See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/234045455

Is Internet addiction a useful concept?

Article  in  Australian and New Zealand Journal of Psychiatry · January 2013

DOI: 10.1177/0004867412461693

CITATIONS READS

80 549

1 author:

Vladan Starcevic
The University of Sydney
305 PUBLICATIONS   3,422 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Development and validation of a scale for assessing situational dysphoria View project

Anxiety Disorders View project

All content following this page was uploaded by Vladan Starcevic on 17 May 2014.

The user has requested enhancement of the downloaded file.

Australian and New Zealand Journal of
Psychiatry
http://anp.sagepub.com/

Is Internet addiction a useful concept?

Vladan Starcevic
Aust N Z J Psychiatry 2013 47: 16
DOI: 10.1177/0004867412461693

The online version of this article can be found at:

http://anp.sagepub.com/content/47/1/16

Published by:

http://www.sagepublications.com

On behalf of:

The Royal Australian and New Zealand College of Psychiatrists

Additional services and information for Australian and New Zealand Journal of Psychiatry can be found at:

Email Alerts: http://anp.sagepub.com/cgi/alerts

Subscriptions: http://anp.sagepub.com/subscriptions

Reprints: http://www.sagepub.com/journalsReprints.nav

Permissions: http://www.sagepub.com/journalsPermissions.nav

>> Version of Record - Jan 4, 2013

What is This?

