the video, and you may or may not like what
you see. When you do, you get the dopamine reward. Online pornography
also directly plays into the human desire for novelty. People follow a
common trajectory starting out with “vanilla porn” and heading deeper and
deeper into nie and kink porn. While there’s nothing inherently wrong
with a person’s preference for a particular type of sex, Internet addiction can
lead people to seek out more and more unique sex acts in the sear for
novelty. e desire to see more new things fuels more addictive behavior.
is has led to some disturbing issues, particularly for young people
exposed to online pornography when their brains are still developing and
their sexual desires still forming. Some people with addictions to Internet
pornography find that real-life sexual experiences don’t stimulate them
because they feel dulled or muted in comparison with the intensity and
cli-cli quiness of the online version of sex. ey want to have sex with
their partners in theory, but they can’t get aroused or rea orgasm in the
real world; yet, they have no trouble doing so with online porn. Even if you
haven’t experienced this yourself, you can easily imagine the many and
varied problems that this can cause in relationships.
 ere’s also the problem of desensitization to the other person when you
do have real-life sexual relationships. Digital tenology generally, and
online pornography addiction specifically, may cause reduced empathy. If
you don’t recognize that the other person whom you’re having sex with is a
living, breathing, emotional human being, then you’re at risk of causing a
whole host of problems. At the very least, both of you leave the situation
feeling a lile bit empty, a lile bit used, and very unsatisfied. Seeking a
beer feeling, the addict returns to porn and continues the cycle.
C 5

Other Forms of Internet Addiction

Relationship-related forms of Internet addiction from social media to

pornography represent very prevalent aspects of online addiction. Many
aspects of that particular type of relational content are highly addictive.
However, people get addicted to all different types of Internet content, some
of whi aren’t relational at all. Gambling and media bingeing are just a few
examples that we’ll explore in this apter.

G A
Like pornography, gaming straddles the line between being a solitary
endeavor and one that’s social. People can become addicted to very simple
games that they play online, su as Solitaire or Mahjong. However, the
most addictive games are also highly interactive with other players. Gaming
addiction is one of the most widely studied forms of Internet addiction. As
we’ve seen, it’s the only form specifically listed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM) and International
Classification of Diseases (ICD) as a mental health disorder.
 Some games are more likely to provoke addiction than others. Low-risk
games include puzzle games like Tetris and physical simulation games like
Guitar Hero. Midrisk games include basic educational, historical context
games and “God games” su as The Sims. Higher-risk games include role-
playing games like Legend of Zelda as well as first person shooter games and
real-time strategy games. e games that are most likely to activate
addiction are the massive multiplayer online role-playing games
(MMORPGs) including RuneScape, EverQuest, and World of Warcraft.
In fact, World of Warcraft is frequently cited as the most problematic
game when it comes to gaming addiction. In its first ten years, the game
gained more than one hundred million subscribers around the world. It
received $10 billion in gross income. People immediately loved this game,
and it became far more than just a fad; for many, it became an addiction.
In World of Warcraft, there are two warring factions called e Alliance
and e Horde, constantly baling it out in a mythical land called Azeroth.
Players create their own avatars, but they do not play alone. ey join guilds
to play in real time with other players from all around the world. Your guild
is your team. Together you fight monsters, complete quests, and explore the
virtual world. Whenever your guild-mates are online, you want to be online
as well. You don’t want them moving forward in the quest without you. is
interactive nature enhances the addictive quality of games like World of
Warcraft.
Interactivity and teaming up with others play right in to the brain’s
tendencies. Mu like social media, this satisfies the desire for approval from
others and the brain’s urge to compare ourselves to others. Guild members
can place a lot of peer pressure on one another to keep feeding the addiction,
to stay online longer and skip other healthier, real-life activities. It’s a primal
instinct to want to fit in with the crowd. But these games prey upon other
primal instincts as well.
ese games feature some of the most highly distracting qualities of any
online activity. ey constantly send signals of sound, sight, and movement
to the brain. Movement, in particular, puts the brain on high alert. Ba
when we humans had to hunt for our food and protect ourselves constantly
from external threats, our brains learned to stay alert for movement. When
we engage with these movement-ri, highly stimulating games, our brains
remain in constant high alert. is messes with our adrenaline and cortisol
as well as with the brain’s neurotransmiers. We’re constantly stressed, and
this stress confuses the brain in ways that increase the risk of addiction.
Players may readily admit to having a gaming addiction, although that
doesn’t necessarily mean that they want to ange their behavior. Author
and gaming addiction expert Adam Alter reports that approximately half of
the players in World of Warcraft consider themselves addicted to the game.
In fact, there are online support groups specifically for people struggling
with a World of Warcraft addiction. (Yes, there is some irony to an online
group to help people stop online behavior, but it can be helpful, something
we’ll look at more in Chapter 9.) But recognizing that there’s a problem
doesn’t necessarily lead people to seek help or to succeed in ending in an
addiction.
At the extreme end of gaming addiction, players may experience gaming-
induced psyosis. Of all the online activities that can addict people, gaming
is the one most likely to cause this most severe of effects. One of the most
common forms of this psyosis is called Game Transfer Phenomena (GTP).
As the name suggests, it causes the player to have trouble separating the
game from reality. It is sometimes called the Tetris effect, aer the game of
the same name, because addicted players may see Tetris-style paerns in the
mind when not playing the game. Other symptoms of GTP include the
experience of involuntary sensations and reacting physically and reflexively
as though in game play even when the game is not on. Players may hear
sounds or see images from the game when they are not playing.
GTP is typically a temporary, short-term effect that will go away with
extended rest from the game. However, it can occasionally become a severe
case of psyosis, especially if combined with sleep deprivation from game
play. e more interactive and stimulating a game is, the more likely it is
that addicted players will play for hours and hours straight without breaks.
ere are multiple known cases of people gaming for well over twenty-four
hours without breaking to go to the bathroom or eat a sna. In severe cases,
patients have had to go into inpatient treatment. ey may spend weeks or
even months there, away from the game, receiving therapy and medication,
before they are fully ba in the real world.
It is no accident that online gaming is addictive. e gaming industry, like
the social media industry, wants people online all of the time, and they go to
great lengths to make their games more and more addictive. Companies will
conduct user studies that seem innocuous, but what they’re really trying to
figure out is how to make their games addictive. For example, they may
measure a test subject’s heart rate during different stages of game play to
learn how to get the heart rate going more effectively. Companies hire
people from fields including psyology and neurobiology to further
strengthen their ability to make games addictive. ey prey upon what we
know about human addiction to make the games addictive.
e result is an impact not only on behavior but also on the brain. In a
2001 study from the Indiana Sool of Medicine, researers found that the
brain anged aer just one week of playing violent video games. Compared
to a sample group that did not play the games, players who gamed for ten
hours in one week had decreased activation in both the le interior frontal
lobe and the anterior cingulate cortex. ese are the areas of the brain that
help to control emotion and aggression. at’s ten hours in one week;
today’s gaming addict is more likely to exceed ten hours in one day.
So far, we haven’t talked mu about aggression, but it’s another
problematic side effect of some online addictions and is particularly
prevalent among people who play violent video games. In the same way that
an addiction to online pornography can desensitize the person to sex,
addiction to violent gaming can desensitize a person to violence. Studies
show that immediately aer playing a violent game, people are more likely
to show aggressive behavior and less likely to feel affected by violence
around them.
Not only does violent gaming beget desensitization but violence in a game
increases the likelihood of addiction as well. A study by author Jennifer
Burek Pierce compared teenagers playing violent and nonviolent action
games. e results found that in comparison the teens who played violent
games had

increased activation in the amygdala, whi means that they were

more emotionally aroused;
decreased activation in the prefrontal areas of the brain correlated with
focus and control; and
increased feeling of fight-or-flight.

ese results happened whether they won the game, lost the game, or
even paused the game in the middle. e effects continued even aer game
play ended. All of these anges in brain activity make a game more
addictive.
In the current age, there is also another motivation for gaming addiction,
whi is that top-level players now have celebrity status. ere is an entire
genre of gaming called eSports, and people tune in to wat the masters at
play. Regular gamers may strive to become a celebrity player, and the only
way to do that is to practice excessively. ey work hard to get the slightest
edge over other players. For example, they will tweak their hand and arm
positions to aempt to get just a fraction more speed in a game. ey play
and play and play. e more they play, the more they want to play, and thus
an addiction can form.

N C: G, A,  M

Net compulsions refer to a variety of activities that addicts engage in
repeatedly and obsessively. ere is a fine line between addiction and
compulsion in psyology. Compulsion, oen but not always associated
with obsessive compulsive disorder, is defined by a fear-based need to
engage in specific behaviors. Compulsion is oen one component of
addictive behavior; the addict feels a compulsive need to keep eing on
something or engaging in a behavior. An addict with a net compulsion may
feel a constant need to e on the status of an online auction or the newest
clearance items available on a site like Amazon. ey may also feel the need
to keep going ba to a site, su as an online gambling site.
Gambling is actually the only behavioral addiction that’s officially defined
as a problem by the DSM-5. is is separate from online addiction and refers
to people with an addiction to gambling of any kind. In the twenty-first
century, gambling can now take place online, leading to potential addictive
behavior both online and offline. In other words, someone with a gambling
problem may or may not have an Internet addiction; someone addicted to
gambling online has an Internet addiction.
Interestingly, gambling in the real world preys upon many of the same
brain weaknesses that we’ve discussed with regard to Internet addiction. e
people who design casinos, for example, have taken a variety of
psyological and neurological factors into play to increase a person’s
tendencies toward addiction. e sounds of slot maines, the placement of
tables in a casino, and the carefully controlled temperature—no part of the
design is le to ance. In the same way that social media companies and
video game designers try to get you to stay online longer, casinos try to get
you to keep spending your money as long as possible. Video game designers
have studied the casinos’ playbooks and implemented their most successful
strategies.
So, it’s no surprise that online gambling is potentially addictive. ese
days you can bet online on everything from the outcome of a sports game to
the gender of a celebrity’s next baby. Jarice Hanson reported that as of 2007,
there were more than $14 billion globally in the world of online gambling.
Also, of great importance, the author explains that people who are already
addicted to some other aspect of the Internet are mu more likely to
become addicted to Internet gambling. If you have an addiction to social
media or video games and you stumble into online gambling, then you’re at
risk of addiction.
ere are a lot of legal issues related to online gambling, whi vary
significantly from location to location. Online gaming website owners
constantly ange their tactics in order to be able to continue operating. For
example, one law says that there’s nothing illegal about a U.S. resident
placing an online bet as long as it’s on a site that itself is located in a
different country, so gambling sites are typically hosted outside of the
United States, but U.S. users can access them. ere is a lot of money at
stake here, and people are willing to go above and beyond to keep these sites
up.
Online gambling is only one of many possible net compulsions though.
Two of the other most common examples are online sto trading and
participating in online auctions. ese activities keep you online at all hours
of the day and night, constantly eing and updating your activity. If you
want to win the eBay auction, then you might set your alarm to remind you
right before the auction is about to end so that you can stop whatever else
you might be doing and get online to make some rush bids. Although it’s
possible to automate many of these activities, the addict thrives on the rush
of the compulsive behavior.
People can develop net addictions to all different types of content. Just a
few more examples include the following:

Compulsively clipping online coupons and looking for the best deal
Regularly returning to a website that sells items to e for new
products and beer prices
Participating in online surveys and entering giveaways

In addition to all of the common consequences of any Internet addiction,

people with net compulsions are those most likely to experience financial
consequences. Many of the net compulsions involve spending money,
whether that’s on gambling or shopping. As a result, people with this form
of addiction oen end up in extreme debt.

A  I M

People can become addicted to any specific type of content, whether
that’s pornography, gaming, or gambling. ey can also become addicted to
specific types of media that are available online. Streaming video, news, and
health information are among the most problematic content types ripe for
addiction.

Television (e Netflix Binge)

One of the most fascinating anges in tenology has been how
seamlessly media now moves from one device to the next. For example,
people used to wat all of their television on a TV set. However, in modern
times, a person may access the same television show on their desktop,
laptop, tablet, or phone. e devices are oen synced so that you can pause a
show on one device and pi up right where you le off using another
device. Advances in streaming tenology have made it possible to easily
wat “live tv” on the go.
Netflix offers one of the best examples of a company that has anged
with the times. e business emerged at a time when bri-and-mortar DVD
and VHS stores su as Blobuster were going out of business. Netflix
created a mail-order service that allowed people to get DVDs sent right to
their homes. e online component at that time was that you had an
account where you looked for the videos that you wanted, set them up in a
queue, and ordered them for home delivery. However, the tenology
continued to ange rapidly, and it wasn’t too long before they launed
their streaming service to wat television and movies directly on the
website. ey went on to create their own content, and those Netflix
Originals are now some of the most popular streaming content.
As far as Internet addiction goes, the most relevant thing has been the
emergence of the phenomenon of “binge wating.” Even the term itself
suggests that this is a disordered behavior. Aer all, nobody typically thinks
of “bingeing” as a positive thing. And yet, the phrase rapidly was adopted by
people who regularly tell others about their viewing binges without any
shame or concern. We use it regularly in everyday parlance. We don’t seem
that concerned about the Netflix binge.
Obviously, you can binge any streaming TV/movie content; it doesn’t
have to be on Netflix. Netflix just cornered the early market on the binge
through smart oices that preyed upon the brain’s addictive nature. e
design of the website, feeding you content that you might be interested in
while also allowing you to collect your own content in your queue, is one of
those smart oices. ey were also brilliant when they first started
releasing entire seasons of their own original content at one time. One of the
early examples was Orange Is the New Black; new fans of the show did not
have to wait from one week to the next to find out what would happen but
instead could wat the whole first season (and then subsequent seasons) in
just a day or two. We now see this model replicated across many different
platforms, of whi Netflix is only one.
Any type of content can become ripe for binge wating. In particular,
content featuring real people (reality TV or docuseries) and content with
fictional aracters that you can really relate to are ripe for bingeing. What
these have in common is that they provide an illusion that the aracters are
real people who viewers can get to know. In some cases, they are real people
(like the Kardashians), but they are exaggerated and edited versions of those
real people. is content is addictive in that the viewer constantly wonders
what will happen next with the aracter. “Just one more episode” has
become a common refrain in this society. e addict simply can’t stop, oen
foregoing sleep and socialization for that next episode.
is plays to the voyeur in people, to the point where some become more
comfortable viewing lives on the screen than interacting with people in real
life. ey use the aracters to replace real companionship. However, these
one-sided relationships are ultimately unsatisfying. erefore, the addict
needs to wat more and more online television to get that same feeling of
“connection.” ey may participate in online discussions and fan groups and
also follow the celebrity’s social media accounts to get even more time
“with” them.

Online News Addiction

ere once was a time, not all that long ago, when the day’s news was
only available for an hour or so per day, with different versions across three
or four annels. en along came cable television and the start of the
twenty-four-hour news cycle. You could tune into news all day long, geing
different versions from various news anors. It became addictive content.
e addictive nature has only heightened now that news is available online.
It’s always at our fingertips.
Online news comes in various formats. You can access mainstream news
through online streaming services. You can view alternative points of view
on various sites including YouTube annels. Add in podcasts, vlogs, blogs,
and social media, and there is a never-ending stream of news that you can
tune into at any time. In fact, with social media at play, it has become
increasingly difficult not to be exposed to news, even if you aren’t actively
seeking it. People constantly post and repost “news” based on an article’s
headlines so that anytime you’re looking at your social media feed, there are
items in there designed to capture your aention.
People become addicted to news for a variety of reasons. Fear of missing
out (FOMO) is one big one. e addict insists that it’s important to stay on
top of our society’s news and worries and that if they aren’t constantly
eing it, then they are going to miss out on important information.
ere’s also an addictive quality to the feelings that news stirs up in us.
Mu of the news out there is “bad” news that produces fear and anxiety,
and the addict has a compulsion to keep eing that news, perhaps hoping
for something beer but becoming addicted to the emicals of fear that the
headlines evoke.

Fitness Apps/Wearable Te

Tenology anges as fast as humans can come up with new ideas.
Wearable te is a relatively new tenology that is already fairly pervasive
in our society. People use smart wates, fitness traer accessories, and apps
on their cell phones to constantly monitor their own activity. On its own,
there is nothing wrong with this tenology. However, it creates one more
way that we can become addicted to the Internet.
 Specifically, this type of tenology can lead to or enhance an exercise
addiction. Apps constantly remind you of your activity so that you can
consistently push yourself further and further in exercise. Someone who is
already prone to guilt over inactivity may pass the tipping point when faced
with a device that constantly reminds them of it. is can lead to self-
destructive behaviors, su as pushing through an injury just to meet a goal
and get that positive feedba from the app.
e “online” component makes this tenology more addictive. Many of
these tools don’t merely provide you with information about your own
body. Instead, they also connect you to a community of peers. e idea is to
provide accountability for exercise. However, it also means that you
constantly have an audience, and you may feel like they are judging you on
your performance. You may feel that you have to tune in and perform
despite messages from your body that what you are doing is not healthy.
Alerts from the devices combined with social interactivity prime you for
addiction.

Cyberondria
Exercise is just one type of health behavior that is ripe for online
addiction. Another related content type is medical information. Perhaps you
have experienced something like this; you have a pimple on your arm that
won’t go away, and you have recently had a headae. ese things are
probably unrelated, and both will likely go away soon. However, you get
curious, so you start searing online for medical advice as to what might be
“wrong” with you.
You aren’t alone. Larry Rosen reports on a Pew Center study that found
that searing for medical or health information is the third-most popular
Internet activity behind only more general Internet seares and use of
email. More than 80 percent of people sear for information on health
websites. So, you think that you might have something wrong with you, and
you do a sear. Before you know it, you are deep in an Internet hole,
concerned that you might have a rare condition aracterized by these two
traits. Most people are eventually able to pull themselves away from the
Internet and sele down, realizing that they are just scaring themselves over
nothing. However, some people get addicted to researing this type of
information, and they can develop a condition called cyberondria.
Cyberondria is a specific form of anxiety caused by looking up health-
related information online. Although it is most common for people to
resear this medical information about their own symptoms, occasionally
the anxiety arises when doing Internet seares to assist friends and family
members; in su a case, the term for the condition is “cyberondria by
proxy.” e condition is a terrific example of how normal human behavior
becomes amplified and exaggerated online, whi can lead to a dangerous
increase in the symptoms of certain psyological conditions, with the
potential for serious physical health consequences that follow.
Cyberondria stems from our brain’s natural tendency to consider the
“worst case scenario” for potentially dangerous situations. is tendency is
reasonable when considered from an evolutionary perspective. Using this
adaptive tool allows us to predict danger and make oices to avoid it. For
example, when we are walking at night and see that the street lights are out
up ahead, we consider that there could be a mugger hiding in the shadows
and adapt our route accordingly. Chances are there is no mugger, but our
minds let us know of this outlier risk to prevent even the small ance of
harm. In su an example, the brain has given us enough warning that we
quily identify the cause of our anxiety and make a shi that alleviates the
anxiety. Unfortunately, this is the same part of the brain that gets triggered
in cyberondria, but the actions that we take in response actually increase
our anxiety instead of quelling it.
Instead of pointing out the worst-case scenario and providing a means of
escaping it, the online medical sear highlights this scenario in su a way
that we are drawn ever toward it. Imagine that you have a hoarse voice and
a sore throat, and you initiate a web sear to find out what might be wrong
with you. Scanning the results of your sear, you guess that the most likely
culprit is all of the yelling you were doing at a concert the night before.
However, before you turn off the screen, you notice that cancerous tumors in
the throat also have the same symptoms. Your mind seeks to resolve anxiety
over this worst-case scenario, so you dig to find additional information.
With just a few clis, you become convinced that you might actually have a
tumor. You spend the entire night awake and terrified, rushing to your
doctor first thing in the morning. e doctor assures you that it is unlikely to
be a tumor, but your brain recalls all of the information from the Internet
sear and insists that you complete a wide variety of medical tests to be
sure. e tumor is as unlikely as the mugger in the shadows, but there is no
relief from taking another route home; treating the hoarse throat doesn’t
rule out the tumor.
Cyberondria itself is a allenging psyological condition. As with all
forms of anxiety, it exists on a spectrum from mild to severe. Symptoms can
range from being tired aer a sleepless night of Internet seares to
persistent fight-or-flight response in the body that causes muscle pain,
migraines, and other physical ailments as well as anges in brain emistry.
is creates a vicious cycle; worrying that you are si makes you si.
Cyberondria also has a number of additional consequences for both
individuals and the greater community. e prevalence of this condition has
led to a significant increase in the number of people visiting their doctors
and a corresponding increase in the number of tests run on patients. is
puts a strain on the medical system, whi frustrates doctors, increases office
waiting times for people with serious medical conditions, and raises
insurance rates. People subject themselves to invasive procedures, including
extensive surgeries, to treat their “medical issues,” all in a futile aempt to
alleviate their own anxiety. is exacerbates physical symptoms that
reinforce the belief that they are ill. Chronic pain, gastrointestinal dress, and
cardiovascular symptoms are all common among people who believe that
they are si. Additionally, there is an increase in likelihood of depression.
Cyberondria is an example of how the brain’s normal adaptive
functions get derailed when interacting with tenology. A fascinating
sidebar to this is that our human behaviors tea computers to behave in a
way that further exacerbates our anxiety. Computer sear algorithms are
designed to gather information about what humans sear for in order to
predict “beer” sear results for the next person. e problem with online
medical seares is that the average person will be more drawn to find out
about the tumor than the classic sore throat. Ea time that a person clis
on the “tumor,” the computer records that this is the “beer” response and
feeds more information about tumors to people who are searing for
information on hoarse throats. is leads an ever-increasing number of
people to consider this worst-case medical scenario. Computer sear
engineers have been working on this issue, and anges are slowly being
made to the tenology to help combat the growth of cyberondria. In the
meantime, it is up to ea individual to use common sense and sound in-
person medical consultation to bale the anxiety that wells up every time a
potential new “symptom” seems to manifest in the body. However, the more
you indulge the urge to do this sear, the more likely you are to fall prey to
an addiction to keep doing it.
Searing for health information isn’t the only issue. ere are so many
different ways that we receive medical information from our devices these
days. ere are advertisements and commercials telling us about various
heretofore-unheard-of conditions and recommending specific medications.
Every streaming video option has some sort of medical-related television
show. Even just posting on social media can become a problem because
when you share that you are ill, others immediately sympathize, and that in
itself can become addictive.
So, as you can see from the past two apters, there are many aspects of
the Internet that can provoke addiction. When you fall prey to one specific
addiction, you may ange your brain in su ways that make you
susceptible to other online addictions.
C 6

At-Risk Populations

As with all addiction, anybody can be at risk of Internet addiction. However,

some people are more susceptible to it than others. One of the things that are
particularly important to understand in terms of the neuroscience of
addiction is that at this point in scientific resear, we oen aren’t able to
differentiate cause from effect. We don’t have the means to know whether
someone first becomes addicted and that causes anges in the brain or
whether they already started out with certain structural and emical brain
issues that primed them to become addicted. It’s likely a combination of
both. With that in mind, let’s take a look at some of the populations that
seem to be most at risk of developing an Internet addiction.

C  T

People who were born before the ubiquity of the Internet may be at
greater risk of Internet addiction than those who were born before its
widespread common use. Gen Z, and to a large extent laer-born
millennials, began using devices at a young age. Because they don’t know
anything else, they may be more susceptible to the Internet’s risks of
addiction. More than that, though, we know that Internet use and misuse
can ange the brain, and we know that ildren’s brains are still in
development, so although we don’t exactly know how these two things are
going to play out over time, we can guess that people growing up with
Internet use are going to have a different neuroemical balance than
previous generations. is might be primed for addiction.
e brains of ildren and teens are still in development, and thus they
are even more susceptible to habit-forming input than the adult brain. Put
simply, ildren’s brains aren’t well equipped to handle the intense level of
stimulation caused by constant computer use. at dopamine hit is strong!
In fact, the teen brain actually receives more of a dopamine hit than the
adult brain does for the same activity. erefore, it loves to seek out the
constant rewards of the Internet. e brain easily habituates to that
dopamine increase. Dopamine plays su a key role in addiction that it’s
likely to place young brains at risk.
We discussed some brain anatomy in Chapter 3, including the important
role that the prefrontal cortex and frontal lobe play in uniquely human
aracteristics. is area of the brain, whi helps control impulsivity, is not
yet fully formed in teens. us, teens notably already have trouble with
impulse control. eir brains literally can’t do it yet. Teens who spend a
significant amount of time on the Internet may inhibit the development of
the frontal cortex, further reducing their ability to develop impulse control.
So, they don’t have the control to stop themselves from the compulsive
Internet behaviors in the first place, and then engaging in those behaviors
makes them less likely to develop the brain’s ability to control their
impulses.
A teen’s natural brain anges happen to be well suited to the kinds of
tenological habits that modern society encourages, habits that can lead to
addiction. For example, have you ever noticed that teens love to stay up late
at night? is isn’t just a social drive; it’s a drive in the teen brain.
Adolescence resets the teen’s circadian rhythm so that biologically they are
driven to stay up later and then sleep in. What can a teen do in the middle
of the night if they aren’t allowed to leave the house? e obvious answer is
to use their phone or computer. e brain embraces a sleep paern that
encourages the teen to stay up, plus it seeks out that dopamine stimulation,
and the Internet is the perfect solution.
Moreover, oices made during this stage of brain development can have
a lifelong impact on a person’s paerns. You see, there are certain periods of
life when the brain is particularly malleable. In other words, the information
you put in at that time will sti more readily than if you learn the same
information at another time. at’s why it’s easier to learn a second
language when you are young, particularly at certain stages of brain
development. is relates to neuroplasticity; younger brains are more
malleable than older brains. However, there are also specific developmental
stages during whi brains are especially malleable. Right around the time
that we learn to speak (ages one to two) and again in our teen years, our
brains are very open to ange.
Teens go through a period during whi there is heightened malleability.
It usually happens just before puberty, and it’s the brain’s last big burst of
sensitivity to growth. Basically, whatever paerns the brain takes on at that
time are likely going to form neural pathways that create habits that can last
a lifetime. erefore, if a teen starts to learn an instrument at that time, they
will probably always have some proclivity toward skill with that instrument.
However, the brain doesn’t discriminate; whatever information and paerns
you put in at this time are what will sti. So, if the teen spends all of their
time playing video games or surfing the web, those are the paerns that will
be strengthened. Of course, ange is always possible, but it becomes
increasingly difficult once those paerns are wired into the brain.
Whatever the teen’s time is focused on, that’s where the pathways will
develop. If the teen is hyperfocused on Internet use, it will be at the expense
of other brain development. For example, the brain emicals and structure
of the teen brain are perfectly primed to learn and develop problem-solving
skills that will help them all throughout life. However, this needs to be
developed, practiced, and maintained in order to become a natural path for
the brain. If instead the teen is distracted by the immediacy of the Internet,
they might not develop those skills. e less developed the brain, the more
prone it can be to addictive behavior.
As for younger ildren, there is a lot of debate about how mu and
what kind of screen time to allow at different ages. ere is widespread
agreement that screen time, including traditional TV time, is detrimental to
the brain growth and development of young ildren. e American
Academy of Pediatrics warns against allowing younger than age two to
consume media. And yet, as many as nine out of ten kids under two years
old do have screen time, plus they’re regularly exposed to the “baground
noise” of screens in use by others around them. We don’t know if this makes
them more likely to become addicted. We do not know that it can impact
their development particularly as it relates to language development and
early social skills, and if those get damaged, then the brain may react in
ways that make addiction more likely.
Of equal importance as the potential damage of screen time is the fact
that if ildren are excessively engaged with Internet devices, then they are
not engaged with some of the most important things that they need in order
to grow and develop healthy brains and healthy relationships. e more
time they spend on their screens, the less time they spend in human
interaction, downtime daydreaming, and experiences out in nature, all of
whi are critical to human development. According to Aention
Restoration eory (an idea first posited in the 1980s by Rael and Stephen
Kaplan), spending downtime in nature has a restorative effect that helps
humans to heal. Nature time improves aention, emotion, social interaction,
and stress reduction in humans. Humans who do not spend time in nature
aren’t geing this all-important restoration.
e reality is that kids today are growing up with screens, both at home
and at sool. Some use of those devices probably doesn’t cause any major
problem or lead the average ild into addiction. But more frequent use, and
use of more stimulating content, might become problematic, particularly for
very young ildren. Certain ildren may also just be more sensitive than
others. We don’t know. If that’s a topic that you’re interested in learning
about in more depth, Anya Kamenetz’s book The Art of Screen Time,
designed particularly for parents, is a balanced starting place about the
current resear. What we do know is that ildren and teens have
developing brains, the Internet does interact with the brain, and as we
continue to learn more and more about Internet addiction, we have to pay
particular aention to risks for youth.

