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| CONCEPT ARTICLE |
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| Year : 2018 | Volume
: 15
| Issue : 1 | Page : 61-68 |
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Internet Addiction: A Growing Concern In India
SK Maheshwari1, Sharma Preksha2
1 Associate Professor, Dept. of Psychiatric nursing, University College of Nursing, BFUHS. Faridkot, India
2 Assistant Professor, Baba Farid University of health sciences, Faridkot, Punjab, India
| Date of Web Publication | 10-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | 4 |
DOI: 10.4103/2231-1505.262510
India stands second in the world with approximately 500 million Internet users. Fast technological improvements have increased the accessibility and uses of internet in all age group tremendously since past decade arising threats that many individuals especially adolescents, will be affected by internet addiction. Purpose of this paper is to present comprehensive overview of the current literature on Internet addiction. Though internet addiction is not officially recognized as a distinct behavioral disorder yet but in context of rapidly growing internet use, the internet addiction (IA) is been recognized as a global concern. It seems necessary to have some effective measures for prevention and management of internet addiction. Multi-model treatment of internet addiction looks promising but focus should also be on prevention. People should be made aware about the negative consequences of irresponsible internet use. Achieving a balance between provision of adequate internet facilities and protection of public from hazards of Internet use poses a challenge for policymakers. Mental health professionals should be aware about IA and work towards implementation of preventive, diagnostic and treatment strategies. World Mental Health Day 2018 will focus on “young people and mental health in a changing world” with an emphasis on the needs of this population on which our future depends. Young people are spending most of their time in online activities including pornography, gambling, online video games, excessive chatting, cyber bullying and cyber crimes etc. India has the youngest population in the world but it’s our responsibility to inculcate the right habits among next generation so we don’t lose the power of our young just in surfing online and they are available in real world instead of a virtual one only.
Keywords: Internet addiction, prevalence, Problematic internet use, treatment, risk factor
How to cite this article:
Maheshwari S K, Preksha S. Internet Addiction: A Growing Concern In India. Indian J Psy Nsg 2018;15:61-8 |
| Introduction | |  |
The Internet is a worldwide system of interconnected computer networks which has gone through various fast technological improvements since its inception in early 1960s, and today it provides a variety of services. The number of internet service provider is also increasing and people can access the internet through computers, mobile, laptop, tablets, smart televisions and other types of emerging gadgets. It has increased the accessibility and uses of internet in all age group tremendously since past decade. There has been a remarkable increase in internet uses from only less than 1% in 1995 to approximately 48% of total world population today1. Despite being the second largest base of internet users in India, the overall internet penetration in India is only around 35% at present in 2018. The number of Internet users in India stood at 481 million in December 2017 and is expected to reach 500 million by June 2018, 730 million by 2020 (Internet and Mobile Association of India, IAMAI)2 829 million in year 2021(CISC0)3.Today Internet has become the integral part of life and a basic necessity. Despite being an exceptional discovery in field of communication, internet is not free of its negative side as many people use it for online pornography, gambling , online video games, excessive chatting, cyber bullying and cyber crimes.
| Concept Of Internet Addiction | | |
Addiction is a “compulsive need and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal” (Webster Dictionary)[4]. Similarly, internet addiction (IA) is uncontrollable and damaging use of the internet that interferes with daily life. Person is unable to control one’s use of the internet despite negative consequences[5],[6] and which persists over a significant period7. The internet addiction is a complex phenomenon and most researchers have used different terms to describe the same phenomenon of excessive internet use. Internet addiction disorder (IAD) is used interchangeably with problematic/ pathologic internet use, internet addictive disorder, internet abuse/ overuse/ harmful use/ dependency, problematic computer use, compulsive internet use etc. But till now internet addiction as a mental disorder is not included in the current version of Diagnostic and Statistical Manual of Mental Disorders (DSM-V in 2013) and it is noted that the only internet related gaming disorder (one type of IAD) which is included in DSM-V also needs more extensive research in order to be considered as a full disorder[8].
