Is There Really Such A Thing As Internet Addiction?

MAUREEN CAVANAUGH: This is KPBS Midday Edition. I am Maureen Cavanaugh. Think about spending a day or two without access to the internet. Would you be able to do your work, connect with your friends or even know what to do with yourself during your free time? When does the internet stop being a great addition to your life and start becoming your life? That is the question posed by a case study of a patient here in San Diego. His reliance on Google Glass has advanced the idea that there could be such a thing as internet addiction. I would like to introduce my guest Dr. Andrew Doan, he is head of addictions and resilience research at Naval Medical Center San Diego. And a coauthor of a paper published in a journal of Addictive Behaviors: Describing the Case. Dr. Doan, welcome to the program. DR. ANDREW DOAN: Thank you for having me. MAUREEN CAVANAUGH: Now, the patient was already in a rehab program for alcohol addiction, but his healthcare workers started to notice a strange tic in his behavior, now tell us about that? DR. ANDREW DOAN: Correct, he was in alcohol rehab for 35day residential treatment, but every time the healthcare provider asked him a question he had a movement of his right fingers to his right temple and that's when we started to inquire why was he tapping the right side of his face. MAUREEN CAVANAUGH: And why did he tell? DR. ANDREW DOAN: He said that basically the withdrawals from not having accessibility or access to his Google Glass that craving was greater than his craving for alcohol. MAUREEN CAVANAUGH: Remind us what Google Glass is and how it works? DR. ANDREW DOAN: So there is nothing inherently bad will Google Glass. It is just a technological device that interfaces with the cell phone that allows a heads up display. So whatever you can do on your cell phone, you can do it right in front of your eye. MAUREEN CAVANAUGH: Right in front of your eye and one would I guess access different kinds of information by tapping the glass? DR. ANDREW DOAN: Correct. MAUREEN CAVANAUGH: Did the patient tell you how often he was using the Google Glass? DR. ANDREW DOAN: Yeah, he was using it for about 18 hours a day. MAUREEN CAVANAUGH: And I believe he also said he began to see the outline of the glass in his dreams? DR. ANDREW DOAN: Correct. Correct. MAUREEN CAVANAUGH: So that made a powerful impact on his mind? DR. ANDREW DOAN: And that's not surprising because when we do a lot of something in life, we start having dreams about that activity. When it becomes invasive and problematic in somebodies life, that's when it becomes an issue. MAUREEN CAVANAUGH: In your discussions with him, did it seem apparent that he was using Google Glass as a memory aid? DR. ANDREW DOAN: Absolutely. So he was using it as a way to memorize equipment and what the equipment did at work. The problem became when he had short term memory problems because he was so dependent on his Google Glass and that's when he really became dependent was when he was using it excessively for work and as a memory aid. MAUREEN CAVANAUGH: Besides that rather strange tic, the movement towards trying to tap the glasses that he didn't have at the time, did he experience any other types of withdrawal symptoms? DR. ANDREW DOAN: Frustration, anxiety and also anger because he didn't have access to his technology. That's how you define addictive behaviors is not the amount of time we use the devices, but the feelings that are negative associated with not having the device around. So that becomes problematic. So we see that with patients that for example sleep with their cell phones because they are afraid to miss the Twitter feeds or the Facebook notifications and they are losing sleep because now they are sleeping with her phones. MAUREEN CAVANAUGH: So this isn't just about Google Glass? DR. ANDREW DOAN: Absolutely not. There is nothing wrong with Google Glass, it is just that the technology gives us boost of reward in our brain and there is no rest period, hardly any rest period between the burst of instant gratification. MAUREEN CAVANAUGH: I am speaking with Dr. Andrew Doan, he is head of addictions and resilience research at Naval Medical Center in San Diego and we are talking about case study of a patient in San Diego who seemed as if his reliance on Google Glass was something of an internet addiction. Now, how would overreliance on the internet fit into the concept of addiction? DR. ANDREW DOAN: Okay. So here is an example. So everything in real life, there is a break period between the events of reward. So let's say you like to surf in Southern California, but each surfing event is separated by time and space, but the internet because the brain loves variation and new images and new games and new stimuli to the brain, that it actually searches for different things to fill up its reward desires, but there are hardly any rest period between the events and that's where the internet becomes problematic. In my research we are trying to discern what is a digital potency and the digital draw factor that makes one person want to really use the internet. For example, PowerPoint and email are probably a scale factor out of one to ten. Right? No one wants to abuse PowerPoint and email. However, on gaming and let's say surfing the internet for information or even pornography, that can be a digital potency of nine or ten. Now, because of the rushes that we feel the adrenaline rush