Harmful internet use Part I: Internet addiction and problematic use STUDY Panel for the Future of Science and Technology EPRS | European Parliamentary Research Service Scientific Foresight Unit (STOA) PE 624.249 – January 2019 EN Harmful internet use Part I: Internet addiction and problematic use Study January 2019 Abstract This report reviews the existing scientific evidence regarding internet-use-related addiction problems at an individual level in Europe. In the last two decades, there has been an exponential growth in research in this field. Since 2013, internet gaming disorder has been included in the appendix of the American Psychiatric Association's fifth Diagnostic and Statistical Manual of Mental Disorders, and gaming disorder has been included in the eleventh International Classification of Diseases published by the World Health Organization. The study includes a detailed critical literature review on generalised internet addiction, online gaming, and gambling addiction in Europe. Based on scientific databases, 19 empirical studies with both community and clinical samples have been selected from Denmark, France, Germany, Greece, Italy, the Netherlands, and Spain. The majority of individuals with internet-use-related addictions were found to be educated adolescents and young males. Comorbidities with other psychiatric conditions were present as a rule, and they were more severe in the case of gaming. Cognitive behavioural therapy was the usual treatment with positive prognosis. This report provides the conceptualisation of these three internet-use-related addiction problems, together with a set of policy options, preventive actions, and evidence to support future policies in the European Union context. PE 624.249 1 STOA - Panel for the Future of Science and Technology The STOA project 'Harmful internet use – Part I: Internet addiction and problematic use' was carried out by Nottingham Trent University (NTU) at the request of the Panel for the Future of Science and Technology and managed by the Scientific Foresight Unit (STOA) within the Directorate-General for Parliamentary Research Services (DG EPRS) of the European Parliament. AUTHORS Dr Olatz Lopez-Fernandez, Department of Psychology at NTU, United Kingdom (UK). Options Brief, Executive Summary, Introduction and Chapters 1.4 to 1.6, Methodology, Results and Chapters 3.1 and 3.3, Discussion, Policy Options, Limitations and Conclusions, and References. Dr Daria J. Kuss, Department of Psychology at NTU, UK. Introduction and Chapters 1.1 to 1.3, Methodology, Results and Chapters 3.2 and 3.4, and References. Acknowledgements Bailey Foster, BSc Psychology at Nottingham Trent University, UK. STOA ADMINISTRATOR RESPONSIBLE Gianluca Quaglio Scientific Foresight Unit (STOA) Directorate for Impact Assessment and European Added Value Directorate-General for Parliamentary Research Services European Parliament, Rue Wiertz 60, B-1047 Brussels E-mail: [email protected] LINGUISTIC VERSION Original: EN ABOUT THE PUBLISHER To contact STOA or to subscribe to its newsletter please write to: [email protected] This document is available on the internet at: http://www.europarl.europa.eu/stoa/ Manuscript completed in January 2019 Brussels, © European Union, 2019 DISCLAIMER This document is prepared for, and addressed to, the Members and staff of the European Parliament as background material to assist them in their parliamentary work. The content of the document is the sole responsibility of its author(s) and any opinions expressed herein should not be taken to represent an official position of the Parliament. Reproduction and translation for non-commercial purposes are authorised, provided the source is acknowledged and the European Parliament is given prior notice and sent a copy. PE 624.249 ISBN 978-92-846-3427-9 doi: 10.2861/315951 QA-04-18-954-EN-N 2 Internet addiction and problematic use Table of contents List of abbreviations ........................................................................................................................................... 5 Executive Summary ............................................................................................................................................ 7 1. Introduction................................................................................................................................................ 11 1.1. Terminology and diagnosis .............................................................................................................. 12 1.2. Prevalence and evolution of internet addiction ............................................................................. 16 1.3. Neurobiological underpinnings ....................................................................................................... 16 1.4. Problematic internet use across platforms ...................................................................................... 17 1.5. The European and the international context .................................................................................. 17 1.6. Comprehensive policy in the prevention of internet addiction ................................................... 18 2. Methodology .............................................................................................................................................. 20 2.1. Search Strategy ................................................................................................................................... 20 2.1.1. Studies selected ........................................................................................................................... 21 3. Results ......................................................................................................................................................... 22 3.1. Internet user characteristics .............................................................................................................. 41 3.1.1. Internet addiction ....................................................................................................................... 41 3.1.2. Online gaming addiction ........................................................................................................... 41 3.1.3. Online gambling addiction ....................................................................................................... 41 3.2. Generalised internet addiction: at clinical and community levels .............................................. 42 3.3. Specific addiction problems: online gaming and gambling ......................................................... 43 3.3.1. Online gaming: at individual level in community and clinical samples ............................ 43 3.3.2. Online gambling: at individual level in clinical samples ...................................................... 47 3.4. Preventive actions and treatment for internet-use-related addiction problems in Europe ..... 49 4. Discussion .................................................................................................................................................. 51 4.1. Online users' characteristics .............................................................................................................. 51 4.2. Internet addiction ............................................................................................................................... 51 4.3. Online gaming addiction ................................................................................................................... 53 4.4. Online gambling addiction ............................................................................................................... 55 3 STOA - Panel for the Future of Science and Technology 5. Policy options............................................................................................................................................. 57 5.1. Policy option 1: No action ................................................................................................................. 57 5.2. Policy option 2: Promote and disseminate applied research and information on responsible internet use and prevention .......................................................................................................................... 58 5.3. Policy option 3: Promote and educate on online and offline health behaviours in young populations ..................................................................................................................................................... 59 6. Limitations and Conclusions .................................................................................................................. 63 References........................................................................................................................................................... 65 4 Internet addiction and problematic use List of abbreviations APA American Psychiatric Association AICA-S Assessment of Internet and Computer Game Addiction ADHD Attention Deficit Hyperactivity Disorder BMI Body Mass Index BSI Brief Symptom Inventory Clinical assessment tool for gaming disorder problems C-VAT 2.0 CERV 'Cuestionario de Experiencias Relacionadas con los Video juegos' CBCL Child Behaviour Checklist CGI Clinical Global Impression scale CBT Cognitive Behavioural Therapy COPE Commonly used coping inventory DSQ Defense-Style Questionnaire DBD Disruptive Behaviour Disorder DIB Dysfunctional Internet Behaviour