Downloaded from anp.sagepub.com at University of Sydney on January 5, 2013

461693
2012
ANP47110.1177/0004867412461693ANZJP PerspectivesStarcevic
Viewpoint
Is Internet addiction a useful concept?
Vladan Starcevic
The Internet is utilised by hundreds
of millions of people worldwide, with
its numerous benefits only leading to
an increase in the number of users.
But there is a dark side to the
Internet, and one of the negative
consequences of the vast potentials
of the Internet has been its excessive
and uncontrollable use, often
referred to as ‘Internet addiction’.
Hardly a day passes without this phe-
nomenon of the modern age being
mentioned in the media. Over the
past decade, Internet addiction and
related behaviours have been attract-
ing the attention of mental health
researchers and clinicians, although
this field is still in its infancy. In some
Asian countries, such as South Korea,
Internet addiction and similar prob-
lems are considered issues of public
health significance. However, in such
countries, competitive online video
gaming is heavily promoted, blurring
the boundary between ‘normal
excessive’ and pathologically exces-
sive use of the Internet and online
video games.
The very term ‘Internet addiction’
is controversial and the concept
remains elusive. This article aims to
examine some of the most important
issues surrounding Internet addiction
and to propose an alternative
conceptualisation.
Terminological
conundrums
As a concept, Internet addiction faces
two types of challenges. The first one
is about it being an addiction. The sec-
ond refers to the Internet as a medium
to which a person is presumably
addicted.
Australian & New Zealand Journal of Psychiatry, 47(1)
Downloaded from anp.sagepub.com at University of Sydney on January 5, 2013
Australian & New Zealand Journal of Psychiatry
47(1) 16­–19
DOI: 10.1177/0004867412461693
© The Royal Australian and
New Zealand College of Psychiatrists 2012
Reprints and permission:
sagepub.co.uk/journalsPermissions.nav
anp.sagepub.com
What is addiction? her society’ (Alexander, 2008: 48).
Likewise, the American Society of
Addiction does not appear as a diag-
Addiction Medicine (2011) has defined
nosis in the diagnostic and classifica-
addiction as ‘impairment in behavioural
tion systems such as the Diagnostic
control, craving and diminished recognition
and Statistical Manual of Mental
of significant problems with one’s behav-
Disorders (DSM)-IV. The diagnostic
iour and interpersonal relationships’. If
concept most closely related to addic-
these definitions were to serve as the
tion has been dependence, which has
basis for a diagnosis of behavioural
been linked with psychotropic sub-
addiction, the diagnostic threshold
stance use. In recent years, however,
would be set very low, leading to an
there has been a trend to replace
epidemic of behavioural addictions.
dependence with addiction and to
However, behavioural addiction
include among addictions not just
is not only about excessive behav-
those conditions caused by sub-
iour and the harm associated with it
stances, but also behaviours per-
(Blaszczynski, 2008; Wood, 2008). If
formed with little or no control and
the concept of behavioural addiction
having detrimental consequences. The
is to be meaningful and useful, the
latter became known as ‘behavioural
activity in question would need to be
addictions’, the prime example of
associated with several characteris-
which is pathological gambling.
tics. These have been integrated and
It was pathological gambling as a
summarised from the literature
behavioural addiction that served as
(Blaszczynski, 2008; Block, 2008;
the model for the concept of Internet
Charlton and Danforth, 2007;
addiction. However, this was inappro-
Hussain and Griffiths, 2009; Kuss
priate because of the differences
and Griffiths, 2012; Sim et al., 2012),
between the two that were either
as follows:
neglected or overlooked. Furthermore,
behavioural addiction itself is a prob-
1. Salience of the activity, which
lematic construct, as it implies that any
refers to preoccupation with it
behaviour that is rewarding can be
because of its pleasurable or
addictive. In other words, any pleasur-
mood-altering effects so that the
able activity performed in excess and
person craves for it, experiences
having some negative consequences
it as central to their lives and
would constitute an addiction. Thus,
neglects other important every-
people could be ‘addicted’ to eating,
day activities.
having sex, exercising, shopping, work-
ing or even indulging in hobbies such as
model railroading (Mihordin, 2012).
Such an understanding of addiction is in
Discipline of Psychiatry, Sydney Medical School
– Nepean, University of Sydney, Sydney,
agreement with the more recent, Australia
broad definitions of addiction. For
example, it has been suggested that Corresponding author:
Vladan Starcevic, Department of Psychiatry,
addiction is an ‘overwhelming involve- Nepean Hospital, PO Box 63, Penrith,
