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Over the last 15 years, research into various online addictions has greatly increased. Prior to the 2013 publication of the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there had been some debate as to whether ‘Internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has been debate as to whether those in the online addiction field should be researching generalized Internet use and/or the potentially addictive activities that can be engaged on the Internet (e.g. gambling, video gaming, sex, shopping, etc.).

It should also be noted that given the lack of consensus as to whether video game addiction exists and/or whether the term ‘addiction’ is the most appropriate to use, some researchers have instead used terminology such as ‘excessive’ or ‘problematic’ to denote the harmful use of video games. Terminology for what appears to be for the same disorder and/or its consequences include problem video game playing, problematic online game use, video game addiction, online gaming addiction, Internet gaming addiction, and compulsive Internet use.

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic Internet use (i.e. Internet gaming disorder (IGD)) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien, IGD will not be included as a separate mental disorder until the

• (i) defining features of IGD have been identified,
• (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally,
• (iii) prevalence rates have been determined in representative epidemiological samples across the world, and
• (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that Internet gaming disorder was not included in the main text of the DSM-5 was that the Substance Use Disorder Work Group concluded that no standard diagnostic criteria were used to assess gaming addiction across these studies. In 2013, some of my colleagues and I published a paper in Clinical Psychology Review examining all instruments assessing problematic, pathological, and/or addictive gaming. We reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. The prevalence rates for problematic gaming were highly variable depending on age (e.g. children, adolescents, young adults, older adults) and sample (e.g. college students, Internet users, gamers, etc.). Most studies’ prevalence rates of problematic gaming ranged between 1% and 10%, but higher figures have been reported (particularly amongst self-selected samples of video gamers). In our review, we also identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the:

• (i) the brevity and ease of scoring,
• (ii) excellent psychometric properties such as convergent validity and internal consistency, and
• (iii) robust data that will aid the development of standardized norms for adolescent populations.

However, the main weaknesses identified in the instrumentation included:

• (i) core addiction indicators being inconsistent across studies,
• (ii) a general lack of any temporal dimension,
• (iii) inconsistent cut-off scores relating to clinical status,
• (iv) poor and/or inadequate inter-rater reliability and predictive validity, and
• (v) inconsistent and/or dimensionality.

It has also been noted by many researchers (including me) that the criteria for Internet gaming disorder assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioral addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used, as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental, and neurobiological research settings.

Video gaming that is problematic, pathological, and/or addictive lacks a widely accepted definition. Some researchers in the field consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the Internet as the main platform that unites different addictive Internet activities, including online games. My colleagues and I have begun to make an effort to integrate both approaches, i.e., classifying online gaming addiction as a sub-type of video game addiction but acknowledging that some situational and structural characteristics of the Internet may facilitate addictive tendencies (e.g. accessibility, anonymity, affordability, disinhibition, etc.).

Throughout my career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e. salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behavior. When I started research Internet addiction in the mid-1990s, I came to the view that there is a fundamental difference between addiction to the Internet, and addictions on the Internet. However, many online games (such as Massively Multiplayer Online Role Playing Games) differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the Internet gaming disorder criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically:

1. preoccupation with Internet games [salience];
2. withdrawal symptoms when Internet gaming is taken away [withdrawal];
3. the need to spend increasing amounts of time engaged in Internet gaming [tolerance],
4. unsuccessful attempts to control participation in Internet gaming [relapse/loss of control];
5. loss of interest in hobbies and entertainment as a result of, and with the exception of, Internet gaming [conflict];
6. continued excessive use of Internet games despite knowledge of psychosocial problems [conflict];
7. deception of family members, therapists, or others regarding the amount of Internet gaming [conflict];
8. use of the Internet gaming to escape or relieve a negative mood [mood modification]; and
9. loss of a significant relationship, job, or educational or career opportunity because of participation in Internet games [conflict].

The fact that Internet gaming disorder was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, my research colleagues and I have asserted that the most appropriate measures in assessing problematic online use (including Internet gaming) should meet six requirements. Such an instrument should have:

• (i) brevity (to make surveys as short as possible and help overcome question fatigue);
• (ii) comprehensiveness (to examine all core aspects of problematic gaming as possible);
• (iii) reliability and validity across age groups (e.g. adolescents vs. adults);
• (iv) reliability and validity across data collection methods (e.g. online, face-to-face interview, paper-and-pencil);
• (v) cross-cultural reliability and validity; and
• (vi) clinical validation.

We also reached the conclusion that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity.

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. There have also been over 20 studies using neuroimaging techniques (such as functional magnetic resonance imaging) indicating that generalized Internet addiction and online gaming addiction share neurobiological similarities with more traditional addictions. However, it is critical that a unified approach to assessment of Internet gaming disorder is urgently needed as this is the only way that there will be a strong empirical and scientific basis for IGD to be included in the next DSM.

