October 17, 2006
STANFORD, Calif. - Is spending too much time online a prevalent and damaging condition, or simply a bad habit among a select few? Stanford University School of Medicine researchers have taken an important step toward resolving the debate over whether compulsive use of the Internet merits a medical diagnosis.
In a first-of-its-kind, telephone-based study, the researchers found that more than one out of eight Americans exhibited at least one possible sign of problematic Internet use. The findings follow results from previous, less rigorous studies that found a significant number of the population could be suffering from some form of Internet addiction.
"Our telephone survey suggests that potential markers of problematic Internet use are present in a sizeable portion of the population," the researchers noted in their paper, which appears in the October issue of CNS Spectrums: The International Journal of Neuropsychiatric Medicine.
"We often focus on how wonderful the Internet is - how simple and efficient it can make things," elaborated lead author Elias Aboujaoude, MD. "But we need to consider the fact that it creates real problems for a subset of people."
Aboujaoude, clinical assistant professor in psychiatry and behavioral sciences and director of Stanford's Impulse Control Disorders Clinic, said that a small but growing number of Internet users are starting to visit their doctors for help with unhealthy attachments to cyberspace. He said these patients' strong drive to compulsively use the Internet to check e-mail, make blog entries or visit Web sites or chat rooms, is not unlike what sufferers of substance abuse or impulse-control disorders experience: a repetitive, intrusive and irresistible urge to perform an act that may be pleasurable in the moment but that can lead to significant problems on the personal and professional levels.
According to preliminary research, the typical affected individual is a single, college-educated, white male in his 30s, who spends approximately 30 hours a week on non-essential computer use. While some may hear this profile and assume that a person's Internet "addiction" might actually be an extreme fondness for pornography, Aboujaoude stressed that pornography sites are just one part of the problem.
"Not surprisingly, online pornography and, to some degree, online gambling, have received the most attention - but users are as likely to use other sites, including chat rooms, shopping venues and special-interest Web sites," he said. "Our survey did not track what specific Internet venues were the most frequented by respondents, but other studies, and our clinical experience, indicate that pornography is just one area of excessive Internet use."
Although studies show that more than 160 million Americans are regular Internet users, little research has been conducted on problematic Internet use. A 1999 Center for Internet Studies survey of 18,000 Internet users, however, did find that 5.7 percent of the sample met suggested criteria for "compulsive" Internet use. And a 2002 study in the journal CyberPsychology & Behavior found that 60 percent of companies surveyed had disciplined, and more than 30 percent had terminated, employees for inappropriate Internet use.
"The issue is starting to be recognized as a legitimate object of clinical attention, as well as an economic problem, given that a great deal of non-essential Internet use takes place at work," said Aboujaoude. But he added that there is little consensus among clinicians on whether problematic Internet use is a distinct disorder or merely an expression of other psychopathologies, such as depression or obsessive-compulsive disorder.
In the Stanford study - which Aboujaoude said is the first large-scale, random-sample epidemiological one ever done - the researchers conducted a nationwide household survey and interviewed 2,513 adults. Because no generally accepted screening instrument exists for problematic Internet use, the researchers developed their questions by extrapolating from other compulsive and addictive conditions.
The researchers found that 68.9 percent were regular Internet users, which is consistent with previous studies, and that:
- 13.7 percent (more than one out of eight respondents) found it hard to stay away from the Internet for several days at a time
- 12.4 percent stayed online longer than intended very often or often
- 12.3 percent had seen a need to cut back on Internet use at some point
- 8.7 percent attempted to conceal non-essential Internet use from family, friends and employers
- 8.2 percent used the Internet as a way to escape problems or relieve negative mood
- 5.9 percent felt their relationships suffered as a result of excessive Internet use
Aboujaoude said he found most concerning the numbers of people who hid their nonessential Internet use or used the Internet to escape a negative mood, much in the same way that alcoholics might. "In a sense, they're using the Internet to ‘self-medicate,'" he said. "And obviously something is wrong when people go out of their way to hide their Internet activity."
While the numbers indicate that a subset of people might have a problem with Internet use, Aboujaoude stressed that it's premature to say whether people in the sample actually have a clinical disorder. "We're not saying this is a diagnosis - we still need to learn a lot more," he said. "But this study was a necessary first step toward possibly identifying something clinically significant."
Aboujaoude said the next step is to conduct comprehensive clinical interviews on a large sample of people to better identify clinically relevant markers for problematic Internet use, and to better understand whether this phenomenon constitutes an independent psychological disorder.
Aboujaoude's Stanford co-authors on this study are Lorrin Koran, MD, emeritus professor of psychiatry and behavioral sciences, and Nona Gamel, a licensed clinical social worker. The study was funded by an unrestricted educational grant from Forest Laboratories; Aboujaoude and Koran are on the speaker's bureau for that company.
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