ment with any pursuit whatsoever that is NSW 2751, Australia.
harmful to the addicted person and his or Email: starcev@wahs.nsw.gov.au
Starcevic 17
2. Loss of control over the activity,
such that the person finds it diffi-
cult to stop it despite an aware-
ness that it is or that it might be
detrimental and despite their will-
ingness to cease the activity.
3. Tolerance, which is a need to
spend more time performing the
activity to achieve the same pleas-
urable or mood-altering effect as
when the activity was performed
initially.
4. Withdrawal manifestations, which
refers to the occurrence of
adverse mood states and behav-
iours (e.g. irritability and agitation)
and perhaps physical symptoms,
when it is not possible to continue
with the activity.
5. Negative consequences, such that
activity engagement leads to inter-
ference with occupational, aca-
demic, interpersonal and/or social
functioning or that it has other
detrimental effects (e.g. financial
difficulties, sleep disturbance, sig-
nificant weight change or various
physical problems).
If all of these criteria are required,
only pathological gambling could so
far be conceived of as a behavioural
addiction. It is uncertain whether
other ‘candidates’ for behavioural
addiction, including Internet addiction
(or addiction to Internet-related
activities), meet all the requirements
for behavioural addiction.
What are ‘Internet addicts’
addicted to?
Although Internet addiction has
become a widely used term, it is a
misnomer and should be abandoned.
This is because of the conceptual
heterogeneity of the term (Starcevic,
2010) and because being addicted to
the Internet implies addiction to a
‘delivery mechanism’ (Sim et al., 2012)
or, more precisely, addiction to a
medium, a means to an end or a
vehicle for achieving something.
Therefore, Internet addiction is
as meaningful a term as ‘casino
Downloaded from anp.sagepub.com at University of Sydney on January 5, 2013
addiction’, which would denote
addictive gambling in casinos.
If it is assumed that addictive use of
the Internet does exist, the addiction
would actually pertain to the corre-
sponding activities and not to the
Internet itself. These activities are
quite diverse and include gaming, gam-
bling, viewing pornography and
related sexual behaviours, shopping,
chatting, sending messages, etc. In
other words, people presumably
addicted to the Internet use it as a
medium to ‘fuel other addictions’
(Griffiths, 2000). Although one can
develop some of these other addic-
tions only on the Internet (e.g. addic-
tion to online video game playing),
that does not justify the term Internet
addiction; it would be more accurate
and appropriate to refer to the spe-
cific activity presumed to be addictive
(e.g. online video game addiction).
Internet addiction should there-
fore be replaced by addictions to spe-
cific online activities, although for
each such activity it would need to be
ascertained whether they follow the
behavioural addiction pattern. As
already noted, the concept of behav-
ioural addiction is not without prob-
lems and should be used with extreme
care. In light of these considerations,
the focus will now shift to problem
video game use and online video game
addiction, as these are usually referred
to when using the term Internet
addiction.
Problem video game use
and online video game
addiction
Given the uncertainty about the puta-
tive online video game addiction as a
true addiction, several concepts over-
lapping with it have been proposed.
One of them has been problem video
game use (PVGU), which was defined
as a preoccupation with playing video
games to the extent that there is a
loss of control over this activity, with
various negative psychosocial and
physical consequences (Porter et al.,
Australian & New Zealand Journal of Psychiatry, 47(1)
2010). As PVGU is not characterised
by tolerance, it does not meet all the
criteria for behavioural addiction.
The criteria for PVGU have been
preliminarily validated (Porter et al.,
2010) and in an online, anonymous
international survey, 8% of video game
players had PVGU (Porter et al.,
2010). Interestingly, other studies
using somewhat different criteria and
terminology (e.g. ‘excessive computer
game playing’ and ‘pathological video
game use’) reported similar rates,
between 8.5% and 11.9% (Gentile,
2009; Grüsser et al., 2007; Tejeiro
Salguero and Morán, 2002), suggesting
that a minority of online video game
players develop a pattern of use that
may resemble addiction. But what
about online video game addiction
itself? Does it exist?
This issue has been debated, but it
is still unclear whether the presumed
online video game addiction meets
the criteria for a behavioural addic-
tion the way pathological gambling
does. A number of important differ-
ences between the proposed online
video game addiction and pathological
gambling have been reported (e.g.
Blaszczynski, 2008; Wood, 2008), sug-
gesting that the former is not a true
behavioural addiction. Opinion is
