Problems Related to the Use of the Internet and Communication Technologies

INTRODUCTION

In recent decades, the Internet and information and communication technologies (ICT) have become an essential tool in everyday life, especially for the younger population, who use them to access a wide variety of content through multiple devices in order to interact, learn, have fun, and play (Cho et al., 2014). Available studies indicate how a portion of the population, especially the young, is developing maladaptive use patterns. These patterns are leading to the development of problems in the daily lives of these individuals, both in their family and interpersonal relationships and in their emotional stability (Griffiths & Meredith, 2009) (Ko, Yen, Yen, Chen, & Chen, 2012)

Problems related to the use of the Internet and ICT arise when individuals begin to neglect their daily routines and activities in order to stay on line, thus modifying daily routines, skipping meals, subtracting hours of rest, and altering sleep schedules. Staying online for more than 3 or 4 hours a day contributes to isolation, loss of interest in other activities, poor academic or work performance, behavioural disorders, as well as sedentary lifestyles and obesity

The term “Internet addiction” was first used by Young (Young, 1998), and refers to a problem that is receiving increasing attention from the scientific community. In recent years, several studies have been conducted to better understand the magnitude of this phenomenon and its aetiology, to propose screening and diagnostic tools and, at the same time, to propose help and preventive interventions for individuals with this problem.

The aforementioned report on behavioural addiction (Observatorio Español de las Drogas y las Adicciones, 2019) states that, in both 2015 and 2017, almost 3% of the Spanish population aged between 15 and 64 years old potentially used the Internet compulsively, which would mean an estimated figure of approximately 900,000 individuals (the prevalence is similar for men and women). The prevalence of a possible compulsive use of the Internet is higher among younger individuals (between 15 and 24 years old). When assessing the presence of different self-reported conditions among individuals with a possible compulsive use of the Internet compared to the general population, it is observed that young individuals report suffering from anxiety, insomnia, and depression more frequently.

However, Internet addiction is currently still a diagnostic category that is not included in either of the two reference manuals (the DSM and the ICD). As a result, there is a great degree of heterogeneity when dealing with this phenomenon (Consellería de Sanidade, 2019) . Besides “Internet addiction”, there are studies which categorise this phenomenon as “pathological Internet use” (Morahan-Martin & Schumacher, 2000), “problematic Internet use” (Caplan, 2002), “excessive Internet usage” (Hansen, 2002) or “Internet dependency”. This inconsistency also affects the set of symptoms listed by each author. As a result, the diagnostic tools available measure different aspects relating to the use of the internet and ICT. Different scales are used in Spain, such as “Problemas Relacionados con el Uso de Internet” (De Gracia Blanco, Vigo Anglada, Fernández Pérez, & Arbonès, 2002) , “Test de Adicción a Internet” (Echeburúa, 2000) “Cuestionario de Experiencias Relacionadas con Internet” (Beranuy Fargues, Chamarro Lusar, Graner Jordania, & Carbonell Sánchez, 2009) or “Escala de Uso Problemático de Internet en Adolescentes” (Rial Boubeta et al., 2015)

SCREENING FOR PROBLEMATIC USE OF THE INTERNET

A recent literature review (Laconi, Rodgers, & Chabrol, 2014) identified 45 tools designed to assess Internet addiction (in 23 different languages). Among the scales found, only 17 had more than one study evaluating their psychometric properties, and only 10 had three or more evaluation studies. This review points out that the Compulsive Internet Use Scale (Meerkerk, Van Den Eijnden, Vermulst, & Garretsen, 2009) is a brief tool that has been validated properly, with good psychometric properties, consisting of 14 items (Table 1. Compulsive Internet Use Scale (CIUS)) measured on a 5-point scale (0, never; 1, seldom; 2, sometimes; 3, often; and 4, very often). The total score is therefore 56 points. A score higher than or equal to 28 would indicate risk for possible compulsive Internet use.

The CERI scale (Beranuy Fargues et al., 2009) , is brief (10 items) and has been validated for use in the Spanish population (Table 2. Cuestionario de Experiencias Relacionadas con Internet (CERI)). The items on this scale have four response options (1 seldom; 2 sometimes; 3 often; and 4 almost always). This scale measures 2 different factors: intrapersonal conflicts and interpersonal conflicts.

The authors set 3 cut-off points: individuals with no problems (10 to 17 points), individuals with occasional problems (18 to 25 points), and individuals with frequent problems (26 to 40 points).

Another brief and easy-to-administer tool is the Problematic Internet Use Scale in adolescents (PIUS-a) (Rial Boubeta et al., 2015). This is an 11-item questionnaire which can be scored using a 5-point Likert scale (from 0, totally disagree, to 4, totally agree).

If no specific tool is used, the severity of the problem may be assessed by evaluating the presence of the following warning signs (Cía, 2013).

TREATMENT

A 2016 review examined the existing literature on interventions to help individuals with problems related to the use of the Internet (Kuss & Lopez-Fernandez, 2016). This review identified a body of research examining psychopharmacotherapy, psychological therapy, and combination therapy. The authors listed some strategies that appear to be effective in some populations. However, they conclude that a consensus on diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for those seeking treatment

The WHO and the American Academy of Pediatrics have recently issued a series of recommendations on the use of the Internet and ICT that will be addressed in the next article.