Abstract
There are now over three billion Internet users in the
1 world. This makes it about 40% of the world
population. In 1995, only 1% of the world population
was using the Internet. The first billion mark of the
Internet users was achieved in 2005, the second
billion in 2010 and the third billion was reached in
2014. Pakistan is no exception. There are currently
2
over thirty four million Internet users in the country.
The number of smart phones that further facilitates
Internet connectivity is expected to cross 40 million
3
by the end of the current year. This increased
internet connectivity has changed many an aspect of
personal, professional and social lives of Internet
users. Consequently, the amount of time people
spent online has been growing steadily. According to
a recent study young people in the UK have started
spending more time online than watching TV for the
4
first time.
The early researchers and adaptors of the Internet
technology generally viewed the online social
engagement, entertainment and discussion in a
positive light because they believed that virtual
communities provide emotional support and a
platform for discussion and sharing information with
relative ease and with less inhibition. However, the
pervasive nature of Internet in daily lives has also led
to excessive or uncontrollable use in extreme cases.
5 6
The seminal studies by Goldberg and Young in 1996
are generally considered as the first efforts in
developing the notion and conducting empirical
research on the topic of Internet Addiction (IA) or
Internet Addiction Disorder (IAD).
Over the years the scope of research on IA has been
considerably widened but without any universal
definition, assessment criteria or treatment
methods. A comprehensive review of IA research in
2014 indicated association of a number of risk factors
7 w it h I A . T h e s e ris k f a c t o rs i n c l u d e
sociodemographic, Internet use, psychological
fa c tors and co-morbid symptoms. Thesociodemographic risk factors may comprise male
gender, younger age and higher family income. The
Internet use risk factors may include time spent
online and using social or gaming applications. The
psychological factors may be impulsivity,
neuroticism and loneliness. Finally, the co-morbid
symptoms may consist of depression, anxiety and
psychopathology in general.
At the conceptual level the difference is whether the
criterion is derived from pathological gambling,
substance-related addictions or the number of
problems experienced. Additionally, there seems to
be a disagreement about the cut-off points used
within each criterion. As far as the psychometric
measures are concerned, Young's Internet Addiction
8
Test seems to be the most popular instrument used
in the empirical studies but different cut-off points
are used across studies making the comparison
9
between studies difficult. Other measures often
cited include Computer Game Addiction Scale (AICA10 11 S) , Compulsive Internet Use Scale (CIUS) and
12 Chen's Internet Addiction Scale.
There is also now a focus on differential diagnosis
and/or co-morbidity of Internet addiction. A more
9
recent review in 2016 indicates that presence of comorbidities in internet addiction in clinical context
appears more prevalent than initially thought.
Individuals seeking help often have symptoms of
mood and anxiety, impulse control and addictive
disorders. This suggests that IA treatment can be
more effective when a holistic approach is taken that
combines evidence-based treatments of any comorbidities that may be present in an individual.
Accordingly, the IA treatment approaches have been
either based on psychopharmacotherapy,
psychological therapy and combined therapy
approaches.
Psychopharmacotherapy has shown an overall
positive effect on IA symptoms and Internet use
times. In a few studies antidepressant medication
has been reported to be successful, indicating that
mood disorders may be more prevalent with Internet
9
addiction. As regards to the psychological therapy, a
combination of individual and group therapy
approaches have also been used. Overall group
therapy treatments have shown better results over
individual therapy approach for both reduction intime spent online and significantly higher selfesteem. Moreover, in case of adolescents, the most
important factor to reduce internet addiction seems
13 to be parent-child relationship. Some studies have
reported combined therapy treatments that have
resulted in positive results in both post-treatment
and follow-up measures. The study that stands out in
this category of therapy is the significantly positive
results in use of electro-acupuncture in combination
14 with a psychological intervention suggesting that
this novel approach may be investigated further to
establish its efficacy and effectiveness.
The Internet connectivity is relatively cheap and
accessible in urban and semi-urban areas of
Pakistan. With advent of 3G and 4G mobile networks
available through Pakistan, the amount of time
people spend online is expected to grow
significantly. Physicians in Pakistan should explore
the possible signs of Internet addiction or
problematic internet use among the vulnerable
segments of the society. The co-morbidity of Internet
addiction with mood and anxiety disorders may also
be explored when deciding a treatment approach.
The role of family structures in Pakistan as support
group may also be useful in group therapy sessions. It
may be kept in mind that presence of co-morbidities
complicates the treatment as it may be important to
establish whether Internet addiction is the primary
or secondary disorder.
9
As suggest in , research scholars in Pakistan are also
recommended to validate the measures already in
use and collaborate with international research
community to develop a universally agreed-upon
criterion for assessment and treatment. This will also
pave the way for public policy debate and
development of health care facilities in the country
that provide early diagnosis and treatment to the
affected individuals. The study reported in this
journal on Internet addiction and its impact on
academic performance is a head start for further
research on the topic.