I  A D H

D
e relationship between aention deficit hyperactivity disorder (ADHD)
and addiction to the Internet is complicated. ADHD can be a risk factor for
Internet addiction. On the other hand, traits of Internet addiction can look a
lot like ADHD. It is hard to separate out cause and effect in a world where
ADHD is on the rise and Internet use is prevalent. We simply don’t know
why there has been an increase in diagnosis of ADHD, and it’s possible that
increased tenology could play a role in how many more people experience
the symptoms of the condition. To complicate things even further, there are
traits about ADHD that make Internet addiction more appealing, but we
can’t generally parse out whi issue came first.
One important thing to understand is that ADHD is a medical condition,
one that is specifically related to the brain. As the brain interacts with the
world around it, ADHD can be triggered or exacerbated. is isn’t to say
that Internet use causes ADHD; we don’t know that. However, it might
increase the development or severity of symptoms in some people because of
the way that it interacts with the brain.
Consider, for example, how frequent Internet use impacts the brain in
terms of that dopamine hit. You want more and more stimulation. e brain
seeking stimulation like that looks very mu like the ADHD brain. We
don’t have enough information, yet, to determine whether tenology can
cause ADHD. However, there is enough information to suggest that further
study is required.
Of more immediate importance, perhaps, is that resear does indicate
that people who do have an ADHD diagnosis are at greater risk of
developing an Internet addiction. Pediatric neurologist Martin L. Kutser
reports that someone with an ADHD diagnosis has a 25 percent risk of
developing an addiction to the Internet. In fact, studies indicate that there
are differences in the ADHD brain that naturally make addictive behavior
more likely. Of course, this includes addiction to Internet usage.
Furthermore, people with ADHD already have a difficult time focusing,
and the Internet provides ample opportunity for continuous distraction.
Specifically, people with addiction tend to have reduced activity in the
prefrontal brain regions, whi is also lower among people with ADHD.
Even people with terrific focus find Internet multitasking to be very
tempting. e ADHD brain has a very low tolerance for routine; it gets
bored quily. erefore, it’s especially prone to finding new things to do
online.
Video games, in particular, can become addictive, because constantly
anging games offer consistent opportunities for novel stimulation. ADHD
is a condition that relates to aention, but remember that the brain has
different kinds of aention. Top-down aention is voluntary; it’s when we
actively make ourselves focus on something. at’s very hard for the ADHD
brain. en there’s the aention that just grabs us, activating our more
primal instincts that look out for movement and other sensory stimuli. e
ADHD brain has no problem with that kind of aention, so a ild with
ADHD may be able to spend hours on a video game despite aention issues
they experience when engaging with more analog activities.

I  A S D

Autism spectrum disorders (ASD), including Asperger’s, also place people
—particularly ildren with the condition—at a greater risk of Internet
addiction. Autism manifests in many different ways, and there are also
related conditions, including sensory processing disorder, that we are still
learning more and more about ea day. However, to simplify things, there
are two basic issues that people with ASD have
 1. trouble with communication and social interaction including allenges
with nonverbal communication, understanding social cues, sharing
emotions with others, and forming strong relationships;
2. a narrow range of interests and/or behaviors including repetitive
moments, intense focus on just a few passionate subjects, and
decreased sensitivity to certain stimuli.

Laura James, writing in Odd Girl Out, shares more about how people on
the autism spectrum oen have special interests. Not only are they
pleasurable but special interests also help provide a sense of identity and
self-esteem for many people with ASD. In some cases, the special interest
becomes an obsession, where they tend toward destructiveness. e Internet
can become part of this destructiveness. James shares that this was the case
for her when two major political elections became the subject of her special
interest. She couldn’t tear herself away from the news, and she
supplemented it 24/7 with Twier and Facebook updates, causing a variety
of problems in her life. She decided to take a Twelve Steps approa—one
minute at a time—to get herself off of political social media. To clarify, she
developed the obsession as part of her autism—it was her special interest—
but the obsessive destructiveness was facilitated by the constant availability
of information from various Internet annels. She developed an addiction
to the Internet as a result of her desire to find information about her special
interest.
Furthermore, specific Internet activities can themselves become objects of
special interests; someone can become passionately interested in a specific
video game or a specific website, for example. Kevin Roberts reports that in
treating ildren on the spectrum, he has found particularly high levels of
addiction to video games. Not only do the kids with ASD tend to play more
than others but they also seem to get mu more physically involved with
the game than the average players. Heavy breathing, jerking legs, and body
gyrations are all common among the kids whom he sees.
is isn’t to say that Internet use is all bad when it comes to people with
ASD. In fact, mu about the Internet is actually helpful for people with
ASD, whi can complicate things, and whi we’ll explore more in Chapter
9. On the one hand, it can be good for them, and on the other hand, it could
make them more prone to an Internet addiction.
In a glance at the good stuff, one example is that people with nonverbal
forms of autism may be able to communicate through the use of
tenological devices that provide them with a voice. Even people with ASD
who are verbal may find it allenging to communicate well with others.
e opportunity to respond in writing online, and taking the time to do so,
helps facilitate socialization for some people. However, it is sometimes used
as an alternative, rather than an adjunct, to communication and
socialization. In other words, sometimes people on the autism spectrum
avoid real-life situations because they are uncomfortable. is means that
they don’t get the practice necessary to improve in-person communication,
thus reinforcing the awkwardness and leading to increased isolation. is is
a particular risk for ildren on the spectrum. So, the Internet can be helpful
or harmful, but this is definitely an at-risk population.

M M  V

Anyone who has experienced trauma is at risk of Internet addiction.
Trauma is oen correlated with overactivity in the amygdala, whi affects
dopamine levels, and as we know, that can lead to increased likelihood of
Internet addiction. People in the military have oen experienced trauma,
and therefore, they are at risk.
In particular, military veterans oen find themselves addicted to video
games, especially violent ones. ere is one famous, unfortunate case, of a
veteran named Aaron Alexis. He was a video gamer addicted to Call of
Duty, whi is a violent shooting game. He would play for upwards of
sixteen hours ea day, oen sacrificing sleep in order to play. He became
delusional, went out into the real world, and killed twelve people.
Of course, most veterans won’t go shoot people in civilian life. Most
won’t even become delusional despite prolonged, addictive play. However,
their experiences with firearms, plus the trauma that affects their brain
emistry, can make shooter games especially appealing to this population.
While first person shooter games aren’t quite as addictive as massive
multiplayer online role-playing games (MMORPGs), they do have addictive
properties that people can fall prey to. e military has been actively
studying Internet and gaming addiction in recent years, and it’s an area
worthy of further study.

S I I

Author Johann Hari did a TED talk in whi he says, “e opposite of
addiction is connection.” Addiction feeds on loneliness and isolation.
erefore, anyone who experiences social isolation for any reason at all can
be at risk of addiction in general. In fact, there is a well-known study called
Rat Park that clearly demonstrates that isolation leads to addiction.
is study built upon earlier studies into drug addiction. In the earlier
studies, rats were placed in solitary confinement inside of boxes where they
couldn’t see or tou other rats. ey were never let out of their cages, and
they had very lile stimulation from their human caregivers. e rats were
able to press a lever that would inject them with drugs. e initial studies
found that the rats would regularly dose themselves, consuming large
amounts of heroin, cocaine, and other drugs. At the time, the information
was used to suggest that rats, and by extension humans, just love drugs and
can’t help themselves.
However, a group of researers at Simon Fraser University decided to
test this theory, in what became known as Rat Park. ey created a
relatively normal environment for the rats, one where they could live
together, socializing and enjoying a variety of activities. It was called Rat
Park because they had playground-like toys to play with, plus they had ea
other. Many variations were made to the situation during the resear, but
basically, the social rats were compared to those in solitary confinement.
Regardless of the other variables, the social rats always consumed far fewer
drugs than those who were loed up alone. When given the opportunity to
interact with others, they apparently didn’t feel the need for the drugs. Put
the other way, rats in isolation numbed out with drugs, because they felt
lonely or bored or both.
is is just one study that has shown that social isolation increases risk of
addiction in general. e Internet offers faux social connection plus ongoing
distraction, making it a rily potential source for addiction. And there are
so many people that this can impact, people who feel socially isolated for so
many different reasons. Illness that leaves people homebound, old age, living
in a rural community, or simply not fiing in can all lead people to feel like
they are alone.
As we saw earlier in the book, loneliness is also a symptom or side effect
of Internet addiction. So, it’s another of those Cat-22, ien-and-egg
problems. People who are already socially isolated are more likely to
develop an addiction, and the addiction itself can increase the feeling of
loneliness. e more you use your devices to reduce loneliness, the less you
feel comfortable socializing in the real world; the more you turn to the
Internet, the lonelier you actually feel. It is self-reinforcing. e Internet
becomes a coping meanism.
For example, Kevin Roberts describes a client who had a gaming
addiction. He intended to quit, and he made every effort to do so, in large
part by going out into the world to socialize. However, going out into the
world triggered his social anxiety, making him feel even more isolated even
though he was tenically out with others. He would get overwhelmed, go
home, and turn to his gaming addiction to soothe that anxiety.

M H  S U I

People living with mental health issues may be at increased risk of
Internet addiction for a variety of reasons. e aforementioned social
isolation is one cause, because despite increased awareness, there is still
mu stigma associated with many of these conditions. Another big factor is
the interplay of brain emistry with addictive tendencies. Ea condition,
and ea person with that condition, has different specific brain emistry
issues to consider. However, generally speaking, any mental health issue can
make someone more prone to Internet addiction. We’ll discuss this in more
depth in Chapter 8, on comorbidity.
One specific diagnosis of particular concern worth mentioning here is that
of sizoid disorder. is is a type of personality disorder, whi is
aracterized in part by emotional detament and a strong desire to be
alone. is drive toward low socialization increases the potential araction
of the Internet. e resear into this connection is still very new. However,
one study from California State University (CSU) Dominguez Hills has
shown a direct correlation between sizoid personality disorder and high
levels of media use. e correlation is particularly strong in younger people.
Another type of mental health issue worth discussing here is that of
substance use. Anyone who has an active addiction to drugs or alcohol is at
greater risk of developing other addictions including Internet addiction.
Moreover, people who are in recovery for substance addiction are at
particularly high risk of developing Internet addiction.
Niolas Kardaras shares in his introduction to the book Glow Kids that
he’s a recovering addict. He notes that despite being in recovery for many
years and being an expert in this field, he finds it increasingly difficult to
maintain a healthy relationship with his own smartphone. Since tenology
triggers the same responses in the brain as drugs, it is especially important
for addicts in recovery to be vigilant about the impact that their Internet use
may have. People who are in recovery for behavioral addictions (e.g.,
compulsive gambling) are also more at risk of developing Internet addiction.
Put simply, some people are just more predisposed to addiction than other
people are. ey crave that dopamine hit more than the rest of us. erefore,
even though a person is in recovery doesn’t mean that they lose that
craving. Instead, they learn coping meanisms to fight the craving. is can
sometimes lead to cross-addiction, whi is substituting one addiction for
another. Someone with an addiction history certainly doesn’t look at the
Internet and think it will have the same effects as the drug. Nevertheless,
Internet use might creep up as part of a recovery coping meanism. It’s
another, safer—or at least legal—way to get a similar feeling.
S T T M M  P S 
A
In addition to all of the risk factors cited in this apter, here are some
specific traits that might increase the risk of Internet addiction:

Desire for escape

Disorganization and la of conscientiousness
Emotional volatility and mood swings
Family history of addiction
High need for novelty
Identity crisis or instability
Impulsive behavior
Introversion
Limited range of coping skills
Low self-esteem
Negative situations in life
Problems with aention span
Problems with anger and aggression
Risk-taking behavior
Social deviance
Stress and/or trauma

Anytime that we talk about risk factors, we also have to talk about
protective factors. In other words, someone may have a lot of traits that
make them susceptible to an Internet addiction, but if they have enough
protective factors, then they might be less likely to develop that addiction.
Protective factors for Internet addiction include high-quality family and
friend relationships, maintaining active engagement with non-Internet
hobbies and activities, and intentionally placing limitations on the duration
of Internet use.
P II

Issues and Controversies

C 7

Treatment Options

Internet addiction is a problem. It exists on a spectrum, and many of us find

ourselves exhibiting some symptoms on that spectrum today even though
we don’t have a true addiction. And, of course, there are the extreme cases
of Internet addiction at the other end of the spectrum: the people whose
lives are ruined because of their Internet activities. People at different parts
of the spectrum may find that different treatments are most effective.
Luily, there are a variety of treatment options available to help deal with
Internet addiction.
Because Internet addiction is new in our society, these treatment options
are relatively new. In some cases, they’re old methods (like talk therapy)
adapted to the new condition. Either way, they’re controversial. Some
people swear by one and don’t believe in the others. Others don’t believe
that Internet addiction is a problem requiring treatment at all. Despite the
controversy, what’s true is that there are some people out there struggling
with what they perceive to be an Internet addiction, and there are different
treatment options that may or may not help those individuals.
H R
In the world of addiction, there are two primary treatment paths. e first
is total abstinence. is is oen used in treating drug addiction, where the
goal is to stop using the drug immediately, entirely, and forever. e second
path is harm reduction. is is common in treating food addiction, where
the goal would obviously not be to never eat food again but instead to
develop a healthy relationship with eating, reducing harm caused by food
consumption.
Since we live in a constantly connected world, it doesn’t make sense to
aim for Internet abstinence. Aer all, what would happen if you went to
your sool or job and told them that you could no longer use computers?
erefore, the Internet addiction treatment goal instead is harm reduction.
e idea is to learn to use Internet devices in intentional, limited ways for
the person’s benefit without falling ba into addictive behavior. In some
cases, this may mean abstinence from specific Internet activities, su as
online pornography or video games.
It may also mean abstinence or “detox” for a period of time. Sometimes a
person with an Internet addiction does have to quit all forms of Internet
activity until they have successfully cut ties with their addiction. Only then
can they start to use the Internet again in limited ways that are less
destructive. Although there may be some treatment providers out there that
recommend complete and permanent Internet abstinence for addicts, that
approa is extreme and not well suited to today’s connected society, so all
of the options in this book are harm reduction treatments.

P  R I A T

Where should you go if you want to get help for an Internet addiction?
ere are a wide variety of options. In fact, the options are increasing
rapidly as more and more people recognize the problem of addiction as well
as the general value of disconnecting at times from the Internet. As with any
addiction, there is no one-size-fits-all treatment plan. e approa needs to
be individualized to the client’s specific needs.
A person might need to try several different treatment options before they
find the one that is the perfect mat. Some people find that even if a
specific type of treatment doesn’t “work” (meaning it doesn’t entirely break
the addiction), it can lend value, increasing insight in ways that lead to
reduction in the behaviors. e takeaway is that people with Internet
addiction may need to try several different approaes, but there is no harm
in ones that appear at first to “fail” because they add to the personal growth
process and aid in harm reduction over time.

Rehab Centers
One of the most popular, and most intense, Internet addiction treatment
options is inpatient rehab. ese centers restrict or entirely cut off Internet
connection. is gives the person a ance to completely disconnect in a safe
seing. Many people will go through withdrawal symptoms, developing
intense cravings for Internet use as they try to break their addiction. A rehab
center provides the structure and support that some people need to get
through this allenging part of recovery.
Rehab centers for Internet addiction are modeled on rehab centers for
other types of addiction. Many rehab centers provide counseling to help
people move forward with their lives in healthy ways. Internet addiction
may be masking other emotional and psyological issues. Counselors on-
site are able to help people work through those underlying issues in order to
reduce the likelihood of relapse. Furthermore, they can help clients learn
coping skills that will improve their likelihood of success.
People who go to rehab centers for Internet addiction typically “step
down” when they leave. In other words, they do not just leave the center
and hope for the best. Instead, they transition to outpatient services,
including the help of support groups and individual therapy to aid in the
recovery process. e rehab center jump-starts the process, and then the
follow-up helps support it over time. is is similar to the way that people
leaving drug rehab may go to a sober living house and/or to twelve-step
groups to help keep their sobriety. Rehab provides the place to detox from
the drug, even when the drug is the Internet.
ere are Internet addiction rehab centers all over the world. ey are
particularly common in Asia, especially in China, Japan, Taiwan, and South
Korea. ey are also easy to find in Holland and some other areas in Europe.
It took the United States a lile while to cat up, but these centers are now
increasingly available in the United States as well. Some inpatient rehab
centers are for all different (or many different) types of addiction including
Internet addiction, whereas others are specific to Internet addiction alone. A
few of the most well-known Internet addiction treatment centers in the
United States include the following:

reSTART, whi is the nation’s first recognized Internet addiction

treatment center. ey offer programs for both teens and adults
including step-down programs in later stages of recovery.
e Computer Addiction Treatment Program, whi emphasizes
behavioral and cognitive behavioral treatment for Internet addiction
including, in particular, gaming addiction.
Illinois Institute for Addiction Recovery, whi is a leader in treating
behavioral addictions including Internet addiction. is is a program
for adults although they also offer an outpatient program for teens.
Behavioral Health of the Palm Beaes, Inc., is a Florida-based
addiction treatment center that includes treatment for both substances
and behavioral addictions including Internet addiction.

Rehab centers are a terrific option for many people. However, they have
their drawbas, the biggest of whi is cost. Health insurance may not
cover treatment for Internet addiction. erefore, clients may need to pay
out of poet, and the costs of inpatient care are exorbitant for some
families. Plus, of course, the client has to take time off of work or sool to
aend inpatient care, so it’s not always an ideal oice. It’s usually reserved
for the most severe cases of Internet addiction.
Wilderness Camp/Eco-erapy
Wilderness camps are another popular option that offer some of the same
benefits as rehab centers. ese are therapeutic programs that last several
days or even several weeks. Participants may live outdoors the entire time
(hiking long distances, for example). Alternatively, they may reside in
cabins, spending a majority of their days outdoors but off-line.
In either case, wilderness camps offer a disconnection—or detox—from the
Internet. Furthermore, they tea survival skills, help people to reconnect
with nature, and encourage face-to-face connection with the others in the
group. Typically, these camps offer individual and group therapy to help
individuals resolve their underlying addiction issues.
ere are many good arguments to be made that nature is vital in helping
humans heal, particularly those humans who have been out of tou with
nature (and themselves) due to Internet addiction. ere’s a theory called the
biophilia hypothesis, whi posits that humans have an innate need to seek
out nature and other creatures. We need this. And yet, increasingly, we are
more and more disconnected from nature. And the more disconnected we
become from nature, the more disconnected we become from our inner
selves and our fellow humans.
In fact, la of interaction with nature might cause humans to become
both physically and mentally ill, thereby exacerbating the negative effects of
Internet addiction. Johann Hari reports on resear from the 1970s
conducted at the State Prison of Southern Miigan, whi found that
simply being able to see nature from a cell made prisoners less likely to
become ill. Wilderness camps and eco-therapy help to resolve Internet
addiction by offering the benefits of nature while also eliminating access to
tenology.
One example of this form of treatment is the Pacific est treatment
center, whi uses a treatment model that focuses equally on nature, the
mind-body connection, and the individual’s place within their community.
Among other things, they use horticulture therapy to offer sensory
integration and somatic experiences that serve as intervention for Internet
addiction. ey offer services to adolescents and young adults. Outba
erapeutic Expeditions in Utah and blueFire in Idaho are two more
examples of teen wilderness therapy programs for Internet addiction.

Individual erapy
Of course, not everyone can take the time to enter inpatient treatment in
the form of a rehab center or even a wilderness camp. Individual outpatient
therapy is another very common treatment option. is is the type of
therapy in whi you visit a therapist, usually for one hour weekly, to work
through your issues. ere are many different types of therapists, so it’s
important to look for one who understands addiction generally and Internet
addiction specifically.
Ea therapist will approa treatment in their own way. However, this
type of therapy commonly incorporates behavior modification, grounding,
and mindfulness teniques. Grounding teniques help people to come into
the present moment by focusing on their senses. is is particularly
important for people with extreme addiction who find themselves dealing
with symptoms like psyosis and depersonalization. However, it can be
useful for anyone entering therapy to bring them into the room and help
them focus on the task at hand.
Likewise, mindfulness practice helps bring people into the present
moment. ese teniques can be used outside of the therapy room to help
work through cravings and sit with uncomfortable feelings instead of
turning to the Internet for distraction and numbing. Oentimes the skills
that you learn in the therapy room are what you take with you to actually
resolve the issue. Practicing skills of self-control and emotional regulation in
therapy will help you deal beer with addiction triggers at home.
Behavior modification provides concrete solutions to problems of Internet
addiction. For example, a person who always turns on streaming Internet
television as soon as they come home from work can learn to instead turn
on music. Likewise, someone who immediately pis up their phone when
they wake up in the morning can learn to leave it aside and go for a brisk
walk before starting their day. erefore, it’s common for Internet addiction
therapy to include some form of behavioral therapy su as cognitive
behavioral therapy. erapists may also use other popular interventions and
treatment approaes, su as motivational interviewing, whi helps the
person with addiction gain insight into their problem so that they can work
toward ange.
In some cases, psyotherapeutic treatment is combined with medication.
For example, Kevin Roberts found that many patients see success when they
combine naltrexone (a drug that acts on the brain’s reward system and is a
common treatment for alcoholism) with selective serotonin reuptake
inhibitors for depression treatment. It not only treats the depression but also
helps treat the addiction. As we learn more and more about the way that
Internet use and addiction affect brain emistry, we’ll likely see more and
more medication options for treatment.

Family erapy
Similar to individual therapy, people sometimes also oose couples’
counseling or family therapy to help with Internet addiction. Families are
systems, and when one part of the system isn’t functioning well, it affects
the entire system.
Family therapy can help address underlying issues that may be
contributing to the addiction. People develop addictions for all different
types of reasons. If the family has a history of trauma, then working through
the trauma can help alleviate the need to escape that might motivate
addictive behavior. If the family has a history of addiction, they can look at
that through therapy to help resolve those complex issues and beer
understand how Internet addiction has become a part of their coping
meanism.
Family therapy for Internet addiction can also help ea family member
work through pain and problems resulting from the behavior. For example,
if parents and teens are fighting over Internet use, then family therapy can
help them develop new communication skills and strategies for negotiating
Internet time. Parents with concerns about a ild’s excessive Internet use
can learn new ways of talking to their ild about the addiction.

Group erapy
Group therapy is yet another option for people with an Internet addiction.
It is oen used in combination with individual therapy. For example, a
person might see an individual therapist once a week and also aend group
therapy once a week. Alternatively, they might see an individual therapist
every other week and then have group therapy on the alternate weeks. Of
course, sometimes people aend only group therapy and do not oose an
individual therapy component at all. Or they may aend individual therapy
for a period of time and then swit and aend group therapy (or vice
versa). Different approaes work for different people.
Group therapy offers some of the same benefits as both inpatient rehab
and outpatient individual therapy. e primary benefit is experiencing the
support of other people who are going through the same struggles.
Sometimes addiction makes people feel very alone, as though they are the
only ones in the world with the problem. When the person with addiction
witnesses others going through the same situations, it decreases that sense of
isolation and hopelessness. is can be especially important with Internet
addiction, since Internet use is a mostly solo activity, despite the illusion of
being connected to others. Isolation and loneliness are already a big part of
the problem, so reflection ba from a group can be an especially powerful
part of treatment.
Ironically there are also online support groups for people struggling with
Internet addiction. Typically, these are most helpful for people who struggle
with a very specific online behavior. In other words, these groups won’t help
people who are addicted to use in general since the online group is another
form of Internet use. However, they can be helpful for people with specific
addictions, su as gaming addiction. For example, a woman who lost her
son to suicide related to an addiction to the game EverQuest launed the
support group On-Line Gamers Anonymous (OLGA), whi offers daily
meetings to support people addicted to gaming as well as to help their loved
ones. Kevin Roberts goes far as to argue that “there is something uniquely
healing about using the computer and the Internet for recovery as opposed
to using them as vehicles for indulging an addiction.”
People who are unable or unwilling to access therapy in their
communities may find that online therapy or an online support group is a
next best option. We’ll discuss this further in Chapter 9.