| Prevalence Of Internet Addiction | | |
Today the problematic use of internet or internet addiction (IA) is been recognized as a global concern but its prevalence varies widely across countries as reported by various epidemiological studies across the world. A multinational meta-analysis of 80 studies (from 1996 to 2012) reports which comprised 89,281 participants from 31 countries across world reported 6.0% global prevalence with highest (10.9%) prevalence in the Middle East with and lowest (2.6%) in Northern and Western9. In China, the rates of internet addiction ranged from 6% to 10%.[10],[11],[12] High variation in prevalence (ranging from 8.1% to 50.9%) is shown among young people and adolescents of Asia[13],[14] F. Few studies conducted in Europe and the United States found prevalence of Internet addiction from 7.9% to 25.2% among adolescents[15],[16],[17],[18] while in studies from the Middle-East and Africa it ranged from 17.3% to [23].[6]%[19],[20].
India’s mobile data consumption is just one-tenth of that in the US and other advanced countries. As a result of affordability and easy access to touch screens mobiles, tablet devices, and WiFi, India is witnessing overuse of internet, especially among youth and children. According to a study, the addiction problem in India is real and at least 24.6 per cent of adolescents have problematic internet use or internet addiction disorder (IAD)21. In this Indian Council of Medical Research (ICMR) funded survey of 2,755 people from Bengaluru aged 18 to 65 years it is found that 1.3 per cent people were addicted to the Internet, 4.1 per cent to mobile phones, 3.5 per cent to social networking sites, 4 per cent to online shopping, 2 per cent to online pornography and 1.2 per cent to gambling22. Several smaller studies restricted to particular cities Jaipur, Mumbai, and Jabalpur found mild level of internet addiction of[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34]% in subjects and moderate addiction at anywhere between[7][8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24]%[23],[24],[25]. In previous years use of internet has increased many folds in India, there are the threats that many individuals especially adolescents, will be affected by internet addiction.
Classification Of Internet Addiction
Young KS has classified Internet Addiction phenomenon under following five subtypes based on the particular application that acts as a trigger for excessive Internet use26.
- Cyber-sexual addiction: addicted individuals are engaged in viewing, downloading and trading online pornography
- Cyber-relational addiction: these people are overly involved in online relationship (chat-rooms, social networks) and consider them more important than real relationships instead of marital discord and family instability
- Net compulsions: these people are involved with online gambling, shopping and trading activities.
- Information overload: under this excessive web surfing for information and database search falls
- Computer addiction: individuals are overly engaged in pre-programmed games installed in computer.
Risk Factors Associated With Internet Addiction
| Social factors | | |
Social problems27, introversion and poor face-to-face communication skills28, lack of social support and loneliness29,[30], low parental involvement31, negative parent-child relationships[32],[33], not living with mother34 and negative peer relationships35 have been found to be related to IA17.
| Psychological factors | | |
Prior addictive or psychiatric history[34],[36], prior or co-morbid psychiatric problems such as depression and anxiety,[13],[37] attention deficit hyperactivity disorder (ADHD)[38], social phobia[39] are reported to be associated with internet addiction disorder. IA can also result from compulsive consumption of online pornography due to its accessibility, affordability, and anonymity.40 Narcissistic features are also reported to correlated with increased selfie taking behavior and later uploading it on the online social sites41.
| Demographic risk factosr | | |
Demographic risk factors include male gender42, metropolitan living area43, living in nations with greater traffic time consumption, pollution, and dissatisfaction with life in general9, adolescent and young age44. Parental educational level, age at first use of the Internet, and the frequency of using social networking sites and gaming sites are among other factors that are found to be positively associated with problematic Internet use[45],[46].
| Negative Health Effects Of Internet Addiction | | |
Internet is useful in various aspects of life but also reported to have negative psychological, physical, social, academic, work and economic consequences if used irresponsibly47.
