Treatment and risk factors of Internet use disorders

Hideki Nakayama, M.D., Ph.D., 1

Satoko Mihara, B.A., 1
Susumu Higuchi, M.D., Ph.D. 1

1. National Hospital Organization Kurihama Medical and Addiction

Accepted Article
Center, Japan

Correspondence: Hideki Nakayama, M.D., Ph.D.,

5-3-1 Nobi Yokosuka Kanagawa Japan
Tel 046-848-1550
FAX 046-849-7743
e-mail matimi19750519@hotmail.com

Treatment and risk factors of IUDs

Abstract
Recently many young people have developed internet use disorders (IUDs) as
a result of the proliferation of internet enabled devices, leading to serious health
and social problems worldwide. On occasion, medical and educational
institutions, governments and other groups, have sought to take preventive
action or treat IUDs. In many cases, the preferred treatment for IUDs is to set
recommendations for appropriate internet use. Reportedly, psychosocial
therapies (including CBT, family therapy, compound therapy) for IUDs and
pharmacotherapies (including antidepressant drugs and psychostimulants) for
co-morbid psychiatric or development disorders have been effective at reducing
the degree and symptoms of IUDs. In some countries, treatment camps have
been developed for adolescents with IUDs, and preventive education (including
lectures, group discussions) has been provided for general adolescents. Such
efforts have been effective at reducing the average degree of IUD severity.
Some future IUD risk factors (e.g. being male, suffering from ADHD, exhibiting

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been through the copyediting, typesetting, pagination and proofreading process, which
may lead to differences between this version and the Version of Record. Please cite this
article as doi: 10.1111/pcn.12493

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 deteriorating psychiatric symptoms) have begun to be identified. However,
clinical studies, treatment and preventive actions are insufficient for treating
IUDs and standard treatments and preventive systems have yet to be
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established. Educational and medical institutions, government, families, and
others must take greater action and cooperate more effectively in order to treat
or prevent IUDs.

Key words
Internet use disorders, Internet gaming disorder, Internet addiction,
Treatment camp, Risk factors.

1. Introduction
Recently, internet technology has made rapid progress, bringing convenience to
our daily lives. The reported percentage of internet users in North America,
Europe, and East Asian countries was between 70%-90% in 2015.1 Internet
use has sometimes been accompanies by negative effects (e.g. crime, data
leaks, waste, slander, bullying, and addictive use). Reports on Internet Use
Disorders (IUDs) began to appear in medical and psychological literature in the
1990s. Diagnostic criteria for IUDs have been proposed by some researchers.
Young produced a diagnostic questionnaire (YDQ) for addictive internet use that
reflected the DSM-IV criteria for pathological gambling.2 Shapira et al. proposed
diagnostic criteria for problematic internet use that reflected the DSM-IV criteria
for impulse-control disorders.3 These criteria have four main components:
excessive use, withdrawal, tolerance, and negative repercussions.4 The
diagnostic criteria for Internet Gaming Disorder (IGD) have been included
among those conditions for further study in the DSM-5, announced in 2013.5
The diagnostic criteria for IGD consist of 9 items: preoccupation, withdrawal
symptoms, tolerance, loss of control, loss of other interests, excessive use
despite adverse effects, lying, use when feeling distressed, and social crises.
However, the use of other internet content (such as SNS, animations, internet
gambling, sexual internet sites and others) is not included among the IGD
criteria.

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 Recent reports suggest that IUDs have begun to spread rapidly
throughout the world, affecting mainly younger people. For example, between
2011 and 2012, school-based surveys for 9th grade and 10th grade students in 7
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European countries (Greece, Spain, Poland, Germany, Romania, Netherlands,
and Iceland) using Youngs Internet Addiction Test (YIAT) revealed that 0.8%-
1.7% of the students were suspected of having internet addiction (YIAT70).6
Between 2012 and 2013, school-based surveys for adolescents in 6 Asian
countries (China, Hong Kong, Japan, South Korea, Malaysia, and the
Philippines) using the YIAT revealed that 1.2%-4.9% of adolescents were
suspected of having internet addiction (YIAT70).7 In a 2012 Japanese school-
based survey of junior and senior high school students using Youngs
Diagnostic Questionnaire (YDQ),2 the results suggested that 6.4% of males and
9.9% of females were addicted to the Internet (YDQ5).8 IUDs have become a
serious health and social problem.
Correlations have been drawn between IUDs and issues such as poor
academic achievement,9 sleep disorders,10 worsening general psychiatric
symptoms,11 lack of exercise (reduction in steps),12 poor parent-adolescent
relationships,13 along with other issues. Many adolescents with IUDs are
reported to have attention deficit hyperactivity disorder (ADHD), social phobia,
obsessive compulsive disorder (OCD), major depression, and other psychiatric
disorders11,14,15,16. Some medical and educational institutions, administrations
and others have proposed preventive actions and treatment for IUDs.
Furthermore, the risk factors of IUDs have begun to be identified. Here, we
review the treatment and risk factors of IUDs.

