December 17, 2008

Is Internet Addiction Really An Addiction?

Depends on your definition. Wovon man...

Keith Bakker, the founder and head of The Smith & Jones Centre, Europe's first and only clinic to treat computer gaming addicts, has changed his mind: 90% of the hardcore, multi-hour gaming addicts are not actually addicted.

These kids sure look like addicts:

"These kids come in showing some kind of symptoms that are similar to other addictions and chemical dependencies," he says. 

"But the more we work with these kids the less I believe we can call this addiction. What many of these kids need is their parents and their school teachers - this is a social problem."

The clinic he runs is a rehab, for all addictions-- alcohol, drugs, etc-- it just happens to be the only one offering treatment for internet addiction using the same model.  And he's abandoning it.

"This gaming problem is a result of the society we live in today...Eighty per cent of the young people we see have been bullied at school and feel isolated. Many of the symptoms they have can be solved by going back to good old fashioned communication."
The article goes on to cite the causes you'd probably guess at:

  • Not feeling accepted in real life
  • rejection, alienation, anger
  • anonymity allows you to be anyone you want
  • games offer you the identity affirmation one so desperately craves

Mr Bakker believes that if there was more commitment from parents and other care givers to listen to what their children are saying then these issues of isolation and frustration could be dealt with at source and bring many young people out of the virtual world and back into real life.
Adults do not take the time to really listen to "kids" as autonomous entities, we treat them either as extensions of ourselves or as pets.

"If I continue to call gaming an addiction it takes away the element of choice these people have," he says. "It's a complete shift in my thinking and also a shift in the thinking of my clinic and the way it treats these people."
The main novelty here is that it's an addiction specialist who is making this concession, admitting that most kids, regardless of how long they are playing, aren't addicted.

Hold on-- none of those kids are Chinese, are they?


The debate about what is and isn't an addiction is a red herring.  It creates a false dichotomy.  Whether it is a compulsion or bad behavior doesn't change the fact that the person needs to stop, and often can't for whatever reason, and needs help stopping.

Focusing on the false dichotomy as the reason for treatment does have several consequences.    We don't know addiction is a disease, we think it's a disease.  It's entirely possible twenty years from now we will discover it actually isn't.  Then what?  Kick the junkies to the curb?

Secondly, it makes control the central issue in its "treatment.  "Loss of control is both the hallmark of addiction and the source of its societal stigma," said one of the country's leading addictions psychiatrist.  If/since that is true, then it implies control must come from the outside.

You should probably stop reading right here.


First the Germans were going to take over the world in the1940s; then the Russians in the 60s.  Then the Japanese in the 80s.  Then the Chinese in the 2000s.  Perhaps every generation's parents need some foreign nation to scare their kids into better SAT scores.  But history is clear that when a bubbles bursts, it gets replaced, not reinflated.  Put away your Berlitz tapes. 

A quick survey of national bubbles also serves to support my contention that nations in decline turn quickly to one of two things: completely whacked out pornography, or fascism, or both.

China-- where they have recently classifed internet addiction as a full blown psychiatric disorder, has invested considerable money and resources into treating it.

USAToday describes a Chinese clinic:

"All the children here have left school because they are playing games or in chat rooms everyday," says the clinic's director, Dr. Tao Ran. "They are suffering from depression, nervousness, fear and unwillingness to interact with others, panic and agitation. They also have sleep disorders, the shakes and numbness in their hands."

You can sense their frustration: whatever the cause, genetic or social, it's a big problem that is taking possibly two million kids out of circulation.

But classifying it as a psychiatric disorder-- that the element of choice is absent or decreased-- means that the state can "offer" you treatment if it thinks you need it.

We do that in America, too-- involuntary commitment laws, etc, for those to ill to take care of themselves.  The difference is that "internet addiction" is sufficiently general that it can be defined by whatever group is in charge of setting definitions-- in this case, the government-- at any time they want, ad hoc. 

Perhaps you're an iconoclastic blogger who thinks China blows?   A couple months at Daxing Boot Camp-- I mean Treatment Center-- will straighten you out.


Suddenly, that false dichotomy isn't so false anymore; suddenly, it matters very much if it's an addiction, or not.

Which brings me to my very unpopular position on this issue, toxic to any self-respecting Kantian: we shouldn't try to find out if addictions are diseases or not.

