Virtual Addiction: a perspective

Over on The Metaverse Journal, Feldspar Epstein wrote a three-part series in recent weeks on virtual addiction. I’ve conglomerated those three parts into one large post here.

    Are you a Virtual World Whore? Virtual Addiction, Part 1

Do you crave the fun, excitement, and pleasure of virtual worlds to the detriment of the rest of your life? Would you do anything, give anything, just to be able to spend another couple of uninterrupted hours in a virtual space, Multi-User Virtual Environment (MUVE) or gaming environment?

Smoking - one of the legal addictions.

You have a problem. You are a virtual world addict.

What does it mean to be “addicted”?

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) uses the term “dependency”. The upcoming DSM-V will use the term “addiction” once again to describe the condition, since “dependency” has other connotations that confuse the issue. “Addiction” is the term used by many physicians and most lay people.

Under the DSM-IV, “substance dependency”, the condition from which the diagnostic criteria for behavioural conditions was extrapolated, is paraphrased as follows:

  1. The substance is required for normal functioning, and withdrawal, a physical and psychological reaction, occurs when the substance is suddenly withdrawn. Additionally, any adverse consequences, be they physical, psychosocial, financial, etc, are endured for the sake of getting and taking the substance.
  2. The substance initially causes pleasure, euphoria and/or feelings of well-being, though this experience diminishes in intensity over time, so that more of the substance must be taken in to experience the same effect. This is known as tolerance.
  3. Any substance in which a person indulges in uncontrollably is addictive.
  4. A “reward circuit” is set up by substance dependency, in the brain; that is, taking the substance leads to a reward, and the brain undergoes a neuro-plastic change, so that the brain is then primed to desire the reward again.

What does it mean to have a behavioural addiction?

Being addicted to a particular behaviour bears a strong resemblance to substance dependency or addiction. The difference is the behaviour is carried out, in place of a substance being taken. The following items hold true:

  1. The behaviour needs to be carried out to maintain normal functioning, and withdrawal occurs if it is not.
  2. The behaviour induces pleasure; tolerance is built up over time, so that the behaviour must be carried out more or more often in order to achieve the same level of pleasure.
  3. Any behaviour in which a person indulges in uncontrollably is addictive.
  4. Changes in the brain occur in response to the repeated pleasure and withdrawal pattern.

“It's a compulsive behavior, and it doesn't matter if it's Everquest, Second Life, World of Warcraft, City of Heroes, Internet porn or gambling.

How is “Internet” addiction different, new, or special? (For “Internet”, read browsing, email, Instant Messaging, online porn, online gaming, and participating in MUVEs).

Short answer: very little. The specifics of the type of pleasure engendered, the type of withdrawal experienced, and the consequences of enacting the behavior differ from other addictions as other addictions differ from each other – otherwise there would be no point in having a different classification for each. The basics, though, are identical to the basics for all behavioral addictions.

“It’s a compulsive behavior, and it doesn’t matter if it’s Everquest, Second Life, World of Warcraft, City of Heroes, Internet porn or gambling,” states Tateru Nino. The sufferer “could not find balance.”

The essential problem seems to be that people mistake the medium for the message. When they hear that folks are “addicted to the Internet”, they blame the Internet, the medium, for the problem, whereas the Internet is simply provides a new source of behaviors for people who would have had behavioral addictions anyway. By extension, it’s not the fault of virtual worlds that people become virtual world addicts.

    On Being a Virtual World Whore – Virtual Addiction, Part 2

There’s been a great deal of debate of whether “Internet Addiction” and its close cousin, “Virtual World Addiction”, should be classified as disorders separate from other behavioral addictions. Psychiatrist Ivan Goldberg reputedly borrowed the criteria for substance use and impulse-control disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and jokingly created the criteria for Internet Addiction Disorder (IAD) way back in 1995. Since then the debate has raged wildly – can these two addictions be meaningfully separated out and classified, or is there little real reason for doing so?

Smoking - one of the legal addictions.

Internet and Virtual World Addiction: what are the specifics?

Internet addiction, and virtual world addiction (by association), seems to revolve around five basic sub-types: gambling, sexual preoccupation, messaging and/or chatting, online gaming and information gathering.

None of these are new concepts. As previously discussed, the Internet and the virtual world are mediums. The problem is with the individual’s pathological need to carry out the activity, not with the medium that provides the means for that activity. Each of the five sub-types mentioned can be performed using other mediums and indeed have been for some time.

Nonetheless, there is a definite appeal to engaging in these activities online. The internet and virtual worlds provide high levels of convenience. It is much easier and quicker to gamble from home, using electronic funds, than to be physically present or to accomplish the task over the phone. If you are looking to be secretive about your behavior, it’s easiest to hide your actions online – no need to hide physical evidence like books or magazines.

Still, this does not constitute sufficient reason to separate out these addictions from other behavioural issues.

What are the withdrawal symptoms of Internet and Virtual World Addiction?

Symptoms include: loneliness, boredom, anger, irritability, frustration, emotional “vacancy” or numbness, disconnectedness, loss, moodiness, depression and restlessness. Interestingly, these symptoms sound suspiciously like those suffered by people cut off from the rest of society. Internet users asked to give up their internet usage reported that they felt “left out of the loop” – an understandable reaction given how many people interact with each other online rather than face-to-face or over the phone.

Of course, these symptoms are not restricted to folks cut off from society – these apply to other behavioural addictions. Internet and Virtual World addictions do not have symptom lists that specifically separate them from other behavioral addictions.

What are the consequences of being addicted to the Internet and Virtual Worlds?