2. Treatment for IUDs

1) Characteristics of treatment for IUDs
Various psychotherapies and pharmacotherapies have been reported to be
effective for IUDs. In many psychotherapy studies, treatment was mainly
provided to motivate patients to recover and learn skills for using the Internet
appropriately. However patients with severe comorbid psychiatric disorders

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 were excluded from some of the psychotherapy studies.17,18,19,20 In many of the
pharmacotherapy studies, the participants were IUD patients with other co-
morbid psychiatric or developmental disorders (such as depression, ADHD,
OCD, etc.).21,22,23,24 The main psychotherapy reports on IUDs are summarized
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in Table 1 and the main pharmacotherapy reports in Table 2.

2) Psychosocial treatment
a) Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) has been utilized for the treatment of many
psychiatric disorders, including substance use disorders, depression, anxiety
disorder, and others.25 CBT is a well known treatment, which is based on the
premise that thoughts determine feelings.26 Patients are taught to monitor their
thoughts and to identify those that trigger addictive feelings and actions while
learning new coping skills and ways to prevent relapses.26 The typical reported
frequency of CBT sessions when treating IUDs has been between 8 and 12
sessions 17,19,23,26 with each session lasting from 45 to 120 minutes.17,19 Young27
proposed that CBT for patients with IUDs consist of a three-phase approach. In
the first phase, behavior modification is used to gradually decrease the amount
of time that the addict spends online. In the second phase, cognitive therapy is
used to address denial that is often present among Internet addicts and to
combat the rationalizations that justify excessive online use. The third phase
applies harm reduction therapy to identify and treat coexisting issues that have
led to the development of the compulsive internet use.
Kim et al.23 has outlined the content of 8 sessions of CBT for the
treatment of patients with problematic online game addiction. The sessions
comprised: an introduction, motives for online game play and irrational belief
system pertinent to online game addiction, problem solving and decision
making, communication skill training, self-control skill training, family therapy,
and future planning. Du et al.17 investigated the effectiveness of group CBT for
patients with IUDs. A total of 56 adolescents with IUDs were assigned to either
the CBT group or the control group. Significant improvements in the IUD
condition were seen in both groups. However significant improvements in time

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 management skills and emotional, cognitive and behavioral symptoms were
only evident in the CBT group. In a meta-analysis28, CBT was significantly more
effective at reducing the time spent online compared to other psychological
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treatments. Meanwhile, no significant differences in terms of improvement of the
internet addiction were seen between CBT and other psychological treatments.

b) Other psychotherapies
Various kinds of psychotherapy have been used for the treatment of IUDs.
Kim29 investigated the effectiveness of a Reality Therapy (R/T) group counseling
program for parents with IUDs. The core component of R/T is to ask clients the
following four questions: 1) What are you doing now? 2) What did you
actually do this past week or month? 3) What stopped you from doing what
you want to do? and 4) What will you do tomorrow or in the future? R/T has
been used as a treatment for addictive disorders (e.g. drugs, sex, food, and
work). Twenty-five university students with IUDs were assigned to either a 10-
session R/T group or a non-treatment control group. The result showed that the
R/T group achieved a significantly lower IUD level and a higher self-esteem
score than the control group.
Su et al.20 investigated the effect of an internet-based intervention on
IUDs. This study involved the development of an online expert system called
the Healthy Online Self-Help Center (HOSC) which acted as an intervention tool
to help those who wished to reduce their online usage. The HOSC was based
on Motivational Interviewing procedures and a client-centered conversation
style and consisted of four modules (Ready to start, Understanding myself, Goal
for change, and Method of change). Sixty-five university students (39
undergraduate students and 26 graduate students) with IUDs participated in the
study, and were randomly assigned to 1 of 4 conditions: using HOSC within a
laboratory environment, using HOSC within a natural environment (e.g. their
home or dormitory), using a non-interactive program, and a non-intervention
control group. The result showed that all HOSC groups exhibited significant
reductions in their online hours per week, an improved IUD level, and online
satisfaction at a 1-month follow-up.

