Several reports today suggest that a study of the brains of people who excessively use the internet show abnormalities similar to those found in people with substance addictions could be proof that the internet has similar addictive qualities to drugs, alcohol or tobacco. The Independent's report here is the most extensive. It says:

Internet addiction has for the first time been linked with changes in the brain similar to those seen in people addicted to alcohol, cocaine and cannabis. In a groundbreaking study, researchers used MRI scanners to reveal abnormalities in the brains of adolescents who spent many hours on the internet, to the detriment of their social and personal lives. The finding could throw light on other behavioural problems and lead to the development of new approaches to treatment, researchers said. An estimated 5 to 10 per cent of internet users are thought to be addicted – meaning they are unable to control their use. The majority are games players who become so absorbed in the activity they go without food or drink for long periods and their education, work and relationships suffer.

But is there really such a thing as internet addiction?

The claim

The reports are based on this study, conducted in China and published yeserday in the online journal PLoS ONE. The abstract says:

Background Internet addiction disorder (IAD) is currently becoming a serious mental health issue around the globe. Previous studies regarding IAD were mainly focused on associated psychological examinations. However, there are few studies on brain structure and function about IAD. In this study, we used diffusion tensor imaging (DTI) to investigate white matter integrity in adolescents with IAD. Methodology/Principal Findings Seventeen IAD subjects and sixteen healthy controls without IAD participated in this study. Whole brain voxel-wise analysis of fractional anisotropy (FA) was performed by tract-based spatial statistics (TBSS) to localize abnormal white matter regions between groups. TBSS demonstrated that IAD had significantly lower FA than controls throughout the brain, including the orbito-frontal white matter, corpus callosum, cingulum, inferior fronto-occipital fasciculus, and corona radiation, internal and external capsules, while exhibiting no areas of higher FA. Volume-of-interest (VOI) analysis was used to detect changes of diffusivity indices in the regions showing FA abnormalities. In most VOIs, FA reductions were caused by an increase in radial diffusivity while no changes in axial diffusivity. Correlation analysis was performed to assess the relationship between FA and behavioral measures within the IAD group. Significantly negative correlations were found between FA values in the left genu of the corpus callosum and the Screen for Child Anxiety Related Emotional Disorders, and between FA values in the left external capsule and the Young's Internet addiction scale. Conclusions Our findings suggest that IAD demonstrated widespread reductions of FA in major white matter pathways and such abnormal white matter structure may be linked to some behavioral impairments. In addition, white matter integrity may serve as a potential new treatment target and FA may be as a qualified biomarker to understand the underlying neural mechanisms of injury or to assess the effectiveness of specific early interventions in IAD.



I'm going to look into whether internet addiction is considered a medical condition. I'm also curious about the source of claims that 5-10% of internet users are addicted and unable to control their use and report back. I also wonder whether internet addiction is always a bad thing? Do you have an evidence or experience that might help? Get in touch below the line, email me at polly.curtis@guardian.co.uk or tweet @pollycurtis

Analysis

The Royal College of Psychiatrists told me that psychiatrists in the UK refer to two international sources to define whether a set of symptoms is a diagnosable illness or not. The World Health Organisation publishes International Classification of Diseases periodically, but the last came into use in 1994 and therefore inevitably includes no reference to the internet.

The other source is the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which is due to be updated next year. The committees responsible for formulating this policy has been debating whether to include internet addiction in its section on addictions. The current proposals reclassify internet gambling as an addiction rather than a compulsive behaviour but don't include internet addiction in its own right. This is still open to consultation, fiercely contested and subject to new evidence, including potentially the Chinese study.

Last year Charles O'Brien of the University of Pennsylvania, the chair of the addictions committee, said in a press conference reported here, that internet addiction would not be included but that they would recommend future research in the area. The report said:



He [O'Brien] said his work group had considered including sex and Internet addictions as disorders, but decided there was insufficient evidence to allow development of reliable diagnostic criteria for them. Consequently, gambling addiction is slated to be the only disorder formally listed in the behavioral addictions category. But O'Brien added that, under current plans, sex and Internet addictions would be included in an appendix to DSM-V, intended to encourage additional research that could lead to their inclusion in future editions.

The first and obvious point to make about the Chinese study is that it's very small and therefore not conclusive of anything. The second was made by Colin Drummond, professor of addiction psychiatry at Kings College London, which has the largest research centre for psychiatry in Europe, on the Today programme this morning. You can listen to him here and he's just expanded his argument in a phone interview with me. I asked him whether internet addiction is a medical illness. He said:

No. It's interesting that people who use the internet excessively seem to have different brain structures compared with people who don't but the big issue is whether we are looking at cause or effect. There is quite good evidence that people who engage in substance misuse and addictions and to some extent gambling do have problems with impulse control which fits with abnormalities in the frontal lobes of the brain similar to those in this study. But it is a big leap to go from there to suggest that the internet is re-wiring your brain. If people have emotional problems and that leads them to use the internet obsessively then they obviously need help to deal with those problems, but that's quite different to saying that the internet is addictive. Perhaps unhappy people or people with impulse control problems may well need some help. I'm not denying it' a problem for individuals, but trying to classify it as an addiction has risks attached to it. They are treating an addiction rather than emotional problems that might lead to the emotional behaviour. Excessively internet use is a symptom not a cause of a person's problems. Are people drawn to the internet because they have impulse control issues? Probably, that's part of the problem they have. The suggestion form this paper is that it's working the other way round; that it's changing people's brain functioning. The implication people who disapprove of the internet can make is that it's potentially addictive and a bad thing that could harm our youth. In China there has been a considerable problem with the publicity that internet addiction has got. In the 1990s there was one doctor giving teenagers electroshock treatment to try and cure addiction to the internet. There are other examples of programmes set up that use physical punishment to try and stop people from excessive internet use. That's one of the side effects of medicalising and trying to turn this into a disorder instead of seeing it as a type of behaviour. Gambling addiction or drug addiction is somewhat different from spending a lot of time on social network sites or playing warcraft. It's a problem if you are surfing Facebook instead of doing your A-levels, but it's a different order to losing all your money from gambling or getting liver disease from drinking. We should be much more concerned about alcohol and tobacco addiction which is killing millions around the world.

