Internet Addiction and ADHD

Todd Love

 Attention Magazine April 2020

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There’s lots of talk and concern about screen time these days. It’s not uncommon for someone to say “OMG, I’m totally addicted to the internet/my phone/etc.” That’s probably not a medically accurate diagnosis. But can you be addicted to the internet? Can you even be addicted to anything that isn’t a drug?

The answer is a resounding yes. The American Society of Addiction Medicine (ASAM) defines addiction as a singular medical condition that includes both behaviors and substances. The American Psychiatric Association (APA) now officially recognizes gambling disorder as a behavioral addiction.

Internet addiction, also known as internet addiction disorder (IAD), is a huge problem around the world, and there have been over 300 neuroscience studies published indicating internet addiction as a biologically based medical issue. The South Korean government declared internet addiction a public health crisis over a decade ago, and currently estimate that 20 percent of their population (almost 10 million people) is at serious risk of internet addiction.

Internet addiction can manifest in a variety of ways, including the overuse of social media, gaming, shopping, gambling, pornography, and even what psychologists are simply calling smartphone addiction.

Internet pornography addiction

There is unnecessary controversy around internet pornography addiction. We can all agree there is a larger problem with too much screen time, and it’s easy for people to agree that too much gaming or social media use can develop into an addiction. Common sense dictates that chronically viewing internet pornography is no different.

Indeed, scientific studies are emerging on the topic that chronic use of internet pornography can create the same changes in brain neural pathways that led ASAM to include some compulsive behaviors as having the potential to become addictions. And when people try to stop, they can experience withdrawal impacts such as increased moodiness (depression, anxiety, anger, irritability), trouble sleeping, and decreased motivation and concentration.

Internet gaming disorder

Internet gaming disorder is the most widely known manifestation of internet addiction. In the worst cases, people have died from heart attacks after playing for days on end. In South Korea, an infant died of malnutrition because her parents couldn’t stop gaming long enough to feed her.

Examples such as this, coupled with scores of scientific studies, have led the World Health Organization to officially recognize internet gaming addiction as a bona fide addiction, and the APA is on the (slow) path to doing so.

How do you tell if you have an internet addiction?

Three of the key criteria for addiction are (1) unsuccessful attempts to quit or cut back, (2) negative consequences (jeopardizing/losing a significant relationship, job, or educational opportunity), and (3) continuation of the behavior despite negative consequences.

Yes, too much online time is a problem for many people. But if someone genuinely wants and tries to stop, yet is unable to do so despite the promises and consequences, that is a next level problem; that may be an internet-related addiction.

Someone may take risks such as viewing porn at work, or miss class regularly because they stay up all night gaming. Someone may promise their relationship partner or friends that they will spend more time together, only to lose those connections because they missed engagements because they got lost in Reddit. Another may get in a loop of continuously deactivating and reactivating gamer accounts or social media profiles in desperate attempts to stop.

Porn addiction may bring about broader consequences. Many consequences are no different from other internet-related addictions; poor performance at work or school because too much time is spent viewing porn, lost/damaged relationships because viewing porn is prioritized over spending time with others, failed attempts to quit or cut back, etc. But the topic of internet porn is also tricky because it can sometimes be harder to identify what is too much or what is a problem. Some might conservatively say any use is too much, while others may have a more permissive attitude. We aren’t talking about casual or recreational use; we are talking about regular, chronic use. What matters here is the ability to control one’s self, and the costs if one cannot.

There can also be sexual impacts for the individual. Addiction neurochemistry results in sensitization and then desensitization of reward circuitry, and the problem of porn induced erectile dysfunction (PIED) is an area of increasing study. Heavy porn use generally decreases relationship satisfaction, and elements of tolerance can result in people losing interest in a real-world partner, leading to further problems.

What happens when some of these internet-related addictive areas combine? Social media use can turn into flirting and sexting. People may be perfectly happy with their relationship; however, the thrill of secretly sexting with others can become overwhelming for the addiction-prone. People may begin taking risks such as sexting with a coworker, communicating outside their relationship, or being catfished into something age-inappropriate. People may find themselves looking at potential consequences such as losing their relationship or breaking up someone else’s, or facing sexual harassment or other legal troubles. These can be considered clear signs that their internet porn use is out of control.

What does this mean for people with ADHD?

A lot actually; this is something about which people with ADHD need be very careful. Among the hundreds of scientific research papers published on internet-related addictions, dozens have studied the specific intersection of ADHD and internet addiction. The ADHD brain is predisposed to be drawn to the novel and shiny; what’s more novel and shiny than downloading a new porn video, playing a video game, finding the absolute best shopping deal, or checking for updates on a social media feed?

People with ADHD are already time-blind, which makes it even easier to get lost in the endless flow of information (or junk) found while scrolling through news, stocks, YouTube, sports, etc. Additionally, people with ADHD are frequently already less aware of consequences. Amazon one-click is not the friend of the ADHD impulsive type, especially one who struggles with internet addiction.