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 Twohig et al.30 examined the effectiveness of Acceptance and
Commitment Therapy (ACT) for parents with problematic internet pornography
viewing. Six male adults with problematic internet pornography viewing received
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8 sessions of ACT. The treatment resulted in an 85% reduction in the average
pornography viewing time after treatment and these results were maintained at
3 months.
Family therapies have been provided for various mental disorders and
the effectiveness of family therapy for IUDs has been reported. Liu et al.31
investigated the effectiveness of multi-family group therapy. Forty-six
adolescents with IUDs aged 12-18 years and 46 of their parents were assigned
to either a family therapy group (6 sessions) or a control group. Significant
improvements in the average IUD score, internet use time and parent-
adolescent relationship were observed in the family therapy group after the
intervention.
Some compound psychotherapy for IUDs has been reported. Shek et
32
al. investigated the effectiveness of a multi-level counseling program for
patients with IUDs. This program was composed of individual counseling (based
on motivational interviewing and other techniques) and family counseling. Fifty-
nine patients with IUDs (most of them adolescents) participated in this program.
A significant improvement in the IUD score and some improvement in family
functioning was reported.
Thorens et al.33 investigated the outcomes of patients with IUDs who
visited an outpatient clinic. Fifty-seven patients with IUDs received
psychotherapy that included standard addiction cognitive behavioral therapy
and motivational interview components adapted for the treatment of IUDs. Six
sessions were held with a mean treatment length of 19.1 weeks. When
evaluated using the Clinical Global Impression Scale (CGI) 12.3% of the
patients were very much improved, 26.3% were much improved, 26.3% were
minimally improved, 14.0% showed no change, and 24.6% had dropped out of
the study. Therefore, various kinds of psychotherapies are effective for the
improvement of IUDs.

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 2) Pharmacotherapy
a) Antidepressant drugs
According to studies utilizing structured psychiatric interviews, between 1.5%-
30.0% of adolescents with IUDs exhibited major depression.11,14,16 Depressive
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symptoms (depressive or anxiety mood, low motivation and other symptoms)
can disturb the recovery of patients with IUDs. As depressive symptoms can
hinder the patients from social participation (e.g. going to school or work, off-line
communicating etc.), IUD patients with depression often tend to stay at home
and spend much of the time online or playing internet games. Therefore,
treatment for depressive symptoms is necessary for patients with IUDs. Some
antidepressant drug treatments have been tried for patients with IUDs and
depression or other psychiatric disorders.
Han et al.22 examined the effectiveness of bupropion administered in a
sustained release (SR) form for patients with problematic online game play and
major depressive disorder. Fifty-seven male patients with problematic online
game play and major depressive disorder, between the age of 13 and 45 years
were assigned to a bupropion group or a placebo group. The study was
designed as a 12-week trial, including 8 weeks of double blind active treatment
and a 4-week post treatment follow-up period. The patients in the bupropion
group were started on 150mg/day of bupropion SR during the first week, and
their dosage was then increased to 300mg/day thereafter. Patients in both
groups received 8 educational sessions focused on healthy internet use and the
adverse consequences of excessive videogame play. During the medication
trial period, the IUD level and the depressive state of the patients in the
bupropion group improved to a significantly greater extent than those of the
patients in the placebo group, and the mean online time in the bupropion group
was significantly less than that of the placebo group.
Han et al.34 examined the effectiveness of bupropion SR against
reducing cravings to play videogame and videogame cue-induced brain activity.
Eleven male subjects with internet video game addiction (IAG) (playing
StarCraft > 30 hours/week) and for comparison, 8 healthy male subjects
(playing StarCraft < 3 days/week and 1 hour/day) participated in this study. All

