Marc Potenza, a psychiatrist at Yale

  Marc Potenza, a psychiatrist at Yale

 and the director of the school’s Program for Research on Impulsivity and Impulse Control Disorders has been treating addiction for more than two decades.

 Early in his career, he, like most others studying addiction at the time, focussed on substance-abuse problems—cocaine and heroin addicts, alcoholics, and the like. Soon, however, he noticed patients with other problems that were more difficult to classify. 

There were, for example, the sufferers of trichotillomania, the inescapable urge to pull your hair until it falls out. Others had been committed to problem gambling: they couldn’t stop no matter how much debt they had accumulated.

 It was to this second class of behaviours—at the time, they were not called addictions—that he turned his attention. Were they, he wondered, fundamentally the same? 

 In some sense, they aren’t. A substance affects a person physically in a way that behaviour simply cannot: no matter how severe your trichotillomania, you’re not introducing something new to your bloodstream. But, in what may be a more fundamental way, they share much in common.

 As Potenza and his colleague Robert Leeman point out in a recent review of the last two decades of research, there are many commonalities between those two categories of addiction.

 Both behavioural and substance addictions are characterized by an inability to control how often or how intensely you engage in an activity, even when you feel the negative consequences. 

Both come with urges and cravings: you feel a sudden and debilitating need to place a bet or to take a hit in the middle of a meal. 

Both are marked by an inability to stop. Substance and behavioural addictions also both seem to have some genetic basis, and, Potenza has found, genetics seem to share many common characteristics. 

Some of the same gene mutations found in alcoholics and drug addicts, for instance, are often found in problem gamblers. Furthermore, the neurochemistry that these addictions evoke in the brain is similar. Drugs, for example, are known to affect the mesolimbic dopamine pathway—the pleasure centre of the brain. Behaviours like gambling similarly activate the same parts of the brain’s reward circuitry.

 Earlier this year, Trevor Robbins, a cognitive neuroscientist at the University of Cambridge, and the psychologist Luke Clark, then at Cambridge and now the director of the Centre for Gambling Research at the University of British Columbia, came to a similar conclusion after conducting an overview of the existing clinical research into behaviour addictions.

 The basic neuroscience of the two types of addiction showed a substantial overlap. In recent years, however, Potenza has been increasingly creating a new kind of problem: people who come to him because they can’t get off the Internet. In some ways, it seems exactly like the behavioural addictions that he has been treating for years, with much of the same consequences. 

“There are core features that cut across those conditions,” Potenza says. “Things like the motivation to engage in the behaviours and put aside other important elements of life functioning, just to engage in them.” 

Or, in the words of Robbins and Clark, “behaviour for behaviour’s sake.” There’s something different, and more complicated, about Internet addiction, though.

 Unlike gambling or even trichotillomania, it’s more difficult to pin down a quantifiable, negative effect of Internet use. With problematic gambling, you’re losing money and causing harm to yourself and your loved ones. 

But what about symptoms like those of a woman I’ll call Sue, who is a patient of Potenza? A young college student, Sue first came to Potenza at the behest of her parents, who were becoming increasingly concerned about the changes in their daughter. A good—and social—student in high school, she found herself depressed, skipping or dropping classes, foregoing all college extracurricular activities, and, increasingly, using the Internet to set up extreme sexual encounters with people she had never met in real life.

 Sue spends the majority of her time online social networking, but does that mean that she has a problem with the Internet or with managing her social life and her sex life? 

What if she were obsessively online, for the rest of her life, but learning languages or editing Wikipedia?

 The Internet, after all, is a medium, not an activity in and of itself. If you spend your time gambling online, maybe you have a gambling addiction, not an Internet addiction. 

If you spend your time shopping online, maybe it’s a shopping addiction. “Some people have posited that the Internet is a vehicle and not a target of disorder,” Potenza said. Can you be addicted to a longing for virtual connectivity in the same way that you can be addicted to a longing for a drink?

 As far back as 1997, before the days of ubiquitous smartphones and laptops, when dial-up and AOL dominated the landscape, psychologists were already testing the “addictive potential” of the World Wide Web. 

Even then, certain people were exhibiting the same kinds of symptoms that appeared with other addictions: trouble at work, social isolation, and the inability to cut back. And, to the extent that there was something that people referred to as an addiction, it appeared to be to the medium itself—the feeling of connectedness to something—rather than to an activity that could be accomplished via that medium.

A 1997 study had suspected, that the Internet could inspire the same patterns of excessive usage, withdrawal, tolerance, and negative repercussions as more traditional substance use. What’s more, Block concluded, “Internet addiction is resistant to treatment, entails significant risks, and has high relapse rates.” It was a disease that needed treatment as much as any other disease did.

 The realization that the Internet may be inducing some addictive-seeming behaviours in its own right has only grown more widespread. 

One study, published in 2012, of nearly twelve thousand adolescents in eleven European countries, found a 4.4 per cent prevalence of what the authors termed “pathological Internet use” or using the Internet in a way that affected subjects’ health and life. 

That is, through a combination of excessive time spent online and that time interfering with necessary social and professional activities, Internet use would result in either mental distress or clinical impairment, akin to the type of inability to function associated with pathological gambling.

