Sunday, February 7, 2016

Internet Addiction: Compare and Contrast Paper - For NCU PSY7102






Internet Addiction: Status of Definition
Laura Ann Collins
Northcentral University


Abstract
From 2000 to 2015, global internet usage has increased from 400 million users to an estimated 3.2 billion users (ICT Data and Statistics Division, 2015).  By the end of 2015, the ICT estimates that there will be over 7 billion cellular phone subscriptions (ICT Data and Statistics Division, 2015).  As the trend of internet connectivity is unlikely to reverse, understanding how internet usage fits into peoples’ lives has become of increasing interest. Specifically, since 1995, when psychiatrist Ivan Goldberg suggested that internet addiction (IA) might be clinically relevant (Hsu, Lin, Chang, Tseng, & Chiu, 2015), questions have arisen about what is adaptive use versus maladaptive use of internet.  While Cheng and Li (2014) found “considerable” national variance in prevalence of IA, the results of their research yielded a global prevalence estimate of 6.0% of IA among internet users.  As IA is still an emerging disorder, controversy about what exactly IA is and is not continues to impede progress toward detecting and treating IA.  With such a significant possible impact, it is essential that researchers solidify the conceptualization of IA.  In order to demonstrate how definition varies across research, the author will analyze 3 articles highlighting similarities and differences.  Common themes will then be linked with possible implications for future research.

Keywords: Internet, pathological internet use, internet addiction, definition of internet addiction, IA

Note:  For the purpose of simplicity, the author will refer to problematic/pathological internet use as “internet addiction” (IA), which is most common descriptor found in the analyzed articles.


Internet Addiction: Status of Definition
Laconi, Rodgers, and Chabrol (2014) stated that while internet addiction appeared to be the most common term used in the literature, a “standard and consensual definition of Internet addiction is still lacking” (p. 191).  This is a theme which is repeated across multiple research studies.  The lack of standard definition creates difficulties in comparing studies, as the following comparison of several articles illustrates.
 In 1995, Ivan Goldberg (psychiatrist) suggested that Internet Addiction (IA) might be a disorder of clinical relevance (Hsu et al., 2015).  Kimberly Young, who established the Center for Online Addiction in 1995 to treat what she recognized as a growing problem (Young K. , 2013).  Young (In Press), traces the evolution of IA as indicated on Figure 1 (additional pertinent information from Laconi, Tricard, and Chabrol (2015) is included in Figure 1) showing how IA started as a “pet project” and evolved into a consensus of problematic internet use without consensus for definition, model, or theory of etiology.
Since 1995, there has been a growing consensus that some individuals do experience distress and negative impact from internet use.  Terms to describe problematic internet use and negative consequence include, but are not limited to, pathological internet use, internet addiction disorder, compulsive internet use, problematic internet use, internet dependency, internet abuse, specific problematic internet use (SPIU), generalized problematic internet use (GPIU), and IA (Laconi et al., 2015).  It has been considered an addiction, an impulse control disorder, a symptom of stress or socioeconomic environment, or a medicalization or pathologizing of normal life activity (Hsu et al., 2015).  Within the last several years, some researchers have subdivided problematic internet use into types of use (Laconi et al., 2015). 

Brief Description of Each Article

Article 1

Douglas et al. (2008) conducted a meta-analysis of qualitative research from 1996-2006 in an attempt to identify common themes and factors in order to develop a theoretical model of IA.  Criteria for inclusion of research included that each study was exploratory and based on primary data collection techniques.  Out of 140 articles identified through various searches, 10 articles[LC1]  met all requirements and were considered appropriate.  Douglas et al. provided thorough explanation how qualitative meta-analysis differs from quantitative meta-analysis and how a small sample size is acceptable.  Douglas et al. identified both factors according to those who experience IA (14 themes) and factors according to those who treat individuals with IA (16 themes).  The themes were grouped into 5 and 6 constructs, respectively.  Douglas et al. suggested a model of IA which incorporated antecedents, push and pull factors, control strategies, deviant behaviors, and negative effects.  Their primary conclusion is that there is a dearth of qualitative research using theory driven constructs which does not support development of either theory or model.

Article 2

Kardefelt-Winther (2014) considered the body of literature regarding internet addiction and arrived at the conclusion that “in terms of theory building, the psychological approach has not contributed much to a better understanding of why some people keep using the internet despite experiencing problematic outcomes” (p. 352).  Kardefelt-Winther suggested that a more fruitful avenue might be to consider why individuals turn to internet use, that motivation may be the missing piece in understanding IA.  Further, Kardefelt-Winther suggested that instead of pathological disorder, the increased internet use noted in the adolescents and youths might be a paradigm switch in lifestyle; an adaptation to life integrated with pervasive media.  Therefore, Kardefelt-Winther suggested several examples of how integrating motivation with internet usage might look and demonstrated how context may change pathology into adaptation.