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 the IAG subjects took bupropion SR daily for 6 weeks. They were started on
150mg/day of bupropion SR during the first week and their dosage was
increased to 300mg/day thereafter. After 6 weeks of bupropion SR treatment,
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the IAG subjects exhibited significant reductions in their craving to play
StarCraft, their total playing time, and YIAT score, while no significant change in
the Beck Depression Inventory score was observed. After 6 weeks of treatment,
cue-induced brain activity in the dorsolateral prefrontal cortex had also
decreased in the IAG group.
DellOsso et al.24 examined the effectiveness of escitalopram for
treating patients with IUDs. Nineteen adult patients with IUDs were enrolled in
the trial, and 12 of them had at least 1 comorbid psychiatric disorder. During the
first 10 weeks (open label phase), all the patients (n=19) were started on
escitalopram at a dose of 10mg/day; the dosage was then increased to
20mg/day during the second week and maintained at this level. During the next
9 weeks (double blind phase) all the patients who completed the first phase
(n=17) were assigned to receive escitalopram or a placebo treatment for 9
additional weeks under double blind conditions. During the open label phase,
the lUD level improved significantly, and the time spent using the Internet
decreased significantly. In the double blind phase, however, no significant
changes were seen in either group (escitalopram or placebo).
Bipeta et al.35 investigated the effectiveness of medical treatment in
patients with IUDs and OCD. Overall 72 subjects (38 OCD, 34 controls) were
enrolled. All the patients with OCD (IA OCD, n=11; non-IA OCD, n=27) received
clonazepam, which was tapered off after three weeks, in addition to either a
selective serotonin reuptake inhibitor (SSRI: fluvoxamine or sertraline or
fluoxetine) or clomipramine for 1 year. The results showed that after 1 year the
IUD levels and OCD symptoms had improved significantly compared to the
baseline values.
Kim et al.23 examined the effectiveness of bupropion and CBT for the
treatment of problematic online game play. Sixty-five male adolescents with
excessive online game play and depression were randomly assigned to a CBT
+bupropion treatment (CBT-MED) group or a bupropion only treatment (MED)

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 group. The study was designed as a 12-week trial, including 8 weeks of active
treatment and a 4-week post treatment follow-up period. The patients in both
groups were started on 150mg/day of bupropion during the first week and their
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dosage was then increased to 300mg/day thereafter. In addition, the patients in
the CBT-MED group received 8 sessions of group CBT focused on their
problematic online game play. During the active treatment phase, the IUD level
and depressive state of the patients in the CBT-MED group improved
significantly, compared with those of the patients in the MED group, and the
mean online game play time in the CBT-MED group was significantly reduced,
compared with that of the MED group.

b) Psychostimulants
According to the studies utilizing structured psychiatric interviews, between
4.4%-83.3% of adolescents with IUDs also had ADHD.11,14,15,16 Ko et al.36
summarized the biopsychosocial relationships between IUDs and ADHD. Firstly,
the core symptoms of ADHD are being easily bored and having an aversion
to delayed reward. As internet behavior is characterized by a rapid response,
immediate reward, and the capacity to engage in multiple activities, it may
reduce feelings of boredom and/or provide immediate stimulation and reward to
subjects with ADHD. Secondly, adolescents with ADHD may utilize the Internet
to counter the frustration they feel in real-life situations. Thirdly, a lack of self-
control may cause individuals with ADHD to have difficulty controlling internet
use and make them vulnerable to internet addiction. Fourthly, internet activities,
especially online gaming, usually offer immediate response and reward, and
increased reward sensitivity may contribute to greater vulnerability to internet
addiction. Finally, impulsivity, hyperactivity, and inattention tend to negatively
influence individuals interpersonal relationships. However, these deficits can
easily be masked online. Thus for people with ADHD, establishing interpersonal
relationships online may be easier than in the real world. For patients with both
IUD and ADHD, the latter should itself be a focus of treatment.
Han et al.21 reported the effectiveness of methylphenidate (ConcertaR)
in addressing internet video game play in children with ADHD. Sixty-two

