Internet Addiction Isn't

Allen Francis, MD recently wrote an article published by Psychiatric Times challenging the proposed adoption of Internet addiction in DSM-V. In his commentary Ronald Pies, MD referred to his article published last year in Psychiatry 2009 which also highlights problems with introduction of the concept of Internet addiction as a mental disorder.

The Internet is not a behavior. It is a complex network of people, devices, and a variety of technologies connecting them, including radio waves, fiber-optic cables, and electrical cables. It is a tool and a conduit analogous to the needle and syringe of a heroin addict or the bottle of an alcoholic. It makes no more sense to suggest that someone might be addicted to the Internet than to suggest that an alcoholic is addicted to bottles or a heroin addict to syringes.

At a minimum we must substitute the term "Internet use" when discussing its merit as a kind of behavioral addiction. We might then consider whether Internet use might represent a class or category of behavioral addictions such as Block's (Block JJ. Issues for DSM-V: internet addiction. Am J Psychiatry. 2008;165:306–307.) so-called "subtypes" of Internet addiction: gaming, sexual, and communication. None of these, however, requires use of the Internet, which begs several questions:

• Is gaming somehow more addictive when using the Internet rather than an isolated computer or no computer? 
• Is text messaging more addictive when conducted via the Internet rather than directly from one device to another? 
• Is solitaire more addictive over the Internet than using a computer? Is it more addictive using a computer than using paper cards?

More questions arise in discussing use of the Internet for sexual gratification. Use of the telephone for sexual contact predated use of the Internet. With today's cell phones it may not always be clear whether or not the communication from one telephone to another uses the Internet. Does that make a difference? References to use of the Internet to access "pornography" are confused by the difficulty in defining that term. I propose that we substitute the less pejorative "erotic media." Once more we must decide whether transmission of such media via the Internet plays a critical role in what ever addiction might be identified. The term "pathological use of electronic media" is equally problematic. If we are to identify behavioral addiction we must focus on the behavior, not the tools used to deliver the necessities of that behavior.
Perhaps there is an analogy here in the field of chemical addiction. Evidence suggests that use of pure cocaine and crack cocaine carries greater risk of addiction then chewing coca leaves. Do we have evidence to suggest that erotic media are more addictive when accessed via the Internet? And is Oxycontin any more addictive when obtained via the Internet than from a physician? What if the physician orders the drug by faxing the prescription via the Internet?

As for invoking psychoanalytic/psycho dynamic theory in this discussion, let me remind Dr. Pies that the DSM is a psychiatric, not psychoanalytic, nomenclature. I would also remind him of the dismal track record of psychoanalytic and psychodynamic treatments in patients suffering from substance use disorders.

Dr. Pies and others also focus too much on the purported "excessive" behavior as a problem existing in the individual patient. We must also learn about the purpose such behaviors serve in the larger family and social system.

It used to be that too much of anything was bad. Now too much of anything is addiction. But I do believe we have abundant evidence for one new diagnosis prevalent among some mental health professionals:

Addiction Addiction.