Society is often not ready for the answers to some "scientific" questions.  As a society, we shouldn't be too quick to want addiction to be a disease, or criminality to be biologically based, or intelligence to be genetic, because we have no ability to deal with the consequences of those truths.  We're barely muddling through now, and that only because not knowing allows us to slide back and forth along the spectrum, as situations require.

So many arguments are really the result of inconsistently applied definitions.  The reason we have endless debates is that we have no agreement on what an addiction is.  Is the primary characteristic a loss of control; escalating use; the presence of tolerance and withdrawal; etc?  Not even all drug addictions have all those things.  And without rigorous definitions, you can't have a scientific inquiry into the question.  You may as well try to find out if sexism is a disease, keeping in mind that our understanding of sexism has been very different over the course of, say, 2000 years-- not to mention our conception of disease.  How does science  determine the biological correlates of something whose definition is applied inconsistently, influenced by prevailing cultural standards?  You don't.  Wovon man nicht sprechen kann, daruber muss man schweigen.

Furthermore, these words have connotations which are more important than their actual definitions, should they even exist.  You can never fully erase these connotations.  When a scientician says that gaming is an addiction like cocaine addiction, a gamer hears, for example, that the scientician means it is "bad."    So no matter how much data, MRIs, southern blots, genetic markers you show him, for him the issue isn't biology, but morality.  The result of this is that rather than the scientician spending time making a case for why gaming can be an addiction, the real thrust of the argument is convincing the kid that addiction has a different meaning.  In other words, the discourse isn't about science, or what is true; it's about semantics.  In other words, a complete waste of time.  Both interpretations are equally right (or wrong) because the word addiction means what you want it to mean.

Doctors love to identify biology in such things because it allows them to assit in making social policy.  Doctors have no place there, they not only have nothing to contribute, their contributions should be assumed to be folly.

Arthur C. Clarke said either we are alone in the universe, or we are not.  Both are equally  terrifying.   Everyone agrees that one of those two has to be right; but as long as we don't have to answer it, we can go on with our lives.


Bingo! You nailed it!... (Below threshold)

December 17, 2008 3:43 PM | Posted by Keith Bakker: | Reply

Bingo! You nailed it!

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The flavor that I'm getting... (Below threshold)

December 17, 2008 4:24 PM | Posted by La BellaDonna: | Reply

The flavor that I'm getting from this is, essentially, a lot of people want the opportunity and/or the right to control what a whole lot of other people do.

This is right up there with New York State's proposed 15-18% sales tax on non-diet soda. Because, apparently, the poor need to be financially punished for picking the "wrong" kind of soda. Too bad for them if they can't tolerate aspartame! New York knows what's best!

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In other words, th... (Below threshold)

December 17, 2008 5:48 PM | Posted by Siderea: | Reply

In other words, the discourse isn't about science, or what is true; it's about semantics.

No, worse: it's about morality and values. It's a facet of the Naturalistic Fallacy: it's the discussion of "ought" cloaked in a discussion of "is".

In any event: rock on, Dr. Dude. I don't suppose you've been reading any Ronald Bayer lately?

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Currently the controlling d... (Below threshold)

December 17, 2008 10:19 PM | Posted by Alexandru: | Reply

Currently the controlling drive that funds these research into biological roots of certain behaviours is aimed at only certain behaviours. When it will get to the point of ranking "objectively" other things (determining if good leadership, political views, parenting skills etc.) the financial backing may hamper a little, but it'll be too late.

The ability of modern science to produce "convincing" (if not really true) theories about such things is like an open Pandora box. It cannot be closed back.

But it will probably lead us to a different "good" vs. "evil" moral paradigm. When everyone discovers they are evil in some degree (as measured by instruments), the idea that "good" must stomp out "evil" will hopefully give way to something like "there must be a balance between 'good' and 'evil'". And no, I did not misread the point of the post...

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"What many of these kids ne... (Below threshold)

December 18, 2008 10:10 AM | Posted by MedsVsTherapy: | Reply

"What many of these kids need is their parents and their school teachers - this is a social problem."

This is the same problem with all of the "bipolar" cases. In the studies I have read, there is not a hint of whether the parenting environment, and parental time, was assessed. Teens need to have responsibilities, and need to have attention and time wit their parents.

How radical is that?

I don't work with kids now. But when I did, I generally used Barkley's 'defiant children' text and methods. first, assess parent-child interaction: observe parent and child together (in therapy room set up for kids, with toys etc.) for 5 minutes; then for 5 minutes, have the kid lead the parent in play as therapist observes; next five minutes have parent lead kid.

