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Caught in the Web
More People Say Heavy Internet Use Is Disrupting Their Lives, and Medical Experts Are Paying Attention

By January W. Payne
Washington Post Staff Writer
Tuesday, November 14, 2006

A few months ago, it wasn't unusual for 47-year-old Carla Toebe to spend 15 hours per day online. She'd wake up early, turn on her laptop and chat on Internet dating sites and instant-messaging programs -- leaving her bed for only brief intervals. Her household bills piled up, along with the dishes and dirty laundry, but it took near-constant complaints from her four daughters before she realized she had a problem.

"I was starting to feel like my whole world was falling apart -- kind of slipping into a depression," said the Richland, Wash., resident. "I knew that if I didn't get off of the dating sites, I would just keep going," detaching herself further from the outside world.

Toebe's conclusion: She felt like she was "addicted" to the Internet. She's not alone.

Concern about excessive Internet use -- variously termed problematic Internet use, Internet addiction, pathological Internet use, compulsive Internet use and computer addiction in some quarters, and vigorously dismissed as a fad illness in others -- isn't new. As far back as 1995, articles in medical journals and the establishment of a Pennsylvania treatment center for overusers generated interest in the subject. There's still no consensus on how much time online constitutes too much or whether addiction is possible.

But as reliance on the Web grows -- Internet users average about 3 1/2 hours online each day, according to a 2005 survey by Stanford University researchers -- there are signs that the question is getting more serious attention: Last month, a study published in CNS Spectrums, an international neuropsychiatric medicine journal, claimed to be the first large-scale look at excessive Internet use. The American Psychiatric Association may consider listing Internet addiction in the next edition of its diagnostic manual. And scores of online discussion boards have popped up on which people discuss negative experiences tied to too much time on the Web.

"There's no question that there are people who are seriously in trouble because of the fact that they're overdoing their Internet involvement," said Ivan K. Goldberg, a psychiatrist in private practice in New York. Goldberg calls the problem a disorder rather than a true addiction, which Merriam-Webster's medical dictionary defines as a "compulsive physiological need for and use of a habit-forming substance."

Jonathan Bishop, a researcher in Wales specializing in online communities, is more skeptical. "The Internet is an environment," he said. "You can't be addicted to the environment." Bishop, who has had several articles published on the topic, describes the problem as simply a matter of priorities, which can be solved by encouraging people to prioritize other life goals and plans in place of time spent online.

The new CNS Spectrums study was based on results of a nationwide telephone survey of more than 2,500 adults. Like the 2005 survey, this one was conducted by Stanford University researchers. About 6 percent of respondents reported that "their relationships suffered as a result of excessive Internet use," according to the study. About 9 percent attempted to conceal "nonessential Internet use," and nearly 4 percent reported feeling "preoccupied by the Internet when offline."

About 8 percent said they used the Internet as a way to escape problems, and almost 14 percent reported they "found it hard to stay away from the Internet for several days at a time," the study reported.

"The Internet problem is still in its infancy," said lead study author Elias Aboujaoude, a psychiatrist and director of the Impulse Control Disorders Clinic at Stanford. No single online activity is to blame for excessive use, he said. "They're online in chat rooms, checking e-mail every two minutes, blogs. It really runs the gamut. [The problem is] not limited to porn or gambling" Web sites.

In the 2005 survey, conducted by the Stanford Institute for the Quantitative Study of Society, single people and younger people were more likely to use the Internet than others. Survey participants reported that an hour spent online reduced face time with family members by nearly 24 minutes; an hour on the Internet reduced sleep time by about 12 minutes.

More than half the time spent online involved communication (including chat rooms, e-mail and instant messaging), the report said; the rest of the time is spent updating personal Web pages and browsing news groups, social networking and dating Web sites, as well as other sites.

Hints of Trouble

Excessive Internet use should be defined not by the number of hours spent online but "in terms of losses," said Maressa Hecht Orzack, a Harvard University professor and director of Computer Addiction Services at McLean Hospital in Belmont, Mass., founded in 1995. "If it is a loss [where] you are not getting to work, and family relationships are breaking down as a result around it and this is something you can't handle, then it's too much."