Article 3

Laconi et al. (2015) expanded the consideration of IA into SPIU and GPIU with a quantitative study.  SPIU was subdivided into subtypes: sexual, video/music, workaholism, communication, information, gaming, shopping, and gambling.  Laconi et al. stated their purpose was to compare multiple types of SPIU (as well as GPIU), time spent online, and psychopathological variables among multiple age groups (including adults to age 65) and both genders. The study involved 378 participants who were recruited through various online platforms including Facebook.  Further, Laconi et al. set the research in France to address a lack of IA research involving French populations.  Multiple assessment tools were utilized.  When no assessment was extant, Laconi et al. customized existing assessments to fit their needs. 
Laconi et al. conceptualized GPIU as addiction to the internet, while SPIUs were addictions which occurred over the medium of the internet.  They found that research needs to distinguish between the different forms of SPIU as not all forms are equally prevalent in all age groups/genders.  Further, they concluded that GPIU and SPIU are distinct and so should be researched separately. 

Similarities and Differences

The most obvious similarity between the three articles is the lack of consensus regarding IA.  That a plethora of information has been generated in the two decades that IA has been studied is taken by all three groups of authors as fact.  The quality, breadth, and comprehensiveness of that research is debated.  Douglas et al. (2008) called for more qualitative research and context.  Laconi et al. (2015) suggested separation of types of internet use in order to understand if the problem is use of the internet or if the problem is behavior occurring while using the internet.   Douglas et al. (2008) stated “the conducted meta-synthesis clearly indicated an urgent need for the development if IAD [Internet Addiction Disorder] theory” (p. 3042).  Likewise, Kardefelt-Winther (2014) stated that “considering the amounts of data that have been collected and the efforts made, the lack of progress indicates that there are issues somewhere along the way that makes theoretical development difficult” (p. 352).
That there are individuals who utilize the internet to the point of incurring negative consequences is also agreed upon. However, while Kardefelt-Winther (2014) stated that maladaptive use is not necessarily pathological, but may be either a response to deficits in “real-life” or a paradigm shift in adapting to pervasive internet requirements in life, Laconi et al. (2015) considered GPIU and SPIU as addictions.  Douglas et al. (2008) framed their research in terms of addiction and completed their qualitative analysis in order to attempt to bring a more “holistic” conceptualization to the field of IA research.  Douglas et al. found that isolation, loneliness, and low self-confidence/esteem are primary antecedents of IA.  They suggested that attending to these in real-life might reduce IA.  Douglas et al.’s antecedents, and suggested remedy thereof, have an interesting parallel to Kardefelt-Winther’s assertion that IA is in actuality a coping mechanism to reduce real-life stress and discomfort.
All three articles discuss the work by Young.  Given her prominence in the field, it is not surprising that her work is included in the three articles.  Douglas et al. (2008) used Young’s frame of addiction to formulate their study.  Laconi et al. (2015) did likewise.  However, Kardefelt-Winther (2015) suggested that Young’s work clearly illuminates the lack of theoretical development by providing multiple possible explanations, without a consensus or cohesion.
Another similarity between the articles by Douglas et al. (2008) and Laconi et al. (2015) is the number of different strands of psychological literature which are woven together.  Douglas et al. consider genetics, environment, social factors, neurology, addiction theory, communication needs, social psychology, psychopathology, etc.    Laconi et al. incorporated multiple types of addiction assessments, quality of life assessments, psychopathology assessments, and compulsion assessments.  They considered age and gender as well, which they stated differs from many research studies which have samples composed primarily of adolescents and young adults.  Kardefelt-Winther (2015) did not incorporate multiple strands of psychological theory.  Instead, he focused on the part of addiction theory which posits addiction is less about action/substance use and more about the reasons behind the action/substance use.
The most obvious difference between the three articles involves type of article and purpose of the authors.  Laconi et al. (2015) presented a research report detailing their quantitative research to add data to the body of literature.  Kardefelt-Winther (2015) wrote a problem statement illuminating what he saw as a deficit in the body of literature.  Douglas et al. (2008) created a meta-analysis which blended statistical analysis with qualitative data in order to expand the current research and attempted to create a workable model.  From each of these disparate perspectives, the authors developed a similar call for future research; essentially that “these” items should be considered in future studies so that a predictive theory may be developed.