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 children, who were aged 8-12, drug-nave, diagnosed with ADHD, and were
internet video game players, participated in this study. The average
maintenance dose of ConcertaR during the 8-week study period was
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30.513.3mg/day. After 8 weeks of treatment, the average IUD level and ADHD
symptoms had improved significantly, and the average time spent using the
Internet had greatly reduced. The number of subjects with a YIAT score higher
than 80 points decreased from 16 to 3 after 8 weeks of treatment.

c) Other drugs
Some case reports have suggested that other medicines are also effective for
37
patients with IUDs. Paik et al. reported that a 25-year-old man who had
abruptly quit an online game that he had played daily for 8-12 hours per day for
2 years become anxious and agitated and had difficulty concentrating or
sleeping. He subsequently attacked his father with a knife, leading to an actual
injury. The man exhibited continued persecutory delusions, impaired reality
testing, and psychomotor agitation. He was hospitalized and treated with
quetiapine (up to 800mg), and his impulsivity and psychotic symptoms rapidly
improved within 4 days of initiating treatment.
Bostwick et al.38 reported that a 31-year-old man with internet sex
addiction was treated with sertraline (100mg/day) and naltrexone (50-
150mg/day). The patient has been receiving this treatment for more than 3
years. During this time his depressive symptoms and compulsive internet use
have been in nearly complete remission.

3) Treatment camps
In many countries, educational camps (such as sports or outdoor activities) for
adolescents have been established. Many medical educational camps, to treat
conditions such as diabetes39 and asthma40 in adolescent patients have also
been reported.
When adolescents with IUDs participate in treatment camps for IUDs,
they gain the opportunity to distance themselves from the Internet or from
gaming for an extended period of time, to learn about appropriate internet and

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 game use, and to engage in other non-internet activities. Change in my way of
thinking about IUDs, Become interested in various activities, Establish a
basic lifestyle, Improve my communication skills, and Improve my
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sensitivity and sociability are some of the expectations of those adolescents
with IUDs who have participated in the camps.
In South Korea, an IUD treatment camp program (Rescue School) was
begun in 2007 and many students with IUDs have since participated.41 At
Rescue School, students with IUDs receive a range of treatments for 12 days
and 11 nights. The main program contents are: treatment for IUDs (group
psychotherapy, lectures, personal counseling and others), sports, cooking,
family education, and other activities.41,42,43 Follow-up evaluations conducted by
the Rescue School manager after a 1-year period showed that around half of
the Rescue School participants considered themselves to have become better
people, and approximately three-quarters of the participants and their families
reported that they were satisfied with the program.41
In Japan, treatment camps for IUDs (Self-Discovery Camp: SDiC)
based on the Korean Rescue School have been held in August since 2014. The
SDiC comprised of a main camp (8 nights and 9 days) and a shorter follow-up
camp. Between 10 and 16 adolescents with IUDs participated in the SDiC,
overseen by medical staff members (doctors, nurses, psychologists and social
workers) camping staff members, mentors (university student volunteers) and
other staff participated. The main contents of the SDiC were treatment for IUDs
(group CBT, personal counseling, lectures, meetings and others), outdoor and
indoor activities (cooking, outdoor trekking, athletic activities and others), and
family meetings. Subsequently, the average of total internet use and gaming
time of the SDiC participants decreased significantly in the 3 months following
the main SDiC camp (from 71.1 hours/week to 41.3hours/week in 2014
[p=0.021], and from 57.4 hours/week to 35.5 hours/week in 2015 [p=0.042]).44,45

4. Measures to prevent IUDs

Action to prevent IUDs is as important for these disorders as it is for other
addictive disorders. In Japan, many educational institutions such as elementary

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 schools and junior high schools have set rules limiting internet use or gaming
after midnight and others. Some educational institutions and administrations
have provided education programs to enlighten students, parents, and citizens
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with regard to the dangers of excessive internet use and gaming.
Tsuruta et al.46 investigated the effectiveness of education programs
dealing with internet use and IUDs (lectures, group discussion, self-evaluation
and others) among 41 senior high school students over a 1-year period. The
average IUD level, anxiety with regard to face-to-face communication, and other
factors improved significantly.
Mun, et al.47 investigated the effectiveness of an 8-session educational
program addressing internet addiction among elementary school students.
Participants were assigned to the experimental group (n=28) or the control
group (n=28). The self-regulation of the experimental group after the program
was significantly higher than the control group. The scores for internet addiction
self-diagnosis and internet use time among the experimental group were
significantly lower than for the control group.
In South Korea, administration offices have cooperated with educational
and medical institutions to provide various preventive and treatment actions,
such as student screening for IUDs, fostering IUD experts, establishing
specialized consultation and treatment organizations, and a shut-down system
(prohibiting internet use after midnight among adolescents under 16 years of
age).42

