In addition to the actual activity there is a social connection with other players, which is highly reinforcing. Another patient, in recovery from several problems, described the sense of belonging he feels at a poker table. It is this same sense of belonging that I have heard expressed by people who belong to chat groups. A depressed patient continues to participate in chat groups even though she has had several traumatic experiences with men she arranged to meet offline.
One of the dormitory counselors at a major university reported that sports gambling on the Internet is a very popular group activity. Although gambling on the Internet is illegal in the United States, it thrives because it is hosted on offshore sites over which the U.S. has no regulatory authority. The other highly controversial topic is the number of sex and pornography sites that exist directly on the Internet and on CD-ROMs. How to regulate this is a subject of concern to many people.
Another view of computer addiction suggests that excessive and inappropriate computer use is a new symptom of other psychiatric problems. Shapira (1998) found that 14 self-selected Internet users who had problematic Internet use fit the DSM-IV criteria for a mean of five different psychiatric disorders. This data may suggest that this technology presents a new way to express affect.
One final consideration is treatment of this addiction. Whether or not this addiction is similar to substance dependency, impulse control disorder or a symptom of other disorders, its treatment cannot require abstinence. Computers are present in workplaces, schools, universities and households. Treatment must be similar to that given for an eating disorder where the aim is to help the patient normalize their behavior in order to survive. A combination of cognitive behavior therapy and motivational interviewing are the most helpful to the patient. Treating the depression and anxiety with antidepressants is also recommended. Shapira (1998) has had excellent results in prescribing serotonin reuptake inhibitors or other antidepressants for his patients.
Computer addiction is a combination of signs and symptoms that fit a dependency model, an impulse control disorder model, and are often comorbid with other psychiatric diagnoses. The treatment, therefore, must be for all three classifications. My hope is that an epidemiological study can be done which will define the limits of normal computer usage. Then we can decide what is pathological.