But people who exhibited problematic use were also more likely to suffer from other psychological problems, such as depression, anxiety, A.D.H.D., and O.C.D. Internet addiction ultimately did not make the list of officially recognized behavioural addictions in DSM-V, but compulsive gambling did. 

It had taken gambling several decades of extensive research to make the cut, and there simply wasn’t enough systematic, longitudinal data about Internet addiction.

 But, to Potenza, Block’s conclusions rang true. Sue wasn’t the first patient that he’d seen for whom the Internet was causing substantial, escalating problems; that number had been rising slowly over the last few years, and his colleagues were reporting the same uptick. 

He had been working with addicts for decades, and her problems, as well as those of her fellow sufferers, were every bit as real as those of the gambling addicts. And it wasn’t just an iteration of college angst in a new form. It was something endemic to the medium itself. “I think there are people who find it very difficult to tolerate time without using digital technologies like smartphones or other ways of connecting via the Internet,”

 Potenza said. It’s the very knowledge of connectivity, or its lack, that’s the problem. He agrees that the subject remains far more disputed than other behavioural areas: psychiatrists are no longer debating that behavioural addictions exist, but they are ambivalent about whether Internet use can be classified as one of them.

Internet addiction remains a relatively minor part of Potenza’s work—he estimates that fewer than ten out of every forty patients he sees come in for an Internet problem. 

These patients tend to be younger, and there seems to be a gender divide: male patients are more likely to be addicted to activities like online gaming; women, to things like social networking. But it’s hard to make generalizations because the nature of the problem keeps changing. “The truth is, we don’t know what’s normal,” Potenza says. “It’s not like alcohol where we have healthy amounts that we can recommend to people.”

One of the most effective ways of treating those addictions is by identifying and removing the catalysts. Cancel the credit card. Get rid of the bottles. Avoid the places you go to drink or to gamble, and, at times, avoid the people you do these activities with. Be aware of your triggers.

 With the Internet, though, that solution is far more problematic. Computers and virtual connections have become an integral part of daily life. You can’t just pull the plug and expect it to function. A student may be suffering from what she’s doing online, but she also might need to use the Internet for her classes. The thing she needs to avoid to do well is also the thing she needs to use to reach the same end. 

QUESTIONS 

1.My feeling is that if you gamble on the internet or have sex using the internet or use the internet to have booze sent to your home, 24 hours a day, it's not the internet that is the problem. All you are doing is using an easier format to get what you want.

 If the internet didn't exist you would have to go and actually physically meet partners or actually go buy booze or actually walk to the betting shop, You would still do them but it would be a whole lot more difficult. What do you think? 

2. With the idea of the above in my opinion internet addiction cannot really exist. If it does it means you are addicted to being online. It's like people who walk in their home turn the telly on but then don't watch it, they just need it on.

So it is like you live to be connected not what comes after. Does that make any sense and if it does what would be the problem? You just need to be connected but you don't actually do anything more just like the Telly. That is basically what Potenza says internet addiction is. If you do things after you are connected that are maybe negative then I say

you would them anyway regardless of the internet? What do you think?

3. If you studied like mad on university-level courses and culture would you still be accused of internet addiction? Of course not so the study on the internet would still go on but you would do it with books if we were in the early 80s and the internet did not exist

4. Potenza said. Can you be addicted to a longing for virtual connectivity in the same way that you can be addicted to a longing for a drink? That means just to be connected. I   would say that anyone who thinks that the idea of millions of connection junkies is wrong. That would mean you turn on the computer and that's your fix. You do not do anything more. Do you agree?

5." Sue first came to Potenza at the behest of her parents,, she found herself depressed, skipping or dropping classes,  increasingly, using the Internet to set up extreme sexual encounters with people she had never met in real life. Sue spends the majority of her time online social networking, " but does that mean that she has a problem with the Internet or with managing her social life and her sex life? I would say that Sue if the internet was not invented would try and find men in the real world. It is something she would do but would have to do it physically. Sue is a Maneater and as Oats and Hall said "Wish you never met her at all!!!!!  

The point is that in all the cases we have looked at they are things that people would do regardless of the internet but the internet makes it easier. If you could buy drugs easily on the internet then druggies would buy them there.

6. The idea of gaming on the internet is also a bit false. Before internet gaming, there was XBOX and the like. Kids stayed on it for hours. Internet just made it easier. Internet gaming has also allowed lonely kids to meet like-minded kids so loneliness becomes much less. 

7. Friends. You could never really meet a friend in real life but with the internet, I have met loads who share my interests. My interests are art and men's fashion and now I have pages with all my new friends on. The point is the internet is an excellent way to meet friends although obviously friendship is not instant but has to be developed. Adults could never make friends but now they can. Again a medium to do something. Obviously, child worriers have an easier way to get to their prey through the internet They can lure young people into their lair much easier. But again that's something that is a new danger and the medium of the internet has made it so.

CONCLUSION 

If you agree with me it would be extremely hard to prove that the actual act of turning on the internet is addictive. After what you have read from Potenza and then my summing up what do you think. I think also that a lot of the antagonism towards the internet comes from people unconsciously afraid of it, for instance, old-style educators or those who can use it as a means of revenue or research. I would also say that the Axiom is a false one. We should be asking different questions.