5. Risk factors for IUDs

Risk factors for some addictive disorders have appeared. For example, the risk
factors for future pathological gambling have been shown to include
demographic variables (age, sex), cognitive distortions (erroneous perceptions,
illusion of control), sensory characteristics, reinforcement schedules, comorbid
disorders (obsessive-compulsive disorder, drug abuse), and delinquency/illegal
acts.48 Some studies have suggested risk factors for future IUDs. The
appearance of risk factors is very important for providing appropriate preventive
interventions. We summarized risk factors for future IUDs, as identified by

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 longitudinal studies in Table 3.

1) Risk factors for primary school students

Today, most students begin using the Internet and playing games while in
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primary school or even earlier, and some primary school students have IUDs.
Preventive intervention for primary students and families based on risk factors
must be considered.
Cho et al.49 has investigated risk factors in childhood in a prospective
study. A total of 1,112 first-grade primary school boys were recruited for this
study. The mean age of participants was 6.85 years at the first time point, and
13.75 years at the second time point. As a result, 524 matched sets of data
were obtained in this study. The results indicated significant relationships
between withdrawal and anxiety/depression symptoms during childhood and
subsequent IUDs.
Chen et al.50 investigated IUD risk factors among primary and junior
high school students in a 3 or 4-month prospective study. A total of 1,253
students in Grades 3, 5 and 8 participated in this study and 1,153 students
completed both surveys. The results indicated that a male sex (OR=1.81,
95%CI=1.08-3.02) and poor academic performance (OR=1.41, 95%CI=1.06-
1.88) at the time of the first survey were significant risk factors for the later
occurrence of IUDs in a multivariable analysis, while a protective parenting style
(OR=0.92, 95%CI=0.85-1.00) was a significant protective factor.

2) Risk factors for high school students

Among high school students, IUDs can easily become further aggravated.
Therefore, preventive and treatment interventions for high school students
based on risk factors are important.
Ko, et al.51 investigated risk factors for IUDs among adolescents in a 2-
year prospective study. A total of 2,293 junior high school students participated
in this study. The mean age of the participants was 12.36 years in the first
survey and 1,356 students completed the final assessment. The results
indicated that ADHD symptoms (Hazard Ratio=1.72, 95%CI=1.21-2.43) and

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 hostility (Hazard Ratio =1.67, 95%CI=1.17-2.38) at the time of the first survey
were significant risk factors for the later occurrence of IUDs after controlling for
sex and age.
Yu et al.52 investigated the risk factors for problematic online game use
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among adolescents in a 2-year prospective study. A total of 431 Grade 7 junior
high school students aged 12-16 years participated in this study; 356 students
completed the final assessment. The result indicated that higher sensation
seeking and lower self-esteem scores, and lower teacher autonomy support, at
the time of the first survey (Grade 7) were significantly correlated with
problematic online game use at the time of the third and final survey (Grade 9).
A lower basic psychological needs satisfaction score at the time of the second
survey (Grade 8) was significantly correlated with problematic online game use
at the time of the last survey (Grade 9). The authors proposed a pathway in
which teachers autonomy support during Grade 7 increased the basic
psychological needs satisfaction during Grade 8, which in turn increased school
engagement and decreased problematic online game use during Grade 9.
Ko et al.53 investigated the risk factors for IUDs in adolescents using a
1-year prospective study. A total of 517 junior high school students ranging in
age from 12 to 16 years participated in this study, and 468 students completed
the final assessment. The result revealed that high exploratory excitability, low
reward dependence, low self-esteem, low family function, and online game
playing predicted the incidence of IUDs 1 year later. Low hostility and low
interpersonal sensitivity predicted remission of IUDs.
Yu et al.54 investigated the risk factors for IUDs in adolescents using a
3-year longitudinal study. The mean age of the participants in the wave-1 survey
was 12.59 years. Between 3,325 and 4,106 secondary school students
participated in surveys conducted at 3 time points, and data from wave-1 survey
to wave-3 studies were successfully matched for 2,667 students. The results
indicated that adolescents without IUDs had a higher level of positive youth
development, academic and school competence, and better family functioning,
compared to adolescents with IUDs.