SH  I A

Internet addiction exists on a spectrum. Some people don’t necessarily
feel like they need outside help from therapy. However, they do feel like they
need to make a shi in their own lives. ey want to reduce their Internet
usage because they feel like doing so will improve their quality of life. ere
are many different self-help approaes for people who want to try reducing
Internet usage on their own. Note that people in full-blown addiction may
not find these solutions helpful enough because they la external support.
One solution for that is to join up with a buddy or find a mentor willing to
support you in your efforts, a solution that can be helpful for people in any
stage of Internet addiction.

Digital Diet
e digital diet is one of the most popular forms of self-help treatment for
Internet addiction. It takes different forms. In fact, there seem to be as many
different digital diets as there are different food diets. Some people do
tenology fasts, others restrict their intake, and still others focus on
oosing the “right” usage. In so many ways, the oices mimic popular food
diets, including fasting, selecting specific amounts and types of
consumption, and focusing on nutrition or wellness rather than just quiing
the habit.
Since there are so many different approaes to digital dieting, we won’t
discuss them all in detail. Generally speaking, a digital diet means that you
restrict your intake of Internet media for a period of time, whi might be
short or could be long. Note that a diet is not typically a lifestyle ange. e
digital diet is for people who just want a break from their addictive behavior
but don’t necessarily have any intention of quiing for good.
Here are just a few of the popular approaes to digital dieting:

Annual Digital Fast, whi is comparable to food fasting (similar to the

religious fasts of Ramadan, Ash Wednesday, and Yom Kippur). e
focus isn’t on deprivation but rather the intention to abstain from
tenology in a meaningful way in order to redirect your aention to
spiritual concerns instead of worldly ones.
“Digital Sabbath,” whi is a term coined by Anne Dilensneider for
taking a full day ea week for nonscreen activities.
Elimination Diet, in whi you stop doing all Internet activities and
then slowly add them ba one by one to see whi ones cause
addictive behavior and whi don’t. You try to cut out the addictive
behavior altogether while still enjoying the other activities online.
No Junk Food, meaning that you only engage in specific, productive
online activities su as answering your work email but don’t do
anything else on the Internet.
Screen-Free Week, an annual event that actually started as TV Turnoff
Week ba in 1994 and then became Screen-Free Week in 2010. It’s a
week-long invitation for sools, families, and organizations to turn off
the screens and interact with one another.
Time-Restriction Diet, whi is similar to counting calories in food. You
can eat whatever you want but only up to a certain calorie amount, or
rather you can consume whatever Internet media you wish but only up
to a certain time limit per day or week.

Regardless of the approa, the general idea of a digital diet is to reduce

(or eliminate) screen usage, replacing that time with low-te or analog
activities, particularly those that include face-to-face interaction with loved
ones and time in nature. Some of the specific features of a digital diet may
include the following:

Choosing to engage with only the most valuable content online

Downgrading Internet services to just the basics
Having in-person conversations about ea thing you see online to
make that content more valuable
Incorporating te-free zones into the home or into specific activities
su as dining
Increasing physical activity including using devices while moving
instead of siing
Only using certain tools, su as Netflix, when you’re with other people
in order to reduce your tendency to stay home alone and engage with
them
Reducing exposure to all content or to specific content
Switing to long-form print reading instead of screen reading
Using only one device at a time (not being on the phone while
wating TV)

Of course, we all know that food diets only work temporarily. You
eventually give up the diet and go ba to your old eating habits. People
oen find themselves regaining the weight that they lost. Certainly, the
same thing can happen with the digital diet. But here’s the difference: the
digital diet gives your brain a ance to relax and daydream and start
working in new ways again. It helps stimulate the neural pathways that you
weren’t activating when you were constantly online. So, a digital diet may
be useful even if you do end up going ba to your old ways. And it may
also help prevent you from going ba to those old ways completely because
of the potential to ange your brain.
You can also use the diet or food analogy to frame your Internet use in a
broader way. Most people agree (even if they don’t follow it themselves) that
a healthy food diet is one that consists primarily of certain healthy foods
while allowing minimal exceptions for junk food. Likewise, a healthy
Internet life might consist of engaging mostly in certain activities with
limited exceptions for those that pose a higher risk of addiction. In neither
case, food or Internet, should you overindulge too oen because doing so
causes health risks.

Rebooting
Rebooting is another self-help approa, ironically named aer the
computer itself (powering down for a time). e idea is that you disconnect
for a period of time using that time to reconnect with yourself, others, and
nature. en you slowly reintegrate the activities that you want in your
online life. is can be similar to a digital diet, particularly the Elimination
Diet, but it involves a lile bit more of a lifestyle ange.
A diet is something that you do, but rebooting is really more about the
relationship that you have with yourself as well as with your tenology. If
you were to reboot, or rekindle, romance with your partner, then it could
lead to long-lasting ange. at’s one of the benefits of the reboot mind-set.
Daniel Sieberg suggests a four-step process for rebooting your
relationship with tenology:

1. Rethink, during whi time you simply notice your Internet usage,
assessing it for problem areas and gaining insight into your online
experience.
2. Reboot, whi is the period of disconnection from all Internet activities.
3. Reconnect, whi means that you slowly, steadily, start reintroducing
tenology in small ways, staying aware of the impact on your mental
well-being.
4. Revitalize, whi means that you prioritize human connect over
Internet usage in an ongoing fashion.

Similarly, Cal Newport offers a two-pronged approa to a digital

decluer:
 1. Take a break from all optional tenologies for one full month. If you
have to engage with specific tenologies (e.g., work email or texting
your ild about piup and drop-off times), then that’s okay, but work
really hard to eliminate as mu as possible for this month-long period.
Use the time wisely to (re)discover those analog activities that make
your life meaningful.
2. Aer the month is up, start to slowly and intentionally reintroduce the
tenologies ba into your life. Always ask yourself, “Does bringing
this tool ba into my life support something that I value deeply?” If it
does, then ask yourself, “Is this tenology the best way to support that
value?” If something offers value and is the best way to get that value,
let it ba into your life. Otherwise, consider your relationship with it
over instead of just rebooted.

Of course, not everyone can completely disconnect from the Internet.

Your job may require some online time. However, during that rethinking
period, you can become aware of the minimum amount of Internet activity
really required as compared to the amount that you do (whi is probably
far higher). Your reboot might mean disconnecting from all Internet
activities except for those that are work related, and you might limit work
activities to specific days and times.

Contemplative Computing
Yet another self-help approa is to learn about and incorporate
contemplative computing practices. is is a mindfulness approa to
tenology. Instead of a diet or reboot, it is about learning an entirely new
way of life. Of course, it could start with a diet or reboot, and in fact, it
almost always starts with some kind of digital elimination. However, the
goal is to entirely shi your relationship with tenology so that you are
using it in the most useful, intentional way possible. is can be the best
long-term solution for many people, since we do live in a world that seems
to require us to use the Internet on a regular basis.
 e term itself—“contemplative computing”—was coined by tenology
forecaster and author Alex Soojung-Kim Pang, who writes about it
extensively in the book The Distraction Addiction. He explains that the
concept incorporates some of the world’s oldest philosophical and religious
teniques for managing your “monkey mind” and focusing your aention.
However, this is combined with the reality of the twenty-first century and
the new scientific information that we have about how humans interact
with computers. Our aention and creativity are shaped and influenced by
the tenology we use; working with that understanding is an important
part of contemplative computing.
Pang says that there are four key principles to contemplative computing,
ea of whi is designed to help you redefine your relationship with
tenology. e first principle is that we can have deep relationships with
our tenology, to the point where it can actually serve us as an extension of
our minds. For example, we no longer need to devote brain space to
memorizing people’s phone numbers, since our tenology does that for us.
is isn’t a bad thing; it’s just a thing, and it can be a good thing if we use it
mindfully. e second principle is awareness that the world is increasingly
distracting but that there are solutions to that distraction. e third and
fourth principles relate to this: we must be contemplative, and in doing so
we have the power to redesign the extended mind. In other words, through
intentional interaction with our computers, we have the ability to make
tenology work for us instead of against us.
Contemplative computing starts with something as simple, and ancient, as
breathing. And although that may sound ridiculous at first, it’s actually
surprisingly important. Did you know that there’s su a thing as “email
apnea”? In sleep apnea, people develop a wide variety of health issues
because of the fact that they aren’t properly breathing while they sleep. In
“email apnea” it’s been found that people have a tendency to hold their
breath, or breathe more shallowly, as they open email. It has to do with the
anticipation of what you’re going to find inside the message, and it likely
happens as we do all different sorts of online activities. Start paying
aention to how mu, and how deeply, you do or don’t breathe as you
engage with your devices.
Of course, “contemplative computing” is just one term (and approa) for
a lifestyle tenology ange. Another example is digital minimalism, whi
is what Cal Newport had in mind with the digital decluer process
described previously. He emphasizes that digital minimalism is “a
philosophy of tenology.” It’s not just a series of tips and has (although
there are approaes that help) but is a way of living. People who embrace
minimalism believe that less is more, and you can apply this to your digital
life. e goal isn’t to eliminate tenology but rather to engage with it in the
most mindful way possible so that it’s always supporting your deepest
values and never detracting from the rest of your life. You mindfully oose
the Internet activities you want in your life and you optimize them as mu
as possible. e thirty-day digital decluer can help you break the addiction,
but it’s the mindful approa to resuming your activity that can help keep
you digitally sober in the long term.
Notably, parents can engage in contemplative computing practices, or
intentional Internet usage, when designing rules for their ildren’s use.
Parents raising ildren today are raising them with devices, oen lots of
them starting at a very young age. We know that young brains are at some
risk of addiction, but we also don’t know the extent of that, and we face the
reality that the devices are going to be a part of their daily lives. erefore,
we don’t have clear answers about what type of content and for how long
ea day is good for kids, bad for kids, or neutral. Parents have to make
those determinations for themselves. Engaging in mindful practices and
paying aention to the effects the experiences have on ildren, thus
implementing some contemplative computer or digital minimalism into
their lives, can be one approa. Anya Kamenetz’s book The Art of Screen
Time is one resource for parents interested in learning more about the pros
and cons of screens for kids and how to engage mindfully with devices in
your own home.
C 8

What Is the Underlying Problem?

One of the most controversial aspects of Internet addiction is the fact that
it’s very hard to differentiate causation from correlation. Causation means
that x causes y; for example, that spending too mu time on the Internet
causes depression. (We don’t know that, but that’s an example of what
would be causation.) Correlation means we can identify that x and y are
linked, but we can’t say that one causes the other; for example, people who
spend more time on the Internet have higher rates of depression, but we
can’t say for sure that one causes the other. Perhaps having depression
makes you more likely to use the Internet, or perhaps there’s some other
variable that makes both things more likely. When it comes to Internet
addiction, there is a lot of difficulty determining cause and effect.
It goes beyond just the ien-and-egg problem that we’ve discussed so
far. at in and of itself makes understanding Internet addiction a very
difficult undertaking. Does the Internet definitely ange the brain, or does a
preexisting neurological difference make some people’s brains more likely to
develop an addiction? More than that, though, we simply can’t account for
all of the different variables that are at play. We can study the brains of
ildren who are engaged with tenology, but we can’t eliminate all of the
other life variables that might be at play in anging their brains.
Life is very different today from two hundred, one hundred, or even
twenty years ago. Tenology, including the tenology at our fingertips
daily, plays a huge role in that. But there are many other issues going on for
people living in society today. From the emicals and plastics in the food
we eat every day to the regular threats of terrorism and mass shootings, we
live with a wide variety of physical and psyological stressors that may
differ from those of previous generations. Perhaps the increase in depression
is linked more to an increase in awareness, and a decrease in stigma, that
allows for more frequent identification. In other words, maybe people aren’t
more depressed; maybe they’re just reporting it more and dealing with it
more publicly. We don’t know. ere are a lot of factors.
Even if we limit the conversation just to the problems of smartphones, can
we say with 100 percent certainty that what’s anging our brains is the
actual tactile individual use of these objects, or could it be a completely
different effect, caused by the electromagnetic energy pulsating in the air all
around us? Our brains are electric, aer all, and surely that electricity in the
air must have some impact on them. Maybe people have more headaes not
because of eye strain from facing those screens all day but because of
electromagnetic sensitivity. Maybe people’s aention spans are shrinking
because of factors that have lile or nothing to do with physically being on
our devices so oen. So even if we blame the phone, it might not be the act
of engaging in behavioral addiction causing all of our physical and mental
health issues. Or it might be. e fact is, we don’t really know.
Of course, legitimate scientific studies do all that they can to account for
all of those other variables. Cal Newport summarizes how psyology
professor and author Jean Twenge found that people born aer 1995 had
significantly higher rates of anxiety, depression, and suicide. She compared
data going ba decades (in some cases as far ba as 1930), and she
accounted for myriad variables “from stressful current events to increased
academic pressure” but found that despite deep investigation into other
causes, the only seeming difference between this generation and the others
was the existence, availability, and use of smartphones and social media.
is is one example of how established researers have done deep dives
into other possible explanations and continued to find enough support to
believe that even though there are other factors at play, the prevalent use of
the Internet is responsible for some serious problems facing individuals in
our society today, problems that may lead to widespread addiction.
We can see that there are anges in individuals and in society over time.
Studies show that there’s a correlation with increased Internet usage. ere
might even be a case for causation. However, we’re just beginning to
understand the impact of the Internet, let alone Internet addiction, so it’s
allenging to say for sure exactly what the ramifications are. We can make
very educated guesses, and we can keep researing; keeping the
conversation open and ongoing can help us learn more about the issue.
As we resear Internet addiction, we have to face the fact that we can’t
say for sure that the widespread problems in our society are directly linked
with increased Internet usage, although they likely do have some link. at’s
at the macro level. But what about the micro level? In other words, let’s look
at any one individual who develops an Internet addiction. Can we say for
sure that the addiction causes the problems (or vice versa, that specific
things put that person at risk and caused the addiction)? Or are we unable to
parse that out? For example, if a person with an Internet addiction also has
social anxiety, can their doctor say for sure that the Internet addiction
caused the social anxiety or, conversely, that the social anxiety made them
turn to the Internet, and then they became addicted?
As with all types of addiction, the truth is probably somewhat murkier
than one or the other. Let’s consider substance addiction, to a very
commonly used (and perhaps misused) drug: caffeine. Imagine that you’ve
had a very restless night. You couldn’t sleep, you tossed and turned, and
when you finally started to dream, the alarm went off. Groggily, you
snoozed a few times, but you needed to get up and get going because you
had to be at work. With glazed eyes and a slight headae, you reaed
immediately for a cup of hot coffee. As the coffee kied in, your headae
subsided, the sleepiness went away, and you embarked on your day. During
the commute, you were irritable with the other passengers. Maybe this is so
normal that you didn’t even notice how grumpy you felt. But if you noticed,
could you say for sure why? Were you irritable because you were still tired,
because you weren’t feeling great, because the caffeine was kiing in and
starting to make you restless, because you hadn’t eaten, or because of some
other factor we haven’t even considered? If you’d had three cups of coffee
instead of one, would you have felt differently? Once we look at something
as seemingly innocuous as coffee, we realize just how hard it is to define
addiction and how mu harder it is to separate cause and effect.
Consider, first: is this really an addiction to coffee? Arguably, even if you
insist on having your daily coffee, find it hard to stop even if you want to,
and develop withdrawal symptoms (like headaes) when you don’t have it,
it’s still not an addiction if it’s not causing problems in your work, in your
financial and social life, or to your health. Most daily coffee drinkers do not
consider it to be a problem and wouldn’t consider it an addiction. Plenty of
reports indicate that it might even be healthy to have coffee every day. But
is it affecting your sleep? Maybe the reason you tossed and turned the night
before was because you had too mu caffeine in your system that day. Is it
affecting your relationships if you’re so irritable every morning? ese are
subtle things. ey certainly don’t rise to the level of harm that we see in
most types of drug addiction. But it goes to highlight that it’s hard to define
what an addiction is.
And it’s even tougher to determine cause and effect. Were you tired
because your system was already off from caffeine the day before, or did
you need caffeine because you were tired? Were you grumpy because the
caffeine hadn’t kied in or because it had or because of some unrelated
issue? What was the cause and effect? If you removed the drug entirely,
would there still be a problem? And that’s where we can get ba to the
Internet. If someone has an Internet addiction, and you remove all access to
the Internet (whi, of course, is a allenge in and of itself in today’s
society), would there still be a problem? Would society as a whole still have
these huge sweeping issues of decreased empathy and increased aention
deficits? Would the individual still have those problems, or would they
resolve themselves? If the Internet addict had never been exposed to the
Internet, would there still be an issue? Does it maer, given that the Internet
is a reality of today’s world and there aren’t going to be many people who
have never been exposed to it?
We know two things for sure: addictions existed long before the Internet
and so did most, if not all, of the problematic symptoms that we associated
with Internet addiction. So, the person with an addiction to Internet
pornography may be a twenty-first-century aracter, but people have been
addicted to pornography since long before the Internet existed. e person
with a pornography addiction may have similar symptoms of depression
and feeling numb to interaction with real live humans, whether that
addiction is to Internet porn or old-fashioned erotic literature.
e argument on one hand is that these problems have always existed and
that the Internet is just one more way to facilitate them. e argument on
the other hand is that the speed and expanse of the Internet has exacerbated
those existing problems, perhaps creating a new level of addiction if not an
entirely new type of addiction.
Consider this: in her book about the benefits of reading aloud, author
Meghan Cox Gurdon reports on fascinating resear from Dr. John Huon
at Cincinnati Children’s Hospital working to understand how young
ildren’s brains react differently to hearing a story read aloud with no
visuals as compared to with still images (e.g., those in a print book) and
animated images (e.g., those on a screen). What they found was that in very
young ildren’s brains, there were five key areas that were most engaged
when they heard a story read aloud and looked at still images—this perfect
combination of auditory and visual stimulation along with the need to
employ some imagination had the best effect in growing ildren’s neural
networks. e different parts of the brain all linked together. In comparison,
when just hearing a story with no visual images at all, the young ildren
had to work too hard to come up with their own meanings, so while some
parts of the brain were well stimulated, others were not. is applies
specifically to young ildren who haven’t necessarily developed a strong
bank of images for their imagination yet.
 So, what does that have to do with Internet addiction? at’s where the
third scenario becomes very important: what happens to ildren’s brains
when they hear a story while also wating animation, as they do on a
screen? eir brains stop engaging almost at all. e visual part of the brain
is highly stimulated, but it seems completely separated from the rest of the
brain. As the ildren wat the animation, they stop employing any sort of
curiosity or imagination. e higher-order parts of the brain just turn off.
e brain works beer just hearing a story and not seeing anything at all
than it does when hearing a story combined with viewing animated images.
Wating those images turns the rest of the brain off.
Obviously, this has huge implications for the dangers of screen time for
young ildren. Gurdon makes a great case for replacing, or at least
supplementing, young ildren’s screen time with reading aloud with kids.
But this also has important implications for Internet addiction for people of
any age. It highlights the fact that our brains act differently when engaging
with screen tenology than they do with other types of media. Can you
become addicted to reading books? Sure, possibly; they’re a great escape, but
you aren’t going to develop the same kind of addiction to them as you are to
online reading with all of its hyperlinked text, moving animation, and other
forms of distraction.
If we completely removed the Internet from our society, there would be
people who got addicted to the same types of content that addicts them
online. But it wouldn’t be as easy. e addiction might not go so deep. And
there would likely be mitigating factors that would help keep that addiction
in e. People had shopping addictions years ago, but they had to
physically go to the store, spend their cash, and face the cashiers (who oen
knew them and their families personally). is not only meant natural
restrictions on the behavior itself (aer all, who wants to hit the same store
three times in a week when that judgmental clerk is going to be there
again?) but also incorporated some protective factors. For example, if you
were shopping because you were depressed or lonely, going out to engage
with the world was part of what helped.
 en came the Home Shopping Network and catalogs and the ability to
order anything you wanted on the phone. It became easier to engage in
addictive shopping behavior, because the clerk on the other end of the phone
was anonymous and you were anonymous to them. Plus, you didn’t have to
leave the house. You could impulsively shop more easily because there were
less barriers to making your purases. And there were less protections; you
weren’t engaging directly face-to-face with people anymore to help soothe
the underlying issues that made you want to shop. And today, of course, we
can easily shop online at any minute of any day without ever engaging in
even voice contact with another human being. We can get same-day
delivery and, in some instances, don’t even need to be home to deal with the
other human delivering the paage. If we suddenly removed online
shopping from our society, some people would still have a shopping
addiction and new people would still develop it, but it wouldn’t happen as
easily and therefore would likely be less prevalent. Some of the people who
have that addiction might venture out into the face-to-face world to do their
shopping and discover that some of those protective benefits of doing so
help reduce the addiction itself.
Someone who is prone to addiction in general—because of brain
emistry, life circumstances, or (most likely) the intersection of both—can
develop addiction anyway, regardless of access to the Internet. But the
Internet sure makes it easier to develop the addiction and perhaps harder to
break it. So maybe we can’t say whi came first—the problem we’re
masking with addiction or the addiction itself—but we can say with fairly
strong certainty that the Internet complicates things. It likely makes
addiction more prevalent in our society. is correlates with other
widespread issues in our society including serious mental health issues. And
the individual who has an Internet addiction may benefit from learning
whi issue came first, but they don’t necessarily need to know that in order
to start addressing their own problems.

C/D D
 Many of the problematic effects of Internet addiction are mental health
issues. Just like at the societal level, it’s hard to say at the individual level
whi problem came first. Did your teen develop depression because they
were on the Internet too mu? Or did they increasingly turn to the Internet
because they already had symptoms of depression that they were trying to
self-medicate? Does it maer? Even if we can’t tell the cause and the effect,
we can talk about comorbidity and dual diagnosis. In other words, we can
anowledge that both things exist for the individual as serious, likely
related, problems. e teen has depression and Internet addiction, and it
doesn’t necessarily maer if one causes the other because you can treat
them both as serious mental health issues, ones that likely reinforce ea
other, and ea requiring aention and treatment.
When I first started writing this apter, I realized that I wasn’t certain
that I knew the difference between comorbidity and dual diagnosis. is
surprised me. I have a master’s degree in psyological studies. I read
psyology literature regularly. is is a very basic topic of addiction. How
could I not know the difference? But then I started digging in, and I realized
that it’s because there’s a lot of really confusing, conflicting usage of the two
terms (and incidentally, a third term, “co-occurring disorders”). Before I
digress for a second, let me clarify that what we’re basically talking about
here is the existence of two different diagnosable issues in one person—su
as when someone has a diagnosis for both Internet addiction and anxiety.
We’re about to read some conflicting definitions (I promise, the reason for
even geing into this will reveal itself shortly), so just keep in the ba of
your mind that more or less, despite these differences, we mean two separate
mental health issues in one person.
Now, for the digression. Some legitimate, well-recognized sources say that
there is absolutely no difference between these terms. Others say that there’s
a subtle difference between comorbidity and dual diagnosis. But they seem
to disagree vastly on the difference. For example, some sources say that dual
diagnosis refers only to times when a person is diagnosed with both an
addiction and a psyiatric illness, whereas others say that a dual diagnosis
can be any two diagnosed issues at the same time including physical health
issues. So, by those laer standards, someone with both diabetes and
depression would have a dual diagnosis, but that same person would not
have a dual diagnosis by the first definition.
e confusion deepens when you try to not just understand the nuances
of dual diagnosis but also separate it out from comorbidity. Let’s go with the
first definition of dual diagnosis given previously: when a person is
diagnosed with both an addiction and a psyiatric illness. Some sources say
that comorbidity is the exact same thing as that. Others say comorbidity is
when a person has both an addiction and a mental health diagnosis but not
necessarily at the same time; in other words, someone has an addiction and
then resolves it but later develops depression. Still others say that
comorbidity means that the person has both an addiction and a mental
health issue at the same time but more specifically that the mental health
issue is directly linked to the addiction (either causing it or worsened by it).
It took me a lile while to parse this out. I dug deeper and deeper to find
increasingly legitimate sources for definitions. And then I realized
something interesting. Although certainly individual people have had two or
more diagnoses at the same time for years upon years, the term “dual
diagnosis” is relatively new. It was really only in the late 1980s that people
started using the term, and they also used the term “co-occurring disorders”
at that time. It was also then that researers began in-depth study into the
relationship between mental health and addiction. ey weren’t any exact
terms in use as the resear developed. It’s not as though there’s a specific
regulating body that says, “We’re going to use this term, only this term, and
only to mean this.” So different researers were using different
terminologies to mean similar things. And we have to consider that this
happened only within the past few decades, whi is right around the time
we started using the Internet. Just when a lot of the resear into dual
diagnosis was becoming mainstream, so were computers in the home. As the
years went on, the resear continued, and so did ever-increasing use of the
Internet to access and spread information. So, it’s lile wonder that we don’t
have a clear-cut definition of comorbidity versus dual diagnosis; there are
many different (legitimate and less so) researers and reporters spreading
those words around without ever agreeing on a definition. e Internet itself
complicates the maer of agreeing on definitions about problems associated
with the Internet.
So, that was the digression into why the terms aren’t so clear-cut and
why that maers. But now we’ll get ba to the meat of the maer, whi is
that it is very common for someone with an Internet addiction to also have
one or more other mental health issues. As we saw earlier in this book,
depression and anxiety are particularly prevalent among people with
Internet addiction. We could debate endlessly whi one caused, or
exacerbated, the other, but when it comes to treatment, it’s not all that
important. What’s important is that the individual has two (or more) serious
issues that rise to the level of a diagnosis and therefore require intervention
and treatment. If your ild has violent aggressive outbursts when their
phone is taken away and also has su terrible social anxiety that they’ve
stopped going to sool, it doesn’t really maer mu whether the phone
addiction caused the anxiety or the anxiety caused them to cling to the
phone; what maers is that they have both issues and you must treat them
both as serious.
One of the problems that arise, though, is the complexity of trying to treat
someone with a dual diagnosis. (Note that for the rest of this book, we’re
going to use the terms “dual diagnosis,” “comorbidity,” and “co-occurring
disorders” interangeably to refer to someone who has both an addiction—
specifically an Internet addiction since that’s the topic of this book—and
another mental health diagnosis.) As we saw in the previous apter, there
are many different treatment options for Internet addiction. Naturally, there
are also many different treatment options for ea second mental health
diagnosis. And so, of course, there are going to be many different ways of
approaing treatment for someone who has co-occurring disorders.
e best treatment option for dual diagnosis clients is something that the
addiction community has been debating since the community first started
using the term. Generally speaking, you can either treat one problem first or
treat both problems simultaneously. For example, if someone has both
addiction and depression, you might first treat the addiction and then deal
with the depression. Alternatively, the individual may work simultaneously
with multiple professionals to treat both the addiction and the depression at
the same time. ere are good arguments to be made for either approa.
What works best for one individual may not work well for another.
Consider, for example, someone who is so far immersed in active
addiction that all they can think about is their next fix. Every single thing
that they do all day long is geared toward geing that fix. ey also have a
history of an eating disorder. But the doctor can’t tell right now if they’re
not eating because of the eating disorder or if they’re not eating because
their priority is geing the drug. In su a case, it might make sense to treat
the addiction first, in order to alleviate the symptoms related to just that
issue so as to make the best determination about what treatment, if any, is
necessary to help with the eating disorder. Removing the complicating
factors of the addiction helps the doctor beer see what the real issue is as
far as the eating disorder. On the other hand, if the person’s eating disorder
is so bad that they are on the verge of death because of la of nutrients,
then it would make sense to treat both issues at the same time, encouraging
healthier eating habits while also dealing with the addiction.
People with a dual diagnosis who go to inpatient rehab oen deal with
both issues simultaneously, although there may first be a short period of
detox that focuses on geing the person unhooked from their addictive
substance. People who go to outpatient therapy may first deal with their
addiction and then their other issue or may deal with both at the same time,
depending greatly on whi professionals they’re working with, what
they’ve told those professionals, and how serious ea of the issues is.
Treatment may also ange over time as one or both of the conditions
start to resolve. For example, think about someone who has both an Internet
addiction and an anxiety disorder. Working to quit the addictive behavior
may temporarily cause the person to be even more anxious than usual. In
the long term, the Internet use may be making the anxiety worse, but in the
immediate moment, it can feel like it helps reduce anxiety. Trying to quit,
and going through withdrawal, may worsen the anxiety in the moment,
even though quiing in the long term could help resolve anxiety issues.
erefore, in the short term, when withdrawal symptoms from the Internet
are at their worst and anxiety is at its peak, the individual may benefit from
antianxiety medications. ey take the medication to deal with the anxiety
while working through the Internet addiction. When the addiction is
resolved, they may oose to address their anxiety in new ways, su as
through cognitive behavioral therapy, and opt to wean off their medication.
ey may, or may not, find that this causes a relapse in Internet addiction.
When dealing with a dual diagnosis, treatment is complicated, but it isn’t
impossible.
In fact, treating one issue oen goes a long way toward helping resolve
the other. For example, someone who treats their Internet addiction with
wilderness therapy may find that the treatment helps reduce their symptoms
of depression. Maybe geing off of the Internet helps, maybe it’s being in
nature, maybe it’s being with all of the people in the group, and likely it’s a
combination of all of these things. In any case, even if the depression existed
prior to the Internet addiction, treating the addiction may help treat the
depression. e most important thing with dual diagnosis is recognizing
both issues as serious and working with professionals who understand both
conditions.
People can have a dual diagnosis of Internet addiction and just about any
other mental health issue. Anyone with a mental health issue could
potentially develop an Internet addiction. Ea individual is unique, and
what they may or may not fall prey to is unique. at said, resear
indicates that anxiety and depression are the two most common types of
disorders that are dual-diagnosed with Internet addiction. Of course, they’re
also the two most common disorders diagnosed in general, so it makes sense
that their numbers are also high for dual diagnosis. Studies indicate that
there’s also a correlation, and a high likelihood of dual diagnosis, for people
with Internet addiction and the following issues:

Aggression disorders including conduct disorder and oppositional-

defiant disorder
All mood disorders, not just limited to major depression
 Aention deficit hyperactivity disorder (ADHD) including adult-onset
ADHD
Personality disorders, su as borderline personality disorder and
sizoid personality disorder, although further resear is necessary in
this area
Sizophrenia and/or dissociative conditions
Sleep disorders, as discussed previously in this book
Specific forms of anxiety including social phobia and obsessive
compulsive disorder

People with an Internet addiction are also more likely to receive a

diagnosis of another substance use disorder. ey are more likely to develop
addiction to nicotine and alcohol, as well as to other substances. A 2010
study by Case Western Reserve University Sool of Medicine found that
teens sending more than 120 texts per day were twice as likely to have tried
drinking and 40 percent more likely to have used illegal drugs. Teens
engaging in three or more hours of social media per day were 84 percent
more likely to have used illegal drugs.
ere is some debate about whether or not having an Internet addiction
and a substance addiction is truly dual diagnosis. If Internet addiction looks
the same in the brain as cocaine addiction, then does a person addicted to
both the Internet and cocaine have one diagnosis or two? Regardless of
whi side of that debate you land on, the resear indicates that Internet
addiction correlates with higher likelihood of other addictions.
Of course, if you have one type of Internet addiction, you’re also more
likely to develop a second type. For example, if you have an addiction to
surfing the web generally, you might also develop a specific addiction to a
particular type of content su as online auctions or catfishing. If you have a
gaming addiction, then you’re more likely than someone who doesn’t to
develop an addiction to social media or Internet pornography. In fact, Kevin
Roberts reports that 90 percent of the people who come to him and receive a
diagnosis of online gaming addiction also have a second diagnosis, most
commonly autism spectrum disorders, ADHD, or depression.
 e more time that you spend online, the more likely you are to engage in
more than one addictive behavior online. at’s not a dual diagnosis, per se,
but it’s worth being aware of. If you have a gaming addiction, don’t think
that you’re safe just because you stop gaming; you likely have to monitor all
of your other online uses as well. When reSTART launed as a treatment
center for Internet addiction, it aempted to include both women and men
in the program together. However, they quily found that people in
recovery for Internet addiction were at great risk of developing sex
addiction, made more problematic by coed programs.
is brings us to one final aspect of this exploration into the underlying
problem of Internet addiction, whi is the question of whether this
addiction might sometimes be used as a “healthier” addiction to replace
something that’s more damaging. If someone has a drug addiction that’s
ruining their lives because of the financial and legal consequences of that
addiction, and they replace that addiction with an Internet addiction, then is
the Internet addiction truly a problem? e underlying issue, whatever is
causing the tendency to addiction in the first place, might still be there. But
if the person’s Internet addiction is comparatively harmless, then is it really
so bad? Of course, in order to qualify as an addiction, it has to do some
harm to the individual. But if their work performance suffers slightly, yet is
so mu beer than it was when the person had a drug addiction, then is it
truly a problem?
e answer is highly individual. It goes ba to the concept of harm
reduction. Someone who has another addiction, including one to substances,
is more at risk of developing an Internet addiction. People who are in
recovery may find themselves staying away from their usual drug of oice
and turning to the Internet instead. Complete abstinence from all addictive
substances and behaviors may be ideal, but it may not be possible. Some
people might argue that for them it’s not even ideal. ey don’t mind having
an addiction; they just want to mitigate the harm. If so, then turning to the
Internet, even if that behavior becomes addictive, might not be so bad. But
do consider the risks. Someone with an addiction who replaces their
substance with the Internet but doesn’t resolve the underlying issues related
to addiction more generally may find themselves slipping further and
further into their new addiction. It may become more harmful. It may lead
to a relapse of the initial drug of oice. It may even become a annel to
access that drug, through addiction to the Dark Net, for example. So, on the
one hand, harm reduction certainly says that the Internet addiction may be
healthier than the substance addiction, but it still recognizes that there are
potential risks involved. e individual should be aware of those risks as
they work toward recovery and mitigating harm. Once again, it doesn’t
really maer if the drug addiction or the Internet addiction came first if one
or both of them start to ruin your life.
We saw early on in this book that there are many ways to define Internet
addiction. We’ve worked out a basic definition that clinicians can use or that
we can look at to self-diagnose if there’s a problem. More or less, that works.
However, it’s worth noting that one of the major reasons that it’s difficult to
diagnose an Internet addiction is because we as a society have no scale for
what “normal” use might be. If we can’t figure out what’s relatively normal
or “okay,” then we can’t easily discern what’s abnormal or troubling. Is it
normal or okay to spend an hour per day on social media? What about five
hours? e tenology is so insidious and the anges are happening so
rapidly that we as a society haven’t figured out what’s normal. Do you think
it would be normal for a person to lose eleven years of their life to handheld
devices alone, not even including their computers, televisions, and gaming
consoles? at probably (hopefully) doesn’t sound normal to you, and yet,
Meghan Cox Gurdon cites resear from tenology writer Adam Alter that
shows that based on current average usage rates, that’s exactly what the
average, “normal” person is doing. ey’re spending eleven years on their
cell phones and tablets, years that could be spent on something else. Is that
addiction?
Are we all becoming a lile bit addicted? In his book iDisorder, Larry
Rosen makes a detailed argument about how the average person in society is
manifesting many of the symptoms of various mental health issues as a
direct result of the relationship they have with their phone. In other words,
even if your Internet use doesn’t rise to the level of addiction, and even if
you don’t meet all the criteria of a second diagnosis, you may find that
increasing Internet use has caused you to develop many of the symptoms of
a second diagnosis, su as depression or a personality disorder. For
example, you might not be truly addicted to the Internet or have a
narcissistic personality, but with increasing Internet use, you may develop
some of the less-than-pleasant symptoms of narcissism. One of the
symptoms is la of empathy; the more you use Tinder for instant
gratification hookups or tweet angry, thoughtless responses to people’s
comments, the more you may start to exhibit signs of laing empathy. Are
you diagnosable? No. But is it of concern? Perhaps.
C 9

But Aren’t ere Benefits to the Internet?

is is a book about Internet addiction. It’s about the most problematic uses
of the tenology we love today. It’s about the worst-case scenarios.
Naturally, it’s focused on the negatives. But I hope that hasn’t given you the
impression that I hate tenology or I am opposed to it. I’m not. I love
tenology. roughout the year or more that I researed and worked on
this book, I read a lot of terrifying information that suggests that all of us
are becoming increasingly addicted to our devices, and I certainly
questioned my own use regularly, but I didn’t give up my own phone during
that time. I curtailed use here and there, trying to implement some
contemplative computing practices into my own life, as well as to look
experientially at what level of addiction I might have myself. However, I
didn’t quit social media or even give up my phone for a full day. While we
could debate ba and forth about whether or not that oice has to do with
my own potential Internet addiction, the point is that I’m personally happy
to have a cell phone and to spend time on it. I’m not the only one.
Very few people in our society, even those who recognize the widespread
and growing problem of Internet addiction, suggest a return to a pre-
Internet society. First of all, the train has already le the station. We aren’t
going baward, and most likely the Internet and the similar tenologies
that will follow it in the future are here to stay. So, it’s pointless to talk
about geing rid of it altogether. But more than that, there are some really
awesome, wonderful things about the Internet that have made our society
beer. We wouldn’t even know about the effect of tenology (or drugs, or
anything else) on the brain if we didn’t have the computer tenology to do
that resear. And more and more of us can access and understand that
information thanks to the Internet.
ere are people who land on either extreme end of the pros versus cons
of tenology argument. Some people believe that social media, or the
Internet more generally, is leading to the end of the world, the downfall of
humankind, and the destruction of all good things on our planet. Other
people believe that tenology itself can solve anything, that it’s perfectly
fine that our brains are anging because that’s just what happens with
evolution, and that the world is always beer off when we’re connected to
the Internet. Most of us, however, land somewhere in the middle. We like
the Internet and don’t intend to give it up, recognizing the many benefits
that it offers, but we also have a creeping feeling in our guts that we could
be beer using some of those online hours engaged in more socially
proactive, concretely creative behavior.
It’s important to understand that this type of debate has taken place with
every single big tenological ange in our society. In fact, even though
today we all generally agree that long-form book reading has terrific
benefits for almost everyone, there was a lot of controversy about the
potential harms of books. Ba when words first began being put to paper,
there were many critics who said that this would harm oral history and
prevent people from utilizing their memories in the future. In the nineteenth
century, a librarian named Mary A. Bean made a big fuss about the damage
reading could do to ildren because the content in some books could
damage young minds. In the 1960s, some librarians were opposed to the fact
that libraries were beginning to offer multimedia materials like filmstrips
and tape recordings because this was unreliable or fragmented information.
And books aren’t the only tools that have had their critics. From clos to
electric lights, people have always been concerned when new tenology
becomes ubiquitous. e Internet is just another extension of this. One could
argue that this means all of the fear around addiction to it is unnecessary
hype. Alternatively, one could argue that we’ve been progressively anging
our society and our brains with tenology and that this is one step further
in a continuous problem.
ere’s a lot to debate there, but this isn’t the place for it. Let’s assume
that we are all likely to keep using the Internet to some degree. It brings a lot
of benefits to us individually and collectively. We also recognize that for
some people it can become an addiction, and that can be a huge problem.
Within that context, let’s talk about the times and ways in whi the
benefits of the Internet balance out or even outweigh the problems
associated with addiction to it. To do that, we need to look specifically at the
mental health benefits of Internet usage.

B   I  A S D

Let’s start by going ba to a topic that we already toued on briefly: the
use of the Internet by people on the autism spectrum, particularly those who
have nonverbal autism. Tenology has the potential to offer people with
this disorder the ability to communicate with others around them. is
opens up a whole new world, not just online, but in their everyday
relationships.
Meghan Cox Gurdon offers a great example of this in her book, sharing
the story of an autistic boy named Gabe. His parents had tried reading aloud
to him when he was young but mistakenly believed that he didn’t enjoy the
experience, so they stopped doing so. Over the years he became, in his own
words, addicted to screens. A professional in his life recognized the potential
in that and introduced a type of screen interaction that would allow Gabe to
begin communicating with his parents through the tenology. ey
discovered that they had misunderstood his cues for all of those years and
that he was actually enjoying interaction with them mu more than they
had thought. ey began to read aloud to him again. He is quoted as saying
that although he is addicted to screens, he would rather hear someone read
aloud to him all day every day if that were possible than be on the devices.
e tenology facilitated his ability to communicate the ways in whi his
family could beer connect with him. If it weren’t for the screens, they
might never have learned that, so even if it’s true that he is “addicted” to
screen tenology (his own word), for that family, the benefits outweighed
the harms.
People on the autism spectrum, whether verbal or not, have trouble with
communication. ey may not pi up on social cues, and this can cause a
lot of awkward, uncomfortable interaction. Resear suggests that social
media can provide a helpful medium for practicing communication. In fact,
a 2017 study completed at Yale University found that teens with ASD
reported beer quality friendships when they utilized social media to aid in
communication. e study further found that although teens with ASD did
experience some level of anxiety related to that online communication, the
benefits of communicating with others via social media outweighed the
drawbas of the anxiety.
e same was not true for teens without ASD, suggesting that there’s a
particular benefit to this medium for people with autism. Perhaps the
medium of social media levels the playing field a lile bit. In-person
communication requires reading a lot of nonverbal cues, trying to
understand subtleties in voice and inflection so as to pi up on sarcasm,
irony, and so forth. ere simply aren’t as many of those cues online.
erefore, all people online are navigating the triy world of trying to
understand one another without those cues. For people without autism,
that’s a drawba; it’s oen what leads to miscommunication online that
can result in breakups, arguments, and so forth. However, for people with
ASD who already experience that disadvantage in communication, it’s just
par for the course. If people with ASD, particularly ildren and teens, can
work with others su as parents and counselors to discuss those nuances,
then online communication can enhance their relationships. If a teen on the
spectrum uses social media to connect with friends and also has
conversations with parents who help them to understand what a particular
online interaction might mean from the other person’s point of view, then
they get the benefit of learning more about communication while on that
even playing field with the other person.
Social media, texting, and other online communication also give the
person with ASD the opportunity to take the time that they need to respond.
Although these mediums feel very immediate, they do allow for a pause in
the way that in-person conversations sometimes la. Particularly in groups,
people with ASD may find themselves standing on the sidelines as the
conversation flies ba and forth, whereas online they can interject more
easily when they are ready to do so. Being able to communicate with the
same people both online and in person gives those people the ance to
beer understand the person with ASD, making them more likely to engage
positively with them when they’re in the real world.
e benefits don’t just apply to teens with ASD. Adults on the spectrum
also seem to benefit from moderate social media use. One study published in
the journal Cyberpsychology, Behavior, and Social Networking found that
adults with ASD who used Facebook in moderation were happier than those
who did not. Notably, they didn’t find a happiness increase when those same
adults used Twier, so more resear is necessary to determine the subtleties
of when and how social media can help people with ASD, but signs do
indicate that there are a lot of potential positives.
e Internet is also the perfect place for people with autism to explore
their special interests. We saw in an earlier apter how that can become
problematic when it leads to addiction that feels destructive to the person.
However, it can also be a positive. e individual gets very passionate about
their special interests, but the people in their own lives may not have the
patience or willingness to continuously listen to in-depth information about
obscure topics. Even the well-intentioned neurotypical parent or friend may
get tired of listening to the intricate details of different types of trains or the
eating habits of dinosaurs. e Internet provides an opportunity to meet
other people who are also deeply interested in these particular topics.
 Special interests are not just a minor hobby to the person with ASD. ey
can be a way that the person self-soothes, keeping them functioning in their
lives particularly during times of high stress. e individual may find that
exploring their special interests helps them feel grounded, restores energy,
and improves their ability to handle allenging situations. Of course, the
individual can explore a special interest on their own. ey can use the
Internet to do so. But connecting with others in a social way to share that
special interest can provide a particularly positive level of relational
interaction that adds additional mental health benefits. e Internet provides
a place to make su connections.
Finding people who share the same interests, or the same struggles, as you
do is one of the key benefits of the Internet. Resear indicates that families
with ildren on the autism spectrum benefit from this in that they can use
the Internet to connect to the autism community. People in their everyday
lives might not understand all that they are going through and therefore
aren’t always able to offer enough support, understanding, or advice. Going
online to connect with others through social media allows parents and other
family members to get that support. Support for caregivers in not to be
underestimated. Caregivers of all kinds (not just those dealing with ASD
issues) suffer a lot of stress and can end up in poor mental health as a result.
Finding communities to help them can be hugely protective. Increasingly,
those communities are accessible online.

B  P W F I

When I did an informal poll of the people I’m connected to online, the
vast majority said that the reason that they love social media is because it
allows them to feel connected to others who are similar to them. Finding the
communities that can support you offers huge benefits, no maer who you
are and what you are struggling with. People feel isolated or “different” for a
vast array of different reasons. Being able to go online to connect with
others who understand them, express similar views, and offer support can be
hugely beneficial. It can’t replace in-person connection, and the risk of
addiction can lead people to use it as a replacement in a way that’s harmful,
but it’s also beer than nothing, so the person who doesn’t feel like they can
connect with others in real life is beer off connecting online than not
connecting at all.
ere are many people who are limited in their real-life connections
because they are housebound or have limited social activity due to mental
and/or physical health issues. If you literally can’t leave your house because
you are physically unable to do so, then having an online community can
serve as a lifeline to protect your mental health. Likewise, if you have
limited access to a diverse community of people who understand you (e.g.,
you live in a very small, isolated town), then finding people who do respect
and empathize with you can be a lifesaver, despite the fact that those people
may “only” exist online.
Ba in 2012, I authored a book called Crochet Saved My Life, in whi I
interviewed about two dozen women about the health benefits of craing.
One of those women, Marinke, expressed that croet had helped her as she
coped with depression and social anxiety related in part to her experiences
as someone on the autism spectrum. Over the next few years, she connected
with a large number of people online, sharing the beauty of the cra of
croet. She began to design croet paerns, particularly colorful mandalas,
and she even published a book of her work. Sadly, aer a few years of doing
well, depression came ba, and she died by suicide. When that happened, I
felt real, strong grief despite the fact that I “only” knew her through online
communication. I launed a project in her honor, Mandalas for Marinke,
through whi hundreds of people contributed croeted mandalas, mostly
using Marinke’s designs, to raise awareness about depression and suicide.
Many, many of those people expressed how deeply affected they were by her
death. ey didn’t know her “in person,” but she had played a very real role
in their lives, blogging and using social media to share not just her love of
craing but also her allenges with mental health. In this instance, many
people felt real grief, whi is, of course, the risk that you take when
engaging in serious relationships. e community also came together online
to honor her and support ea other through that grief. is is just one
example out of so many showing how the relationships that people form
online are genuine, authentic, and deep. For all the shallow interactions that
form the negative side of online life, there are also these very meaningful
relationships. For anyone suffering from social isolation for any reason at all,
those relationships can’t be underestimated.
People can feel isolated because they are literally housebound. ey may
feel isolated because a mental health disorder, including ASD, separates
them from others due to communication problems, differences in
understanding one another, and so forth. Or they may be different in a way
that causes people in the real world to bully and judge them—someone who
is very overweight, someone who is transgendered, someone who is
“different” and unfortunately lives in a place where difference is not
accepted. Any of these things can drastically impact the person’s mental
well-being, and the Internet has the potential to provide a safe space for that
person to get through those allenges. It’s not always a safe space, as we’ve
seen. And even when it is, there’s the risk of becoming so comfortable in
that space that the individual opts out of the real world, limiting themselves
in ways that are unhealthy. It’s not either-or; the Internet has risks but can
also provide massive benefits particularly for people who are suffering in
real life. at benefit is not to be underestimated even as we consider the
risks. is potential to go either way is what makes understanding Internet
addiction su a complex issue.

B  O G

As we discussed previously, one of the most-studied forms of Internet
addiction is addiction to online gaming. It comes with a lot of risks. But it,
too, has another side. ere are benefits, including social benefits and mental
health benefits, to online gaming. Even though it poses su a great risk of
Internet addiction, it’s not all bad and may at times be a good thing.
Massively multiplayer online role-playing games (MMORPGs), su as
World of Warcraft, have the most potential for addiction. But they also have
the ability to tea players important life skills and give them the
opportunity to practice them. ose skills include working together with
others as a team; planning ahead and adapting to anges in a narrative or
situation; engaging in real-time communication (whi is oen voice
communication); improving skills in reading, problem-solving, and math;
and developing fine motor skills as well as hand-eye coordination.
Resear published in the January 2014 issue of American Psychologist
found overwhelming potential benefit in four key areas of life: cognitive,
motivational, emotional, and social. ey emphasize that many of the key
benefits of gaming for ildren in particular come from the fact that gaming
is a type of play and that ildren engage in play to work through many of
their emotional allenges in life. When ildren go to therapy, for example,
they don’t sit and talk to a therapist like an adult might. Instead, they play
games, whi is how they express themselves and problem solve, especially
when they don’t have the words to explain what they’re going through.
While there are certainly differences between online gaming and playing tag
or soccer with your real-life friends, the authors of this resear argue that
many of the benefits of play can be found in online game play just like they
are in real life.
In addition to the benefits of play, they found that gaming offers other
widespread benefits. For example, they found that people who play shooter
games have improved aention allocation as well as beer spatial skills. is
may correlate with long-term success in science, math, and tenology.
Notably, they agree that Internet use and gaming ange the brain, whi is
one of the biggest issues in addiction, but they argue that those brain
anges aren’t necessarily a bad thing. ese games may ange the brain in
ways that improve performance and ability over time. at said, they noted
that different games have different benefits; games that weren’t shooter
games didn’t ange the brain in these same potentially beneficial ways.
Another benefit of some games is a self-esteem boost that they offer.
MMORPG, in particular, may offer self-esteem benefits for some players.
Games are set up to offer continuous rewards. e addictive side of that is
the dopamine hit it gives, but it also provides positive reinforcement, whi
can help boost feelings of good self-esteem. is is magnified when team
members also provide positive reinforcement. Seing and meeting goals in a
game can make the player feel more competent. Geing peer support
enhances that. Since negative self-esteem correlates with many mental
health problems, including but certainly not limited to eating disorders,
activities that boost self-esteem can be an important protective factor.
Speaking of feeling competent, let’s talk about Self-Determination eory.
is is a theory in psyology that presents a framework for understanding
human motivation. is theory argues that people are motivated by both
extrinsic and intrinsic rewards and that the three key rewards in motivation
are competence, autonomy, and relatedness. When these three things are
present, people are more motivated, whi also makes them feel beer
mentally and socially, persist through allenges, and experience
improvements in both performance and creativity. When people la any of
these three motivations, they experience negative mental health
consequences. We’ve already seen one way in whi gaming can foster
competence. A 2006 paper on the topic argues that gaming can also foster
autonomy (in that you can make a lot of independent decisions in the game)
as well as relatedness through teamwork. us, gaming has the potential to
offer great levels of motivation, whi in turn can lead to improved mental
health. at said, it’s important to note that the same paper found that
people who play the games obsessively are less likely to reap these rewards,
so when game play heads toward addiction, the costs may outweigh the
benefits.
However, we have to be careful when making assumptions about those
costs and benefits. For example, it’s easy to assume that if you enter a
dissociative state when gaming, then that’s always a bad thing. But a 2010
study published in Culture, Medicine, and Psychiatry found that when
World of Warcraft players get so immersed in their game play as to “induce
dissociative states in whi players aribute dimensions of self and
experience to in-game aracters,” it has the potential to actually benefit the
player’s well-being. Many of the benefits found in this study associated with
being in a flow state, not the least of whi was stress reduction. Ultimately,
they found that whether these immersive states were positive or negative
depended on whether the individual used gaming to reduce stress or gaming
was likely to cause them stress. us, whether gaming specifically, and
Internet use more generally, is negative or positive depends significantly on
the individual. Even what looks like a problem generally may not be
problematic for a specific individual. at’s why it’s helpful to go ba to the
definition of Internet addiction that includes the aspect of causing harm or
negative repercussions in life; constant game play may not be a problem if
it’s not causing harm. For some people, it may even be beneficial.
One interesting area of exploration is the use of video games to assist with
pain management. Immersion in a video game can help reduce or even
eradicate ronic pain. e game SnowWorld, for example, was created
specifically as a nonopioid form of pain management for particular use in
the military and in burn treatment. Gaming releases not just dopamine but
also endorphins that can help protect against pain. People who for any
reason don’t want to utilize a substance su as morphine can sometimes
reap the same pain management benefits from gaming. Of course, that itself
could turn into an addiction, so there are pros and cons, but it can certainly
be a short-term benefit if not one useful in the long term.

