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Internet addiction disorder is not an official psychological diagnosis but treatments exist
Before COVID hit, Jillian, 68, didn't have internet access at her home — not because she couldn't get it connected, but because she was afraid of what might happen if she did.
"I initially got onto the internet at the library to look up real estate because I was thinking of moving and even then, I was aware that I seemed to linger on it," she tells ABC Radio National's series Brain Rot.
The internet's irresistible pull was enough to keep her browsing confined to the local library.
Then in 2020, when parts of the country went into lockdown, Jillian could no longer access her local library, so she decided to get Wi-Fi at home.
And that's when she felt her internet use became chronic.
"I spent hours alone at home looking at my phone," she says.
"At the time I called it 'internet research' but it was just trivial news that was consuming me."
She tried to limit her internet use but found that one quick search would inevitably lead to another and another.
They sound like behaviours associated with an addiction. Yet the term "internet addiction" is not formally recognised as it's not listed as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.
And the medical community is divided as to whether the term should be classified as a diagnosis.
Regardless of the current classification, some people report feeling addicted to online activities. Depending on the individual, that could be endless online shopping, gaming, social media use or video streaming.
Before delving into treatments for what many call internet addiction, it's worth examining just how online we've become.
A decade ago, around a third of the world's population used the internet. That figure has since doubled.
And recent evidence suggests the COVID pandemic drove an uptick in screen time globally too. A 2022 meta-analysis of 89 studies, collectively analysing data from more than 200,000 people, found spikes in screen time across the board during the pandemic.
The increase was highest in primary school kids, whose screen time went up by 1.4 hours a day. Adult screen time increased by an hour each day compared to pre-pandemic use.
Whether that screen time has fallen back to pre-COVID levels isn't yet known. Increased internet use does not, however, automatically mean it becomes an addiction.
So: is it possible to be addicted to the internet?
Anna Lembke, a psychiatrist in addiction medicine at Stanford University School of Medicine, thinks so.
She explains that all addictions — whether they're due to substances or behaviours — operate using the brain pathway responsible for processing reward and motivation.
"Basically when we do something rewarding or pleasurable or just simply something that our brain recognises as important for survival, our brain releases dopamine in the reward pathway.
And many digital platforms were designed to elicit quick dopamine bursts, Professor Lembke adds.
"They were made to make [device use] frictionless and easy for us to access the content and very difficult to get off because of the reinforcing nature of the medium itself.
"Most people who use digital media will not go on to develop a severe and life-threatening digital media addiction.
"But a vulnerable subset will, and it's probably going to shake out at around the same 10 per cent that we see for addiction to drugs and alcohol."
And while there is no official diagnosis for internet addiction, Anastasia Hronis, clinical psychologist and researcher at University of Technology Sydney, agrees with Professor Lembke.
"It's not yet a diagnosable condition but the evidence emerging is certainly telling us that children, teens and adults can certainly become hooked and experience some sort of harm as a result of using their phone," she says.
Others in the field aren't confident that the current level of evidence justifies an official "internet addiction disorder" diagnosis yet.
Dar Meshi, who researches social media use and mental health at Michigan State University, thinks there's "some compelling evidence right now but … some of the evidence hasn't reached the levels of proof".
He also warns "we shouldn't throw the baby out with the bath water" by insisting that all internet use is "bad" until we know more.
While the field of internet use research into problematic internet use has grown significantly in recent years, it's still taking shape.
But generally, treatment for problematic internet use or internet addiction — whatever you might call it — draws on the principles of addiction treatments, Dr Hronis says.
"We know that the treatments are somewhat similar when it comes to working with people who have addictions as well. The target of the addiction might change, but the fundamental principles around helping someone through an addiction are similar."
South Korea has been considered a world leader in tackling problematic internet use. In 2002, the nation — of which 97 per cent of the population use the internet — established a network of "digital detox" camps that mostly cater to children and teenagers.
Participants have their phones removed for the entire 12-day camp. The aim of the treatment is to increase human interaction and decrease periods spent online.
Elsewhere around the world, private treatment facilities have also sprung up.
In 2008, US psychologist Hilarie Cash and a colleague opened reSTART, a residential treatment facility for people they believed needed a higher level of care to treat their video game addiction, internet gaming, excessive screen-time and social media use.
Dr Cash says she has been treating clients with what she describes as internet addiction disorder since the mid-90s.
"At the time I knew nothing about the internet … I didn't own a computer.
ReSTART operates on a rural property in Washington, and, like the South Korean digital detox camps, there are no phones allowed.
"When our clients come, they are abstinent from screens and the internet for three months or longer … we believe total abstinence is extremely important," Dr Cash says.
Clients generally find the first month of treatment the most difficult, she adds: "The brain is going through the process that is recognised as withdrawal … once that process is finished they are typically just feeling so much better, they're more relaxed and just starting to be able to enjoy life once again."
However, there are no reliable statistics on how well this kind of addiction-focused treatment works for internet overuse.
As the pandemic started to tail off, Jillian, who has been a member of Alcoholics Anonymous since her late 20s, "recognised the same feelings of addiction and the need to do something about it."
That's how she stumbled upon Internet and Technology Addicts Anonymous (ITAA), which formed in 2017 and has more than 3,000 members worldwide.
The program is closely modelled on Alcoholics Anonymous. According to its website "it's a 12-step fellowship of individuals who support each other in recovering from internet and technology addiction" and members are encouraged to attend regular free online support meetings.
Thanks to ITAA, Jillian has been "sober" from the internet for more than two years.
Listen to the full episode of Brain Rot about problematic internet use, and subscribe to the podcast for more.