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 3) Risk factors for university students
Some university students live alone and it may be difficult for their families and
teachers to gain a proper understanding of their lifestyles. Some university
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students demonstrate aggravated forms of IUD, resulting in having to repeat
grades or even withdraw from university.
Dong et al.55 investigated the risk personality traits for future IUDs
among university students using a 2-year longitudinal study. A total of 912
freshmen students participated and the valid subject number was 868 (mean
age 20.8 years) at the time of the first survey. None of the students had reached
the level of internet addiction (YDQ5) at the time of the first survey. A total of
49 students were diagnosed as having IUDs (YIAT80) at the time of the final
survey and students scores on the Eysenck personality questionnaire for adults
for the IUD group and the non-IUD control group were compared. The IUD
group showed significantly higher Neuroticism/Stability scores, higher
Psychoticism/Socialization scores, and lower Lie scores at the time of the first
survey compared to the non-IUD control group.

6. Conclusion
Some medical and educational institutions, administrations and other parties
have taken preventive action or provided treatment for IUDs. Some psycho-
social therapies (CBT and others) for IUDs and pharmacotherapy
(antidepressant drugs, psychostimulants and others) for co-morbid psychiatric
or development disorders have been effective in reducing the symptoms and
degree of IUDs. In some countries, treatment camps have been provided for
adolescents with IUDs. Preventive actions are as important for IUDs as they are
for other addictive disorders. In some countries, the preventive education
programs (lectures, group discussions and others) for IUDs have been provided
for adolescents by educational institutions, medical institutions and
governments, and these programs have been effective in reducing the average
level of IUD severity. Some risk factors (male sex, ADHD, some psychiatric
symptoms, and others) have been reported. However, clinical studies and
treatment and preventive actions are insufficient in the area of IUDs, as

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 standard treatments and preventive systems have yet to be established.
Educational and medical institutions, administrations families, and other
institutions must act and cooperate to prevent and treat IUDs to a greater extent
Accepted Article
than at present.

Disclosure Statement
No conflict of interest is declared.

Authors Contribution
Corresponding author drafted the manuscript. All authors offered reference
articles and reports, supervised writing, commented on the revisions of the
article and approved the final manuscript.

Reference
1. International Telecommunication Union (ITU) homepage/ ICT STATISTICS
Homepage/ Statistics/ Percentage of individuals using the Internet/
http://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx (2016/8/9
accessed)
2. Kimberly S Young: Internet Addiction: The Emergence of a New Clinical
Disorder. CyberPsychology and Behavior. 1996; 1(3): 237-244
3. Shapira NA, Lessig MC, Goldsmith TD, Szabo ST, Lazoritz M, Gold MS,
Stein DJ: Problematic Internet Use: Proposed Classification and Diagnostic
Criteria, Depression and Anxiety. 2003; 17: 207-216
4. Kimberly S Young: Internet Addiction: Diagnosis and Treatment
Considerations. J Contemp Psychother. 2009; 39: 241-246.
5. American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders Fifth Edition (DSM-5), 2013.
6. Tsitsika A, Janikian M, Schoenmakers TM, Tzavela EC, Olafsson K, Wjcik
S, et al: Internet Addictive Behavior in Adolescence: A Cross Sectional
Study in Seven European Countries. CyberPsychology Behavior and Social
networking. 2014; 17(8): 528-535
7. Mak KK, Lai CM, Watanabe H, Kim DI, Bahar N, Ramos M, et al:

This article is protected by copyright. All rights reserved.