A T O

We can’t talk about the potential mental health benefits of the Internet
without talking about the fact that today it is used as a medium for therapy.
People use the Internet to find therapists and to get therapeutic advice.
People also seek social support, whi sometimes looks a lot like group
therapy, through forums, social media, and other aspects of the Internet.
More directly, people can access therapy services with educated and licensed
professionals whom they meet with online. Sometimes online therapy is an
adjunct to in-person therapy; other times people complete their entire
therapeutic experience online only. Online therapy usually takes place over
video to allow for as mu face-to-face communication as possible.
However, it’s also possible to have voice-only therapy, and sometimes people
even get therapy or therapeutic support through text messages and voice
messages. It’s an emerging field, and one that anges rapidly, so we are
only just beginning to understand the pros and cons.
Overall, therapy is a helpful supportive tool for people in many situations,
and online therapy is no exception. Like with all aspects of the Internet, it
seems to provide the most benefit when it is a supplement to, instead of a
replacement for, in-person connection. at said, just like in the cases of
isolation described earlier, online therapy is beer than nothing for people
who can’t access in-person therapy for one reason or another. Online
therapy tends to be low cost (although it may or may not be covered by your
insurance). It makes therapy, particularly more nie forms of therapy,
available to people in small towns and rural areas where they might not be
able to access the same services in person. People who are housebound due
to agoraphobia, paranoia, another mental health issue, or a physical
limitation may find that online therapy is their only viable therapeutic
option. People who travel frequently, or couples who are currently in a long-
distance relationship, may be able to keep therapy appointments more
regularly when online therapy is an option.
Online therapy might be particularly valuable for someone who is in
immediate crisis. When you’re in crisis—feeling suicidal, for example—it’s
critical that you get help immediately. Depending on where you are and
what kind of professional support you already have in place, that help may
or may not be easy to access. For example, if you already have a therapist
whom you see regularly, then you may be able to call that therapist and get
in for an immediate appointment. On the other hand, if you don’t have a
therapist and you aren’t even sure how you would pay for one, trying to get
help in the midst of a mental health crisis can feel almost impossible.
Oentimes people resort to calling a hotline, whi is really a form of online
or phone therapy, and the person there may suggest that they go to the
emergency room for immediate help. While that might be a good solution
for some, it’s not for others. e option of online therapy for crisis situations
becomes a good one. If you need help immediately and a licensed therapist
is on the other end of your computer at any time of day or night, then they
can help you during your crisis.
 Crisis intervention is only one type of therapy. Another type of therapy
that seems to work well in the online world is cognitive behavioral therapy
(CBT). is is a popular type of therapy that helps you beer understand
your thoughts and actions and learn new coping meanisms. It’s been
found to be an effective treatment option for many mental health issues
including anxiety disorders and substance use. Since it is effective for
substance addiction, it has the potential to be beneficial for people struggling
with Internet addiction. Resear so far indicates that there may be no
difference in the success of CBT when received as online therapy versus in
person. Someone may be able to visit an online therapist or one in person
and get the same results when it comes to the benefits of this particular form
of treatment. In comparison, if your personality and mental health issue are
beer treated by something su as somatic therapy or relational therapy,
then you might not benefit from online therapy because you need that in-
person tou and communication style.
Some people find that online therapy is a good “first step” for them when
they’ve never tried therapy before. Going to therapy for the first time can be
intimidating. If you’re coping with social anxiety, or you struggle to let
down your guard with people in person, or you simply aren’t sure whether
or not therapy is right for you, then you might put a toe in the water by
trying out online therapy first. If you have a positive experience, then you
benefit immediately from that and may also decide that you want to go to
in-person therapy as a next step, whi offers additional benefits. If a person
wouldn’t have goen therapy any other way for whatever reason, then
online therapy is a good solution. Whether the benefits outweigh drawbas
for other people is up for debate.

P  C   I  E

One of the arguments commonly made for tenology is that it can be
used by ildren to enhance education. It’s an interactive, educational tool,
aer all (or at least it can be), but according to Niolas Kardaras, “ere is
not one credible resear study that shows that a ild exposed to more
tenology earlier in life has beer educational outcomes than a te-free
kid; while there is some evidence that screen exposed kids may have some
increased paern-recognition abilities, there just isn’t any resear that
shows that they become beer students or beer learners.” is doesn’t
necessarily mean that tenology and the Internet can’t be beneficial to
students; it means that on its own the Internet isn’t an educational tool. It’s
all about how we use it, so anges need to be made to educate ildren (and
their parents and teaers) about ways to utilize the Internet that enhance
their existing skills and improve their educational outcomes rather than
serving as a substitute for other skills.
Consider the scenario of learning language from a dictionary. In the olden
days of the twentieth century, when a ild was reading a book and came
across a word that they didn’t know, the way to find out (other than asking
an adult) was to e out a dictionary. at action is still the same today,
and doing so is mu simpler thanks to at-our-fingertips tenology. ere is
no need to stop reading, sear the house for where the dictionary is, find
the right page, and read the word. But, while it’s more convenient to do a
qui online sear on your phone for the meaning of a word, is it as
effective? e entire process of finding the word in the dictionary may lend
itself beer to actually remembering the meaning of the word that you learn
than the qui look-it-up Internet option. When you look up a word on the
Internet, or ask Siri for the definition, you see what it means and then
quily move on to something else, and usually that word falls out of your
memory. e tangible multistep action (and the more dedicated intent to
learn) that comes with looking the word up in your desktop print dictionary
can help to solidify the meaning of that word in your memory.
Does this mean that you can’t learn language through reading and
looking up the words that you don’t know in an Internet dictionary? Of
course not. What it means is that we have to be more intentional about our
actions, noticing that this is a word we want to learn and taking the extra
steps to learn it. is means not just looking up the word on the Internet but
taking the time to write the word down along with its meaning, maybe use
it in a sentence or write out the context in whi we found the word and go
ba to it again to keep reminding ourselves of what it means until it’s
loed into our memory. If we use the Internet only as a shortcut, then it
may not offer benefits, but that doesn’t mean it doesn’t have the potential to
be a great thing.
Creating a vocabulary list on your phone and seing a phone reminder to
review it regularly can be just as effective as using index cards to learn new
words. It is all about seing the intention and the behaviors that support
that intention, whether we do that with tenology or not. It’s just that in
today’s Internet-dominated world, it becomes mu easier to mindlessly
look up the word, see what it means for the moment that you need it, and
promptly forget its meaning moments later. at can happen when looking
up a word in the physical dictionary as well, but the effort put in to find the
word gives you the time and focus to solidify your intention to learn the
word. If you can find ways to slow down your Internet use long enough to
set and meet that intention, then the tenology can serve the same purpose.
Of course, this is just one example of the Internet as it applies to
education. is is really a very broad discussion. It ranges from whether or
not kids should use tenology in the classroom (and if so, how mu of the
time and in what ways) to the potential benefits and drawbas of an
online-only education. If kids are ignoring the teaer because they’re
wating funny memes on their phones during class time, then that’s a
negative, but if the teaer uses a funny meme at the start of a lecture to
capture the kids’ aention, then it can be a positive. If a ild drops out of
sool because of bullying, then aending an online-only program might be
the best option, but if a ild never has to face the outside world because
they’re able to do their entire education online, then that could be
problematic. Like many aspects of the conversation around where we’re
going with tenology as a society, this is a huge topic that we can’t fully
address here.
One issue that’s specifically relevant to mental health is the growing
problem of aention disorders. Children who are exposed to a lot of screen
time, and certainly those ildren who develop a full-blown addiction to the
Internet, seem to have problems with aention that relate to those anges
in the brain discussed in previous apters. Many of the teaers I’ve spoken
to say that in their own experience, aention levels have decreased
dramatically in recent years and they believe that tenology is at least
partially to blame. If ildren aren’t able to pay aention in a classroom,
then they aren’t able to learn as well. But if tenology can be utilized in
positive ways in the classroom, then perhaps it can mitigate some of that
harm. It’s a controversy that our society is still in the early stages of sorting
out.

C  I H S  P  I

A?
e Internet is here to stay (at least until tenology advances again and
replaces itself with something else). So, one course of action is to utilize the
power of our tenology for good. We can use the Internet itself to help
mitigate the negatives of Internet use. Perhaps we can even use the Internet
to resolve Internet addiction.
In terms of minimizing harm, there are numerous apps and tools now
available to help people who are concerned about overusing the Internet. At
a very basic level, we can easily resear the problem of Internet addiction
and come to find solutions, as well as peer support and perhaps even
professional support, through the Internet itself. If you think that you or
someone you love might have a problem with Internet addiction, one of the
first things that you might do is head to Google or ask Alexa to tell you
more about Internet addiction. is is one of the simplest ways in whi the
Internet itself can help bale the problems of using the Internet.
Once you determine that either you have an addiction or you want to
limit your Internet use so as to reduce the risk of developing an addiction,
you can implement a variety of safeguards. In the earlier apter on
treatment options for Internet addiction, we saw that a harm reduction
approa means that most people are going to use the Internet to some
degree but will limit that use in various ways. ey will reduce their use to
specific tools, limit their time on devices, or do both of those things. Our
tenology now comes with built-in tools and easy-to-download apps to
help facilitate that self-limitation. (Parents can also use those same tools to
limit ildren.)
When Apple released the iOS 12 update for its devices, it came with a new
feature called Screen Time. is means that anyone who has an up-to-date
iPhone, iPad, or other Apple device can not only see how mu time they’re
on the device but also easily limit themselves based on that information.
Screen Time allows you to see the following:

How many minutes you’ve spent on your phone today and across the
past seven days
What time of day you were using those minutes (so you know what
else you were doing at the time)
How many minutes were spent on different applications su as
messaging, a particular game, and Facebook
How many times you pied up your phone and what application you
first used upon piing it up
How many notifications you received, the average per hour, and whi
apps sent you those notifications
Whether that’s an increase or decrease in your usage compared to the
prior week

is gives you a lot of information that can help you see what features of
your device might be addictive for you personally. You can alter the seings
to include all of your devices or just one. Moreover, you can use the app to
sedule “downtime” (time when you don’t want the screen to work) as well
as time limits for ea app and specific content/privacy restrictions. So, if
you see that you overuse Facebook, especially at luntime, you can put a
limit on your daily Facebook use and also sedule downtime at luntime
to make sure you aren’t using up your limit then. You can easily turn these
things on and off. If you have a full-blown addiction, that ease is a problem
because you can quily resume your problematic use. But if you’re in the
early stages of problematic use, tools like this can help you regain control
over your Internet use so that it’s working for you instead of against you.
is built-in iPhone app is just one of many examples. ere are many
similar apps available to monitor and limit use of your phones, tablets, and
computers. ere are also many other types of apps and soware programs
that have the potential to help limit online distractions so that you can reap
the benefits of the Internet without engaging in the more addictive
properties. For example, you can look for Zenware, whi is a category of
soware that helps restrict usage during certain activities. One great
example is WriteRoom, whi blos out your whole screen so that all you
see is the text that you’re writing (green text on a bla baground that
harkens ba to the early days of computer tenology), allowing you to
focus on deep thought and writing without any of the tempting distractions
of other tabs and windows. Similarly, Ommwriter turns off email and at
notifications and also allows you to oose one of three calming
bagrounds that were specifically osen by a color therapist to allow for
relaxation.
e Internet has the potential to cause addiction for some people. But it
also has a lot of benefits, and the Internet itself can provide solutions to
addiction. One of the scariest things about Internet addiction is that the
tenology has advanced so quily that we are anging our daily
behaviors, and potentially our brains, in the blink of an eye. But one of the
most amazing things is that as fast as we’re seeing problems, we’re using
both tenology and the connectivity to others that the Internet allows to
identify and resolve those problems.
C 10

What Are the Implications of New and

Emerging Tenologies?

e first iPhone launed in 2007. Prior to that, some people had

smartphones. BlaBerry was the most common brand, and it had its own
potential for addiction (the term “CraBerry” was bandied about). But it
wasn’t until aer the laun of the iPhone that we began to really see
everyone around us using them all of the time. In terms of global history, the
Internet is young, and smartphones and social media are even younger. And
yet, new tenologies are emerging every day. ings that we are only just
starting to see right now—like self-driving cars and lifelike smart robots—are
going to be ubiquitous before we know it. ere will also be other
tenologies that perhaps we can’t even fathom right now. What are the
implications of these new and emerging tenologies for Internet addiction?
We can only guess.
ere are so many different new and emerging tenologies. A short list
includes artificial intelligence (AI), augmented and virtual reality, biometrics
and implanted ip tenology, bloain, cryptocurrency, Dark Net sites,
drones, edge computing (a variation of cloud computing), improved haptic
response, robots (including sex robots), self-driving vehicles, smart home
tenologies, targeted advertising, voice assistants (Alexa and Siri), and 3D
printing. We can imagine so many different scenarios in whi ea of these
things might help or hinder problems of Internet addiction. For example, if it
becomes the norm that we implant tenology directly into our bodies, how
is that going to affect the brain, and can we do something with that
tenology to maximize the benefits without leading to more addiction? is
isn’t the realm of science fiction; it’s tenology that’s emerging here and
now. at said, for all of our guesses, we can’t say for sure where any of this
is going, yet. For the purposes of this book, we’ll explore only two particular
aspects of this new and emerging tenology: augmented and virtual reality
and AI.

A  V R

We are right on the cusp of a huge ange in tenology thanks to
developments in virtual reality, and we’ve already seen some of that when it
comes to augmented reality. Augmented reality is when you view the real
world through a screen and see something on the screen that isn’t there in
real life. Virtual reality is when you look only at a screen (usually through
glasses or headsets) and immerse yourself entirely into the world there,
sometimes with additional sensory input from haptics to make it feel even
more like you’re in that world.
We’ll discuss augmented reality first. Not that long ago, some friends
visited here from out of town with their three ildren, all under the age of
twelve. San Francisco is a fascinating city, with not only ri history and
aritecture but also really fun, colorful aracters and activities. I was
curious what the kids were enjoying most about this fabulous city that they
were visiting for the first time. e five-year-old barely glanced up from his
screen as he answered, “ere are so many Pokemon here.” Pokemon Go was
one of the first augmented reality games to really hit the mainstream and
start a craze. In this game, you look at the real world through your phone
screen, and various lile Pokemon creatures pop up on the screen. You have
to navigate around the real world to find and collect them. On the plus side,
the kid was out in the real world, moving his body around and avoiding
some of the negatives associated with a sedentary life. On the other hand, he
didn’t seem to see this ri city around him because he was narrowly
focused on finding the Pokemon.
e augmented reality game became so popular that psyologists (and
others) almost immediately began questioning whether it was a positive or a
negative for mental health. On the positive side, people were moving around
in the fresh air, whi reduced depression and anxiety. In some cases, it
encouraged social engagement with people in the real world, whi was a
further benefit. Plus, it had some of the benefits of gaming su as the
feeling of competence when aieving a new goal by cating a new
Pokemon. On the other hand, if you’re engaging with your phone instead of
the people around you, then you’re risking some of those same problems
(loneliness that begets depression, etc.). Plus, you run the risk of addiction,
and if you get addicted to the game, then there are more negatives than
positives. Fiy-two-year-old Dominic Rushe shared in an article in the
Guardian about a time when he ignored warnings to evacuate an area and
risked his life in a lightning storm because he wanted to capture a Pokemon
in a particular area. is sounds ridiculous, but reports indicate that there
was a spike in distracted driving accidents right aer the laun of Pokemon
Go; people were paying aention to the augmented reality instead of the
actual reality of the road. If you’re risking your real-world physical health
and safety, then you’re dealing with addiction. If augmented reality helps
you engage with the real world, that’s a benefit; if it helps you escape the
real world even when you’re out in it, then that’s a risk.
Virtual reality takes you completely out of the physical world, immersing
you into the virtual world. It looks and feels like you’re in a completely
different place. If you’re in virtual reality and it looks like a hole opens up in
front of you, in the real life you will jump ba because it feels real.
You can be a completely different person in virtual reality. e same
problems that we see when it comes to prolonged Internet use may get
exacerbated with virtual reality. For example, consider the rare but
problematic issue of psyosis among people with Internet addiction.
Prolonged gaming, in particular, can lead to a break with reality where the
person doesn’t know that they aren’t in the game anymore. Virtual reality
allows games to become even more realistic, whi can increase the
potential for confusing the brain as to what’s real and what’s not, thereby
risking the problem of increased likelihood of psyosis.
Highly immersive tenology increases the risks of our existing
tenology. e more immersive the tenologies get, not only the more
potential harms but also the more potential benefits. Consider when
augmented and/or virtual reality becomes a regular part of social media
experiences. A highly immersive social media interaction with peers and
support groups might greatly enhance their benefits, offering more of the
positives associated with “real life” experiences while also negating some of
the problems that the limitations of social media currently incur. If you feel
like you’re “really there” with people, then perhaps you’ll feel more empathy
online instead of less (as is oen the case today). On the other hand, if you
use virtual reality to create an avatar that’s not anything like yourself, you
risk greater self-dislike, more problems with your own identity, and
increased likelihood of falling into catfishing behavior.
Likewise, consider the implications of virtual reality when it comes to
pornography. If online porn is addictive, then virtual reality porn has the
potential to be even more addictive. It stimulates more of the brain. If you
would rather engage in virtual porn with a stranger than spend time with
your partner, then that’s likely to cause significant problems in your
relationship. In contrast, though, if virtual reality pornography can be made
to incorporate some sense of “real person” feedba that makes you feel like
you’re actually interacting with another human and have to be sensitive to
their needs and feelings, then there’s the potential that it could reduce some
of the numbing sensation that online pornography today seems to cause. It
could go either way, and only time will tell whi way it’s going to go. How
it plays out will also vary from person to person.
 Like with most aspects of the Internet, augmented reality and virtual
reality both have the potential for either good or harm. One benefit, for
example, is that some people may actually develop beer self-esteem when
playing with an avatar that looks beer than they do in real life. is is
counterintuitive and may not be true for all people, because there’s always
the risk that you won’t be satisfied with your real life self and therefore have
higher risk of addiction since you’re more comfortable in the game.
However, Pang reports that Jeremy Bailenson of VR Lab has done some
convincing studies that people playing with beer-looking avatars have
beer self-esteem even when they are not playing the game.
Augmented and virtual reality may have naturally protective benefits that
help to reduce problems with addiction. ey may also have built-in features
that increase the likelihood of addiction. How that plays out from person to
person, and across society as a whole, is something yet to be seen. Because
we know about the potential harms of Internet addiction, we as a society
have the ability to look forward to these new tenologies with a wiser eye
and hopefully design them and utilize them in ways that are more positive.
One important thing to note as a potential positive is the role that
augmented and virtual reality can play in mental health treatment. Virtual
reality offers sensory feedba and allows you to deeply immerse yourself
into experiences that feel very real but that you also know aren’t real. is
combination of features makes it helpful in certain types of mental health
care. Resear indicates that it can be particularly effective when used in
therapy for people with posraumatic stress disorder (PTSD). It’s also been
shown to have positive outcomes for people dealing with phobias, social
anxiety, and certain types of paranoia.
Some mental health issues just don’t respond that well to traditional talk
therapy. Trauma, including PTSD, is one of the biggest ones. Many people
find that it’s not helpful to talk about the traumatic experience. At worst, it
can trigger negative reminders that make the symptoms of trauma even
worse. Even when it’s not harmful, though, it’s not particularly helpful.
at’s why PTSD is oen treated with alternative therapies including animal
therapy and somatic therapy. Virtual reality can also be helpful. It’s been
used specifically with military veterans who suffer from PTSD. ey use
immersive virtual reality to return to the war zone where they can
physically work through the situations that caused the trauma in the first
place. While at first glance you might think that would be more
traumatizing, resear indicates that many veterans find it helpful—being
able to control the situation in a new way through virtual reality while in
the company and supportive care of a therapist helps them to heal.
People with anxiety, including phobias, can also benefit from virtual
reality. One of the most effective treatment for phobias (and one also used
for obsessive compulsive disorder [OCD]) is exposure and response
prevention. In this treatment, the therapist exposes you to the things that
trigger your fear, and you prevent yourself from engaging in the negative
response. For example, if you have a fear of spiders, the therapist might have
you hold a spider, and you work to breathe through the fear instead of
running away. Virtual reality provides a way to offer more immersive
exposure experiences while also placing the individual at less actual risk.
Someone can work on their fear of spiders or heights without having to
actually hold a spider or climb up on a ledge. People who have social
anxiety can practice being with others and communicating in a virtual
seing that feels very real. Of course, the goal of this therapy would be to
eventually translate that to the outside world; if the individual is limited
only to virtual relationships, then the problem isn’t resolved. But it can be a
huge stepping stone in therapy.
And we’re just beginning to scrat the surface as to how virtual reality
might help in the therapy room. For example, some very early resear
indicates that it can help in concrete ways with symptoms of depression.
One of the problems in depression is that you lose interest in things and feel
numb; a therapist might help you through virtual reality by exposing you to
immersive experiences that reignite some of your interests again. If you feel
more excited about things again, then you can start to do more, whi
means that you can start engaging in treatments that further help you
resolve your depression. But this is all new. We don’t know yet how it will
all play out. Virtual reality could help resolve some types of depression, but
it could also cause depression in the same way that existing forms of
Internet addiction seem to cause depression for some people. Consider, for
example, if your depression is linked with loneliness. If you use virtual
reality to connect with others in meaningful ways, then it could ease your
symptoms, but if you use virtual reality to escape and not deal with the
problem, then it could exacerbate your symptoms.
One way that people might benefit mentally from virtual reality is
through the use of immersive meditation experiences. Mindfulness practice
is increasingly popular as a treatment for a variety of mental health issues.
It’s allenging for some people to sit still and practice mindfulness on their
own, so guided meditation is a great way to get started. If you’re siing in
your room trying to do guided meditation through an app, then there are a
lot of potential distractions. If, on the other hand, you’re immersed in a
virtual world that’s guiding you into meditation, then that could be a
benefit. erapists are working on ways that they can incorporate
mindfulness, de-stressing, and centering/grounding practices into their
therapy through virtual reality.
Limbix and Psious are just two of many virtual reality companies that
focus specifically on creating tools for therapists to utilize in their sessions.
ey both have products that offer entryways into mindfulness and
breathing practice. ey also have tools to help with various types of anxiety
and phobias. For example, they both offer their own versions of a virtual
reality bar scenario in whi you can learn to overcome social anxiety by
practicing siing at the bar and speaking with people. Some of the other
specific anxiety-provoking situations they offer include taking an exam,
geing a shot from a needle, and flying on an airplane. People who have
serious anxiety could work through that fear in therapy. And we can
imagine that these tools could also help the average person without serious
mental health issues, like the ild who might be flying for the first time or
afraid to go to the doctor and get that shot.
Virtual reality isn’t just a benefit in the physical therapy room but could
also enhance the benefits of online therapy. One of the biggest limitations of
online therapy is that you’re missing that personal tou of being present
one-on-one with your therapist. If you and your therapist both enter a
virtual reality world together, then you mitigate some of that. Someone who
can’t access therapy due to cost or location can reap the benefits of a face-to-
face talk in a therapy room using virtual reality.
One of the things we looked at in the previous apter was whether the
tenology itself can help resolve the problems of tenology. We can ask
more specifically, is it possible to use augmented and/or virtual reality to
solve Internet addiction? ere is a very promising study published in the
June 2016 issue of Computer Methods and Programs in Biomedicine that
suggests it’s possible. e researers found that virtual reality therapy
could actually improve areas of the brain affected by online gaming
addiction. ey specifically found that use of virtual reality as a form of
therapy helped balance the cortico-striatal-limbic circuit of the brain,
reducing the severity of online gaming addiction. ey compared their
virtual reality method with traditional cognitive behavioral therapy (CBT)
and found that it produced comparable results. In other words, someone
with a gaming addiction could go to traditional CBT, or they could use
virtual reality therapy to resolve the problem of online gaming addiction.
Virtual reality has been found to be a helpful treatment for other types of
addiction as well. ere has been specific resear into the use of virtual
reality therapy for nicotine addiction, and it points to great success. People
in recovery are traditionally at great risk of developing other addictions,
including Internet addiction. If we can figure out a way to utilize virtual
reality during the recovery process as a positive thing instead of a potential
tool for more addiction, then it could turn out to be a great thing. For that to
happen, the makers of the tenology have to have an interest in the positive
use of their tenology, and one strong motivator is the marketplace, so we
as buyers have to put our money toward those more positive uses
particularly when it comes to the new and emerging tenologies su as
augmented and virtual reality.

