Background

What Is Internet Addiction?
Machines
Hope being hooked up for tests. Photo: Dogwoof Global

China is the first country in the world to classify Internet addiction as a distinct clinical disorder. While other countries focus on the behavior associated with Internet addiction, Chinese psychologists view dependence on the Internet as a unique addiction with separate criteria for diagnosis--akin to other addictions like those to alcohol or drugs. In China, the evaluation is quantitative--all those who spend more than six hours per day on a computer for purposes not related to school or work are considered "addicted" to the Internet. In the United States, such a patient might be diagnosed with obsessive-compulsive disorder or receive another diagnosis that relates to the behaviors exhibited by the patient rather than the Internet specifically.

Experts subdivide Internet addiction into five areas--chat room relationships, cybersex, net compulsions (such as online shopping or gambling), video and online gaming and information overload. In China, and at the camp in the film, the majority of young people experience an addiction to online gaming--although there is typically a chat function associated with online role-playing games as well. Most young patients have withdrawn from exterior social environments. For example, they no longer visit with family and friends in person.

However, the writers of the Diagnostic and Statistical Manual of Mental Disorders, which provides standards for mental illness in the United States, don't see the Internet as an official separate clinical disorder and instead in the most recent edition marked Internet addiction as a subject requiring further study. Alcohol and drugs are clearly damaging when used in excess, but U.S. psychologists are reluctant to categorize the Internet in this way--especially when the Internet serves as a means of social interaction for many people.

Sources:
American Psychiatric Association. "Internet Gaming Disorder." http://www.dsm5.org/Documents/Internet%20Gaming%20Disorder%20Fact%20Sheet.pdf

Block, Jerald J. "Issues for DSM-V: Internet Addiction." American Journal of Psychiatry 165 (2008): 306-307.

A Day Without Media. "24 Hours: Unplugged." https://withoutmedia.wordpress.com/

Kershaw, Sarah. "Hooked On the Web: Help Is on the Way." The New York Times, Dec. 1, 2005. http://www.nytimes.com/2005/12/01/fashion/thursdaystyles/01addict.html?pagewanted=all&_r=0

Latham, Tyger. "Can You Really Become Addicted to the Internet?" Psychology Today, July 26, 2011. https://www.psychologytoday.com/blog/therapy-matters/201107/can-you-really-become-addicted-the-internet

On-Line Gamers Anonymous. http://www.olganon.org/home

Pies, Ronald. "Should DSM-V Designate 'Internet Addiction' a Mental Disorder?" Psychiatry 6, no. 2 (2009): 31-37.

Weinstein, Aviv and Michel Lejoyeux. "Internet Addiction or Excessive Internet Use." The American Journal of Drug and Alcohol Abuse 36, no. 5 (Sept. 2010). http://www.researchgate.net/profile/Aviv_Weinstein4/publication/44670852_Internet_addiction_or_excessive_internet_use/links/02e7e53101c0a14b25000000.pdf

Young, Kimberly S. "Internet Addiction: The Emergence of a New Clinical Disorder." CyberPsychology & Behavior 1, no. 3 (Jan. 2009): 237-244.

Treatment of Internet Addiction in China

Patients marching. Photo: Dogwoof Global

The Daxing Internet addiction treatment center, located in a suburb of Beijing, is one of as many as 250 centers in China providing treatment for teenagers whose parents identify them as being addicted to the Internet. The majority of the teenagers present at the military-style center began their journeys by being drugged by their parents and waking up in a barred dormitory with other teens who share their passion for online gaming.

China is one of the first countries in the world to label Internet addiction a distinct clinical disorder with diagnostic criteria and treatment plans. Careful regulation of schedules, exercise and diet aim at helping reconnect the teens with the world around them. The center's director, Tao Ran, claims a 70 percent success rate. However, in November 2009 the Chinese government banned physical punishment to "wean" teens from the Internet. This was in response to a child who died inside an Internet addiction center due to prolonged physical activity.

