Can we become addicted to the internet?
The latest revision to the World Health Organization’s compendium of global health, the International Classification of Diseases (ICD), includes – for the first time – two types of addiction related to our use of the internet: gambling and gaming disorders. This update reflects the unique way in which the internet has come to play a part in our daily lives and impact our mental health.
It’s thought that up to three percent of young people suffer from gaming disorder, while unspecified internet use disorders (the ICD-11 also considers problematic pornography use as a subtype of compulsive sexual behavior disorder, with other potential diagnoses including problematic use of online shopping platforms or social networks) may affect seven percent of the world’s population.
“Feel better” and “must do” pathways
In his article, Brand lays out a review of our current understanding of how behavioral addictions like gaming and gambling disorders act on the brain. “We know from addiction research that, particularly within the online environment, applications that are used addictively obviously relate to positive reinforcement in terms of delivering pleasure and reward feelings,” Brand tells Technology Networks in an interview.
Anyone who has felt the micro-rush of seeing a like or share pop up on their phone knows what Brand is talking about. The flip side of this, says Brand, is that such applications also offer “negative reinforcement” – the chance to “escape from reality to modify negative moods”. Again, anyone who has clicked on a shopping platform to distract from a stressful or depressing day knows that many apps rely on this ability to tweak their users’ psychology.
These two forms of reinforcement are governed by a brain pathway that Brand’s paper succinctly dubs the “feel better” pathway. Previous research has identified that the brain areas involved include frontal-striatal loops related to reward anticipation and circuits in the ventral striatum that are also known to play roles in substance use disorders. “When you’re doing an fMRI scan with subjects with alcohol use disorder, for example, presenting them with pictures of a glass of beer compared to neutral pictures, you usually see this ventral striatum activity,” says Brand.
These circuits, Brand says, drive the initial stages of addiction, be it to alcohol or Fortnite, but later on in the condition course, other circuits come to predominate brain activity. He has collectively termed these subsequent circuits the “must do” pathway. This charts the addiction’s progress into becoming more habitual and compulsive, where the behavior persists despite the awareness of the harm it causes.
Drug addiction vs. internet addiction
One key distinction between addictions that involve substances and those that don’t, is that drugs like alcohol and cocaine can actually cause neurotoxic damage to the very areas of the brain that would otherwise help users stop harmful behavior. This direct harm isn’t present in behavioral addictions.
But Brand is careful to point out that he believes addiction to gaming or internet gambling is not a choice: “There are neural adaptations in every human related to all behaviors, basically. This means that if you engage in specific behaviors frequently and very intensively, that may lead to neural adaptations that may also change your ability to control the usage,” he says.
The birth of addiction
The final part of Brand’s paper considers some of the glaring gaps in our knowledge of how addiction begins and sustains itself. The internet is not only an integral part of the great majority of people’s lives, but it is also something that they use every day without becoming addicted. Why do some users of social media networks find themselves totally reliant on the buzz of notifications, while others can easily put their phone down?
Brand says that the answer involves vulnerability factor that are shared with other mental disorders: genetic predisposition, early childhood trauma and specific personality traits all play a role.
The trait that these factors may influence, says Brand, is self-control – the ability to say “no” to the temptation of a screens or chime from your phone. But what’s not clear is whether the vulnerability factors mentioned above erode individuals’ capacity to make beneficial choices for themselves, or whether positive and negative reinforcement from the addictive activity are the causative factor in users’ loss of control.
The final unknown that Brand discusses is how specific the mechanisms of internet-based addiction are. He points out that addiction to online apps and gaming platforms present some unique obstacles to recovery. Unlike, for example, alcohol, apps that want to keep users hooked actively modify themselves based on previous activity to make themselves as appealing and hard to put down as possible. Additionally, for the great majority of our population, being online is impossible to avoid in a way that cocaine, for example, isn’t. This means, says Brand, that “complete abstinence is not the goal and cannot be the goal.”
To answer these questions, long-term studies that combine multiple types of analysis are required, Brand says. If it was to be shown that internet-specific mechanisms were causative in these addictions, what could public health authorities do to help patients? Brand says that there is no need to “stigmatize all the gamers or everyone that uses online shopping,” but that specific elements could be looked at by regulators.
Brand mentions loot boxes, which bring an element of gambling into online gaming setups, and the harvesting of private data by social media networks as the price of free access to their platforms, as potential targets. Part of the solution, he concludes, will also be on the user’s end: “Early intervention and therapy should also be improved. I think it’s on both sides; you may work on the societal level, and I think this is important, and also on the individual level, in terms of helping people not develop this problematic behavior.”
Reference: Brand M, Can internet use become addictive? Science. 2022;376(6595). doi:10.1126/science.abn4189