A I
 We use the term a lot, but what does “artificial intelligence” really mean?
Put very simply, it refers to maines (computers) that respond in ways that
are consistent with how humans respond. A 2018 Brookings report suggests
that AI systems have three key qualities: intentionality, intelligence, and
adaptability. Intentionality means that they can make decisions based on
real-time data without being limited to preprogrammed responses. For
example, autonomous (self-driving) cars have to be able to respond to
whatever happens on the road in the moment. Intelligence means that AI
systems utilize maine learning and data analytics to respond in ways that
consider complex issues su as bias and justice. Adaptability means that the
computer is able to keep on learning, adjusting, and improving upon itself as
conditions ange.
Autonomous vehicles are one example of AI in action today. Here in San
Francisco they’re on the road regularly. I frequently see them waiting at
four-way stops as they seem to be “thinking” about what to do next. ey’re
a lile bit clumsy right now. I imagine that the driver inside has to take over
now and then. But they’re geing beer every day. It causes a lot of
controversy. Some people are terrified of the idea of maines taking over
the planet. Do you want to be in a car that’s driving itself and decides to
take you somewhere that you don’t want to go? Or that gets haed by
someone with bad intentions? (Of course, even the cars we drive ourselves
are computer based today, so it doesn’t have to be a self-driving car to have
haing as a potential risk.) Trusting a car to drive itself may seem a lile
crazy, but is it crazier than trusting all of the other humans on the road?
Especially when most of those humans are now distracted by their devices,
among other distractions? Whether you are for, against, or neutral about
autonomous vehicles, they’re here, and they’re a great example of AI in
society today.
If you can’t quite get a mental grasp on the self-driving car, though,
consider a different type of AI that many people use daily: voice-activated
personal assistants like Alexa and Siri. We say, “Hey, Siri,” and then we ask
the device to answer questions, set timers, or perform calculations. If Alexa
is linked with your home’s other smart tenology, then the options for
what you can ask the device to do open up even more. As these tools keep
learning, they’ll be able to do more and more.
Okay, but how does all of this relate to Internet addiction? Darren Austin,
writing for Business Insider, makes a great argument for how devices like
Alexa have some of the same built-in addictive qualities as other aspects of
the Internet. He uses the hooked model, whi is author Nir Eyal’s
description of how tenology hooks us (remember, we explored this ba in
Chapter 3), to explain how his own behavior with Alexa has some of the
warning signs of addiction. e hooked model starts with a trigger—external
as well as internal. One of the biggest triggers for Internet addiction is a
negative feeling; you want to escape feeling bad, so you engage in the
addictive behavior. Austin noticed that every time he felt the uncomfortable
feeling of uncertainty, he’d quily turn to the reassuring voice of Alexa.
Asking her for the answer relieved the feeling, and asking is the second step
in the hooked model. e easier it is to perform the action, the more
addictive the tenology is likely to become, and asking Alexa is mu
easier than even doing a qui Google sear on your phone.
e next part of the hooked model is that part of addiction that we’re very
familiar with by now—the reward. You get the immediate reward of geing
your answer from Alexa. But Austin points out that it’s more than that.
Sometimes these devices respond in a clever or funny way. at surprises us.
It feels good. It might offer that dopamine hit. It’s not all of the time, so it’s
an intermient reward, and we are primed to love that. And Austin also
points out that sometimes Alexa is wrong—or she doesn’t give us the answer
we want—and that in itself means that geing the right answer from her is
another intermient reward. It’s annoying to say, “Alexa, turn on the room
light” and get no response, but when she finally gets it right, we get the
reward.
And finally, as we know, we are more likely to become addicted to
tenology when we invest time, energy, money, and the like into the
device. With Alexa, you’re constantly teaing her new things. You might
take the time to download a new skill for her to use, or you might let her
know what your favorite restaurant is. As she learns, you’re becoming more
invested, whi makes you more prone to addiction.
For the addict, this could mean preferring Alexa over human interaction.
One blogger, Kathy Goberg, noted that she felt like her husband was more
interested in Alexa than in her, and when she asked what he liked so mu
about her, he basically responded, “She does what I want and doesn’t talk
ba.” We can get instant gratification from our devices without having to
deal with the messy interaction that other humans cause us. at’s one of
the problems of social media, as we know, but at least on some level we
know that somewhere on the other end of the social media app is another
human being. With Alexa, we know no su thing, whi has the potential
to further reduce empathy and increase the problems of social isolation.
Consider as these tenologies come together in the form of very lifelike
robots, including sex robots. Using virtual reality and haptic feedba, you
can begin to feel like your robot is as real as any human. But she’ll respond,
like Alexa, mostly only in the ways that you want. What potential risk does
this create for humans who are already having trouble bonding with others?
We don’t know. e tenological advances that we are just beginning to see
could mitigate some of the problems of Internet addiction, or it could make
them worse. How we proceed individually and as a society could help
determine the difference.
C 11

Whose Responsibility Is It to Resolve Internet

Addiction?

is brings us to the final big controversy in the topic of Internet addiction:
whose problem is it to resolve? If we agree that some forms of tenology
have a risk of Internet addiction and that certain populations are at potential
risk of that addiction, then whose job is it to solve that problem? Like all of
our problems in society, it’s not an easy question to answer. How you feel
about it is affected not only by who you think is most to blame but also by
your views on su things as the role of government in individual lives and
the importance of personal responsibility.
For example, if you believe in limiting government involvement as mu
as possible, then the role of the government in resolving Internet addiction
will be smaller for you than for someone who believes the government
should be involved in handling societal issues. If you believe that addiction
is an individual issue, then you’re more likely to think that addicts and their
parents should resolve the issue than someone who looks at the
intersectionality of the many causes of addiction and finds that perhaps
institutions must play a bigger role. ese are all huge questions, and there
are no simple solutions. But by starting the conversation about the different
roles that various people and organizations can play, we can start to come
up with new ways that we can benefit from the advances in tenology
while mitigating some of the addictive harms.

T R   I

Picture a heroin addict in active addiction. What responsibility does that
person have to take care of their addiction alone? Now imagine that the
heroin addict is only fourteen years old. Does that ange how mu
responsibility you think that person must take as compared to how mu
involvement there should be from parents, sools, and authorities? How
mu should the government offer in terms of support and care to stop the
addiction, and how mu should the person have to be responsible for? As
we know from substance addiction, there’s no easy equation for distributing
“blame” or coming up with a solution. It’s no different with Internet
addiction. We may be tempted to think that the individual should just put
the phone down, but addiction is more complicated than that.
When it comes to individual responsibility for dealing with Internet
addiction, there are two types of individuals: the addicts themselves and
parents of (potential) addicts. Parents are tasked with the huge responsibility
of seing rules around device use in their homes. Children are at greater risk
of addiction than adults because their brains are still developing. But there is
no blueprint for what a parent should do to help their ildren thrive in a
te-dominated society while still avoiding addiction.
And, as author Anya Kamenetz highlights, there is more intersectionality
than you might guess at first. In other words, not all parents are on an even
playing field. A very simple example that she gives is that if you’re an
upper-middle-class parent who pays a nanny a lot of money to engage in
analog activities with your ild, then you have a lot more control over
whether or not they use devices in your absence than does the lower-income
parent who has to ask a neighbor for the favor of wating the kids while
she goes to work. Similarly, if you’re in a two-parent home with an only
ild and one of you is a stay-at-home parent, then perhaps you’re more
likely to be able to provide your ild with nonscreen engagement and
activities than the single, working parent with four ildren who might give
their ildren screens just to get enough quiet in the house to get dinner on
the table. e lower-income or busy working parent is not at fault; it’s
simply a difference that we have to notice in our society. Individuals,
including parents, can and should play a huge role in seing boundaries that
limit the risks of Internet addiction, but we also have to recognize that not
all individuals are in the same circumstances, and so there are varying levels
of ability to be able to set su limits.
And, even when you can set boundaries for yourself and your ildren,
it’s hard to know what those boundaries should be. We are all new at this.
e resear is young, the tenology is anging quily, and we’re just
beginning to get a grasp on what Internet addiction might look like. Perhaps
the best the individual can do is just try.
We can look closely at what kind of relationship we have with our
devices. What do you like about your use? What causes problems? Learn the
signs of addiction, and determine whether or not you see those cropping up
in your own life. As a parent, pay aention to how your ildren act when
they use their devices more as compared to less—or when they experience
certain content as compared with other types of information online. Pay
aention, ask questions, tweak usage, and see what happens. In particular,
be curious, but vigilant, when adding new tenologies to your life. Whether
it’s a new device, a new app, or simply a new feature of one of those things,
take the time to think carefully about it. It’s easier to prevent an addiction
than to interrupt one, so take the time to be thoughtful about how you
incorporate new things into your life. Resear seems to indicate that
balancing screen time with active engagement in real life (including hands-
on activities and in-person relationships) is one simple, effective starting
point.
On the one hand, individuals have a great capacity for controlling their
usage (and to some extent, that of their ildren). On the other hand, beating
yourself up for not being perfect at it doesn’t help the situation. As we
know, bad feelings make us even more likely to turn to addictive behavior.
So, we have to strike a balance here. e individual does have a huge
amount of personal responsibility to take, but there’s also only so mu the
individual can do.

T R  I  G

ere are two big questions that provoke a lot of smaller questions: what
role should the individual play in stopping Internet addiction and what role
should institutions and government agencies play? And these aren’t
necessarily easy to separate. Consider, for example, the role that sools
should play as well as the potential role of the individual teaer. ese are
very different things, and there are no clear-cut answers. But we can at least
ask the questions about what different groups, and individuals within those
groups, can do to be aware of and help prevent or resolve Internet addiction.

Role of Sools
Sools play a huge role today in identifying problems for at-risk ildren
as well as in educating ildren and their parents about risks. ey also have
to grapple with the huge questions of when and how tenology should be
used in the classroom. Different sools are addressing this in different
ways. Kamenetz has identified three common types of classrooms today (in
so far as te goes):

1. e paperless classroom, whi means that the teaer uses tenology

(oen Google Apps for Education) to perform common classroom tasks
from grading papers to marking down behavioral problems. Gone are
the days when the disruptive ild’s name went up on the board with
tally marks to indicate how many minutes of detention they’d get
because all of that happens on computers today. Parents can stay
 connected with daily updates, and both parents and kids can see
homework, grades, and notes online.
2. Rotation stations, whi means that ildren spend part of the day on
devices, oen doing activities at their own pace. When I was in sool,
this was called “going to the computer lab,” and sometimes it still looks
that way, but more oen the ildren are on mobile devices in their
regular classrooms.
3. Distraction derbies, whi are te-enabled classrooms where ildren
spend all or most of the day on their devices engaging in what may be
classwork or may be social media, games, aing, and so forth. ey
may use sool-provided devices, their own devices brought from
home, or a combination of both.

Sools are still figuring out how best to implement tenology in the
classroom, and it can look any of these ways. ere are some great
advantages to te in the classroom. A busy teaer with too many students
can have ea student work at their own pace on their devices while
aending one-on-one to students who have special needs, and they can
perhaps more efficiently identify those needs with computer feedba than
they could when they had to grade every paper by hand. But if ildren are
at risk of Internet addiction, then having more screen time in the classroom
has to be considered a potential risk. What should sools be doing to
mitigate that risk? Should teaers be educated in the warning signs of
Internet addiction, and if they see those signs, what should they do?
So, the question of the role of sools is twofold: (1) how should sools
incorporate tenology in the classroom with an understanding of and
respect for the risks of Internet addiction among ildren and (2) what
responsibility do sools have to identify, prevent, and raise awareness
about Internet addiction. ose are huge questions. And they don’t even
take into consideration the way that the answers might trile down and
affect individuals—not just students but also teaers, principals, and sool
counselors. We don’t have the answers, but it’s important that we are
thinking about these things.
Role of the Media
e 2018 movie Ready Player One depicts a possibly near future in whi
intensity in the virtual world bleeds over into violence in the real world, but
it also speaks to the potential for merging the two worlds in a positive way.
At the end of this film, the hero and heroine take over the virtual world, and
they make the controversial decision to shut off access to that world on
Tuesdays and ursdays. ey do this based on the sage advice of the
game’s creator who has shown them that no maer how amazing virtual
reality gets, it is no comparison to “real reality.” Viewers hear this
announcement as a narrative over a visual of the couple happily cuddling
and kissing in their real world, despite the fact that their virtual avatar
aracters are arguably sexier and more exciting than the flesh-and-blood
selves. is is a great example of how media itself can highlight the pros and
cons of oices in tenology and encourage people of all ages to get off the
screen and out into the real world to experience real kisses, real connections,
and real feelings.
e media can and does highlight the risks of Internet addiction and other
problems associated with tenology. (And, of course, the Internet is itself
“the media.”) Ready Player One is just one example. Another is the
television/Netflix show Black Mirror that depicts a variety of different near-
future scenarios related to problems associated with tenology. Television
and other forms of entertainment make commentary on social issues, and
the topic of Internet addiction is no exception. But what responsibility, if
any, does the media have to help resolve the issue? Given the importance of
free spee, we can’t—and shouldn’t—mandate what messages media should
share. We should, perhaps, make sure that all voices in the debate can be
heard.
Notably, there are limitations on media already. e movie rating system,
for example, prevents (at least theoretically) ildren under a certain age
from viewing specific types of content. ere’s a similar system in place for
gaming content. ese systems are arguably flawed, but they offer one way
that media companies share responsibility for regulating content for
ildren. Could we eventually put a system in place that warns about how
addictive certain content might be? Resear indicates, for example, that
people can become addicted to a game as simple as Tetris, but they are
significantly more likely to become addicted to a game like World of
Warcraft, so could those games have different ratings based not just on
content but also on risk for addiction?
Media also comes with warning labels besides ratings. Television shows
with graphic content warn that “viewer discretion is advised.” Increasingly,
we even see trigger warnings at the start of online articles. Media is leing
people know, “Hey, there’s something here, and you might want to see it,
but you also might want to think twice because it could have a negative
impact on your wellbeing and/or mental health.” e individual gets the
oice, but the media gives them additional information to help them make
that oice. Could the media do something similar with not just the content
but also how the content relates to addiction? “Some people who view this
content regularly find themselves developing Internet addiction. Viewer
discretion is advised.”

Role of Other Businesses

Media companies certainly aren’t the only types of businesses or content
producers that might bear some responsibility for the issue of widespread
Internet addiction. Te companies, for example, play a crucial role in
creating the tools that are leading to the addiction. What role should they
have to play in resolving the problem? Many individuals have come out of
these companies to raise awareness about the issue. If you read widely about
Internet addiction, then you’ll almost certainly come across the name
Tristan Harris. He was a design ethicist at Google who became well known
for a 140+ slide presentation he created in-house called “A Call to Minimize
Distraction & Respect Users’ Aention.” In it, he warned that Google and
other big companies were engaging in behavior that was addicting their
users and that they should take responsibility for that. He went on to laun
the Time Well Spent movement and founded the Center for Humane
Tenology, and he continues to speak about the problem of Internet
addiction, including the risks of emerging tenologies, and the role that the
companies creating this tenology have to play in mitigating the problem.
Part of the mission of the Center for Humane Tenology reads:
We envision a world where Humane Tenology is the default for all tenology products and
services. A combination of new design processes, new goals and metrics, new organizational
structures, and new business models would drastically reduce harmful externalities, actively
supporting our individual and collective well-being.

is organization believes that the te companies have a responsibility to

consider the human behind the devices and that it’s possible to move
forward in su a way that we create new tenologies without utilizing the
“get them hooked” mentality that many companies currently rely upon. is
brings us to the convergence of two different types of business: te
companies and the responsibilities that they have and nonprofit
organizations that have the potential to raise awareness and create ange.
Should we limit te companies in what they can do with their tools? If you
agree with the free market and the rights of innovators, then probably not.
But perhaps we can encourage the organizations, including the nonprofits,
that are doing something about the problem. And this, actually, brings us
ba to the individuals—because ea individual within a company plays a
role and has a voice (even though sometimes it doesn’t feel like it).
Moreover, the individual as a consumer has a lot of power. You can put your
money toward the companies that are encouraging addiction, or you can put
your money toward the companies that want to create a te-enried world
that doesn’t, as Tristan Harris puts it, downgrade humanity.

Role of Government
What role should the government play in raising awareness about
Internet addiction? What about providing funding and support for the
people who do develop addiction? And what role, if any, should the
government play in regulating the most problematic companies that are
aiding in developing addiction? ese are murky waters. Government
regulation is a divisive topic. But asking the questions is a good starting
point.
Author Anya Kamenetz points out something very interesting in her book
The Art of Screen Time. Ba in 1982 (long before smartphones were in our
poets), the National Institutes of Mental Health conducted federally
funded resear called “Television and Behavior” to determine the effects of
those particular screens on our ildren. What’s interesting is that she
highlights that this was “the last major piece of federally funded resear on
ildren and media.” Of course, there has been plenty of other resear done
by various individuals and institutions. But the quality of the resear and
its results is always debatable. Perhaps one starting place for the
government’s role in dealing with Internet addiction would be a federally
funded study that’s more relevant to our daily lives than the one that took
place in 1982. In fact, in 2017, the government started exactly that resear.
e National Institutes of Health launed a two-year study at the
University Study of Connecticut Sool of Medicine to help determine
whether or not Internet addiction is a true disorder. is study looks
specifically at gaming, so it doesn’t fully address the wider spectrum of
Internet addiction risks, but at least it’s a starting point. Arguably, the
government should play some role in funding this type of resear to raise
true awareness about the risks of harm, particularly for our society’s
ildren.
If the government should be involved in funding resear into Internet
addiction, should it also be involved in funding treatment? Of course, this
gets into the triy questions associated with government-funded health
care. When it comes to substance addiction, there are currently several
different ways that the government helps with treatment including through
Medicare/Medicaid, Substance Abuse and Mental Health Services
Administration grants, specific aid for military veterans, and state-funded
addiction treatment centers. Since the government plays a role in funding
treatment for drug and alcohol addiction, should the government also help
fund treatment for Internet addiction?
 Funding is one thing, but what about government regulation? Should the
government have laws related to Internet addiction risks? e government
regulates intake of addictive substances; some (like heroin) are completely
banned, and others (like alcohol) have age and location restrictions. Should
there be similar restrictions on certain Internet content? Despite the
importance of free spee, we do limit certain types of content, and there are
government rules about this. For example, we don’t allow ild pornography
in our society; there are laws against it. But what about how readily ildren
today have access to hard-core pornography featuring adults? ere is some
regulation in place. In 2000, Congress enacted the Children’s Internet
Protection Act, whi helps to limit the “obscene content” ildren can view
at sools and libraries. In order to receive certain funding, those places
must prove that they have an adequate Internet safety policy in place. Can
and should the government go further in helping to protect ildren from
this type of content, or is this as far as the government should get involved?
From a tenology perspective, it would be relatively easy to make it harder
for underage people to access hard-core pornography. Whether or not the
government should be involved in that is a question up for debate.
In fact, all of this is up for debate. is book is just a starting point for
discussion about Internet addiction. We’ve come up with a basic definition
for what Internet addiction is, described the types of content that make
people prone to addiction and why that is the case, examined some of the
most at-risk populations, looked at different types of treatment options, and
reviewed some of the biggest questions and controversies including whether
or not we can truly define it as addiction, how widespread the problem is,
whether the benefits of tenology may outweigh the risks of addiction, and
who might be responsible for helping to resolve the addiction problems that
do arise. You have a lot of information. Now you can take that forward, dig
deeper into your own relationship with tenology, and broaden the
conversation.
P III
C 12

Case Studies

C S 1: S M  T A

Mariah is a thirteen-year-old girl who lives with her mother and sees her
father every other weekend. She’s an outgoing, social girl who sometimes
gets gently reprimanded by her teaers for talking too mu during class.
However, overall her teaers like her a lot, and she’s always done well in
sool. She’s been on an aer-sool soccer team for several years. Recently,
however, she’s geing into more trouble at sool, her grades are slipping,
and she doesn’t want to go to soccer practice. Her parents agree that there’s
a problem, and they’re on the same page about social media and tenology
being a big part of that problem.
Her parents report that Mariah got her first cell phone when she was ten
years old. She also has an iPad and uses the family computer regularly. At
first, her parents strictly limited her cell phone use to texting her family
members and the close friends that her parents already knew. However, as
time went on, she asked for more privileges. Her parents let her set up a
Facebook account and an Instagram account, but they have the passwords
and would monitor the content regularly.
Over time, they noticed that Mariah was using her phone more and more
oen. She was constantly on social media. She was also texting all of the
time. When Mariah’s mom would ask her who she was texting, she would
say “Oh, just a friend” but not give any more explanation as to who it was.
When her mom would come over to look at the phone screen, she would
quily close the apps she was using. is started to cause a lot of fights with
her mother.
At first, her father wasn’t as worried as her mom was. He said, “She’s a
teenager; it’s what they do.” Mariah’s mom takes the phone away at night,
so when she found out that her dad was allowing her to be on the phone all
night long, she was concerned. ey had a co-parenting meeting, in whi
Mariah’s mom expressed that she was worried this behavior was affecting
Mariah’s sleep and causing her to be more irritable. Mariah’s mom
explained that her teaers had said she was sassing them, plus she wasn’t
geing her homework done. Her dad agreed to take the phone away at
night. However, the first night that he tried to do so, Mariah threw a
tantrum. She was screaming and crying and couldn’t seem to control her
emotions. Her dad was so overwhelmed that he gave the phone ba to her
for the night.
He met with Mariah’s mother again. ey decided that they needed to set
up stricter boundaries with Mariah’s device use. Plus, they decided that it
was time to dig deeper into her texting and social media use. ey
discovered that she had anged the passwords on her accounts, and they
didn’t know how to access them. When they eventually got into her social
media, they discovered that she had been sending topless photos to boys
online. Some of them were in other states, and Mariah had clearly never met
them in person, whi made her parents worried about who was actually
seeing those photos. When her parents tried to talk to her about it, she
exploded, screaming about them invading her privacy. At a loss, her parents
decided that it was time to seek professional help from a therapist.
Analysis
Mariah is showing several warning signs of Internet addiction. She is
using social media and texting more and more oen. She is using her phone
in the middle of the night, whi is compromising her sleep. She doesn’t
want to engage in extracurricular activities like soccer that she used to love.
Although she used to get along well with her teaers and be able to get
good grades in sool, that’s slipping and geing replaced with negative
behaviors. All of these are signs that her use of social media could be
problematic.
Her secrecy around what she’s doing online and the fact that she’s been
sending risqué photos to people she doesn’t know are of particular concern.
ese are risk-taking behaviors that could pose a significant threat to her
real-life safety. ey also put her at risk of cyberbullying, so-called revenge
porn, catfishing and grooming from online predators, and various problems
with her real-life peers. Her parents are right to be concerned.
However, we should be careful not to pathologize Mariah’s behavior.
Texting, social media use, and beginning to explore her own sexuality are all
age-appropriate behaviors. Although her secrecy is concerning, it’s normal
for young teens to start seeking independence from their parents and to feel
upset when their privacy is violated. Despite being of concern, we should
recognize the normalcy of these problems among teens Mariah’s age today.
Moreover, her therapist not only should take care to consider Internet
addiction but also look at other potential issues in Mariah’s life before
making any diagnosis. Many of Mariah’s problems are warning signs of
depression—la of interest in activities, not doing her homework, and mood
swings including outbursts. It is possible that Mariah has depression from an
unrelated cause and that her misuse of social media is just a symptom of
that. It’s also possible that she has both depression and Internet addiction,
and the two conditions are making ea other worse. A therapist should
evaluate her completely and neither assume that the Internet is the problem
nor avoid addressing that it might be.
 It’s helpful that her parents are on the same page and are seeking early
intervention. ey may work together to limit Mariah’s use of the Internet.
ey may opt to take away her cell phone for a period of time, institute
stricter rules about when and how she can use it, and/or monitor her
activities more vigilantly. ey will also want to engage in discussion with
her about why they are concerned and what behaviors they would prefer to
see. ey should also work to address any other underlying issues that arise
in therapy. ey may wish to supplement Mariah’s individual therapy with
family counseling to help address both underlying issues and how to
negotiate use of social media in their homes.

C S 2: T O G A

Sam is a seventeen-year-old gender-fluid individual who uses the
pronouns they/them. ey began gaming when they were very young. At
first, they enjoyed gaming with the family, but soon they became more
interested in gaming with friends. Some of their friends from real life also
really enjoyed gaming, so when everyone couldn’t get together in person,
they would meet online in the games instead. Everyone’s parents felt like
gaming was a supplement to their real-life activities. ey noticed benefits
for their kids including improved motor skills, beer problem-solving
abilities, and enhanced ability to work together as a team. All of the friends
were in a gaming guild together, and it seemed to strengthen their real-life
relationships.
However, over time, things anged for Sam. While the other teens
seemed to be able to balance gaming with the rest of their responsibilities at
sool, activities, and family life, Sam seemed to become obsessed with
gaming. ey didn’t want to get together with their friends in real life
anymore; they’d rather just see them in the game. When the gaming guild
wasn’t online, Sam would game with strangers from the online world. In the
last year, Sam has become particularly interested in virtual reality gaming,
begging their parents to spend increasing amounts of money on gaming
accessories to enhance the virtual reality experience.
 Sam’s parents are concerned. ey’ve always had a hard time in sool.
ey were diagnosed with aention deficit hyperactivity disorder (ADHD)
at age eleven. ey were sent home from middle sool more than once for
aggressive outbursts. Once Sam got into high sool, they seemed less
aggressive but more withdrawn. eir grades got worse. e only time that
they got excited in sool was when they were able to do a presentation on
the fictional world from the games. at was last year. is year Sam is
barely aending classes at all. eir parents can’t wake them up to go to
sool in the mornings, and they’re at risk of failing senior year. Sam says
that it doesn’t maer. ey say that sool isn’t teaing them anything
anyway and that they learn a lot more from the Internet than they’ve ever
learned in class.
Although Sam wasn’t acting aggressively at sool anymore, their
aggression at home has increased. Whenever Sam’s parents suggest that Sam
put their games away and join the family, they resist, and if the parents
insist, Sam gets very upset. ere are several holes in their bedroom wall
due to su incidents. Sam’s parents are also increasingly concerned about
their health. Sam will sit at the computer for upward of twenty hours at a
time, not sleeping and refusing meals. eir parents don’t want them to
sna on junk food, but it’s the only thing they’ll eat—quily, with eyes still
on the screen—so sometimes the parents give in. ey can’t remember the
last time that Sam joined them for an activity outside of the house. ey’re
worried about Sam, and they are also frustrated; if Sam doesn’t have any
plans to finish sool or get a job, then will they have to support them
forever while they spend all of their time in an online world?