and the reward system in our brain, what if feels because of the lack of rest period between these events, somebody can abuse it to escape or if they have emotional dysfunction or borderline mental problems, so now it becomes a problem when people try to escape with that mechanism of reward. MAUREEN CAVANAUGH: So the rush that you are talking about, would that be similar to the kind of high a drug addict would get if they were, you know, abusing drugs and trying to rehab from that? Would that be the addiction part of the internet addiction that rush that you are describing? DR. ANDREW DOAN: Absolutely. So the peer reviewed medical research shows that when children play video games for example, their sympathetic tone increases, they perspire and their heart rate goes up they breathe faster. So there is an adrenaline being released into their system and if they played certain games they can actually have their blood pressure shoot up to 180 over 140 within 30 minutes of play. There is also research that shows that when people look at things on the internet that are arousing or images that are arousing, their pupils dilate and there is increase in sympathetic tone. There is also a research project or research papers that show that two men that play against each other in a game called Tetris versus playing against a computer, their testosterone also goes up. So the neuro chemical hormones in our body that cause an adrenaline rush that people are attracted to when they use the internet for gaming and the computer. MAUREEN CAVANAUGH: In addition to an adrenaline rush in order to be an addiction it has to in some way interfere with the person's normal life, right? How do these internet this overreliance on the internet how can that influence a person's other life? DR. ANDREW DOAN: Okay so it is all about dysfunction. So, again if they use it so much, if they are escaping work to use the internet and play games, if they are now suffering in their behavior in terms of their school work, doing chores at home, personal hygiene, sleep, if they are giving up relationships, if they are giving up what they normally like to do in real life to do more and more of the online activities that becomes problematic. The number one thing that we are seeing right now is sleep deprivation. MAUREEN CAVANAUGH: People online when they should be asleep for hour after hour after hour. DR. ANDREW DOAN: Absolutely. So now we are seeing cases where people are not sleeping and they are playing 30 to 60 hours a week combined with their job. So people are falling asleep at the wheel and they are having problems staying awake and having attention at work. So when they present to the medical clinics they are complaining about sleep deprivation and want sleep medications, but when you ask them the real questions they are staying up all night on the internet or Facebook or Twitter or doing other things that they should have not have been doing. MAUREEN CAVANAUGH: Dr. Doan, is this a primarily a problem experienced by young men and teenage boys, gamers? DR. ANDREW DOAN: No. So what is interesting about this is the internet offers so much different stimuli that the women are relational, they love the relationships. They love the Facebook and the Instagram and the social media aspects of the internet, whereas young boys love the war games. But now we have a game called Second Life and Second Life has about 10 million users and men and women are online interacting with each other. MAUREEN CAVANAUGH: Now, last month the first hospital program to treat internet addiction disorder opened in the United States, do you expect that to be the first of many? DR. ANDREW DOAN: You know I think so, because if you look at China and South Korea there are rehab centers everywhere in those countries. You can link it back to accessibility of high speed internet. Because Nick Yee out of Stanford shows that the thing that makes gaming or internet gaming really attractive is the achievement, immersion and social interaction, those are the three elements when he pulled 10s of thousands of gamers. So what is interesting about this is as the internet matures and we have widespread accessibility everywhere, there are going to be more people that get hooked. MAUREEN CAVANAUGH: Now, here in the U.S. internet addiction is not included in the American Psychiatric Association manuals of mental disorders as the DSM. Does this mean that it is not recognized as an official disorder among the medical community? DR. ANDREW DOAN: Correct, because we need more research. This case study of Google Glasses is only one case study, we need more research to understand how to patients present and how many people are presenting with certain symptoms. So just because the DSM has not pseudo colored it an official diagnosis does not mean it does not exist. For example, before we knew AIDS was a real disease caused by HIV medical people saw certain symptoms associated with that problem. So we are kind of like in that stage in the game too for mental illness in certain areas, especially when the technology advances so quickly before the medical community and medical research can catch up. MAUREEN CAVANAUGH: So things it is not an official diagnosis, but people are presenting with symptoms that look pretty much like they are having an internet disorder of one kind or another, how is that being treated? DR. ANDREW DOAN: Well, you know the psychologist and psychiatrists can