Three Common Findings about ADHD and Internet Addictions

  1. People with ADHD are unusually sensitive to screen media technology. (2019 Duke paper)

  2. Approximately 20 percent of young adults with ADHD struggle with internet addiction.

  3. All presentations of ADHD are vulnerable to IAD.

Two Myths about ADHD and Internet-Related Addictions

Myth: Too much internet use causes ADHD.
Truth: Impossible; ADHD is “prewired” in the brain. The symptoms and side effects of internet addiction can look like ADHD symptoms. However, ADHD is a lifespan disorder, and the symptoms must have been present before the problematic internet use began.

Myth: Males with ADHD have more problems with internet addiction than females with ADHD.
Truth: Males and females with ADHD are equally vulnerable to internet addiction

Treatment for internet addiction

So, what do we do about it?

  • First and foremost, treat the ADHD.

    Studies from substance abuse research have shown that untreated ADHD poses an elevated risk for addiction. Similarly, researchers studying ADHD plus IAD have found the severity of ADHD symptoms links to the risk for, and severity, of internet addiction. Not surprisingly, research has also found that ADHD meds can help with ADHD+IAD treatment.

  • Protect yourself from yourself.

    Those of us with ADHD aren’t great with willpower to begin with. People seeking recovery must be honest with themselves: Do I need social media, games, news, sports, and shopping apps on my phone? Are they truly helping me to live a better life, or are they just making things worse? These are questions that everyone should ask themselves; however, someone struggling with ADHD plus IAD may have to make sacrifices and trade-offs, to give up convenience in exchange for stability and recovery.

    Review your environment. Delete apps you don’t need, set limits on others; set up filtering, restrictions, and accountability systems. The Screen Time app is built in to the Apple ecosystem; however, there are many add-on tech solutions for devices and entire homes. It is possible to turn the smartphone/tablet/laptop back into the productivity tool it was designed to be.

  • Keep time structured.

    There is a three-word phrase that represents a huge risk factor for people with ADHD: “unaccountable free time.” Managing this factor is important for anyone with ADHD, and is critical for someone struggling with ADHD plus IAD.

  • Try recovery coaching.

    Accountability is a core component for addiction recovery, and the accountability component of ADHD coaching can be incredibly helpful. An ADHD coach could help someone build and implement the solutions needed to create a recovery structure.

  • Seek peer-based support.

    Thousands of people have banded together on internet forums and found solutions to their common problems that resulted from chronic internet porn use. NoFap and Reboot Nation are two primary examples of very large online communities. There are other smaller online support groups such as On-Line Gamers Anonymous and Computer Gaming Addicts Anonymous to help people work through gaming addiction problems. Unfortunately, none of these groups are specific to ADHD.

  • If necessary, seek clinical support and therapy.

    ADHD+IAD is a tough beast, so the above may not be enough. Research has found that people with ADHD+IAD are also more likely have comorbid issues of depression and/or anxiety, so treatment for such conditions may be needed.></p

    Porn addiction recovery can get more complicated as it also includes variables of intimacy, personal values, and relationship factors. People with ADHD often already suffer from low self-esteem and feelings of shame, so working with an informed and nonjudgmental therapist can be critical.

    Internet addiction recovery is unique from other addictions in that the strict abstinence model doesn’t apply. People must be online in today’s connected world, so part of IAD recovery is about changing the (unhealthy) relationship with the internet and screen time. People must learn healthier ways to cope with their struggles. Here is where recovery becomes similar to that for any addiction. Self-medication for life stressors is one of the key drivers for addictions, and people with ADHD are particularly vulnerable to stress. Living the life you want to be living is the optimal outcome. Evidence-based models such as cognitive behavioral therapy and mindfulness are core tools for helping people find recovery and start building a better, healthier life.

  • For severe cases, seek inpatient/residential treatment.

    The most severe cases may need a residential treatment environment. For the heavily internet-addicted, withdrawals can be extreme, as people cycle through brief periods of hopeless depression, debilitating anxiety, and explosive outbursts of anger.

    There are hundreds of internet addiction treatment centers in China, Japan, and Korea. The largest “internet addiction camp” in South Korea has treated over 1,200 patients in the last five years. Most of these programs use the same evidence-based practices found in substance abuse treatment centers (medication, group/individual/family therapy, etc.), but also focus on offline activities such as promoting regular exercise and social skills development. These programs also have a special focus on helping clients unplug and learn to be independent from the online world.

    Unfortunately, there is very little dedicated treatment for internet addiction here in the United States. ReStart is a small residential treatment facility outside Seattle that offers long-term and short-term programs for both adults and teens.

When extensive screen time becomes problematic

We don’t want to pathologize everything. Research indicates that 94 percent of Generation Z (those born between 1997 and 2012) are online daily, and 25 percent are online “almost constantly.” Extensive  screen time is today’s norm.

Unfortunately, many people have unhealthy relationships with the internet, using it to avoid their problems, rather than learning to cope with real life. But we don’t want to call something an addiction until the behavior starts to bring about real-life consequences. When someone fails out of school, loses their job, or gets divorced because they couldn’t get away from their online behaviors, those are real consequences indicating addiction-related brain changes have occurred.

Todd Love, PsyD, JD, LPC, BCC, runs a men’s counseling and coaching practice in Athens, Georgia, and online. Dr. Love is an expert in the area of behavioral addictions, having written his dissertation on the topic of internet addiction and the DSM-5, as well as other articles and book chapters on the subject. He is a passionate advocate for educating others about the elevated risks people with ADHD have for the problem of addiction.