15 minutes.

It was sad to see parents fumbling to figure out how to play with their child - either directing child or following along with child.

Then: you prescribe the same 15-miute span of "special time" at least once per week. Parents look at you as if you are from outer space. Then, they tell you they do not have 15 minutes to devote exclusively to child. This is almost the universal response.

The parents that follow thru discover that the child's problems dissolve. I would also do chore charts, etc. For teens, things get modified. But same idea: spend quality time taking your child seriously. I actually had to force or convince parents to do this.

Partly, because our society has changed and we believe we are so advanced that our children do not need any of this - we can just give them TV and cell phones and they will turn into decent adults. We see them setting up myspace pages, and assume that they have some great community, and creativity, and are 'finding their way.'

Partly a prob is parents don't expect a lot from themselves - parents use recreational drugs regularly, are devoted to hobby-type stuff including watching TV, figuring out how to get financing for the next toy (boat, vacation, big tv, harley, etc) despite lack of means to eventually pay, etc.

But also this quality time issue is hard to accept because the alternative explanation - that your child has [insert disorder de jour: bipolar, "sensory integration disorder," ODD, Conduct d/o, ADHD, etc] and should be receiving [insert medication under patent].

Yes, psychiatry gets turned into the answer to society's problems.

I made parents do this, and generally had great success. One woman brought her kid in, and was emphasizing that he needed adhd dx. I side-stepped and went into treatment as above. I eventually learned from mom that her original goal was to get her son declared "disabled," so he could get social security benefits. I spoiled her plans, but she was glad to get her son 'back.'

It still stuns me how many times parents declared that they did not have 15 minutes per week of special time for their child.

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I dunno, I'm one of those h... (Below threshold)

December 18, 2008 10:22 PM | Posted by Dusty: | Reply

I dunno, I'm one of those hardcore gamers and sure, whatever, I was never the most popular kid in school or even accepted. Thing is, there's a lot of things people can put a lot of time into in order to hide from society, such as reading books, getting into drugs ... writing poetry, suicide. Reading is "good for us" so nobody argues against it, anyway, the other thing is if it's gaming then it's also fun, right? Playing games is fun, and some of us find it more fun than being in the bar on a Friday night. Others are really competitive, competitive in the way of board games, console games, mmo games, and in ordinary society these people leap at any change for a challenge in gaming when it's brought up.

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I just can't get the image ... (Below threshold)

December 22, 2008 1:12 AM | Posted by xon: | Reply

I just can't get the image of a dread-locked surfer dude when I read the "Wovon man". Like, Wove on, dude. . .

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And here I was using the wo... (Below threshold)

December 23, 2008 3:34 PM | Posted by spriteless: | Reply

And here I was using the word as a lable for the kind of roomate that will steal and pawn my TV to feed their addiction. Coka and gambling fit; video games, $60 for a hit that lasts weeks, don't.

Does psychiatry care what kind of roomate their patients make?

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I don’t know whether Intern... (Below threshold)

December 29, 2008 1:56 AM | Posted by Justin: | Reply

I don’t know whether Internet addiction is really an addiction but I know one thing exactly. My children need to have responsibilities, to spend time outdoors and engaged in other activities in order to have a healthy, well balanced life.
To control my kids’ on-line activity, I use Internet filtering software ">"> Ez Internet Timer. It allows me to restrict internet access at specified times or on demand

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I don’t know whether Intern... (Below threshold)

December 29, 2008 1:59 AM | Posted by Justin: | Reply

I don’t know whether Internet addiction is really an addiction but I know one thing exactly. My children need to have responsibilities, to spend time outdoors and engaged in other activities in order to have a healthy, well balanced life.
To control my kids’ on-line activity, I use Internet filtering software Ez">">Ez Internet Timer It allows me to restrict internet access at specified times or on demand

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Have you ever met an addict... (Below threshold)

December 29, 2008 2:45 AM | Posted by Chris Farley: | Reply

Have you ever met an addict who is seriously trying to quit? There is a lack of resources, not a bunch of boot camps. When there isn't even enough help for people who want it, why so paranoid that it would it be forced on people? Even people who've killed others by drunk driving and have court-ordered treatment plans aren't forced into psych wards.