Analysis
Sam appears to be in active addiction with online gaming. is is
evidenced by the fact that they’re obsessed with gaming to the exclusion of
all other activities, that they get angry (whi is a withdrawal symptom)
when asked to stop gaming, that sool performance has gone down as what
seems to be a direct result of online gaming, and that there are health
concerns including la of sleep and poor nutrition. At the very least, Sam
does not have a balanced relationship with online gaming and the rest of
life.
It’s of particular concern that Sam has an ADHD diagnosis. As we saw in
Chapter 6, people with ADHD have a greater risk of developing addiction
than their peers. Perhaps this is the reason that Sam seemed to become
addicted to gaming, whereas their friends are able to control and balance
their use. It’s sometimes hard to discern cause and effect because Internet
addiction can mimic symptoms of ADHD, but because Sam was diagnosed
with ADHD when they were young, it’s likely that they had ADHD first
and have since developed Internet addiction. So, Sam will likely have the
dual diagnosis of both mental health disorders: ADHD and Internet
addiction. Sam’s therapist will have to work with them to determine
whether to treat both mental health issues at the same time or address first
one and then the other. It will be important to look at the medications Sam
is already on for ADHD to get a complete picture.
One potential intervention for Sam could be wilderness camp therapy.
is type of therapy would take Sam entirely away from tenology for a
detox period while also providing them with activities to keep their brain
engaged. Wilderness therapy includes both peer support and professional
counseling; it will be important to oose a program with counselors who
understand both ADHD and Internet addiction. Spending several weeks or
months in this type of program might offer Sam the opportunity to build a
sense of competence outside of the gaming world, whi could foster new
outside interests. e slower pace of the natural world compared with that
of the gaming world could be very frustrating for Sam at first, but adjusting
to that ange could help Sam in the long run.
If Sam and their parents oose a wilderness camp, they will also likely
want to follow up with individual and/or family therapy. It sounds as if
Sam’s parents have given up a lot of control in their household. It’s age-
appropriate for Sam to have a lot of independence, but their parents should
still set boundaries. Family therapy could help them establish appropriate
boundaries, set new rules around gaming and online activities, and improve
their overall family communication so as to heal their fractured
relationships.

C S 3: I P A

Joseph is a twenty-three-year-old male who lives with his girlfriend who
is the same age. ey have been dating for about a year and moved in
together recently. He is in college and works part-time on campus in a work-
study program. He is doing moderately well in sool, and there are no
complaints from his job. However, he and his girlfriend are fighting a lot
recently due to problems associated with his addiction to Internet
pornography.
Joseph first started wating porn online when he was a freshman in high
sool. All of his friends were showing ea other different clips and sites.
roughout high sool, they continued to share pornography with one
another, oen one-upping ea other to see who could find something more
hard-core or unique than the last thing that they saw. Toward the end of
high sool, though, his friends spent more time focusing on college and
relationships with peers. Joseph, on the other hand, turned more and more
to Internet pornography.
Whereas it had been easy for him to get aroused when he was younger, it
started to take more and more intense scenes to arouse him as he got older.
He started venturing into forms of kink that made him feel embarrassed and
uncomfortable. He wasn’t even sure that he liked these types of scenarios,
but nothing else was novel enough to arouse him anymore. He no longer
shared his online porn interests with his friends but instead became more
and more secretive about it.
When he moved out of his mom’s house during his second year of college,
he hit ro boom with his pornography addiction. He started thinking
obsessively about porn all of the time. He would spend hours of ea day
trying to find the perfect clip. He spent less and less time with peers. He
struggled in sool, and he ended up failing out of the first college that he
aended. Aer failing out, he had to return home. It was then that he
admied to himself, and his mother, that he thought he might have a
problem.
Joseph started therapy for a pornography addiction. He did outpatient
cognitive behavioral therapy (CBT) to help him beer understand what had
led him down this path and to resolve the problem. With his permission, his
mom was allowed to control the Wi-Fi password, and she would turn the
Wi-Fi off except during very limited hours to help him restrict his use.
Eventually, he got things under control, and he felt like he was doing well.
He got ba into a new college program, and he met his current girlfriend.
However, once he and his girlfriend moved in together, things started to
baslide. He felt anxious about the relationship. Given the free rein of not
being in his mother’s house anymore, he started to look at porn online a
lile bit again to relieve some of that anxiety. When his girlfriend found out,
she wasn’t upset at first. She figured it was common for people their age to
wat porn, and she didn’t know about his history of addiction. However, it
quily became clear that he had a more serious problem. She brought up
her concerns that he was wating porn instead of spending time with her.
Joseph immediately recognized that he was having a relapse. Instead of
returning to in-person therapy, he joined an online support group for people
with an online pornography addiction. He has been able to break the
addiction but is now undergoing withdrawal symptoms. He has libido
flatline; he can’t seem to get an erection at all and doesn’t have any interest
in having sex with his girlfriend. is is causing a lot of arguments between
them. She would like to go to couples’ therapy, but he doesn’t want to go.

Analysis
Joseph has an online porn addiction, whi was diagnosed in therapy in
the past, and he has self-diagnosed that he is in a relapse. Some people can
wat a lile bit of online porn and have no problem, but for Joseph it
started to interfere with his entire life. Because he has a history of failing out
of sool and losing out on peer relationships as a direct result of his
addiction, it’s important that he take this relapse very seriously. He’s
currently doing well at work and sool and is in a serious relationship that
is in jeopardy if he falls further into addiction.
It seems that there were two major triggers for the relapse: leaving the
structured environment of his mother’s home and dealing with anxiety
around his new relationship. He wanted to escape the feelings of anxiety,
and perhaps never completely learned how to do that in a healthy way, so
he turned to online porn. He was able to do so because there was no
structure in place (external or self-imposed) to reduce his access to
pornography. It’s also problematic that he hadn’t revealed his past history of
addiction to his girlfriend because she didn’t know to help him look out for
the warning signs. Plus it points to secrecy in their relationship, whi is a
risk of Internet addiction.
Online therapy has some potential to help Joseph, and it’s good that he’s
working toward a solution. However, online peer groups vary in quality.
Because of his history of addiction, Joseph might be beer off returning to
in-person therapy. Alternatively, if he prefers online therapy at this time, he
might want to look for a licensed counselor, particularly one with training in
both CBT and Internet addiction, since CBT did work for him in the past.
It’s concerning that he hasn’t sought in-person therapy, particularly
because his girlfriend would like to try couples’ counseling to deal with the
problems in their relationship. is suggests that perhaps on some level,
Joseph doesn’t want to deal head-on with his problems. Maybe he’s
embarrassed about his porn addiction. Or maybe something else is going on,
and he’s not ready to address it. For example, it could be that he’s not happy
in the relationship and doesn’t want to stay in it but can’t admit that, so he’s
using his addiction to escape. By not seeking professional help, he’s seing
himself up for further relapse and subconsciously could want to blame any
future relationship failure on the addiction.
Sometimes addiction anges over time. e individual can benefit from
not only relearning their coping skills but also digging deeper to gain further
insight into their addiction. Joseph may find that talk therapy is helpful for
that. On the other hand, if he decides to keep treating himself through peer
support online, he might at least want to implement a structured method of
contemplative computing or some form of digital diet to help him in daily
life.

C S 4: A O G A

Mahew is a thirty-three-year-old father of two young ildren. He has
been married to their mother for almost ten years. ey used to have a great
relationship, but aer the ildren came along, they seemed to grow apart.
Mahew feels that she focused all of her aention on them, and it made him
feel lonely and unvalued in his home. In the past few years, whenever he’s
home, he spends all of his time on online gaming.
Mahew had always enjoyed gaming when he was younger and never
had any problems with it. He would sometimes lose tra of time because he
would get so immersed in a game, but it never presented any serious issues
in his life. When he got married, he stopped gaming so mu because he and
his wife would do other things with their downtime su as go to movies
together and throw parties with friends. Once he started finding himself
bored at home, it made sense to him to return to online gaming. He enjoys
coming home from work, heading to the computer, and relaxing in that
online world.
His wife is not happy with this situation. Her perspective is that he
doesn’t want to spend any time with her and the kids. He would rather have
fun in the online gaming world than sit down to a family dinner or help the
kids with bath time and bedtime. She feels completely disconnected from
him. When she tries to talk to him about it, he gets upset. He says, “I go to
work and earn the money for this family. I’m not out at a bar or with other
women. I’m right here in the house. So, what if I want to ill out with my
game?” Mahew’s online friends agree with his perspective and say that his
wife is nagging him too mu.
Recently, Mahew’s wife has been considering geing a divorce. She had
hoped that the problem would pass, but it seems like it’s geing worse.
Recently, her youngest son walked over to his dad when Mahew was
gaming because he wanted to ask his dad to read a book to him. Mahew
didn’t even hear what the ild was saying, and his son got very upset at
being ignored. He threw a tantrum, and his mother was unable to make him
feel beer for nearly an hour. Another recent problem was that their oldest
son tried gaming with their dad. She had concerns about her young ild
playing violent video games but thought that at least it could be a way for
him to bond with his father. Unfortunately, Mahew got really upset
because his young son couldn’t keep up in the game and made him lose out
on some points that he wanted to acquire. He exploded, his son ended up in
tears, and Mahew went ba to his game alone. At her wits’ end,
Mahew’s wife is starting to think it would be beer if he weren’t there at
all.

Analysis
It’s hard to say whether or not Mahew has a full-blown gaming
addiction. He’s never had a problem with it before now. He’s able to hold
down a job, and gaming doesn’t interfere with his finances. He hasn’t noted
any particular health symptoms associated with gaming. In fact, he doesn’t
think that there’s a problem at all. But it’s of great concern that he seems to
be increasingly distant from his family, even to the point of blowing up at
his young son for “losing” a game, and that’s one warning sign that there’s a
problem. It might not qualify as an addiction, but it also might be one.
An addiction oen develops when a person wants to escape
uncomfortable feelings. It sounds as though that’s exactly what Mahew has
been doing—trying to escape the discomfort in his family that developed
aer the birth of his ildren. Something about being a father makes him
feel incompetent and unneeded, and perhaps gaming offers him not just an
escape but a place where he feels like he’s competent at something. He
excels at online gaming, and he has peer support there, whereas at home it
just feels like he’s doing everything wrong.
 e gaming seems to be making the problem at home worse. Ironically,
although he thinks that his family doesn’t need him and that he’s useless
there, his family is actually very clearly making bids for his aention. ey
want him engaged with their daily activities, like reading a book to the kids
at bedtime, but he’s so immersed in his game that he can’t seem to see that.
Perhaps this is because he has an addiction and is blind to their bids.
Perhaps he feels like if he tried to participate in family time, it would just be
a fight, so he turns to gaming instead. Either way, the family is in trouble.
If Mahew wants to resolve the problems at home, then he might benefit
from seeking individual or family counseling. ese are two very different
approaes to the problem, and he would have to determine whi is best
for him. Since he doesn’t feel like online gaming is a problem, he wouldn’t
likely seek therapy specifically for Internet addiction. However, he could get
therapeutic help to deal with his family issues. He recognizes that there’s a
problem there, and talking to a professional—alone or with his family—could
help him deal with those underlying issues. If it turns out that there’s a true
Internet addiction, that might arise later in therapy and could be dealt with
in turn. It may instead be the case that resolving his family issues naturally
causes him to turn to gaming less frequently.

C S 5: O S A

Marni is a fiy-three-year-old woman who lives at home alone. She has
three ildren, the youngest of whom just le for college last year. She had
been a stay-at-home mom when her ildren were young, and that was the
best time of her life. She loved caring for them, baking with them, making
costumes for Halloween, and participating in their sool activities. As they
got older, they needed her less, so she went ba to work part-time. Her
husband, who had supported the family, asked for a divorce when the
youngest ildren were in high sool. At that time, she had to get a full-
time job. She started doing administrative work at an office, and she’s
competent at it but doesn’t enjoy it at all.
 Marni doesn’t really know what to do with herself now that her kids have
all le the home. She works in order to pay her bills, but she doesn’t derive
any satisfaction from the work. She longs for the old days when her house
was filled with noise and laughter. She’s always asking her kids to come
home on their sool breaks, and she’s thrilled when they do. She can’t wait
until they start having kids of their own so that she can be a grandma. But
in the meantime, she’s just passing the time.
When she gets home from work, she immediately turns on the television
for baground noise. en she starts browsing online. Since she works full-
time now, she never feels like going out to the store, so she does all of her
shopping online. It started out with just geing her groceries delivered once
a week. She discovered that she really enjoyed browsing those online aisles,
puing new foods in her cart that she never noticed at the grocery store. She
loves that moment when the delivery person arrives, and she exanges a
qui hello and then gets to unpa everything she ordered.
In fact, she loves it so mu that she started doing a lot of other online
shopping as well. She visits Amazon almost every day to see what new
items she might need for her home. She’s even started stopiling items for
her grandbabies, despite the fact that none of her ildren are ready to have
kids yet. She loves piing out just the right thing and gets excited again
when it arrives at her doorstep. Sometimes she even forgets what she
ordered, so it’s particularly thrilling to get those lile surprises in the mail.
Unfortunately, all of that shopping has added up. Marni has nearly maxed
out all of her credit cards. She received the house in the divorce, and she has
refinanced in it in order to cover her debts. She is thinking about digging
into her retirement accounts because she needs more money. Despite hating
her job, she’s been working overtime to help cover the costs of shopping
online. Her ildren do not know that she’s in this situation.
Marni has friends who would like to spend time with her. However, she
always tells them that she doesn’t have the money to go out. Recently,
they’ve been making less of an effort to see her. When she’s not shopping
online, she’s usually streaming television shows and simultaneously playing
simple games, su as Farmville, on her phone. She doesn’t like that she
spends her time that way but figures it’s beer than spending money
shopping. Inevitably, though, she always heads ba to that Amazon buon
to see if there’s something new there that she “needs.”

Analysis
Marni has an Internet addiction that is primarily focused on online
shopping. However, when she’s able to restrict herself from online shopping,
it does manifest in addiction to other forms of content su as simple games.
is suggests that when she tries not to shop online, she experiences feelings
of withdrawal, whi is a huge red flag that she’s got an addiction. In order
to quell the withdrawal, she turns to other online activities to soothe herself.
Her use has grown over time. She has stopped seeing her friends, claiming
that she doesn’t have the money to go out but then spending that money
shopping online instead. She is able to hold down her job, so the addiction
hasn’t hindered her in that way, yet. However, she’s in serious debt due
specifically to her online addiction. It’s compromised her future in that she’s
refinanced her home and might use her retirement income to pay for her
addiction. ese are all serious problems that seem to only be growing with
time. She has not admied her problem to anyone else; keeping it a secret is
another sign of addiction.
Marni seems to have developed this addiction specifically because of her
ange in life circumstances. Her husband le, and her ildren moved out
on their own. Her identity as a mother, the experience of whi gave her
great joy, has anged. Having not fully processed that loss in a healthy way,
Marni seems to be trying to escape those uncomfortable feelings of grief
through her addiction. A therapist should assess Marni for depression, as it
is possible that her grief turned into depression and that triggered the
addiction. Marni likely gets a pleasant “feel good” hit of dopamine ea time
she puts something into her online shopping cart and again when it arrives
at her doorstep. She’s trying to feel good more and more by engaging more
and more in that behavior.
 Most likely, dealing with the underlying emotional issues will help Marni
in reducing her compulsion to shop online. However, because it’s become
su an addictive activity, she and her therapist might want to address that
issue directly as well. ey may want to put a plan in place to help restrict
her from online shopping while simultaneously dealing with the underlying
issues of loss, ange in identity, depression, and so forth. Hopefully, over
time, Marni will find new ways of spending her time rather than shopping
online. Perhaps she’ll get a job she actually likes or begin spending time out
of the house with friends.
G

Addiction: the need to engage in a behavior or use a substance despite

negative life consequences, oen increasing the duration and intensity of
use over time and experiencing withdrawal when trying to quit.
ADHD: aention deficit hyperactivity disorder is a mental health issue
aracterized by problems with aention and impulsivity.
Adrenaline: a hormone in the body that we secrete when we feel stress, also
called the fight-or-flight hormone.
Affective Forecasting Error: a tendency in the brain to incorrectly assume
that something that gave us pleasure before will give us pleasure again.
Amygdala: a part of the brain related directly to how we experience
emotions.
Anxiety: excessive worry and fear, whi you are unable to control, and
whi causes you distress.
ASD: autism spectrum disorders, with symptoms that include trouble with
communication and social interaction as well as a narrow range of
interests and/or behaviors including repetitive moments.
Attention Restoration eory: an idea first posited in the 1980s by Rael
and Stephen Kaplan that spending downtime in nature has a restorative
effect that helps humans to heal.
Augmented Reality: when you view the real world through a screen, su
as a cell phone, and see something on the screen that isn’t there in real
 life.
Body Dysmorphic Disorder: mental health condition in whi the person
obsesses over their flaws, grooms and exercises excessively, avoids
mirrors, constantly works to ange their appearance, and has negative
self-esteem.
Bottom-up Attention: when something aracts us and demands that we
notice it, so we don’t control where our focus goes.
Catfishing: the act of pretending to be someone else online in order to lure
one or more people into a relationship with your fake persona.
Causation: proof that one thing happens as a direct result of another; in
contrast to correlation.
CBT: cognitive behavioral therapy, a form of therapy that uses goal-oriented
problem-solving to help people ange their paerns of both thought and
behavior.
Cellular Neuroplasticity: a ange in the number of brain cells that are
talking to ea other.
CIAS: Chen Internet Addiction Scale, a tool used to measure Internet
addiction in Chinese adolescents.
Circadian Rhythm: physical and mental paerns that we follow ea day,
related to our experience of the anging sunlight, and directly related to
our sleep cycle.
Classical Conditioning: how we learn to respond to one thing when two
items are paired together even aer the second item is removed from the
equation.
Comorbidity: when one person has two or more diagnoses for different
mental health disorders, one of whi is usually an addiction; also called
dual diagnosis or co-occurring disorders.
Compulsive Behavior: repeatedly engaging in a specific action whether or
not you get any satisfaction from doing so.
Contemplative Computing: mindfulness approa to limiting Internet use
in order to maximize the benefits and minimize the addictive harms.
Correlation: indications that two phenomena are linked but not necessarily
that one happens as a result of the other; in contrast to causation.
Cortisol: a stress hormone in the body.
Cyberbullying: persistent bullying of one or more people that takes place
through apps, text, and social media.
Cyberondria: a form of hypoondria directly related to the tendency to
sear online for information about potential medical conditions,
becoming increasingly certain that you’re deathly ill because of what the
Internet has to say.
Dating App Addiction: using apps su as Tinder or Hinge with increasing
frequency even though the rewards that you get from it are diminishing
and/or there are negative consequences in other areas of your life.
Depersonalization: the feeling that you are not a real person.
Depression: feelings of low mood and la of interest in things that you
previously enjoyed as well as other physical and mental health symptoms.
Derealization: an inability to know what is real.
Desensitization: diminished emotional response to something aer being
exposed to it multiple times.
Digital Diet: reducing or eliminating use of some or all Internet devices and
activities to help break an Internet addiction; also called a digital fast.
Disconnectivity Anxiety: feelings of fear, stress, anger, and frustration
caused by the unexpected inability to connect to your phone or the
Internet.
Dopamine: a neurotransmier in the brain oen called the “feel good
emical.”
DSM: Diagnostic and Statistical Manual of Mental Disorders, a guide used
by psyologists and other health-care professionals in the United States
to officially diagnose all mental disorders.
Email Apnea: a tendency to hold your breath or breathe more shallowly
when opening email, eing social media comments, and so forth.
Euphoric Recall: a tendency to remember positive feelings associated with a
behavior or event while forgeing the negative feelings.
Exposure and Response Prevention: a form of CBT for treatment of
phobias and some other disorders in whi the person is exposed to the
source of their fear and learns to modulate their response.
FOMO: Fear of missing out, the feeling that other people are online doing
something interesting and that if you fail to get online as well, then
you’re going to be excluded from the fun.
Frontal Lobe: part of the brain that helps us with “higher-level” functioning
su as problem-solving, planning, and regulating our emotions.
GABA: gamma-aminobutyric acid, neurotransmier related to stress
reduction.
Game Transfer Phenomenon: short-term psyosis that causes a gaming
player to have trouble separating the game from reality.
Gaming Addiction: playing video/Internet games with increasing frequency
even though the rewards that you get from it are diminishing and/or there
are negative consequences in other areas of your life.
General Internet Addiction: problematic Internet use including
withdrawal, tolerance, and continued use despite negative consequences—
with no particular content focus but instead to the compulsive use of
being online.
Gray Matter: the bulk of what we see when we look at a human brain—the
wrinkled, pinkish-gray tissue consisting of cell bodies, dendrites, and
nerve synapses.
Grounding: therapeutic teniques to help people to come into the present
moment by focusing on their senses.
Harm Reduction: an approa to treating addiction in whi the goal isn’t
abstinence but rather reducing the damages of use.
Hippocampus: part of the brain related to learning and forming memories.
HPA Axis: hypothalamic pituitary adrenal axis, a combination of interacting
parts of the brain that relate to our stress responses.
Hyperarousal: an increase in physical and psyological response to stimuli,
whi might include being abnormally alert to danger and having a
racing heart.
Hypoondria: extreme anxiety about one’s health, oen imagining that
you have an illness that isn’t there.
ICD: International Classification of Diseases, a system maintained by the
World Health Organization (WHO) to classify all different types of health
issues, including those related to mental health.
Imposter Syndrome: the belief that you are a fraud and other people are
eventually going to find out the truth about you.
Intermittent Rewards: when we sometimes receive pleasure, but sometimes
don’t, from the same activity or trigger; also called variable-ratio reward
sedule.
Mesocortical Pathway: dopamine pathway in the brain linked with
cognitive and emotional abilities as well as memory, aention, and our
ability to learn.
Mesolimbic Pathway: dopamine pathway in the brain linked with seeking
pleasure and reward.
Mindfulness: the practice of focusing on being entirely present in the
moment.
MMORPG: Massive multiplayer online role-playing games, in whi
thousands or sometimes millions of people around the world participate
in the game at the same time, playing in a virtual scenario.
Myelin: an insulating layer that wraps around the white maer in the brain,
protecting the axons and solidifying their function.
Net Compulsions: variety of activities that addicts engage in repeatedly and
obsessively including online gambling, auction bidding, and sto trading.
Neuroplasticity: the brain’s ability to ange and grow over time; also
called brain plasticity or neuroelasticity.
Neurotransmitters: the communicators, or messengers, in the brain that
transmit information from one area to another.
Nigrostriatal Pathway: dopamine pathway in the brain linked with
movement and sensory stimulation.
Norepinephrine: neurotransmier related to the fight-or-flight instinct.
Nucleus Accumbens: a cluster of nerve cells oen called the “brain’s
pleasure center.”
Online Pornography Addiction: accessing pornographic websites and/or
apps with increasing frequency even though the rewards that you get
from it are diminishing and/or there are negative consequences in other
areas of your life.
Phantom Vibration Syndrome: imagining that you feel the vibration of a
phone alert when the phone isn’t even on you.
Prefrontal Cortex: the front part of the frontal lobe in the brain, responsible
for higher-order functions like aention, planning, prioritizing, impulse
control behavior, emotional control, and adjusting to complicated and
varying situations.
Psyosis: a mental disorder in whi you lose contact with what is real.
PTSD: posraumatic stress disorder, a mental health condition that can
occur aer many different types of trauma and includes symptoms su
as intrusive thoughts, flashbas, and panic.
Sedentary Lifestyle: spending most or all of your time either siing or lying
down rather than engaging in physical activity.
Selfie Addiction: taking, editing, and posting photos of yourself with
increasing frequency even though the rewards that you get from it are
diminishing and/or there are negative consequences in other areas of your
life.
Serotonin: neurotransmier related to mood stabilization.
Social Media Addiction: using sites su as Facebook and Instagram with
increasing frequency even though the rewards that you get from it are
diminishing and/or there are negative consequences in other areas of your
life.
Social Phobia: anxiety related to social seings, whi can include being in
groups and speaking in public.
Specific Internet Addiction: problematic Internet use including withdrawal,
tolerance, and continued use despite negative consequences—with focus
on one or more very specific types of content su as gaming, gambling,
social media, or pornography.
Swittasking: moving our focus from one thing to the other and ba
again, whi is what we’re usually doing when we think that we are
multitasking.
Synaptic Neuroplasticity: A ange in the strength of the connection across
the junction from one brain cell to the next.
Text Ne: ronic pain associated with damage to the spine done because
of poor posture when spending excessive amounts of time on a cell phone.
Texting Addiction: using text apps and direct-to-one-person at tools with
increasing frequency even though the rewards that you get from it are
diminishing and/or there are negative consequences in other areas of your
life.
Texting umb: repetitive stress injury that typically results in pain at the
base of thumb due to excessive smartphone use.
Tolerance: adapting to an addiction so that you need more of the behavior
or substance in order to aieve the same feelings.
Top-Down Attention: When we set goals and direct where our aention
will go in order to meet those goals.
Trolling: purposely posting inflammatory comments online in order to get a
group riled up and engaging negatively.
Ventral-Tegmental Area: part of the brain ri in dopamine and related to
our desire for rewards.
Virtual Reality: when you look at a screen (usually through glasses or
headsets) and immerse yourself entirely into the world there, sometimes
with additional sensory input from haptics to make it feel even more like
you’re in that world.
Voyeurism: taking pleasure in wating someone else, particularly when
they’re doing something private, dangerous, or scandalous.
White Matter: bundles of axons that connect gray maer areas in the brain.
Withdrawal: physical and mental symptoms that appear when trying to
quit an addiction.
T

1994 Kimberly Young begins a three-year study into the

emerging issue of Internet addiction. e results are
published in a book titled Caught in the Net.
1995 Kimberly Young founds the Center for Internet
Addiction.
1995 Mat.com launes the first-ever commercial dating
website.
Mar 8, 1995 The New York Times publishes an article titled “e Lure
and Addiction of Life OnLine.” is is likely the first time
that the term “Internet addiction” is used in a major
publication.
Late 1990s Scientists begin identifying the traits of Internet
addiction using criteria from substance and behavior
addiction.
Late 1990s Pacific est opens in Hawaii as a wilderness therapy
program for teenagers; it will eventually come to focus
on Internet addiction treatment.
2001 An Indiana Sool of Medicine study finds that the brain
anges aer just one week of playing violent video
 games.
2003 Mary Christina Cordell and her boyfriend are so focused
on playing the online game EverQuest that they forget
their ild in the car and the ild dies. e media
suggests that gaming addiction is the cause of death.
2004 Facebook launes.
2004 World of Warcraft launes. In its first ten years, the
game gained more than one hundred million subscribers
around the world. It received $10 billion in gross income.
It is considered one of the most highly addictive online
games available.
2004 e first Internet addiction treatment center opens, in
Beijing, China. It is a military-style boot camp.
2007 Apple releases the first iPhone, and soon smartphone use
becomes ubiquitous.
2007 Jarice Hanson authors the book 24/7: How Cell Phones
and the Internet Change the Way We Live, Work, and
Play.is is one of the earliest books on the potential
negative harms of our modern use of the Internet.
2008 Chinese Ministry of Health approves a manual
addressing Internet addiction disorder and naming it a
number one health crisis.
2009 Facebook introduces the addictive “like” buon.
2009 Dr. Dean Fisherman opens the Text Ne Institute to
treat ronic pain associated with excessive phone use.
2009 reSTART opens. It is the first residential treatment center
in the United States for people struggling with Internet
addiction.
2010 Instagram launes.
2011 Israel Journal of Psychiatry and Related Sciences
publishes a study from Tel Aviv University of the first
documented cases of Internet-related psyosis.
2012 Larry Rosen authors the book iDisorder, in whi he
suggests we are all increasingly showing symptoms of
common mental health issues due to the ubiquity of
smartphone and computer use.
2013 Alex Soojung-Kim Pang authors the book The
Distraction Addiction. He coins the term “contemplative
computing” to describe mindful practices of using the
Internet while avoiding its addictive nature.
2013 Psious is founded. is is a virtual reality company that
uses tenology to help treat mental health issues.
February 2013 Tristan Harris of Google releases an internal presentation
called “A Call to Minimize Distraction & Respect Users’
Aention.” It criticizes how major te companies are
exploiting the brain’s addictive tendencies in order to
grow their boom line.
May 2013 e American Psyiatric Association releases the DSM-
5. For the first time, it includes online gaming addiction
as an area suggested for further study.
2014 American Psychologist publishes resear into the
benefits of online gaming for ildren, suggesting that
there are both positives and negatives to frequent
Internet use.
2014 A study called Facebook’s Emotional Consequences finds
that social media can cause depression.
2014 Nir Eyal authors the book Hooked: How to Build Habit-
 Forming Products, whi others go on to use in their
resear into Internet addiction.
2015 Tristan Harris, who previously criticized Google’s
exploitation of users’ tendencies toward addiction, leaves
his job at Google. He founds the Time Well Spent project
and the Center for Humane Tenology.
2015 Mai-Ly Steers conducts a study at University of Houston
that specifically finds that Facebook use increases the
frequency of users comparing themselves to others,
whi in turn leads to depression.
2015 Dr. Kelly Lister-Landman completes a study into
compulsive text messaging among adolescents that finds
that girls experience negative consequences at mu
higher rate than boys.
2016 Niolas Kardaras authors the book Glow Kids: How
Screen Addiction Is Hijacking Our Kids—and How to
Break the Trance.