Conclusion

Excessive use of internet has been considered pathological, perhaps most similar to addiction (Douglas, et al., 2008; Laconi et al., 2015).  This is the dominant conceptualization (Kardefelt-Winther, 2014).  However, it is also possible that excessive internet use is a coping skill (Kardefelt-Winther, 2014), a response to environmental or life stress (Cheng & Li, 2014), or a natural pattern of adapting to a new aspect of pervasive internet connectivity in modern life (Suissa, 2014)
Assessment tools are based on definition of what the tool is supposed to assess.  When the shape of what is being assessed changes, then the tool may no longer be precise.  For example, if a researcher is trying to assess addiction to the internet and is utilizing an assessment tool which measures craving, withdrawal, and seeking to access the internet, then the fact that the internet is almost ubiquitous in modern life may render the third option obsolete.  Or, if the tool measures time spent online, does cell phone use to access the internet count?  What about time spent at work in required activities which may be online? 
Research that separates types of SPIU may find differences based on gender and age.  However, those results will be difficult to compare to research results which analyze GPIU or IA as a singular construct.  In the research conducted by Laconi et al. (2015), assessment tools needed to be customized to fit the project.  This could affect the validity of the tools.
Other than agreement that the study of internet use has blossomed into a complex field which has rapidly grown over the last twenty years, there is not much consensus on what does exist.  Because there is a lack of agreement about the structure of IA, the defining characteristics of IA, and even if IA is a pathology or if it is a coping tool, results of research yield data points, but have not yet produced a predictive model or even a cohesive theory.  This could be an indicator that the field is still very young and is in need of more data in order to grow.  Or, it could mean that in the pursuit of correlation, causation has been moved to a place of lesser importance.  Regardless, the field of IA research has many data points answering questions of “what”.  Now, the task is to answer questions of “why” in order to answer the question of “how”.

References

Cheng, C., & Li, A. Y.-I. (2014). Internet addiction prevalence and quality of (real) life: A meta-analysis of 31 nations across seven world regions. Cyberpsychology, Behavior, and Social Networking, 17(12), 755-760. doi: 10.1089/cyber.2014.0317.
Douglas, A. C., Milles, J. E., Niang, M., Stepchenkova, S., Byun, S., Ruffini, C., . . . Blanton, M. (2008). Internet addiction: Meta-synthesis of qualitative research for the decade 1996-2006. Computers in Human Behavior, 24, 3027-3044, doi: 10.1016/j.chb.2008.05.009.
Hsu, W.-Y., Lin, S. S., Chang, S.-M., Tseng, Y.-H., & Chiu, N.-Y. (2015). Examining the diagnostic criteria for internet addiction: Expert validation. Journal of the Formosan Medical Association, 114, 504-508. doi: 10.1016/j.jfma.2014.03.010.
ICT Data and Statistics Division. (2015, May). ICT facts & figures. Retrieved from International Telecommunication Union: Retrieved from the International Telecommunication Union: https://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2015.pdf
Kardefelt-Winther, D. (2014). A conceptual and methodological critique of internet addiction research: Towards a model of compensatory internt use. Computers in Human Behavior, 31, 351-354. doi: 10.1016/j.chb.2013.10.059.
Laconi, S., Rodgers, R., & Chabrol, H. (2014). The measurement of internet addiction: A critical review of existing scales and their psychometric properties. Computers in Human Behavior, 41, 190-202. doi: 10.1016/j.chb.2015.04.056.
Laconi, S., Tricard, N., & Chabrol, H. (2015). Differences between specific and generalized problematic internet uses according to gender, age, time spent online and psychopathological symptoms. Computers in Human Behavior, 48, 236-244. doi: 10.1016/j.chb.2015.02.006.
Suissa, A. J. (2014). Cyberaddictions: Toward a psychosocial perspective. Addictive Behaviors, 39, 1914-1918. doi: 10.1016/j.addbeh.2014.07.027.
Young, K. (2013). Retrieved from Center for Internet Addiction: http://netaddiction.com/
Young, K. S. (In Press). The evolution of internet addiction. Addictive Behaviors, doi: 10.1016/j.addbeh.2015.05.016.




Appendix A:
FIGURE 1: Evolution of Internet Addiction
-        1995 – IA is a Pet Project of Kimberly Young[1]
-         1998 -1st study of IA by Kimberly Young is published1
-         1999 – Research and Publications by “early pioneers” David Greenfield and Marissa Hecht Orzack1
-         Early 2000s – China, Korea, and Taiwan –  publication of studies on IA1
-        2000 – IA is subdivided into types:  Cybersexual, Cyber-relationship, Compulsive (gambling, shopping, trading), Information, Gaming[2]
-        2001 – Two categories of problematic internet use:  Specific Problematic Internet Use (SPIU) and Generalized Problematic Internet Use (GPIU).  SPIU is subdivided into types and “could be considered addictions on the internet” while GPIU is “addiction to the internet”[3] [italics added].
-         2006 – 1st inpatient IA treatment center – Beijing China1
-        Late 2000s – Several Asian Cultures developed comprehensive prevention programs1
-         Late 2000s – New statistical models emerged which identified factors/components1
-         2103 – Development of Internet Addiction Gaming Disorder1
-         2013 – IA Inpatient Treatment Center in Pennsylvania1
-         2014 – American Academy of Pediatrics recommends no media access for children under 21
-         2015 – IA continues to be a disputed term.  Problematic Internet Use is gaining popularity in literature as a descriptive term.2
-         2015 – Laconi, Ticard & Chabrol suggested that each type of SPIU should be researched individually as well as part of overarching problematic internet use.2



[1] Young, In Press
[2] Laconi, Tricard, & Chabrol, 2015
[3] Laconi, Tricard, & Chabrol, 2015, p 237



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