| Psychological health effects | | |
Although the results are not always consistent, IA has been reported to be associated with alcohol abuse48, depression[35],[49],[50],[51], anxiety and stress49. In a longitudinal study, Chinese high school students with moderate to severe risk of Internet addiction had 2.5 times more risk to develop depressive symptoms.52 Problematic Internet use is also reported to be associated with lower well- being[53],[54] decreased positive view towards life[53],[55],[56] and psychotic-like experiences.57 In addition internet addiction negatively affects memory, concentration and academic performance of students.[58],[59] Studies have demonstrated lower brain gray matter density (GMD) in the parts of left brain60 and more sleep deprivation, excessive daytime sleepiness, insomnia, snoring, apnea, teeth grinding, and nightmares in internet addicts compared to non addicts61.
| Physical health effects | | |
Obesity and visual impairment are major health effect of excessive internet use as the individual uses a lot of time looking at the computer screen[62],[63]. Too much use of internet can also affect growth and development, especially for teenagers and young adults,[64],[65] Psychological stress and loneliness pertaining to lack of time to socialize with others among internet addicts can affect them physically and lead to several health issues66.
Social health effects
Addicts spend too much time online in socializing which don’t leave time to socialize with real friends and family members. Online gambling and trading can result in financial loss, loss of work and status. Family relationship distortion, marital, academic, and job-related problems arise because partners, children and bosses are not ready to accept such behaviors[67],[68],[69].
| Assessment and Diagnosis Of Internet Addiction | | |
A variety of assessment tools are developed to assess the phenomena of internet addiction. The most commonly used questionnaire is Young’s Internet Addiction Test (IAT)70 which is based on criteria of pathological gambling and used to screen out internet addiction. Individual is considered “addicted” when answering “yes” to five (or more) of the questions (in absence of Manic Episode) out of the following eight items.
- Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate next on-line session)?
- Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
- Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?
- Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
- Do you stay on-line longer than originally intended?
- Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
- Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?
- Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?
Other assessment tools are the Internet Addiction Scale (IAS) of Griffiths73, the Problematic Internet Use Questionnaire74 (PIUQ) developed by Demetrovics et al, Chen Internet Addiction Scale (CIAS)75, , Generalized problematic internet use scale76, the Compulsive Internet Use Scale (CIUS)77, the Internet-Related Problem Scale (IRPS)78 and the Online Cognition Scale-OCS79 etc. Beard (2005)71 reviewed these scale and noted different theoretical underpinnings across various scale. He also did not agreed with underlying dimensions that make their utilization problematic.
| Treatment | | |
Though till now internet addiction is not an officially recognized disorder, it is demonstrated to have significant negative health, social, mental, and financial effects and thus requires prevention, control and treatment. The goal of treatment is to control problematic Internet usage and not to abstain from internet use completely.80 Clinicians working in the field of IAD have examined the efficacy of the various treatment options and have provided the treatment guidelines. Psychotherapy, pharmacology or a combination of both are the established strategies that are commonly used in other behavioral addiction problems such as OCD, impulse control disorders and substance use disorders etc are also have been shown to have effect in symptoms related to internet addiction81. Published studies on this topic are few and most of them are inconsistent with the definition and diagnosis of internet addiction, thus precluding any strong recommendations82. Treatment options for internet addiction can broadly be categorized under three categories including psychological, pharmacological and multi model treatment modalities.
| Psychological Treatment | | |
a) Cognitive-behavioral therapy (CBT)
Cognitive-behavioral therapy (CBT) is commonest and effective psychological treatment of IA (Young, 2013) which focuses on identifying the triggers for addictive online behavior and learning how to modify them into more adaptive ones.83 CBT also encourages activities that are helpful in fighting against IA such as Participation in physical activities would compensate for decrease in dopamine which results due to decreased internet use in person affected with IA84. Young85 has suggested some activities such as (a) practice opposite time of Internet use (disrupt patient’s patterns of Internet use by new schedules), (b) use external stoppers (external events forcing the patient to log off), (c) set goals (with regard to the amount of time), Du et al. 2010, and Young 2007 have reported effectiveness of CBT in controlling symptoms of IA[86],[87].