still treat it because there are other problems that can be address, the anxiety, the sleep deprivation, but we become more educated psychologists and psychiatrists can ask the right questions because if you are treating the anxiety and depression for example but not treating the gaming addiction or the internet addiction then you are medicating something without taking away the cause. Once you take away the cause it is easier to treat the person, so you really, you can treat them without having an official diagnosis. MAUREEN CAVANAUGH: Some mental health professionals are saying things like well, you wouldn't have an internet disorder if you were not already obsessive compulsive or depressed or had an underlying condition and that is just basically a symptom of that underlying condition, do you agree with that? DR. ANDREW DOAN: I do. What is most interesting about most of the research is that addictions are cooccurring with other addictions and other mental illnesses, so let's say you have alcohol abuse disorder and someone has obsessive compulsive disorder, you now have somebody OCD or obsessive compulsive disorder and alcohol abuse disorder. It took 30 to 40 years for alcoholism to become a real clinical diagnosis, so just because something is not pure in terms of diagnostic criteria, it is not isolated by itself doesn't mean it does not exist. MAUREEN CAVANAUGH: And Dr. Doan you mentioned that in China, South Korea, Japan internet addiction camps have been around for years, why is that recognized as a problem there? Why are so many people seemingly suffering from that in these Asian countries? DR. ANDREW DOAN: You know in Asia it is amazing because they love technology and gaming, it is not a stereotype. I am Asian and I love technology and gaming too. Um, but I think in those countries if you look at South Korea, they one of the first to get high speed internet to be distributed everywhere, so the high accessibility rate caused more accessibility and more usage as a young child that develops these habits and that's where it starts and also internet gaming disorder can be recognized in China because people don't do it in isolation in their homes. When you talk about it in the U.S. you will find that there is somebody in the family or friends that has a son or daughter that lives in the home of the basement and all they do is surf the internet. Except in China they have to go to the internet cafes, so now people see there is a guy that spends MAUREEN CAVANAUGH: He is there all the time. DR. ANDREW DOAN: That's right. MAUREEN CAVANAUGH: (LAUGHTER) now, your case study of the San Diego patient struggling without his Google Glass that story went virally on the internet. Besides that being ironic, does it indicate to you that there are a lot of people that are concerned about how much time they are spending online? DR. ANDREW DOAN: Absolutely. So when you speak the truth everybody speaks the truth. So that's why people were interested in this article. It is only a case study, we need more research. When you see problems in your own family, when you see people all zoned out at dinner and they are not concentrating on each other, but focused on a screen. People know it is a problem. It is just a matter of now defining that problem. MAUREEN CAVANAUGH: And could you go through the symptoms one more time for people who might be concerned that perhaps it is something more than simply really really liking to be online, you were mentioning losing sleep. DR. ANDREW DOAN: Sure. Losing sleep. People have to spend more and more time in that activity to feel happy or normal or satisfied. They have trouble cutting back and when they try and cut back, they are agitated and frustrated and angry maybe their school work or work life is suffering. Maybe their interpersonal relationships are suffering and now they are not spending as much time with their parents or loved one or friends. Maybe they are spending so much time and money into the activity that now they have financial hardships. So those are the signs of an addictive behavior, is what are the dysfunctional aspect because they spend too much time? MAUREEN CAVANAUGH: Okay. Dr. Doan, how has the patient here in San Diego responded to treatment? DR. ANDREW DOAN: He is doing well. He is um, he is using Google Glass less. It starts with education. So once you are aware it and they can actually take positive strides to changing their lives and that's why the Navy is really interested in looking at this type of research. We want to increase our force readiness. We want to increase and improve the lives of our service members. MAUREEN CAVANAUGH: So it is not like being an alcoholic where you can't have a drink, you can never use Google Glass again if you are suffering from a condition like this? DR. ANDREW DOAN: So you know what is interesting about this, you have to train people on that digital potency. So now if you use Google Glass, you have to go and digest the digital veggies which are things that are good for work and stay away from the digital candy. MAUREEN CAVANAUGH: (LAUGHTER) I see. This is hard for all of us to do I think. I have been speaking to Dr. Andrew Doan, he is head of addictions and resilience research at Naval Medical Center San Diego. Thank you so much for your time. DR. ANDREW DOAN: Thank you for having me. MAUREEN CAVANAUGH: Coming up the San Diego Asian Film Festival celebrates 15 years that as KPBS Midday Edition continues.