This is an ignorant post from a person who doesn't seem to have experienced or observed closeup the effects of addiction and the trouble people have quitting. Which is surprising, considering that addiction impacts just about every family.

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This is an ignorant respons... (Below threshold)

December 29, 2008 10:54 AM | Posted, in reply to Chris Farley's comment, by Matthew: | Reply

This is an ignorant response from a person who couldn't read an objective assessment without fully encompassing and including some huge and apparent interest in an addict's (likely a close friend or relative) addiction/struggle/recovery/whatever. Chris Farley, I am close with, and also do traffic with many addicts, and was absoltuely able to get through this article without detecting what you say you have: the writer of this article, some PSYCHIATRIST, hasn't observed the effects of addiction close up...

The punchline to the joke: What the psychiatrist wrote struck a nerve, and you took it personally.

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"It still stuns me how many... (Below threshold)

February 2, 2009 1:59 AM | Posted, in reply to MedsVsTherapy's comment, by SentWest: | Reply

"It still stuns me how many times parents declared that they did not have 15 minutes per week of special time for their child."

I have never worked clinically with children, but I did spend my four years of college tutoring math as a side job. I can sympathize with your experience.

My penultimate example is a high school senior who I was tutoring in calculus after he failed the class for the second time and was in danger of not graduating. He was reported to have severe ADHD. He also knew he was supposed to have severe ADHD. His parents were both doctors and they were all quite wealthy.

This kid was in a school band, a personal rock band, lacrosse, swim team, on the yearbook staff, and two or three other college-application-padding sports and leadership activities. Every second of his daily schedule was packed to the minute. When I got to him it was invariably 8pm after swim and he could barely keep his head off the table, much less think about math that he already hated and feared due to his repeated failures.

I actually did a lot of behavioral coaching with him with some degree of success. I at least was able to instill in him the ability to come to the session with the tools he needed to work on math, and show him that he could indeed sit still and focus for an hour if he set himself up to do so. He was surprised at this, since he had been told for years that he couldn't.

Problem was, and I'm sure you'll not be surprised, the parents. His mother interrupted our one-hour sessions no less than three times a session. To ask if he wanted a coke (yeah, ADHD boy needs caffeine at 8pm), to tell him his friend called and she took a message (because THAT's not distracting), to ask what he wanted to tomorrow/this weekend/in 2036. The last study session before his big midterm she canceled because there was a rock concert that night and her son "would only be young once." And the kid obviously can't pass math because he has a mental disorder.

After the midterm (which he failed) I sat down with his parents to discuss his progress. I explained that their son had a limited understanding of basic mathematics, and struggled with simple fractions. His attempts at calculus would fail until he mastered some of the skills necessary to build up to it. I could not teach him the last four years of math in one hour a week in time for him to pass calculus. It would really be best for him to go back to algebra or even pre-algebra, take the time to really know the material and succeed with it (which, in fact, is the same situation that jump started my great love of math just a few years earlier).

I also suggested that they, his doting parents, could help set him up for success if they would retrieve his homework schedule from his teachers, and help him keep track of which assignments were due when. They should check early in the evening to see if he completed the correct assignment for the correct day (because he had never acquired any scheduling skills) and initial it or cross it off a big visual calendar of upcoming homework deadlines.

I also, as gently as possible, suggested that it appeared he had very little time out of school not taken up by scheduled activities. They might drop one or two sports that he did not enjoy so dearly in favor of extra time to spend on classes that were giving him difficulty.

Their response: We're busy people, how do you think we're going to have time to check his homework? He HAS to be in three sports and two leadership activities to get into an ivy league like we went to (yeah folks, like he'll get into Princeton if he can't get through high school calc). We'd better take him back to Dr. Amphetamine to get his twelve prescriptions adjusted if he can't pass this class.

And by the way, you're fired you presumptuous bitch.

So I feel for you. Kid wasn't broken, he was just over tired, over medicated, and under too much pressure with too little support and a nice heaping of active interference. This had gone on his entire life, and now it was too late, at least for 12th grade calc. His parents didn't really seem to want a kid, they wanted a few plaques on the wall documenting their genetic material's achievements and something they could brag about at cocktail parties. God forbid they actually have to put some work into it, there's a pill for that, isn't there?

Now repeat 50x in similar situations for nearly all of my "special needs" tutoring kids. Forgive me if I'm a little skeptical of parents who are convinced their kids are ADD or ADHD or bipolar or internet addicts, I earned it.