Having an addiction implies that one relationship or activity has become all-important, other relationship or activities are ignored or given a minimum amount of attention. As with any other addiction, this often includes a reduction in time spent at work (or complete absence), resulting in loss of employment, financial loss and hardship and less time spent maintaining or creating relationships. This leads to existing relationships breaking down, new relationships not created through other mediums, a more secretive approach to relationships (where the true nature of the addiction is hidden from other parties) and reducing relationship quality, Other obligations and chores are neglected, sometimes to the extent that a health risk exists.

For humans as social and physical animals, the most significant of these consequences after health health concrens, is the loss of close relationships with other people, particularly family relationships. Humans require some amount of physical contact to remain healthy – the portion of a relationship that can be experienced online is no less real when experienced over a distance instead of face-to-face. Nonetheless, online relationships will never be able to fully replace relationships where physical contact is possible.

Who gets addicted to the Internet, or to Virtual Worlds?

Intriguingly, those people who suffer from this addiction may have suffered from symptoms very similar to the symptoms for this affliction prior to becoming addicted: depression, guilt, and anxiety. There are often other symptoms (dysphoric mood, feelings of helplessness, interpersonal distress, low self-esteem) and other issues (abandonment, shame, fear) that presage this type of addiction. It’s surprising how common it is for people with these underlying conditions to become addicts; up to 86% of study subjects also exhibit other diagnosable mental health disorders.

Two of the factors that are not necessarily indicators for who will become addicted are age and social capacity, even though stereotypically socially awkward or inept youths are seen as the main sufferers. Daniel Loton of the Victoria University in Australia has shown that what he terms “problem play” (as relates to gaming in virtual worlds) is not restricted to those people who have little capacity for socialization. Low self-esteem is however a good predictor of whether someone will become an addict, according to the study.

Treatment of addiction in behavioural cases?

A diagnosis is most useful where it can be used to treat an affliction. Most behavioral addictions respond well to Cognitive Behavioral Therapy (CBT). Indeed, internet and virtual world addiction cases reportedly respond well to CBT. Thus, there would seem to be little reason to separate out internet and virtual world addiction solely on the basis of needing a treatment specific to the new diagnosis.

In conclusion, there seems to be no need for the distinct and separate classifications of internet and virtual world addiction. These terms merely clump together several different behavioural addictions with the same delivery method. It’s like saying that snorters and injectors of an addictive drug should get a different diagnosis. Even if there are cases where the presentation, withdrawal symptoms or consequences are different, the therapy used to treat the different cases remains the same. Unnecessarily differentiating labels seems to do no more than confuse more than they contribute.

    What looks like addiction, but is not – Virtual Addiction, Part 3

I spend hours with my computer. It is my favorite tool. I spend time in and out of virtual worlds; I spend time on and off the Internet, surfing with my browser. I communicate, I work, I play. From the sheer amount of time spent with my machine during the day, according to some measures, it would be correct to say that I am addicted to the behaviour of using my computer. I do not, however, consider this to be an addiction.

Several people within my experience also spend a great deal of time with their computers. Interestingly, the particular people I am thinking of were also at one time thought to be drug addicts. Each of these people suffers from either a physical pain disorder, or from a chemical mental disorder. The drugs they take assist their functioning, above and beyond the side effects they cause. I do not consider any of these people to be addicts, either, with regards to drug use or computer use.

Why is this not addiction?

The most important signs of addiction, and indeed the ones that cry out for treatment, are loss of control regarding the addiction and destructive behaviors of and surrounding the addiction. Neither I nor my friends exhibit these signs in our computer usage nor drug usage; therefore, this behavior is not an addiction, by definition.

Why does it look like addiction?

One of the primary signs attributed to addictions of computer usage is time spent engaging in the behavior. This sign may help with the diagnosis of an addiction, but alone cannot be used to make the diagnosis.

Consider how many hours a day the average person spends at work. Perhaps eight hours all up, divided into an hour for lunch, a couple of hours for meetings and other communications, and the rest for the actual work they do. Then consider that person gets home (two hours for travel), eats (two hours for eating at home), and watches TV or reads (four hours). This accounts for sixteen hours of the day, roughly.

Imagine, then, if all of this could be accomplished from their computer at home. Suddenly, rather than seeing a person spending sixteen hours a day in mindless clicking, there is someone working, communicating, gathering news and information and finding entertainment using the same tool.

Another sign often taken alone and out of context is a lack of face-to-face communication on behalf of a person who uses computers.

There are many different scenarios in which face-to-face communication is not applicable, but for example, consider a person with a physical disability in which face-to-face communication is difficult to achieve. For someone with limited mobility or large amounts of pain, getting out of the house may range from impractical to impossible. Consider sufferers of social anxieties, or autistic folk, who are barely able to communicate face-to-face, but whom are liberated by the digital space.

Is quality of life being gained or lost?

Where there is a gain in quality of life which exceeds the downsides to the behavior, there is unlikely to be an addictive problem. With drugs for pain relief, it has been found that it’s very rare for folks who require the drug for pain relief to exhibit loss of control or destructive behaviors concerning the drug, even though they have a physical dependence on it. There may be withdrawal symptoms and side effects, but overall the quality of life increase for these folks. Being able to take care of themselves, their homes, their families, and having enjoyment in life far outweighs the problems in most cases.

Technology is enabling.

Can you imagine telling someone with no legs to forsake their wheelchair? How about someone with a pain disorder? Are you going to tell people with crippling mental disorders that they are not allowed to take drugs to normalize and enable them? Are you going to tell deaf people they can’t use Teletype in place of the telephone?

Each of these technological advances were radical in their time; some of them were seen as being destructive, to society or to the individual. It’s hard to imagine any of these people being denied their enabling technologies in today’s first world society (one hopes). I hope to live in a future where my enabling computer habits are accepted.

What harm is being done, to whom, if I take care of myself, my family, my house, my dog, my finances and my business, while still spending many hours a day at my desk at home?