CCPR: Dr. Moreno, please tell us a little about your background.

Dr. Moreno: i am a pediatrician and adolescent medicine specialist. My primary areas of research are social media and problematic internet use.

CCPR: What exactly is Internet addiction and where did the idea of it come about?

Dr. Moreno: A lot of the early literature used the term “Internet addiction” as something that was synonymous with other addic- tive behaviors. In some research they would take a scale, for example, for substance use, and essentially just “white-out” everywhere that said “substance use” and replace it with “Internet addiction.” That fascinated me because it didn’t seem like a very evidence- based approach, and I wasn’t sure whether Internet use was going to function like substance use or like a problematic behaviorlike gambling. internet addiction early on was defined as essentially the same thing as a substance use disorder, with qualities like dependency and excessive and compulsive use. in my research, i tried to approach it more as a blank slate and look at what aspects of internet use would make it problematic.

CCPR: What did you find?

Dr. Moreno: We did a study that will be published in the coming months, where we worked with a large group of college stu- dents and adolescent and college health providers, including primary care providers, psychiatrists, and mental health counselors,to define what this is. Not surprisingly, there is a lot of overlap with other addictive behaviors. There is overuse, excessive use, and compulsivity—the idea that when you walk away from your computer you are thinking about it or you can’t put your phone down. But there is an interesting angle in that we found risky use was a component, too—the idea that the way you use the Internet mat- ters as well as how much you use it.

CCPR: What do you mean by risky use?

Dr. Moreno: Risky Internet use is doing things that you wouldn’t do in offline life that now you do online, things like looking at pornography and bullying other people. so if people are using the internet in a way that introduces them to behaviors that are not part of their offline life, then that gets them ensnared in using the internet for maladaptive behaviors. We also think of risky behav- ior in terms of social consequences; by engaging and centering social life within the internet, adolescents and young adults are not getting offline experiences that are critical for their development. if people are using the internet to the exclusion of making con- tacts in the offline world, they may fail to build an identity and establish a peer group, which may be to their detriment for the rest of their lives.

CCPR: So does Internet addiction have a withdrawal syndrome?

Dr. Moreno: People have described a feeling of withdrawal even in the short-term acute sense—when they can’t get access to their phones for a couple of hours and can’t concentrate in class because of it, for example.

CCPR: Is problematic Internet use common?

Dr. Moreno: The prevalence estimates are all over the place. european prevalence estimates are between one and nine percent, asian prevalence between two and 18 percent, and in the states it is between zero and 26 percent (Moreno Ma et al, Arch Pediatr Adolesc Med 2011;165(9):797–805). One of the better scales, the Young Internet Addiction Test, has found a prevalence in the 7% to 10% range in the Us (see the young test at http://bit.ly/Te4wa).

CCPR: How do you treat it?

Dr. Moreno: To study this, my research assistant and i took advantage of a naturalistic experiment when i was at the University of Wisconsin in which all women rushing a sorority were required to deactivate their Facebook accounts for the entire length of the rush period. so we studied those women before the period where they shut off their access, and then during, and then after. it was a small pilot study so it really isn’t something to take to the bank, but the data suggested that, when the women were not using Facebook, social anxiety decreased, perceived stress decreased, and for some people depressive symptoms decreased. What makes problematic internet use so fascinating in comparison to things like substance use is that typically the gold standard treatment is abstinence, but it is impossible to get through school and find a job without using the internet. so treatment is hard.

CCPR: How should we screen for this disorder?

Dr. Moreno: This is difficult because in a systematic review we couldn’t find a single screening instrument that had actually gone through validation on its own, although the young internet addiction Test had some nice studies after it was already in use. it is somewhat out of date, though—some of the questions are about things like chat rooms that were quite relevant 10 years ago but really aren’t now. My graduate assistant built an evidenced-based screening instrument that has held up very well in different valid- ity tests. [The tool is not yet published.]

CCPR: So this brings us back to the question: Does Internet addiction actually exist?