b) Motivational interviewing
Motivational interviewing (MI) is a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalent.88 It is used to enhance intrinsic motivation to give up addictive behaviors. In this individual learn new behavioral skills, open-ended questioning, reflective listening, affirmation, and summarization that help individuals to explore and resolve ambivalence regarding addiction.89 MI is found moderately effective in the areas of alcohol, drug addiction, and diet/exercise problems 90 but it is not tested in field of IAD.
c) Reality therapy (RT)
Reality therapy (RT) includes sessions to show clients that addiction is a choice and introduces alternative activities to the problematic behavior91. RT is a effective addiction recovery tool for a variety of disorders such as drugs, sex, food, and Internet[92],[93].
d) Community Reinforcement and Family Training
It involves interventions with family members or other relatives that can be useful in enhancing the motivation of a person affected with IA in reducing Internet use[94],[95]. Life skill training may also be helpful in prevention and management of IA as it found to be effective in combating against other addictions96. Other psychological treatments tested for IA are self-imposed bans on Internet access97, abstinence programs98, counseling programs99, CBT-IA which is a variations of cognitive-behavioral therapy (Young 2011), Acceptance & Commitment Therapy (ACT)100 electro acupuncture (EA) along with CBT101 and multifamily group therapy102.
| Pharmacological Treatment | | |
Pharmacological interventions tested by some researcher are found effective may be due to the co-morbid psychiatric symptoms of IAD (e.g. depression and anxiety). Escitalopram (a SSRI)103, citalopram (SSRI)- quetiapine (antipsychotic) combination50 naltrexone (an opioid receptor antagonist)104, Methylphenidate (a psycho stimulant drug)105, mood stabilizers50and bupropion (a non-tricyclic antidepressant)106 are reported to decrease problematic internet use.
| Multimodal Treatments | | |
A multimodal or multidisciplinary treatment approach includes a mixture of different interventions from various disciplines such as pharmacology, psychotherapy, case managers and family counseling simultaneously or sequentially107. A combination of readiness to change (RtC), CBT and MI interventions was found effective for problematic Internet- enabled sexual behavior (IESB)108 whereas a multimodal school-based group CBT (including parent training, teacher education, and group CBT) was found effective for adolescents with IAD86. The combination of solution-focused brief therapy (SFBT), family therapy, and CT109 in one study whereas group counseling program (including CBT, social competence training, training of self-control strategies and training of communication skills)110 in another Chinese study are reported to be effective. The reSTART Program111,112 (a holistic inpatient Internet addiction recovery program) program which involves combination of various interventions and targets on technology detoxification (no technology for 45 to 90 days), showed an improvement in self-reported subjective discomfort, interpersonal relationships and social role performance among adults.
| India’s internet de-addiction centre | | |
An internet de-addiction centre with the name of ‘shut down’ has been set up in the National Institute of Mental Health and Neurosciences (NIMHANS), India for healthy use of technology. Also a clinic for behavioral addiction is initiated in AIIMS, New Delhi. Few similar centres has been set up in a other cities but India need many more such centres across the country considering that millions of Indians are either already or likely to be affected with IAD,.
| Implications | | |
Researchers in past decades have strived to conceptualize and operationalize the problematic internet use but still internet addiction is not officially recognized as a separate and distinct behavioral disorder. Also there is a lack of consensus over it’s diagnostic criteria but in context of rapidly growing internet use, it seems necessary to have some effective measures for prevention and management of internet addiction. India has the youngest population in the world but it’s our responsibility to inculcate the right habits among next generation so we don’t lose the power of our young just in surfing online and they are available in real world instead of a virtual one only.
| Conclusion | | |
With increasing use of internet especially among young population it is expected that problems of IA will become more prevalent and failure to acknowledge it can affect millions of people, especially children and adolescents. As Internet use is encouraged in wide range of activities of professional, educational and everyday life, total abstinence from internet is neither possible nor recommended and emphasis should be on responsible use of internet. Current review presents a good overview of the state of research in the field of internet addiction treatment. This review may be helpful for the nurses and health professionals engaged in prevention and care of persons affected with pathological use of internet may find review useful during clinical practice as well as in designing the research to developing any preventive and curative interventions for IAD.
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