Reflections on the first International Congress on Internet Addiction Disorders - Cultural and Clinical Perspectives

Internet addiction is a global and rapidly evolving disorder. I just returned from the first International Congress on Internet Addiction Disorders held in Milan, Italy. While the ideas are still fresh, I wanted to write about the new and exciting programs being started to address this rapidly evolving problem.

Cultural Approaches

The panel of speakers and attendees were amazing. They showed the deeply global nature of Internet addiction with each country developing its own methods representative of what worked best for their own circumstances. For instance, in Korea, they are a leader in this field as they are the first to have established a comprehensive Master Plan to prevent and treat Internet addiction. Developed by multiple Ministries of the Korean Government, they provide testing for risk of Internet addiction among adolescents, specialized re-education programs for those at risk, and hundreds of specialized inpatient treatment programs across the country. In Japan and Germany, they utilize Internet fasting camps for children identified at risk, also backed by government support. In China, they utilize military-style boot camps for re-education as depicted in the new documentary, Web Junkies. In Italy, Milan and Rome developed the first inpatient programs with alternative treatments in theater therapy to tap into the emotions of an Internet addict and they explore avatar therapy (in vivo) with peer group training and support. In France, they do not talk as much about pathological Internet addiction but in general focus on early education on technology use for all families. This way, they focus on what parents should do at home when introducing technology for a child. In the U.S., unfortunately, we are lagging behind with respect to prevention and treatment. We do no formally recognize the disorder in the DSM, we only have a handful of specialized treatment programs, we have some digital detox camps but nothing to the scale of Korea, and we do not implement policies for early childhood prevention as they do in France.

This was very enlightening to me, as the only American at the Congress to see how other cultures were addressing what is seen as a significant mental health issue.  There was considerable discussion on how to define Internet addiction. Is it its own disorder? Is it always co-morbidly related to clinical syndromes such as depression and anxiety? How do social problems influence the development of this condition as Internet addicts are highly isolated? What is the relationship with Autism and Asperger’s Syndrome, as these disorders were seen across cultures as a significant risk factor with Internet addiction disorders?

Age of Onset

There was also significant debate on the age of onset for the disorder. How young is too young for children to be introduced to technology? While all the countries represented recognized the benefits of technology use and adaptation among children and adolescents for careers and future job performance, it was asked if technology should also come with warning signs for parents. For instance, in Japan, middle school children were identified to be the most at risk and this launched a greater discussion on what parents need to know at home to address potential Internet addiction disorders.

This is not a new discussion. When I was in Australia this past summer for a Media Addiction conference at Macquarie University in Sydney, this debate of how young is too young also was discussed (and again, to no clear answer). In my own consulting work, throughout the U.S., I have toured several adolescent clinics seeing a growing number of young people with an addiction to technology and visited school systems struggling with how to address the growing problem of students becoming addicted to the very technology that they are required to use. The problem hits home domestically too.

Types of Internet Addicts

The Congress also debated if there were different types of Internet addicts. Were there differences in terms of addicts related to how much time they spent online or what applications they were involved with? For instance, a child who was addicted to video games may be experiencing a developmental phase the he will grow out of into adulthood, whereas an older adult male who suffers from sex addiction is now hooked on online pornography and has long-standing problems with relationships, depression, and substance abuse. Would these two patients be classified the same or are these different types of addicts, one being more phased developmentally and the other more chronic and pervasive?

Also, how does what someone becomes addicted to impact the course of treatment? For instance, in Italy, they use Theater Therapy for young people to act out their avatars for addicted gamers. This has been very effective. But, how does this translate to an older adult who may be addicted to online pornography? Also, how does culture impact treatment?  While Korea has a comprehensive Master Plan (and actually, it was just repurposed as the Master Plan II to address smartphone use), would this be possible in American to implement? My view at the Congress was “no” as our U.S. government does view Internet/technology addiction as a problem. Again, most people did not understand why this is as many other countries are rapidly addressing what they see as a significant mental health concern.

The Role of Government

This led to an important discussion on the role of government involvement and policy. If the government is not supportive of initiatives on Internet addiction prevention, education, or treatment, than it seems that little can be done to properly address the condition. In Korea, they had statistics that showed the effectiveness of their Master Plan in Prevention and Treatment but they also were one of the few countries with widespread government support for the development of their national programs.

Best Practices

In closing, the Congress struggled with the best practices in this emerging field. The issues involved with Internet Addiction Disorders were complex. The issues cited were developmental, clinical, social, cultural, and familial. Developmentally, what was the impact of technology overuse on children? Clinically, what were the best treatment approaches to resolve Internet addiction, especially with the reliance of mobile devices in our daily and work lives? Socially, what were the long-term effects of an over-reliance on technologies that seem to disconnect us more than connect us, especially among children who are using this at younger ages? Culturally, did Internet addiction disorders manifest themselves differently based on ethnic and cultural backgrounds requiring various forms of treatment and prevention? From the family perspective, how should parents learn to integrated technology for their children and what resources were available to help them manage this at home and at school?

Conclusions

Overall, the Congress was an important step in the field of Internet and technology addictions. It seems we are all doing something in our respective countries to address an emerging problem. No matter the terms we use, although, I agree that terminology is highly important, it is clear that this has become a global condition and that we are all experiencing problems with integrating technology into our lives.

Future initiatives based on the Congress are determining: 1] Defining Internet addiction (be it problematic Internet use, pathological Internet use, technology addiction, or other terms, we need to define a clear set of standardized criteria). 2] Consider how co-morbid psychiatric syndromes and personality traits play a role in the development of Internet addiction disorders. 3] Consider how age of onset (and age in general with the introduction of technology) influences childhood development and what parents and families need to know for prevention and what resources are available to them as well as to schools. 4] Conduct outcome studies to investigate the best practices in treating Internet addiction disorders among adolescents and adults. Finally, 5] Examine the role of culture in the development of Internet addiction disorders and how public health policies through government and healthcare systems can enable more effective responses for providing resources, prevention, education, and treatment. 

For more information, please visit the International Congress on Internet Addiction Disorders website.