Thursday, April 03, 2008


Addiction — specific or general?

New Scientist tells us that some psychiatric professionals are pushing for inclusion of “Internet addiction” as a specific disorder:

In the American Journal of Psychiatry, psychiatrist Jerald Block of Portland, Oregon, argues that internet addiction should be included in the next version of DSM, the US handbook of recognised psychiatric conditions, which is currently being drawn up. The condition is characterised by excessive use of the internet, anger or depression if computer access is lost, poor achievement and social isolation.

Dr Block’s American Journal of Psychiatry editorial gives more detail:

Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging. All of the variants share the following four components: 1) excessive use, often associated with a loss of sense of time or a neglect of basic drives, 2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible, 3) tolerance, including the need for better computer equipment, more software, or more hours of use, and 4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue.

It seems to me that all forms of addiction share those basic components. What is addiction, if not “excessive use” — of the Internet, of alcohol, of sex, of television, of work...? Similarly, people addicted to any of those things experience withdrawal symptoms, develop tolerance and require more stimulation for satisfaction, and have their lives negatively affected by their addictions.

Also, as I look at Dr Block’s descriptions of the problems associated with widespread Internet addiction, I see a pattern similar to those associated with other forms of addiction — with one notable difference being how seriously it’s affecting very young children (thought TV has a similar issue). In other words, I see most types of addiction as being substantially similar.

Further, it seems that people often drift from one addiction to another. Someone who used to spend his life in a game arcade might since have switched to video games on his computer, then to multiplayer online games, then to social networking, and so on. Availability of new mechanisms — or removal of old ones — might change the specific addiction, but not the fact that the person is an addict.

So does it really make sense to list X addiction and Y addiction and Z addiction as separate disorders? It seems more sensible to me — as someone who is not a psychiatric professional, of course, so what do I know? — to have “Addiction” as a diagnosis, perhaps with subcategories of “Substance Addiction” for things like alcohol and other drugs, and “Social Addiction” for things like TV, Internet, and sex. The specific addictions could then be discussed, and listed in the patient’s diagnosis, as manifestations of the addiction.


Dr. Momentum said...

I am not a psychologist, but it seems to me there is more to creating a taxonomy than simply having neat organization, with sublcasses, or making sure you name everything.

What if the mechanisms of addiction are different? Should the organization reflect that, even though the symptoms may be similar? Perhaps the treatments for different addictions are significantly different.

Additionally, I'm not convinced that generic addiction itself is a class of behavior on the personal level. If I knew alcoholics who suddenly decided to be addicted to TV instead, I might think differently.

Interesting question!

Barry Leiba said...

That's why I separated substance addiction from social addiction. It does seem that there's crossing over between alcohol and cocaine, for instance... and between TV and games and Internet. So in my dilettante role, I see the mechanisms for those two classes as different.

Perhaps there are other classes that have different mechanisms (or treatments, or whatever), and they should also be split off. And, indeed, of most importance for the DSM is separating diagnoses for which the treatments differ.

But just to list addictive behaviours seems silly and pointless. One might be addicted to working out at the gym, to attending baseball games, to eating at McDonald's, to going shoe shopping, to........

The Ridger, FCD said...

Back in the day, before AA became every judge's option to jail - back, in other words, when only the seriously addicted alcoholic who really wanted to quit drinking went, not the guy who was taking an option to keep his driver's license and who didn't really think he was a drunk and didn't buy the whole program in the first place - back in those days, I remember it was often said that AA members had swapped their alcohol dependency for a trifecta of coffee, cigarettes, and company ...

Dr. Momentum said...

... and religion.

Garrick D. Conner said...

I don't think there is any doubt that one can be addicted to the internet, e-mail, sex, etc. I believe that the controversy within the field of counseling and psychology is rooted in the lack of specific criteria to make a diagnosis. As a counselor myself, I believe that including internet and sexual addiction in the DSM would go a long way to legitimize the problem and pave the way for managed care to cover costs associated with treatment.

Barry Leiba said...

Thank you, Mr Conner, for a comment from someone who knows the field — someone who knows what he's talking about far more than I.

I hadn't thought about that aspect of it: the relationship between the DSM and health insurance decisions. Yes, I can see how a clear listing of "Internet addiction" as a specific diagnosis would greatly help patients get coverage for their care, rather than having the treatment blown off as some frivolity.

I know that mental health care has consistently been a problem in "managed health care". Things have improved in recent years, but it's often still an uphill battle get more than minimal coverage. If you aren't sorted out after six or eight sessions, many insurance companies will cut off payments unless your practitioner can come up with an official diagnosis that merits longer-term therapy.