Whether we view disordered computer use as a primary or secondary problem, this syndrome can inflict human suffering. When clinical guidelines for treating people struggling with an addiction rest on immature and uncertain science, however, there is potential to violate the most basic principle of medical ethics: do no harm. Without a solid empirical foundation, addiction workers -- in spite of their benevolent motivations and the need to respond to patients struggling with computer-related problems -- cannot know with certainty that they are not making matters worse.
Even in the more established field of substance abuse treatment, practice guidelines are relatively new and equivocal (Nathan, 1998). Because of these complex conceptual conditions and the absence of rigorous empirical research, practice guidelines in the area of computer addiction are premature.
Clinicians also must avoid the possibility of inadvertently doing harm because they have not established empirically supported treatments for a problem with little construct validity. For example, if clinicians cannot distinguish primary clinical depression from the more transient depression that can follow excessive computer use that costs someone a relationship or financial gain, they might employ clinical strategies that over- or under-treat. A myopic paradigm can encourage clinicians to miss important signs and symptoms associated with more serious disorders (Shaffer, 1994, 1987, 1986). Faced with computer addiction patients, clinicians must perform thorough diagnostic evaluations and determine the extent of comorbid conditions. To date, most computer addiction clinicians have adopted strategies from traditional drug and alcohol(Drug information on alcohol) addiction treatments. However, many of these approaches have little empirical evidence to support their clinical utility (Miller et al., 1995). Consequently, I encourage clinical workers to proceed cautiously.Conclusions: Considering Treatment
There is no simple solution to the matter of what constitutes an addiction. For computer addiction to find a legitimate home in the psychiatric nomenclature, clinicians will need to view it as the consequence of overwhelming and uncontrollable impulses, compromised bio-behavioral regulatory mechanisms or a combination of both. Anything less leaves observers to think that it is simply the result of an unwillingness of certain people to control their "habits" for uncertain reasons.
Despite this critical view, people who believe they are suffering from an uncontrollable impulse to use their computers are beginning to seek treatment. Human suffering deserves our attention and response. Therefore, the clinical issue -- as opposed to the scientific and conceptual debate -- is not whether computer addiction is real or primary. Rather, it involves establishing a working formulation that clinicians and patients can share (Perry et al., 1987; Shaffer, 1986). Such devices permit clinicians to select treatment methods that offer patients a favorable prognosis given knowledge of the problem and the patient.
For science, the value of improving our understanding of computer addiction rests in the development of better theory. Improved theory can guide better research, which in turn will improve our understanding. As our understanding of addiction improves, then the vehicle for more effective social policy emerges. From the treatment side, there is little or no value to understanding any individual as addicted or mentally disordered unless it permits clinicians to choose a treatment plan that will maximize the well-being of the patient. The value of the concept of computer addiction or the classification of any addictive behavior, then, is dependent upon the extent to which an individual sufferer benefits from its application. While the art and science of diagnosis is dependent upon comparisons among groups, clinicians should apply their choice of treatments prescriptively. Prescriptive or differential treatment requires consideration of three interactive domains: 1) the physician (e.g., medical management strategy); 2) the patient (e.g., compliance rules and expectations of care and concern); and 3) society (e.g., social mores and attributions of responsibility). Together these domains define the "sickness" that is to be treated (Kleinman, 1988). The relationship between computer use and addiction ultimately rests upon sociocultural acceptability. After all, "It is best to think of any affliction -- a disease, a disability -- as a text and of 'society' as its author" (Blum, 1985).Acknowledgements
Preparation of this manuscript was supported by a grant from the Gambling Education and Research Foundation and a grant from the Center for Substance Abuse Treatment (#1U98TI00846).
Special thanks are extended to Jayne West and Chrissy Thurmond for their thoughtful comments on earlier versions of this article.
Portions of this article are reprinted with permission from Shaffer HJ, Hall MN, Vander Bilt J (2000), "Computer addiction": a critical consideration. Am J Orthopsychiatry 70(2):162-168.