Problematic use in context
Authors: JYRKI KORKEILA
Journal: World Psychiatry (2010)

E. Aboujaoude provides us with a lucid and inclusive overview of what is currently known on the problematic use of Internet. Even the earliest studies of Internet use indicated that the expansion of use carried risks as well as advantages 1. The terminology surrounding the problematic use has been versatile, due to the differences of viewpoints regarding the validity of the concept. Nevertheless, there is mounting evidence of the harmful effects on finances, work and relationships of high level of use of the Internet 2. A new form of media has historically sprouted both worry and criticism by observers. In the 18th century, novels and reading were spread in the population, leading to the concept of "reading mania" or "reading fury". This was described as an epidemic associated with physical exhaustion, rejection of reality and immobility. Novels were described to have drug-like qualities similar to inflame passions. D.L. Smail describes how cultural changes create neurophysiological ecosystems, in which "the sorts of customs and habits that generate new neural configurations or alter brain-body states could evolve in unpredictable ways" 3. Emotion/mood altering practices, behaviours and institutions can be defined as psychotropic mechanisms that have effects not very dissimilar from those produced by psychoactive drugs. These mechanisms may be divided into teletropic, i.e., those that alter the states of others, like religion or social institutions, and autotropic, which influence the brain-body states of the self. In fact, modernity can be viewed as a significant expansion in the variety of autotropy and acceleration of the importance of autotropy for consumer society. According to Smail, there is a crescendo of civilizational achievement through psychotropy on human cultural evolution. Given the evolutionary-cultural background described above, it is obvious that there is a range of objects and activities, which may be particularly risky to the extent that modification of behaviour by the person herself/himself becomes very difficult. Addictive behaviour can be viewed as the development of a strong attachment to an appetitive activity, such that self-control is diminished, and behaviour may appear to be disease-like 4. Defined in this manner, individuals attached to gambling, surfing the Internet and drinking may be found equally attached to the activity in question. The definition of addiction merely by use of substances overlooks the situation of those who are unable to overcome their excessive appetites. Furthermore, a thorough explanation of addiction would require an understanding of the proximate (immediate causes) as well as the ultimate sources (evolutionarily background) of behaviours associated with addiction. Flooding the brain systems with substances or hijacking the natural rewards by excessive behaviours are not adaptational, although they rely on evolved adaptive systems related to social attachment, rewards, attention, decision-making and internal signalling of emotional systems. The best-known motivational system uses dopaminergic networks, which have no built-in brakes 5. During evolutionary times, it was not necessary to develop such a mechanism, as the environmental scarcity would largely prevent excessive appetites. Seen from this viewpoint, addiction is an evolutionary price tag of the development of our biological predispositions and cultures. The implied conclusion is that whenever new substances influencing the brain or technologies and innovations enabling the behavioural manipulation of the motivational-rewarding brain are developed, new forms of excessive appetites and related behaviours will continue to develop. The most important question may not be whether some form of problematic behaviour is a new independent disorder or definable as a disease in relation to some theoretical general definition, but whether the diagnostic label will plausibly serve as a tool in differentiating subjects that may benefit from treatment from those who likely do not. The potential to produce health gains is one of the quintessential justifications for considering some type of condition or behaviour a disorder. If there is evidence of adverse consequences associated to high level of Internet use and if problematic behaviour causes impairment and lack of control to such a level to require treatment, Internet addiction should be no exception. Internet may provide an easy access to rewards and behaviours previously considered to be associated with excessive appetites, such as gaming and various forms of sexual activities. Hence, the web might be a new forum for the appearance of old perils. Currently we lack sound evidence on comorbidity and development of problematic use of Internet in order to study the means of treatment and eventually to provide the best help for those afflicted. Furthermore, the question of how the shift from moderate extravagance to highly problematic excess should be defined and understood does not totally escape value assessments. The pioneers of the digital revolution did consider even in the early 1980s that virtual reality might "unleash the demons of human nature" and people could be addicted to virtual reality as if it were a drug and become trapped into it 6. As more and more people become familiar with computers and the Internet, the role of the web in their lives will continue to increase and for some the use of the Internet will become a dominating feature in their lives, given the loss of control and the salience of use. One can but agree with Aboujaoude's conclusion that the gap between our knowledge base and the evolution of this new technology needs a bridge.