Back on topic, it's still the parents. These young kids who are "addicted" to the internet. Last I checked the computer doesn't run on moonbeams and unicorn farts. I see the living room, I see a computer, I see the plug running into the wall. Do these parents not have opposable thumbs with which to both grasp and pull? Are they so emasculated by their own spawn that they can't say "oopsie, we let the DSL subscription expire, oh shucks?"

Just who is running the asylum here?

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i have a friend who has dec... (Below threshold)

March 1, 2009 3:02 PM | Posted by Jay Elmeister: | Reply

i have a friend who has decided to make a living playing video games and asks:

if you're able to make money doing it, what's the difference between a gaming addiction and workaholism?

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Im very late to this party,... (Below threshold)

January 4, 2012 12:59 PM | Posted by The Next-to-Last Man: | Reply

Im very late to this party, but hey, that never stopped me before...

I think the problem is worse than not having a uniform definition of "addiction." We dont even have a uniform definition of "disease." And its even worse than that: there is no "ought" about what "disease" somehow must refer to. Disease is a symbol, and the meanings of symbols are established by consensus. If there were a society that, for example, defined "disease" as meaning, oh, say only genetically-based conditions, they would not be wrong to do so. Nor right. Thats just what they chose to mean by the term "disease."

Heres an example: a hiker is lost for a couple days while hiking in the southwest. She comes into the ER with mild-mod dehydration and exposure. Here's the question: **from the standpoint of the ER doc**, does she have a disease?

Trick question. Whether you say yes or no, youre wrong. The correct answer is, "Who gives a f***??"

The ER doc is interested in two questions: (1) is it a *problem*? and (2) Do I have something to offer that might help? The rest is semantics.

Similarly, for internet addiction: is it a problem? (yes), does medicine/psychiatry/psychotherapy have something to offer that might help? (probably, though I doubt its meds). Whether this counts as a "disease" or not is a question of interest to insurance companies & and state agencies who might be billed for it, directly or indirectly. And a society that wants to know if its okay to morally condemn people with this problem, or if they are obliged to pity them.

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Wovon man nicht sprechen ka... (Below threshold)

February 24, 2012 9:44 PM | Posted by Anonymous: | Reply

Wovon man nicht sprechen kann, daruber muss man schweigen.
What is bad must also be evil. I'm bad at cooking.

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I like your site, it... (Below threshold)

March 28, 2012 10:27 AM | Posted by surgical instruments: | Reply

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Your ending was particularl... (Below threshold)

May 4, 2012 9:17 AM | Posted by FatherRussia: | Reply

Your ending was particularly tasteful, I really liked it for some reason.

What if, what if there is no God and we are alone? To be honest, I don't take solace in the thought that God exist and it might be that I prefer the opposite to be true.

I have one short comment on addiction. Although I have no experience with heavy physical dependency, I imagine the point (whatever) would include this case also. Addiction is a symptom more then a cause. The causes of such symptoms could be manifold. It could just be a bad habit, inherited from the environment, or a it could be a need for escaping reality, or it can be associated with general loss of meaning. I mean, what the hell? Does it matter? Do I matter? I'm in pain, so why not just make myself comfortable?

And than, we have hope, which I'm sure everyone know as the most enduring and least effective motivation a human can have. Faith is similar in my view, but different. Seeing what's possible and probable might cause a person to start moving mountains instead of rolling in a sandbox. It's probably better to focus on the small steps, but I know revolution of mind take place and can't help wonder: What happened that very instant?

I know several lifelong heavy "addicts". Everyone around them say "oh it's such a waste. If he just stopped drinking, how fine of a life wouldn't he get". Bullshit! Yeah I can see the drinking problem(don't we all), but it doesn't even make it to the top 10 list.

It doesn't matter what were whose faults when - you're the one who's gonna fix it, or not. In the latter case you'll probably grow old and when no-one is there to help your selfish ass with a change of diapers, you'll regret that you didn't shoot yourself in u twenties.

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That's harsh man. I wish y... (Below threshold)

May 4, 2012 6:11 PM | Posted, in reply to FatherRussia's comment, by Anonymous: | Reply

That's harsh man. I wish you well.

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What a great article, i jus... (Below threshold)

July 10, 2012 6:38 AM | Posted by Surgical Guru (@SurgicalGuru): | Reply

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Exactly :)... (Below threshold)

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