Could internet addiction be treated?

Internet represents one of the most important productions of the mass media in the last two decades. It has affected many individuals’ lives not only positively but also negatively. Many people have reported negative consequences of excessive or problematic Internet use, such as deterioration of work and/or school performance, diminished interpersonal connections, decreased physical activity, obesity, physical complaints, as well as increased psychiatric comorbidity. The term “Internet addiction” was first used in 1996. Since then, hundreds of papers have been published about this controversial concept. Diagnostic criteria and assessment questionnaires used for diagnosis vary between countries and studies, hence, the prevalence rates of Internet addiction has been reported to range from 0.3% to 38%. Although Internet addiction appears to be an expanding problem worldwide, researchers and clinicians still argue about its existence, classification and how to assess this condition reliably and accurately. Although some researchers claim that Internet use problems should be classified in impulse-control disorders or in obsessive-compulsive spectrum disorders, most insist that problematic internet use is a type of non-substance or behavioral addictions. Regardless of the classification of Internet addiction, most of the researchers and clinicians agree that this problem does affect many individuals and deserves appropriate management strategies. Hence, several kinds of treatment modalities have been proposed for the treatment of Internet addiction. Treatment approaches to Internet addiction can be divided into two categories; pharmacological treatment and psychotherapy. Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most widely studied pharmacological agents in Internet addiction treatment. This is because of the aminergic systems’ role in the suppression of inhibitory responses and the control of compulsive repetition as well as data indicating a high lifetime prevalence of major depression in Internet addicts. Escitalopram and bupropion, a norepinephrine/dopamine reuptake inhibitor, are shown to exhibit long-term benefits in patients with Internet addiction, especially in the co-presence of depressive mood. Opioid receptor antagonists are used in the treatment of substance dependence. Owing to the strict association of Internet addiction with other substance use disorders and to similar neurobiological findings between Internet addiction and substance dependence, opioid receptor antagonists are also suggested to diminish Internet addiction symptoms. However, there is only case study which reported successful treatment with naltrexone, an opioid agonist. Although antipsychotics are shown to be effective in the treatment of behavioral addictions such as pathological gambling, compulsive shopping, and physical exercise addiction, literature about the use of antipsychotics in the treatment of Internet addiction is currently limited to a single case study that reported the successful use of quetiapine in a subject with Internet addiction. There is a high comorbidity between Internet addiction and attention-deficit/hyperactivity disorder (ADHD). In a study which included adolescents with ADHD and online game addiction, methylphenidate was shown to reduce Internet usage time and Internet addiction scale scores. Several psychological approaches have been proposed in the treatment of Internet addiction. These include cognitive behavioral therapy, acceptance and commitment therapy, psycho-education, family therapy, and the twelve-step support groups. All these psychotherapy modalities have proved to be effective in the treatment of Internet addiction. In conclusion, there are several options including psychopharmacological agents and psychotherapies in the treatment of Internet addiction. An individual-based approach may offer a valuable perspective when helping patients with Internet use disorders.