divided and evidence is equivocal as to
whether tolerance is associated with
online video game playing (e.g. Hussain
and Griffiths, 2009; Tejeiro Salguero
and Morán, 2002; Wood, 2008); this
is important because in addition to
PVGU-like characteristics, tolerance
would qualify such online video game
use as a true addiction. Some authors
have emphasised similarities between
addictive use of video games and sub-
stance-related addiction (Chappell et
al., 2006). Certain structural charac-
teristics of online video games, such
as their ability to reinforce playing,
have been implicated in making these
games potentially addictive (Kuss and
Griffiths, 2012). Complicating matters
further, there is some uncertainty
about the criteria for addiction and
distinction between the ‘core’ and
‘peripheral’ addiction criteria (e.g.
18 ANZJP Perspectives
Charlton and Danforth, 2007). Only a
consensus on the criteria for addic-
tion and further research can resolve
the question of whether online video
game addiction is real or not.
Conceptual and
classification issues related
to DSM-5 and beyond
The trend of replacing the concept of
dependence with that of addiction is
also reflected in the proposals for the
upcoming DSM-5, with the suggestion
to create a broader diagnostic group
called ‘substance use and addictive
disorders’. This group would include
pathological gambling, renamed as
‘gambling disorder’ and moved from
its current classification as an impulse
control disorder. Internet addiction
was considered for inclusion into the
same group, but it was decided not to
include it in the list of the official
DSM-5 diagnoses. Instead, ‘Internet
use disorder’ was proposed to be
classified in Section III of the DSM-5
and thereby recommended for fur-
ther study.
While such placement of Internet
use disorder may seem like a reason-
able compromise, there are several
problems with this concept. The first
pertains to the retention of ‘Internet’
in its name, which is over-inclusive
and unsuitable in light of the above
discussion. Also, nine criteria have
been listed for Internet use disorder,
of which seven mention ‘Internet
gaming’, while two refer to ‘Internet
use’ and ‘Internet’. Therefore, these
criteria imply that the disorder in
question is in fact about Internet
(online) gaming, not Internet use in
general. Furthermore, the proposed
criteria cor­respond to all the criteria
for behavioural addiction, prema-
turely suggesting that Internet use
disorder is in fact an addiction. The
inclusion of tolerance is controver-
sial, as noted above. Finally, one of
the proposed criteria is also prob-
lematic: ‘use of the Internet gaming to
escape or relieve a dysphoric mood’.
Australian & New Zealand Journal of Psychiatry, 47(1)
Downloaded from anp.sagepub.com at University of Sydney on January 5, 2013
Notwithstanding the ambiguity about
what is meant by ‘dysphoric mood’,
people with PVGU or any form of
pathological online gaming resort to
this activity for a variety of reasons,
including socialising, experimenting
with various identities, escaping from
a painful reality, attempting to cope
with specific problems, obtaining
gratification, etc (e.g. Kuss and
Griffiths, 2012). Limiting these rea-
sons to one or two motivations as a
diagnostic criterion is clearly
inappropriate.
Despite pressure put by some cli-
nicians and relatives of people afflicted
with PVGU and similar problems to
attach a formal diagnosis to these
behaviours, it is laudable that online
gaming-related problems are not
likely to find a home in DSM-5 as an
official diagnostic category. Doing so
would be premature in view of so
many uncertainties and controversies.
The proposed Internet use disorder
in Section III of the DSM-5 might be
renamed ‘online video game use dis-
order’, with the criteria modified to
ensure consistency and coherence
and avoid a premature closure of the
issue of whether online video game
addiction exists.
Future research in this area needs
to tackle several key issues, as
follows:
•• The first task is to determine
under what circumstances exces-
sive online video game use consti-
tutes a mental disorder (online
video game use disorder), thereby
delineating it from normality.
Diagnostically subthreshold forms
could be labelled ‘online video
game use problem’, still allowing
individuals to seek and receive
help and care.
•• The relationship with other psy-
chopathology needs to be studied
further to determine whether
various aspects of psychopathol-
ogy are non-specifically related to
online video game use problem or
online video game use disorder
(e.g. Starcevic et al., 2011), or
whether certain forms of psy­
chopathology such as depression,
excessive social anxiety and atten-
tion deficit and hyperactivity dis-
order (Ko et al., 2012) may be a
risk factor for or predispose to
such a problem or disorder. A
related issue is whether online
video game use disorder repre-
sents a separate condition or
whether it can be better under-
stood as a manifestation of the