Since the early 1990s, several clinics have been established in the United States to treat heavy Internet users. They include the Center for Internet Addiction Recovery, in Bradford, Pa., and the Connecticut-based Center for Internet Behavior.

The Web site for Orzack's center lists the following among the psychological symptoms of computer addiction:

· Having a sense of well-being or euphoria while at the computer.

· Craving more and more time at the computer.

· Neglect of family and friends.

· Feeling empty, depressed or irritable when not at the computer.

· Lying to employers and family about activities.

· Inability to stop the activity.

· Problems with school or job.

Physical symptoms listed include dry eyes, carpal tunnel syndrome, migraines, backaches, skipping meals, poor personal hygiene and sleep disturbances.

If college settings are any example, excessive Internet use may be a growing problem. Jonathan Kandell, assistant director of the counseling center at the University of Maryland at College Park -- one of the first universities to offer a support group for this type of behavior in the 1990s -- said that surveys of students who seek counseling show an increase in those reporting that "they either always or often had trouble controlling themselves on the Internet." In the late 1990s, about 2 to 3 percent reported that problem; in 2005 and 2006 surveys, the figure has increased to about 13 percent, Kandell said.

The APA is considering whether to take up this issue when it updates its official manual of psychiatric disorders in 2012, said William E. Narrow, associate director of the association's division of research. If such behaviors begin affecting a person's life and "they feel like they can't stop, [then] that's the type of thing that we would start to have concerns about," Narrow said. It's also important to consider, "Are there any other disorders that can account for the behavior?"

Many online discussion boards -- with names such as Internet Addicts Anonymous, Gaming Addiction and Internet Addicts Recovery Club -- focus on Internet overuse and contain posts from hundreds of members. On such boards, posters admit that they feel as though they can't step away from their computers without feeling drawn back and that their online habits interfere with personal relationships, daily routines and their ability to concentrate on work or school. Reports of failed relationships, slipping grades and workplace problems that writers attribute to their preoccupation with the Internet are not unusual.

People who struggle with excessive Internet use may be depressed or have other mood disorders, Orzack said. When she discusses Internet habits with her patients, they often report that being online offers a "sense of belonging, an escape, excitement [and] fun," she said. "Some people say relief . . . because they find themselves so relaxed."

Goldberg, the New York psychiatrist, said he has seen patients "whose marriages were deteriorating who retreated behind a keyboard." The Internet "becomes another way that people use to try to cope with their own disorder," he said.

Less Game to Play

Some parts of the Internet seem to draw people in more than others, experts report. Internet gamers spend countless hours competing in games against people from all over the world. One such game, called World of Warcraft, which charges a $14.99 monthly subscription fee, is cited on many sites and discussion boards by posters complaining of a "gaming addiction."

Andrew Heidrich, 28, an education network administrator from Sacramento, plays World of Warcraft for about two to four hours every other night, but that's nothing compared with the 40 to 60 hours a week he spent playing online games when he was in college. He cut back only after a full-scale family intervention, in which relatives told him he'd gained weight and had become "like a zombie."

"There's this whole culture of competition that sucks people in" with online gaming, said Heidrich, now married and a father of two. "People do it at the expense of everything that was a constant in their lives." Heidrich now visits Web sites that discuss gaming addiction regularly "to remind myself to keep my love for online games in check."

Toebe also regularly visits a site where posters discuss Internet overuse. In August, when she first realized she had a problem, she posted a message on a Yahoo Internet addiction group with the subject line: "I have an Internet Addiction."

"I am self-employed and need the Internet for my work but I am failing to accomplish my work, to take care of my home, to give attention to my children who have been complaining for months," she wrote in a message sent to the group, which had more than 300 members as of last week. "I have no money or insurance to get professional help, I am not making money, I can't even pay my mortgage and face losing everything."

Since then, Toebe said, she has kept her promise to herself to cut back on her Internet use. "I have a boyfriend now, and I'm not interested in [online] dating," she said by phone last week. "It's a lot better now."

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