The post Dependent variables: a brief look at online gaming addictions appeared first on OUPblog.

        

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By Arturo Hernandez

Before I wrote my last blog entry, I got a Twitter account to start tracking reactions to that entry. I was surprised to see that people that I had never met favorited my post. Some even retweeted it. Within a day, I started to check my email to see if someone else had picked up on it. It felt so good to know that people that I had never met from all over the world were paying attention to me.

The addictiveness of Twitter is not specific to me. There have been articles about getting Justin Bieber to follow you as a form of addiction. But the problem is much more pervasive than that.

Many of the symptoms associated with cocaine addiction are popping up in people who are simply on the Internet. The toxic effects of cocaine addiction have been known for years. Studies find that rats will self-administer cocaine to the point of death over a period of time. The pharmacological effects are also well known; cocaine magnifies the effects of dopamine chemically. The interesting part is that Twitter, Facebook, and video games seem to have a similar effect as well. Thus, dopamine is part of a reward system.

Interestingly, dopamine is also known to play a role in the brain systems that are used to control our mental focus. Recent work has found that dopamine plays a role in the connection between the frontal areas that are involved in cognitive control and the posterior areas of the brain involved in processing incoming information from the senses.

And here, work in bilingual literature might have found an antidote to the plague of Internet addiction. Ellen Bialystok and her colleagues have found that bilinguals tend to be better at switching between tasks and at using inhibition — what researchers call cognitive control. Theoretical work by Stocco, Pratt and colleagues proposes that the use of two languages on a regular basis helps to strengthen the use of brain areas that are highly linked to dopamine. Many of the same frontal areas have been shown to be involved in control in bilinguals. Thus, it is logical to conclude that dopamine which leads to increased addiction may also be involved in giving bilinguals an edge in focusing. It is a classic U-shaped function where too little and too much are bad but somewhere in the middle is just right.

So what happens when a bilingual faces the onslaught of Internet addiction. Is s/he more resistant? I don’t know the ultimate answer to that question. But I was struck by how quickly the Twitter craze that had me checking my page every minute faded. Perhaps it is the four languages that I have learned that serve to protect me more and allow me to stop the urge to check my page again. Today, I am happy to report that I have written this blog entry with the understanding that any benefit will come long term. And I have my language learning history to thank for that.

But, please, favorite this; please, retweet it. Please, please, please!

Arturo Hernandez is currently Professor of Psychology and Director of the Developmental Cognitive Neuroscience graduate program at the University of Houston. He is the author of The Bilingual Brain. His major research interest is in the neural underpinnings of bilingual language processing and second language acquisition in children and adults. He has used a variety of neuroimaging methods as well as behavioral techniques to investigate these phenomena which have been published in a number of peer reviewed journal articles. His research is currently funded by a grant from the National Institutes of Child Health and Human Development. Read his previous blog posts and follow him on Twitter @DrAEHernandez.

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Image credit: Apple’s iPhone 4 with a busy home screen on the grass with chamomile flowers. © ZekaG via iStockphoto.

The post Dopamine, Twitter, and the bilingual brain appeared first on OUPblog.

        

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Cate doesn’t write here anymore… Or to put it another way, my name is Cate and I have an internet problem.

A serious internet problem and I feel so guilty. I know many of you have children and finding the time to sit down and write is hard, well I have lots and lots and lots of time and I just waste it. When I’m sitting at my computer, my mental stream goes something like this…

“Open word, going to write today… Should just check blogs & LJ first… Now must check Twitter… Ooh, anything happening in any forums… Must check statcounter… God, I need to write… Open word… Ooh, meant to check Google groups… Anything happening on Twitter… Yay! Someone’s posted a blog… Twitter… Twitter… Twitter… Huh! How have two hours passed… Must do some writing… Open word, write two sentences… Oh, I need to research this bit… Research… Twitter… Forum… Blog… Stats… Twitter… Forum… Group… Twitter… Two more sentences… And repeat…”

I am going insane. It’s probably the equivalent of sitting in a room with twenty people talking to you all at once. Darn me, I even downloaded TweetDeck the other day so that I could manage Twitter. Not manage my writing, manage my tweets for Christsake. That’s bad. Soooooooo, and this was not my decision (I’m addicted remember) but a family one, I've bought a laptop. I've set myself up in the kitchen with no internet access and hopefully this means I'll write (or search the cupboard for food).

I’m not disappearing from the internet – good grief, no way José – but I’ll only be popping in for about half an hour when I finish work-work and then for another half hour or so (mentally I’m trying to up it to an hour even as I type) before I finish for the day. So an hour tops… That ‘thud’ was the sound of me fainting. You probably won’t even notice any less activity (twitter aside). If you’ve got any sense, you won’t even care… :)