Drummond is explaining the brain patterns found in the Chinese study as being similar ones found in people who have impulse control problems – but that doesn't mean that the internet is the cause but instead it could be the symptom. He didn't deny that excessive internet use can be a problem for individuals but he argues that it trivialises "real" addictions if other behaviour is included and can warp treatment programmes. If problematic over-use of the internet is a symptom of other emotional problems, there's no point treating the symptom.

But others within the psychiatric community do believe it's a real disorder. The Independent's story reports:

Henrietta Bowden Jones, consultant psychiatrist at Imperial College, London, who runs Britain's only NHS clinic for internet addicts and problem gamblers, said: "The majority of people we see with serious internet addiction are gamers – people who spend long hours in roles in various games that cause them to disregard their obligations. I have seen people who stopped attending university lectures, failed their degrees or their marriages broke down because they were unable to emotionally connect with anything outside the game." Although most of the population was spending longer online, that was not evidence of addiction, she said. "It is different. We are doing it because modern life requires us to link up over the net in regard to jobs, professional and social connections – but not in an obsessive way. When someone comes to you and says they did not sleep last night because they spent 14 hours playing games, and it was the same the previous night, and they tried to stop but they couldn't – you know they have a problem. It does tend to be the gaming that catches people out."

Summary

Lives can suffer profoundly as a result of overusing the internet whether they are gambling, obsessively using social media sites or playing online games. But whether this means they are addicted to the internet or not is fiercely contested by psychiatrists. Some argue that there is a growing body of evidence such as the Chinese study published this week which suggests that there is a physical effect of internet addiction. But that study was too small to draw conclusions from. It also did not establish whether the brain patterns found in compulsive internet users were a cause or symptom of their behaviour. Others say that regardless, the impact is serious enough for it to require classification.

The counter argument is that in fact problem compulsive use of the internet is a symptom of other conditions. Studies show that many people who cannot control their internet use have other psychiatric disorders as well. If it's taken as a disorder in its own right not only will the true cause of the problem not be identified and treated, but it could also distract focus from "real" substance addictions or mental illnesses.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has rejected classifying internet addiction as a disorder in its forthcoming revised guidance that heavily influences diagnosis and treatment in the UK. But it has indicated that further research is needed to settle the debate once and for all. The jury is still out.

Confessions of a self confessed addict

Jonathan Haynes, web news editor at the Guardian, has written the below few paragraphs for us about his obsession with the internet. It's anecdote, rather than evidence, but I think it raises a neat point about whether compulsive use of the internet is always harmful - it's been quite instructive in Jonathan's career. Evidence of his compulsive use can be seen on his twitter home page, here. Jonathan writes:

Addiction to the internet itself seems unlikely, however addiction to accessing information on it, well I'd love to try to argue against that but I cannot. When you find yourself with five columns of Twitter on Tweetdeck on a big screen right in front of you - but your hand still inexplicably reaching for your iPhone to check if what's on Twitter there is even newer … you know there's a problem. When you've disabled your email accounts because you're on holiday - and yet you still find your phone in your hand and your fingers having moved without you even noticing in search of latest messages … you know it's really not healthy. When your router breaks and your housemate suggests calling an engineer and living without the internet for a few days and you literally run to the shop to buy a new one because you can't bear the thought of even an evening without connection to the net … When the last thing you do before you sleep is tweet and the first thing when you wake up, and sometimes when you even wake up in the middle of the night and tweet then too. The internet may not be addictive itself, but it sure helps!

Below the line there are a couple of points related to this. @mattmags makes thids reference:

According to Professor Bruce Hood's latest book, it's not the Internet that you get addicted to, but email and social networking sites like Facebook and Twitter. It's the little hit of that you get when someone likes your post, or retweets or otherwise demonstrates approval of your input that is addictive. It's also the fact that it doesn't happen automatically, but only occassionaly, that is the real hook. Like a one-armed bandit, you only get the payback sporadically, and it's that that keeps you coming back for more.

Jonathan says he's hooked on the information the internet brings, Prof Hood writes about addiction to networking sites and @epinoa makes this point:

If it triggers a dopamine response then you can become addicted to it. Not a difficult assessment.

If it does trigger a dopamine response is that coming from the internet or what the person is finding there? Are people addicted to the internet, or to social networks, information, gaming, shopping or pornography?

Prevalence

I've just been speaking with Mark Griffiths from Nottingham Trent University who has been researching online addiction since 1994. I asked him specifically about the prevalence issue. He thinks that the estimations of 5-10% are wildly excessive. However, he does believe that a very small number of people are addicted to the internet in its own right but that that number is over-inflated by others who compulsively use the internet as a symptom of another psychological disorder or people who are addicted to doing things that the internet facilitates like gaming or pornography. He said: