Online addiction

Email, YouTube, TikTok, Wikipedia and weather apps – the internet is as much part of everyday life as eating and sleeping. People use it to listen to their favorite music, book vacations, and shop. People watch series, look for the love of their life on Tinder, share ideas with other users, or battle against virtual monsters with them. With its infinite possibilities, the internet permeates every aspect of life. The danger is that it can also make people ill. But when is internet use an illness or, as doctors say, pathological? 

This question is quite difficult to answer, because the subject is a relatively new area of medical research. This is apparent just from the wide range of terms that are used: cell phone addiction, pathological internet use, online dependency, and internet-based addictive behavior. The term “internet addiction disorder” (IAD) is increasingly becoming the favored medical expression. But what exactly does it mean?

An IAD is a mental disorder. It refers to the harmful or improper use of the internet. It originally referred to negative effects or risks resulting from internet gaming addiction. These have been well researched and accepted by the World Health Organization’s (WHO) International Classification of Diseases (ICD) as a distinct disorder.

Most researchers believe that the mechanisms are similar with IAD. So findings on internet gaming addiction have also been carried across to other internet uses. The feature they have in common is loss of control. Most common are computer games (online and offline), social networks, online shopping, and consumption of pornography.

Everyone has seen cartoons or photos of people who are all staring at their smartphones at the same time. You have a mirror held up to yourself, you find it funny, but you also get an affirmation: if everyone is doing it, it can’t be so bad. Or can it? Actually the lines between frequent internet use and dependency are blurred.

Early indications of a problematic development are negative impacts on different areas of life: in favor of their online activities, people neglect school and work, hobbies, healthy eating, or their real world social life. They have a strong craving for online activities which they increasingly lose control over. Doing without the internet is unimaginable for them. Another typical characteristic: online activities are continued even though negative consequences are already being experienced.

Scientists still disagree to some extent as whether internet addiction disorder (IAD) is really an addiction. Critics believe that the internet cannot be compared with a drug, for example alcohol. Rather, it is a medium that provides access to virtual content or creates social contacts.

So, for the critics, the purpose plays a key role: whether the internet is being used for work, for gaming or as a platform for social contacts makes a difference, they say. It is not the technology that produces dependency, but the user’s behavior, they argue.

However, most experts assume it is an addiction. Not least because of this, the WHO have also recognized Gaming Disorder as an addiction illness, and classified it as such. This means that forms of therapy can be used as treatment that have had proven results with mental disorders.

As yet there are few reliable figures on online addiction. According to a 2011 study, 1 to 2 percent of the population in Germany, or between 800,000 and 1.6 million people, have internet addiction disorder.

Adolescents are most at risk. It is noticeable that girls and young women are more susceptible than boys and young men. Amongst young females aged between 12 and 25, computer game and internet dependency more than doubled between 2011 and 2019.

However, this data is based on a brief questionnaire, not on clinicians’ estimates. At the same time, girls and women ask for advice or treatment far less frequently. This is explained by the fact that they use social networks more frequently and intensively. This is usually more casual and does not normally impact their everyday life, while a gaming addiction tends to cause problems in everyday life.

It seems that the educational level and work situation also have an influence. Problematic internet behavior is most commonly found, in almost 10 percent of adolescents and adults, in vocational schools. Students in more academic school types have fewer internet use problems than other students. Unemployed people are also at higher risk.

A study conducted by the DAK-Gesundheit insurance company in 2018 showed that there was problematic use of social media, such as WhatsApp, Instagram and Snapchat, in 2.6 percent of the children and adolescents studied. Here, too, girls were at greater risk than boys.

Three-quarters of all adolescents play computer games regularly. The figure is 90 percent amongst boys, and 50 percent among girls. The gaming behavior of every sixth gamer was rated as critical.

The time spent on the internet alone says nothing about whether there is a problem. So there are 9 criteria which help identify problems. When there is suspicion, the question is asked, for example, whether the person feels distinctly unwell if they are unable to use the internet, whether they have ever unsuccessfully tried to curtail their internet activities, or whether they keep this secret from their friends or family.

If up to 4 of the 9 criteria are met, the internet use is problematic. If a person’s performance drops significantly at school or work, medical practitioners categorize this as harmful. Internet-based (self-)help groups, counseling, or a short spell of psychotherapy (‘brief intervention’) may be useful in this case.

If 5 of the 9 criteria are met, internet addiction disorder (IAD) is likely. If more than 5 criteria are met, and if the internet use has had a serious negative impact on everyday life, this is a dependency. Depending on how many criteria are deemed to have been met, additional outpatient or inpatient therapy are options.

You can check whether you are dependent on the internet with an online test from the DIA-NET working group (in German) which will take about 20 minutes. The test captures your internet usage and evaluates it using diagnostic criteria.

How an online addiction is treated depends on how severe it is: i.e. how many of the 9 diagnostic criteria are met, and whether there are any co-morbidities, for example, depression.

The treatment aims to:

• reduce time spent on the internet
• direct the focus towards other possible occupations
• strengthening the personality and the feeling of self-esteem
• reducing any fear of social contacts

The following treatment methods are available:

• self-help
• short spell of psychotherapy (brief intervention)
• outpatient therapy
• inpatient therapy

Self-help

This includes counseling options, online training, online self-help groups, forums, self-tests, and information on other forms of help. These options are also aimed at family members. A key benefit is that these options are easy to access.

Brief intervention

Sometimes minor changes to everyday life are enough to improve the situation. A so-called brief intervention can help in this. This a form of psychotherapy. It is particularly suitable in the early phases of an addiction problem. The brief intervention consists of between 1 and 4 chats with a therapist.

The motivational interviewing method is recommended specifically for an internet addiction disorder (IAD). This method aims to support the person. The therapists act as partners who do not exert any pressure or impose any rules. Rather, they try to motivate the patient to get to grips with their own behavior and change it.

Outpatient therapy

Outpatient psychotherapy is recommended when the dependence is marked, there are certain co-morbidities, or an earlier treatment has been unsuccessful over the longer term. This approach aims at getting the person to understand the mechanisms of the addictive behavior so that they manage to change their behavior. This is also known as cognitive behavioral therapy. Problem management strategies are also imparted, and social and interpersonal skills are strengthened.

Inpatient therapy

When a dependency is severe it can be useful to provide the treatment as an inpatient. The main benefit here is the geographical distance from the everyday environment, which is often linked to the problematic internet use. The therapy can help with relearning day-to-day structures, developing alternative behaviors, and finding strategies that can be used to control internet use.

Information about contacts, places to get help, and all forms of therapy is available on the DIA-NET working group website (in German).

Everyone can incorporate simple things for healthy internet use into their everyday life.

The following measures help to prevent online addiction:

• Log time spent on the internet for a week, to get an objective overview of one’s own behavior.
• Take offline breaks, known as “digital fasting” or a “digital detox”.
• Avoid triggers: i.e. disable visuals and acoustics that indicate new messages have arrived, or just set the smartphone to mute. These triggers act on the reward center, so they can have an addictive effect.
• Put the smartphone aside at meals and in bed.
• Keep the smartphone where it cannot be quickly accessed, for example in a rucksack, when moving around.
• Remember pastimes or hobbies that used to be enjoyable, and take them up again.

There is a lot of information about online addiction from the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung – BZgA).

For example, parents and young people can order free brochures there.

The BZgA also runs various websites aimed at particular target groups:

The www.ins-netz-gehen.de website has a scheme for changing young people’ behaviors (in German).

There is a lot of information (in German) for parents, teachers and specialists on preventing addiction in young people at www.ins-netz-gehen.info.

Other options

The DIA-NET working group at the University of Lübeck provides information, checklists, help options, and material about online addiction based on the latest research (in German language).

The Section for Addiction Medicine and Addiction Research at Tübingen University Hospital has created the German-language portal Erste Hilfe Internetsucht – a searchable database of help options.

The German Association for Inpatient Addiction Support (Bundesverband für stationäre Suchtkrankenhilfe) can help with finding a therapy place in a hospital.