underlying psychopathology.
•• There is clearly a need to establish
whether online video game addic-
tion exists and, if it does, the
nature of its relationship (dimen-
sional or otherwise) with online
video game use problem and
online video game use disorder
should be elucidated. Thus, a pro-
posal that online video game use
problem, online video game use
disorder and possibly online video
game addiction may exist on a
continuum of severity needs to be
tested.
•• The classification of online video
game use disorder and online
video game addiction may need to
be revisited. Current thinking is
that they belong to the group of
addictive disorders, but there are
also views that these conditions
might alternatively be conceived
of and classified as impulse control
disorders (e.g. Liu and Potenza,
2010; Sim et al., 2012).
Conclusion
Internet addiction is a misleading term
and should be replaced by addictions
to the Internet-related activities if the
pattern of such activities meets the
criteria for behavioural addiction. Of
all the activities performed mainly on
the Internet, video gaming has appar-
ently been the one with most poten-
tial to lead to a problematic and
perhaps addictive use. This calls for
further study of the patterns of patho-
logical online video game use and clar-
ification as to whether online video
game addiction exists.
 Starcevic 19
Funding
This research received no specific grant
from any funding agency in the public, com-
mercial, or not-for-profit sectors.
Declaration of interest
The author reports no conflicts of inter-
est. The author alone is responsible for
the content and writing of this article.
References
Alexander BK (2008) The Globalisation of Addiction:
A Study in Poverty of the Spirit. New York:
Oxford University Press.
American Society of Addiction Medicine (2011)
Public Policy Statement: Definition of Addiction.
Available at: www.asam.org/pdf/Advocacy/Press
Releases/20110815_DefofAddiction-PR.pdf
Blaszczynski A (2008) Commentary: A response
to ‘Problems with the concept of video
game ‘addiction’: Some case study examples’.
International Journal of Mental Health and
Addiction 6: 179–181.
Block JJ (2008) Issues for DSM-V: Internet addiction.
American Journal of Psychiatry 165: 306–307.
Chappell D, Eatough V, Davies MNO, et al. (2006)
EverQuest – It’s just a computer game right?
Downloaded from anp.sagepub.com at University of Sydney on January 5, 2013
View publication stats
An interpretative phenomenological analysis
of online gaming addiction. International Journal
of Mental Health and Addiction 4: 205–216.
Charlton JP and Danforth IDW (2007) Distin­
guishing addiction and high engagement in the
context of online game playing. Computers in
Human Behavior 23: 1531–1548.
Gentile D (2009) Pathological video-game use
among youth ages 8 to 18: A national study.
Psychological Science 20: 594–602.
Griffiths MD (2000) Internet addiction – Time to be
taken seriously? Addiction Research 8: 413–418.
Grüsser SM, Thalemann R and Griffiths MD (2007)
Excessive computer game playing: Evidence
for addiction and aggression? Cyberpsychology
and Behavior 10: 290–292.
Hussain Z and Griffiths MD (2009) Excessive use
of massively multi-player online role-playing
games: A pilot study. International Journal of
Mental Health and Addiction 7: 563–571.
Ko C-H, Yen J-Y, Yen C-F, et al. (2012) The asso-
ciation between Internet addiction and psy-
chiatric disorder: A review of the literature.
European Psychiatry 27: 1–8.
Kuss DJ and Griffiths MD (2012) Internet gaming
addiction: A systematic review of empirical
research. International Journal of Mental Health
and Addiction 10: 278–296.
Liu T and Potenza MN (2010) Problematic Internet
use: Clinical aspects. In: Aboujaoude E and
Australian & New Zealand Journal of Psychiatry, 47(1)
Koran LM (eds) Impulse Control Disorders.
New York: Cambridge University Press,
pp.167–181.
Mihordin R (2012) Behavioral addiction – Quo
vadis? Journal of Nervous and Mental Disease
200: 489–491.
Porter G, Starcevic V, Berle D, et al. (2010)
Recognising problem video game use.
Australian and New Zealand Journal of Psychiatry
44: 120–128.
Sim T, Gentile DA, Bricolo F, et al. (2012) A con-
ceptual review of research on the pathologi-
cal use of computers, video games, and the
Internet. International Journal of Mental Health
and Addiction (in press).
Starcevic V (2010) Problematic Internet use: A
distinct disorder, a manifestation of an under-
lying psychopathology, or a troublesome
behaviour? World Psychiatry 9: 92–93.
Starcevic V, Berle D, Porter G, et al. (2011)
Problem video game use and dimensions
of psychopathology. International Journal of
Mental Health and Addiction 9: 248–256.
Tejeiro Salguero RA and Morán RM (2002)
Measuring problem video game playing in
adolescents. Addiction 97: 1601–1606.
Wood RTA (2008) Problems with the concept
of video game ‘addiction’: Some case study
examples. International Journal of Mental Health
and Addiction 6: 169–178.