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Internet addiction: own illness or just a symptom?

The scientific community has been interested in internet-related behavioral disorders for the last century. With the inclusion of computer game addiction in the international diagnostic catalog ICD-11, the discussion has reignited. Is computer game addiction really a disease in its own right? Or just the symptom of another illness, such as depression? And what about the addiction to social networks or other Internet offers? Is there really internet addiction?

The Center for Behavioral Addiction Research (CeBAR) at the University of Duisburg-Essen deals intensively with behavioral addictions. Research is carried out there from several perspectives and in several projects on the subject of the Internet and addictive behavior. Our online editor Saskia Rößner interviewed the research assistant Annika Brandtner.

Comparison of substance addiction and behavioral addiction

Saskia Rößner: Ms. Brandtner, you and the team around Prof. Dr. Matthias Brand researches "cognitive and emotive correlates of excessive playing of Internet computer games and the pathological use of social network sites". What does that mean?

Annika Brandtner: Right, this is one of several projects on potentially pathological Internet use. Here we deal with the basic mechanisms of these two behavioral patterns, i.e. the problematic use of computer games and social networking sites. The following is hidden behind the cognitive and emotive correlates: We look at the way in which feelings, thoughts and external stimuli are processed to control behavior.

The basic idea: We compare already known processing processes that are associated with substance dependencies (e.g. alcohol and drug addiction) with those non-substance-related behaviors that can assume addiction-like tendencies. For computer game addiction, this has already happened in recent years, until it was included in the ICD-11 in 2019. This is not yet the case with the problematic use of social media - the necessary research has so far been lacking. We assume, however, that this could also be a behavioral addiction.

In order to draw attention to this research gap, the project contrasts research on processing (e.g. distorted attention or decision-making behavior) on social network sites and research on addictive computer games. If processes can be discovered that work in the same way for both, this is an indication that the problematic use of social network sites can be well described by these addiction processes, sometimes better than, for example, by mechanisms of compulsive behavior.

In addition to computer games and the use of social media, we are also investigating similar questions for online shopping or Internet pornography use.

Is Internet Addiction Really An Addiction?

Saskia Rößner: So your research is about investigating whether the pathological use of Internet offers such as social media is actually an addiction disease?

Annika Brandtner: Exactly. There are people who have problems with special Internet offers. However, there is sometimes disagreement in research about which disease model best describes a new phenomenon. Our team would like to uncover the mental processes of internet-based behavioral phenomena. In this way we can assess whether the behavior is addictive.

With sufficient relevant research from multiple disciplines, social media addiction could be included in the diagnostic catalog as an addiction, as has already been done for computer game addiction and gambling addiction.

In this way, sick people would have the opportunity to take advantage of psychological help that is tailored to the clinical picture and can be billed to the statutory health insurance physician. Without inclusion in the diagnostic catalog, such disorders can only be treated as a concomitant disease to an underlying disease.

How can you find out if internet addiction is a real addiction?

Saskia Rößner: You come from cognitive psychology. Are there any other scientific disciplines involved in the research?

Annika Brandtner: Definitely. Cognitive psychology only sheds light on a small part of these behaviors. In addition to us, genetics is researching what connections there may be between our genes and psychological factors in the development of addiction. Research in the field of social work, for example, continuously reviews advisory services. And clinical psychology is dedicated to the question of which treatment methods are most promising. It is extremely important to exchange ideas with these other disciplines. That is why we regularly go to conferences where we meet other scientists and see what our colleagues find out. At CeBAR, however, we research fundamentally cognitive and neuropsychological.

Saskia Rößner: And what exactly does this type of research look like?

Annika Brandtner: Our methods look like this: Our studies are largely based on theoretical model assumptions. A special model for behavioral dependencies is the Interaction of Person-Affect-Cognition-Execution (I-PACE) model. It summarizes processes that could be involved in the development and maintenance of behavioral addiction. It thus provides the basis for checking to what extent the processes of different behavioral dependencies are similar or different.

Like other psychological disciplines, we try to make mental processes measurable. For example, we use online questionnaires for self-assessment. But we also work experimentally in the laboratory with computer-based tests for reaction control or decision-making behavior in an addiction context.

Part of our team also researches neurophysiological processes. To do this, we place test subjects in a magnetic resonance tomograph (MRI) and look at which brain areas are active, while our test subjects see images of addictive stimuli (e.g. a screenshot from a computer game) or perform certain tasks. In this way we can study how the brain works in an addiction development and maintenance.

Challenge: Find suitable test subjects

Saskia Roessner:Who and how many people do you work with in your studies?

Annika Brandtner: In our research, we mostly work with healthy subjects, i.e. people who are not receiving treatment. Because even with a healthy sample, there is often a range of people who have no problem at all with Internet offers, right up to those who already show addiction-like tendencies. In this way we can investigate the development processes of addictive behavior. In such healthy samples, the number of participants is usually between 100 and 500.

For our psychologist, Dr. Patrick Trotske, or in cooperation with clinical institutions, however, it is a little more difficult to find sick test subjects because there are not that many patients and the journey from surrounding cities is a hurdle. The number of cases here is significantly lower, usually between 20 and 100 participants per study.

Internet addictions are similar to recognized addictions

Saskia Rößner: Back to the question of whether internet addiction is really an addiction. Are results already foreseeable here?

Annika Brandtner: It must be said that there are correspondingly many more studies on computer game addiction and gambling addiction, which are already recognized addictions, than on a possible addiction to social networks. This is exactly what we have at CeBAR for: We want to provide more knowledge and clarification.

However, we see in our results that certain mechanisms that are involved in recognized addictions can also be measured in people with pathological online shopping, pornography consumption or problematic use of social network sites. Here we find, for example, reduced reaction control or an increased urge to use a certain Internet offer. These are indications that these behaviors may be addictive behavior.

Computer game addiction: illness or hobby?

Saskia Roessner:In the scientific community, opinions on the subject of internet addiction, especially computer game addiction, differ widely. There are researchers who actually consider this disorder to be an addiction. Others assume that addictive internet use is only a symptom of an underlying disease. Still others criticize that a time-consuming hobby would be over-pathologized here, that is, talked worse than it really is. How do you feel about it?

Annika Brandtner: We consider the inclusion of Gaming Disorder in the ICD-11 to be correct. But we're only part of the research community. Others are convinced that it might just be a hobby that they hold dear. To a certain extent, I would also like to agree with the other side: Of course, we must not over-pathologize a hobby. There is a large part of the population who manage to use computer games and other Internet offerings to a healthy extent, i.e. stop using them after a certain period of time and devote themselves to other activities.

However, we should take behaviors seriously if they show symptoms of addiction - the frequency of pathological computer games is between 3 and 5 percent of the population. So there are actually people who have extreme problems with quitting gambling and who suffer greatly from it. Sometimes the whole night is played through and the school or the job is neglected. Some also lose their jobs or their relationship breaks up as a result. And to distract yourself from the bad feelings that arise from these events, the game continues - a vicious circle! This can look similar for other usage disorders.

We are aware of this ambivalence. So in a certain way it is a tightrope walk not to over-pathologize Internet use on the one hand, but on the other hand to take addictive behavior seriously enough and to offer help to those affected. Research will definitely continue to be on the ball.

Saskia Rößner: Thank you very much for the interview!

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about the author

Saskia Roessner

Project coordinator and online editor for webcare + since January 2019, employee of the Hessian State Office for Addiction Issues, studied political science, philosophy and conflict research, has been working as a public relations specialist since 2011 and for and with self-help groups since 2017.