June 2016 Computer Methods and Programs in Biomedicine

publishes resear suggesting that virtual reality can help
in the treatment of online gaming addiction.
July 6, 2016 Pokemon Go launes on smartphones as the first highly
popular augmented reality video game.
October 2016 Virtual reality company Limbix is founded. It uses
tenology to aid in mental health treatment.
2017 e National Institutes of Health launes a two-year
study at the University of Connecticut Sool of
Medicine to help determine whether or not Internet
addiction is a true disorder.
2017 An episode of Real Time airs in whi Bill Maher
 compares “the tycoons of social media” to tobacco
farmers, exploiting our tendency toward addiction.
2017 Psyologists Mark Griffiths and Daria Kuss of
Noingham Trent University publish a paper analyzing
the specific addictive nature of social media.
2017 VICE reports on a Mat.com study that finds that one
out of six single people feels addicted to the process of
seeking out a partner online.
2017 A study by Yale University finds that teens on the autism
spectrum reported beer quality friendships when they
utilized social media to aid in communication. is
suggests that there are both benefits and harms to
Internet use for certain populations.
2017 Adam Alter authors the book Irresistible: The Rise of
Addictive Technology and the Business of Keeping Us
Hooked.

2018 e movie Ready Player One hits theaters. It explores the

benefits of living in a virtual world but makes an
argument that it’s also valuable to live in “real reality.”
September 17, Apple releases iOS 12, whi includes the new Screen
2018 Time feature to help users monitor and limit their
smartphone usage.
May 2019 e World Health Organization publishes ICD-11. For the
first time, it names online gaming as a specific health
disorder. e criteria it offers for diagnosing this issue go
into full effect in 2022.
S  F I

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T P
Behavioral Health of the Palm Beaes. hps://www.bhpalmbea.com.
blueFire Wilderness erapy. hps://bluefirewilderness.com.
e Center for Internet and Tenology Addiction. hps://virtual-
addiction.com.
Computer Addiction Services. hp://www.computeraddiction.com.
e Computer Addiction Treatment Program.
hps://www.computeraddictiontreatment.com.
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Life Process Program from Porn Addiction Recovery.
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Outba erapeutic Expeditions. hps://www.outbatreatment.com.
Pacific est. hps://pacificquest.org.
reSTART. hps://www.netaddictionrecovery.com.

A O R

Center for Humane Tenology. hps://humanete.com
Internet Addiction Test Kit for Families.
hps://www.stoeltingco.com/internet-addiction-test-kit-iat-kit.html.
On-Line Gamers Anonymous. hps://www.olganon.org/home.
Pornography Addicts Anonymous. hps://www.pornaddictsanonymous.org.
Time to Log Off. hps://www.itstimetologoff.com.
Wowaholics Anonymous. hp://www.wowaholics.org.
I

Aarons-Mele, Morra, 59, 61

Abstinence, 95, 96, 118
Academic pressure, 108
Aievement porn, 59
Action, of hooked model, 50
Addiction, 3–4; alcohol, 3–4; brain and, 39–40; caffeine, 109–10; gaming, 71–74; hooked model of, 49–
50; to Internet media, 76–82; net compulsions, 74–76; online pornography, 68–69; shopping, 111–
12; of social media, 53–65; spectrum of, 4; texting, 65–67; use of dating apps, 67–68. See also At-
risk populations; Internet addiction; Internet media addiction; Social media addiction
Adrenaline, 28, 72
Aggression, 5, 33, 73–74, 92, 160; dual diagnosis and, 116
Alcohol addiction, 3–4, 12, 91, 100, 117, 154
Alexa, 10, 133, 137, 144, 145
Alexis, Aaron, 89
Alone Together (Turkle), 24
Alter, Adam, 54, 118
Amazon, 19, 75
American Academy of Pediatrics, 85
American Psyiatric Association (APA), 23
American Psyological Association (APA), 8
American Psychologist (journal), 127
Anhedonia, 29
Annual Digital Fast, 102
Anxiety, 21–23, 108; cyberondria, 79–82; disconnectivity, 21, 22; dual diagnosis issues, 116
AOL, 65
Apple, 29, 134
Artificial intelligence (AI), 16, 137, 143–45
The Art of Screen Time (Kamenetz), 86, 106, 153
Asperger’s, 87
Atari system, 17, 18, 68
At-risk populations: ildren and teens, 83–86; individuals with aention deficit hyperactivity
disorder (ADHD), 86–87; individuals with autism spectrum disorders (ASD), 87–89; military
members and veterans, 89; people with mental health and substance abuse issues, 90–91; socially
isolated individuals, 89–90; susceptibility traits, 92
Aention deficit hyperactivity disorder (ADHD): at-risk addiction of individuals with, 86–87; case
study of teen online gaming addiction, 160–61; dual diagnosis and, 116
Aention engineering, 49
Aention Restoration eory, 85
Auctions, online, 76
Augmented reality, 137; virtual reality and, 138–43
Austin, Darren, 144
Autism spectrum disorders (ASD), 117; at-risk addiction of individuals with, 87–89; benefits of Internet
for, 123–25

Baby boomers, 6
Bailenson, Jeremy, 140
Bean, Mary A., 122
Behavioral Health of the Palm Beaes, Inc., 97
Benefits of Internet, 121–22; accessing therapy online, 129–31; for autism spectrum disorders (ASDs),
123–25; for education, 131–33; for online gaming, 127–29; for people feeling isolated, 125–27; for
solving Internet addiction, 133–35
Big Tobacco, 50
Binge wating, Netflix and, 76–78
Biopsyosocial model, social media addiction, 56
Bipolar mania, 24
BlaBerry, 137
Blaberry thumb, 28
Black Mirror (television/Netflix), 151
BlueFire, 99
Body dysmorphic disorder, 57
Brain: addiction in, 39–40; cortisol and, 26, 28, 72; dopamine and reward system of, 40–44; frontal lobe
and prefrontal cortex of, 45–46, 84; gamma-aminobutyric acid (GABA) in, 44; gray maer and
white maer in, 46–47; growth and development of young ildren, 85; neuroplasticity of, 47–48,
84; neurotransmiers of, 40–45, 72; norepinephrine in, 44–45; nucleus accumbens of, 40, 43;
serotonin in, 43–44; stimulation with gaming, 72; susceptibility of, 48–51; teenager’s, 84–85
Bullying. See Cyberbullying
Businesses, role of, in Internet addiction, 152–53
Business Insider, 144

Caffeine, 109–10
CAGE questionnaire, 12
California State University (CSU), 91
Call of Duty (game), 89
Carpal tunnel syndrome, 27
Case studies: adult online gaming addiction, 164–66; Internet pornography addiction, 161–64; online
shopping addiction, 166–68; social media and texting addiction, 157–59; teen online gaming
addiction, 159–61
Case Western Reserve University Sool of Medicine, 117
Caspar, George, 64
Catfish (television show), 63
Catfishing, 62–63
Caught in the Net (Young), 7
Causation, 107, 108
Cause and effect, 107, 110
Cell phone adoption, 17
Center for Humane Tenology, 152
Center for Internet Addiction, 18
Centers for Disease Control, 30
Chen Internet Addiction Scale (CIAS), 12
Children: at risk for addiction, 83–86; relationships with parents, 35–36
Children’s Internet Protection Act (2000), 154
China: Internet addiction and myelin, 47; Internet addiction disorder in, 12
Christakis, Dimitri, 31
Chronic sleep deprivation, 23–24
Cincinnati Children’s Hospital, 110
Coffee, caffeine addiction, 109–10
Cognitive behavioral therapy (CBT), 142–43, 162, 163; online access to, 130–31
Comorbidity: dual diagnosis and, 113; Internet addiction and, 112–19; for social media addiction, 56;
term, 114
Compulsions, net, 74–76
Computer Addiction Treatment Program, 97
Computer Methods and Programs in Biomedicine (journal), 142
Contemplative computing: as self-help for Internet addiction, 105–6; term, 105
Co-occurring disorders, term, 114
Cortisol, 26, 28, 72
CraBerry, 137
Cravings, withdrawal and, 37
Crisis intervention, online therapy for, 130
Crochet Saved My Life (Vercillo), 126
Culture, Medicine, and Psychiatry (journal), 129
Cyberaddiction, term, 16
Cyberbullying, 30, 64–65
Cyberondria, 79–82; by proxy, 80
Cyberpsychology, Behavior and Social Networking (journal), 124

Dark Net, 118, 137

Dating apps, addiction to use of, 67–68
Demand engineers, 49
Depersonalization, 38
Depression, 5, 29–32, 108, 115, 117; Facebook-linked, 30; gender and, 29; MySpace and, 31; socially
isolated people, 126
Derealization, 38
Diagnostic and Statistical Manual of Mental Disorders (DSM), 14, 71; diagnosis of Internet addiction,
8–10; DSM-3, 9–10; DSM-5, 9, 10, 75
Digital diet, as self-help for Internet addiction, 101–3
Digital minimalism, 106
Digital Minimalism (Newport), 50
“Digital Sabbath,” 102
Dilensneider, Anne, 102
Disconnectivity anxiety, 21, 22
The Distraction Addiction (Pang), 105
Doan, Dr., 26
Donkey Kong (game), 18
Dopamine, 30; addiction to, 40–41; brains of ildren and teens, 84; neurotransmier in brain, 40–45;
pathways in brain, 42–43; reward system of, 40–43
Dual diagnosis: best treatment option for, 115; comorbidity and, 113; Internet addiction and, 112–19;
issues associated with, 116; term, 113, 114

Eating disorder, 115

eBay auction, 76
Eco-therapy, for Internet addiction treatment, 98–99
Education: pros and cons of Internet for, 131–33; sool’s role in identifying at-risk ildren, 149–50
Electronic cocaine, 39
Electronic heroin, 39
Elimination Diet, 102, 103
Email apnea, 106
eSports, 74
EverQuest (game), 35, 71, 101
Exercise, online addiction, 79
Eyal, Nir, 49–50, 144
Eye strain, 27

Facebook, 31, 56, 88, 134; catfishing on, 62; depression and, 30; like buon of, 54–55; texting, 65
Face-to-face interpersonal relationships, 24–26, 36–37
Family therapy, for Internet addiction, 100
Feelings, loss of control over life, 28–29
Fisherman, Dean, 27–28
Fitbit, 17
Fitness apps, 78–79
FOMO (fear of missing out), 55, 61–62, 78
Forward head posture, 28
Frogger (game), 18
Frontal lobe of brain, 45–46, 73, 84

Gambling, net compulsion, 74–76

Game Transfer Phenomena (GTP), 73
Gaming addiction, 71–74; case study of adult online, 164–66; case study of teen online, 159–61; online
website owners, 75
Gaming widows, 36
Gamma-aminobutyric acid (GABA), neurotransmier in brain, 44
Gay rights, 6
GChat, 65
Gen Xers, 6
Gen Z, 6, 83
German Psyological Association, 31
Glossary, 169–73
Glow Kids (Kardaras), 26, 91
Goldstein, Meredith, 62
Google, 51, 61, 133, 152
Goberg, Kathy, 145
Government, raising awareness of Internet addiction, 153–54
Gray maer, brain and addiction, 46–47
Griffiths, Mark, 16, 55
Group therapy, for Internet addiction, 100–101
Guardian (newspaper), 139
Guitar Hero (game), 71
Gurdon, Meghan Cox, 110, 111, 118, 123
Habit, addiction vs., 14–15
Hanson, Jarice, 22, 33, 75
Hari, Johann, 25, 26, 89, 98
Harm reduction, addiction treatment, 95–96
Harris, Tristan, 152, 153
Health information, searing for, 79–82
Health issues, common physical, 27–28
Hemorrhoids, 28
Hiding in the Bathroom (Aarons-Mele), 59
Hills, Dominguez, 91
Home Shopping Network, 111
Homosexuality, 8–9
Hooked model, 49–50
Huon, John, 110
Hypothalamic pituitary adrenal (HPA) axis, 26, 28, 38

I Can’t Help Myself (Goldstein), 62

iDisorder (Rosen), 16, 119
Illinois Institute for Addiction Recovery, 97
Impulse control disorder, 10
Indiana Sool of Medicine, 73
Individuals, role of, in Internet addiction, 147–49
Individual therapy, for Internet addiction, 99–100
Infants, 35
Instagram, 6, 54, 56, 65
Intermient reward, of hooked model, 50
International Classification of Diseases (ICD), 14, 71; ICD-10, 11; ICD-11, 11, 12; on Internet addiction,
11
Internet addiction: addiction vs. habit, 14–15; comorbidity/dual diagnosis, 112–19; criteria, 5; defining,
3–15; diagnostic criteria for, 11–13; DSM’s diagnosis of, 8–10; history of defining, 5–8; ICD-10

(International Classification of Diseases) on, 11; ICD-11, 12; key components of, 4; self-
identification of, 13–14; term, 4; traits of addicts, 8, 13–14, 92. See also Treatment options
Internet addiction disorder, term, 7
Internet addiction issues: anxiety, 21–23; brain anges and, 34–35; ronic sleep deprivation, 23–24;
common physical health and, 27–28; depression, anhedonia and suicide risk, 29–32; feeling loss of
control over life, 28–29; in-person relationship difficulty, 24–26; loneliness, 24–26, 32; psyosis, 38;
relationship problems as, 35–37; sedentary lifestyle and, 26–27; time as, 33–34; withdrawal and
tolerance, 37–38; work or sool performance, 32–33
Internet media addiction, 76–82; cyberondria, 79–82; fitness apps, 78–79; Netflix binge, 76–78; online
news, 78; television, 76–78; wearable te, 78–79
Internet pornography, 110; case study of addiction, 161–64
Investment, of hooked model, 50
iPhone, 29, 137; app, 134

James, Laura, 88

Kamenetz, Anya, 86, 106, 148, 149, 153

Kaplan, Rael, 85
Kaplan, Stephen, 85
Kardaras, Niolas, 26, 31, 42, 91, 131
Kardashians, reality TV of, 77
Korea University, 44
Kuss, Daria, 55

Legend of Zelda (game), 71

Like buon, Facebook’s, 54–55
Limbix, 142
Lister-Landman, Kelly, 66
Loneliness, 24–26, 32, 63

Maher, Bill, 50
Massive multiplayer online role-playing games (MMORPGs), 18, 71, 89, 127, 128
Mat.com, 67
Mat survey, 68
Media, role of, in Internet addiction, 150–52
Medical information, searing for, 79–82
Medicare/Medicaid, 154
Mental health issues, at-risk addiction individuals with, 90–91
Mesocortical pathway, dopamine in brain, 42
Mesolimbic pathway, dopamine in brain, 42
Military members, at-risk for addiction, 89
Millennials, 6, 23, 83
Mindfulness practice, 141
Minecraft (game), 41
Monkey mind, 105
Mood disorders, dual diagnosis and, 116
Myelin, Internet addiction and, 47
MySpace, 31

Naltrexone, 99
Narcissism, 119
National Institute of Mental Health, 29, 153
Net compulsions, 74–76
Netflix, 3, 103, 151; binge wating, 76–78
Neuroplasticity, of brain, 47–48
Neuropsychopharmacology (journal), 43
Newport, Cal, 50, 104, 106, 108
News addiction, online, 78
New York Times (newspaper), 7
Nicotine, 117, 143
Nigrostriatal pathway, dopamine in brain, 42
Nintendo thumb, 28
No junk food, 102
Nomophobia (fear of being without a smartphone), 55
Norepinephrine, neurotransmier in brain, 44–45
Noingham Trent University, 16, 55
Nucleus accumbens, as brain’s pleasure center, 40

Obesity, 26–27
Obsessive compulsive disorder (OCD), 74, 141
Odd Girl Out (James), 88
Ommwriter, 135
Online gambling, 76
On-Line Gamers Anonymous (OLGA), 101
Online gaming, 75; benefits of, 127–29; case study of adult addiction to, 164–66; case study of teen
addiction to, 159–61
Online perfect life, curating, 58–59
Online pornography addiction, 68–69
Online therapy, benefits of Internet, 129–31
Orange Is the New Black (Netflix show), 77
Outba therapeutic expeditions, 98–99

Pacific est treatment center, 98

Pang, Alex S.-K., 105, 140
Parent-ild relationships, 35–36
Partners/spouses, relationships with, 36
Pavlov’s dogs, 66
Pearlman, Leah, 54
Pelley, Virginia, 64
“Perfect” life, self-curating, 58–59
Personality disorders, 91, 116
Pew Center study, 79
Phantom vibration syndrome, 21–22, 37
Physical health issues, 27–28
Pierce, Jennifer Burek, 74
Pokemon, 138–39
Pokemon Go, 138, 139
Populations at risk. See At-risk populations
Pornography, 110; addiction to online, 68–69, 117, 139–40; case study of Internet addiction to, 161–64;
desensitization to violence, 69, 74
Posraumatic stress disorder (PTSD), 140–41
Prefrontal cortex: of brain, 45–46; damage to, 48; development of, 84
Pregnancy, image of perfect, 59
Psious, 142
Psyosis, 73; Internet addiction and, 38

Rat Pa, 89–90

Ready Player One (movie), 150–51
Reality television, 77
Real Time (talk show), 50
Rebooting, as self-help for Internet addiction, 103–5
Rehab treatment centers, 96–98
Relationships: face-to-face, 36–37; Internet addiction leading to problems with, 35–37; online, 37;
parent-ild, 35–36; problems with in-person, 24–26; selfie addiction impacting, 58; on social
media, 53–54; tenology-based, 25
Repetitive stress injuries, 27
Responsibility: role of government, 153–54; role of individual, 147–49; role of institutions, 149–53; role
of media, 150–52: role of other businesses, 152–53; role of sools, 149–50
reSTART, Internet addiction treatment center, 97, 117
Roberts, Kevin, 13–14, 27, 42, 88, 90, 99, 101, 117
Robots, social use of, 24
Rosen, Larry, 16, 61, 79, 119
Rosenstein, Justin, 54
RuneScape (game), 71
Rushe, Dominic, 139

Sizoid disorder, 91
Sizophrenia, 116
Sools: Internet addiction and performance in, 32–33; role of, in Internet addiction, 149–50
Screen-Free Week, 102
Screen Time, 134
Sedentary lifestyle, problems associated with, 26–27
Self-curated “perfect” life, 58–59
Self-Determination eory, 128
Self-help for Internet addiction: contemplative computing as, 105–6; digital diet as, 101–3; rebooting
as, 103–5. See also Treatment options
Selfie addiction, 56–58
Self-reinforcing behavior, 25
Sense of control, Internet use and, 29
Seo, Hyung Suk, 44
Serotonin, 43; addiction risk and, 48–49; neurotransmier, 43; role in gambling addiction, 43–44
Shiba Inu Puppy Cam, 41
Shopping addiction, 111–12; case study of online, 166–68
Sieberg, Daniel, 104
Simon Fraser University, 90
The Sims (game), 71
Siri, 137, 144
Sleep: ronic deprivation, 23–24; disorders, 116
Slot maines, apps similarity to, 49
Smartphones, 18, 108
SnowWorld (game), 129
Socially isolated individuals, 89–90; benefits of Internet for, 125–27
Social media, 18; autism spectrum disorders and, 124; case study of, 157–59; dopamine and, 30
Social media addiction, 53–65, 117; catfishing and, 62–63; cyberbullying and trolling, 64–65; fear of
missing out (FOMO) and, 61–62; “like” buon and, 54–55; models for, 56; online relationships of,
53–54; to other people’s content, 60–61; self-curated “perfect” life in, 58–59; selfie addiction and,
56–58; stalking and, 60–61
Social skills model, social media addiction, 56
Socio-cognitive model, social media addiction, 56
Stalking, 60–61
State Prison of Southern Miigan, 98
Steers, Mai-Ly, 30
Stimulation, excessive, video games in, 31–32
Stonewall riots, 5–6
Stress, 16, 21, 92, 125; injuries, 27–28; neurotransmiers and, 44, 72; reduction of, 44, 86, 129; response
levels, 24, 26, 28, 33
Substance Abuse and Mental Health Services Administration, 154
Substance addiction, 109
Substance use issues, at-risk addiction individuals with, 90–91
Suicide, 101, 126; crisis intervention, 130; depression and, 29–31, 108, 125
Sunset Heart Hands, 58
Superfan, 60
Susceptibility, brain and addiction, 48–51

Taco Bell commercial, 58

Tenology: anges in, 17–19; contemplative computing, 105–6; defining, for addiction, 16–17; digital
minimalism, 106; fitness apps, 78–79; history of anging, 15–19; hooked model for, 49–50; keeping
up with the Joneses for, 29; rebooting relationship with, 104; wearable te, 78–79; withdrawal and
tolerance, 37–38
Teenagers: at-risk for addiction, 83–86; case study of online gaming addiction, 159–61
Television, binge wating, 76–78
Tetris (game), 71, 151
Tetris effect, 73
Texting: addiction, 65–67; autism spectrum disorders and, 124; case study of addiction to, 157–59; text
ne, 27–28
erapy, cognitive behavioral therapy (CBT) online, 130–31. See also Treatment options
Time, Internet addiction and, 33–34
Time-restriction diet, 102
Time Well Spent movement, 152
Tinder finger, 67
Tobacco, 50; nicotine addiction, 117, 143
Tolerance, withdrawal and, 37–38
Trauma, 140–41
Treatment options: abstinence as, 95; contemplative computing, 105–6; digital diet as, 101–3; eco-
therapy as, 98–99; family therapy as, 100; group therapy as, 100–101; harm reduction as, 95–96;
individual therapy as, 99–100; places to receive Internet addiction, 96–101; rebooting as, 103–5;
rehab centers for, 96–98; self-help as, 101–6; wilderness camps as, 98–99
Trigger, of hooked model, 49
Trolling, 64–65
Turkle, Sherry, 24
TV Turnoff Week, 102
Twenge, Jean, 108
Twier, 6, 56, 88, 124

University of Houston, 30
University of Pisburgh, 7
University of Tubingen, 31
University of Connecticut Sool of Medicine, 153

Veterans, at risk for addiction, 89

Vice Motherboard article, 64
Victoria University, 31
Video games: Atari system, 17, 18, 68; designers of, 75; excessive stimulation and, 31–32; intermient
rewards in, 41; kids and, 5; real life and, 33
Virtual reality, 137; augmented reality and, 138–43
Voyeurism, 60, 78
VR Lab, 140
Wearable tenology, 78–79
WeChat, 65
White maer, brain and addiction, 46–47
Wilderness camps, for Internet addiction treatment, 98–99
Withdrawal: Internet addiction and, 37–38; psyosis and, 38
Work performance, Internet addiction and, 32–33
World Health Organization (WHO), 11
World of Warcraft (game), 12–13, 71–72, 127, 129, 151
World Wide Web, 17
Wowaholics.com, 12
WriteRoom, 135
Writer’s cramp, 28
Yale University, 123
Young, Kimberly, 7, 12, 18
YouTube, 29, 78
Zenware, 135
A  A

Kathryn Vercillo is a full-time writer with a master’s degree in

psyological studies. She is passionate about mental health topics and
helping to raise awareness about these issues in ways that destigmatize them
while offering inspiration and help to those in need. She loves tenology
but feels that it needs to be balanced with analog activities that connect
mind-heart-body. Some of her previous books are Crochet Saved My Life and
Hook to Heal, whi explore the possibilities of handcraing for dealing
with mental and physical health issues. When not writing or croeting, she
enjoys long walks with her rescue dog, deep talks with her family and
friends, and partaking of the creativity that her San Francisco home has to
offer.