Inside the Internet treatment facility in the film, teenagers experience a treatment regime that includes medication, group therapy (sometimes including parents) and military-style training. Their sleep and diet are carefully regulated. Ran calls Internet addiction China's most significant public health hazard. This does not necessarily convince the center's patients, one of whom calls the classes an attempt at "brainwashing."

Sources:
Aldama, Zigor. "Inside the Chinese Boot Camp Treating Internet Addiction." The Telegraph, Jan. 17, 2015. http://www.telegraph.co.uk/news/health/11345412/Inside-the-Chinese-boot-camp-treating-Internet-addiction.html

Osnos, Evan. "Talking to China's 'Web Junkies.'" The New Yorker, July 28, 2014. http://www.newyorker.com/culture/cultural-comment/talking-chinas-web-junkies

Sanderson, Henry. "Chinese Teen Dies at Internet Addiction Rehab Camp." Associated Press, Aug. 6, 2009. http://abcnews.go.com/Technology/story?id=8269601

Williams, Sarah. "'Electronic Heroin' Spawns Chinese Internet Addiction Camps." Voice of America. Aug. 25, 2014. http://www.voanews.com/content/electronic-heroin-spawns-chinese-internet-addiction-camps/2427495.html

Treatment of Internet Addiction Outside of China
Military style training
Military-style training at the Daxing Boot Camp. Photo: Dogwoof Global

While treatment for Internet addiction has been rapidly expanding over the past decade in China, the United States has been slower to create specific treatment programs for Internet addiction. Internet addiction has never been included as a specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the reference that collects conclusions of research on specific psychological conditions and is used by psychologists in the United States to guide treatment plans.

The fifth and most recent edition of the DSM published in 2013 did not include Internet addiction as a separate condition, but did designate Internet gaming disorder as a phenomenon deserving further study. Treatment of Internet addiction in the U.S. centers on co-occurring conditions, such as social anxiety, depression, obsessive-compulsive disorder and general addictive personality disorder. However, some researchers argue that as the use of the Internet pervades everyday life, addiction to the Internet deserves specialized study and treatment. In 2006, the Stanford School of Medicine conducted a nationwide study that found one in eight Americans fit at least one criteria for problematic Internet use.

The most commonly used questionnaire for exploring Internet addition is Young's Internet Addiction Test (IAT), which has been approved by doctors in the United States, the United Kingdom, Finland and Korea. This questionnaire addresses issues of increased Internet use over time, lying to friends and family members about time spent online and emotional distress and avoidance.

A Chinese study using the IAT found that 10.2 percent of respondents aged 13 to 18 years used the Internet moderately and .6 percent were severely addicted. This is a lower percentage of "addicts" than the figures found using the Chinese quantitative diagnosis of more than six hours spent on the Internet outside of school or work.

Treatment for Internet addiction in the United States is based on interventions and strategies used in the treatment of substance abuse disorders, such as detoxing, individual and group therapy and medication. As there are not many treatment centers in the United States dedicated to Internet addiction treatment (there are only two centers that dedicate themselves to Internet addiction treatment exclusively), those who believe they may be suffering are encouraged to seek out general addiction counseling and treatment.

Sources:

Aboujaoude, E., et al. "Potential Markers for Problematic Internet Use: A Telephone Survey of 2,513 Adults." CNS Spectrums 11, no. 10 (Oct. 2006): 750-755.

American Psychiatric Association. "Internet Gaming Disorder." http://www.dsm5.org/Documents/Internet%20Gaming%20Disorder%20Fact%20Sheet.pdf

Geranios, Nicholas K. "Internet Addiction Center Opens in U.S." Associated Press, Sept. 3, 2009. http://abcnews.go.com/Technology/internet-addiction-center-opens-us/story?id=8498176

Global Addiction. "Internet Addiction Test (IAT)." http://www.globaladdiction.org/dldocs/GLOBALADDICTION-Scales-InternetAddictionTest.pdf

Grant, Jon E., et al. "Introduction to Behavioral Addictions." The American Journal of Drug and Alcohol Abuse 36, no. 5 (Sept. 2010): 233-241. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164585/

reSTART. http://www.netaddictionrecovery.com/