 Epidemiology of Internet Behaviors and Addiction Among Adolescents in Six
Asian Countries. CyberPsychology Behavior and Social networking. 2014;
17(11): 720-728
Accepted Article
8. Satoko Mihara, Hideki Nakayama, Yoneatsu Osaki, Kaneita Yoshitaka, Itani
Osamu, Ikeda Maki, et al: The situation of internet addiction in junior and
senior high school students. Proceedings of the 110th Annual Meeting of
the Japanese Society of Psychiatry and neurology in Yokohama. 2014 S709
(in Japanese)
9. Vasilis Stavropoulos, Kiriaki Alexandraki, Frosso Motti-Stefanidi:
Recognizing internet addiction: Prevalence and relationship to academic
achievement in adolescents enrolled in urban and rural Greek high schools.
J of Adolescence. 2013; 36: 565-576
10. Choi K, Son H, Park M, Han J, Kim K, Lee B,et al: Internet overuse and
excessive daytime sleepiness in adolescents. Psychiatry and Clinical
Neurosciences. 2009; 63: 455-462
11. Tang J, Zhang Y, Li Y, Liu L, Liu X, Zeng H, et al: Clinical characteristics and
diagnostic confirmation of Internet Addiction in secondary school students in
Wuhan, China. Psychiatry and Clinical Neurosciences. 2014; 68: 471-478
12. Masato Nishiwaki, Atsushi Kiuchi, Tomohiro Nakamura: The relationship
between Internet addiction and steps A cross-sectional study in a sample
of male college freshmen in Japan. Japanese Journal of Physical Fitness
and Sports Medicine. 2014; 63(5): 445-453 (in Japanese)
13. Xu J, Shen LX, Yan CH, Hu H, Yang F, Wang L, et al: Parent-adolescent
interaction and risk of adolescent internet addiction: a population-based
study in Shanghai. BMC Psychiatry. 2014; 14: 112.
14. Bozkurt H, Coskun M, Ayaydin H, Adak I, Zoroglu SS: Prevalence and
patterns of psychiatric disorders in referred adolescents with Internet
addiction, Psychiatry and Clinical Neurosciences. 2013; 67: 352359
15. Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH: Psychiatric Comorbidity
Assessed in Korean Children and Adolescents WHO Screen Positive for
Internet Addiction. J Clin Psychiatry. 2006; 67(5): 821-26
16. Ko CH, Yen JY, Chen CS, Chen CC, Yen CF: Psychiatric Comorbidity of

This article is protected by copyright. All rights reserved.

 Internet Addiction in College Students: An interview Study. CNS Spectrums.
2008; 13(2): 147-153
17. Ya-song Du, Wenqing Jiang, Alasdair Vance: Longer term effect of
Accepted Article
randomized, controlled group cognitive behavioral therapy for Internet
addiction in adolescent students in Shanghai. Australian and New Zealand
Journal of Psychiatry. 2010; 44: 129-134
18. Wlfling K, Beutel ME, Dreier M, Mller KW: Treatment Outcomes in
Patients with Internet Addiction: A Clinical Pilot Study on the Effects of a
Cognitive-Behavioral Therapy Program. Bio Med Research International.
2014 Article ID 425924, doi:10.1155/2014/425924
19. Li Huanhuan, Wang Su: The role of cognitive distortion in online game
addiction among Chinese adolescents. Children and Youth Services
Review. 2013; 35: 1468-1475
20. Wenliang Su, Xiaoyi Fang, John K Miller, Yiyuan Wang: Internet-Based
Intervention for the Treatment of Online Addiction for College Students in
China: A Pilot Study of the Healthy Online Self-Helping Center.
CyberPsychology Behavior and Social Networking. 2011; 14(9): 497-503
21. Doug Hyun Han, Young Sik Lee, Churl Na, Jee Young Ahn, Un Sun Chung,
Melissa A Daniels, et al: The effect of methylphenidate on Internet video
play in children with attention-deficit/hyperactivity disorder;. Comprehensive
Psychiatry. 2009; 50: 251-256
22. Doug Hyun Han, Perry F Renshaw: Bupropion in the treatment of
problematic online game play in patients with major depressive disorder. J
of Psychopharmacology. 2012; 26(5): 689-696
23. Sun Mi Kim, Doug Hyun Han, Young Sik Lee: Combined cognitive
behavioral therapy and bupropion for the treatment of problematic online
game play in adolescents with major depressive disorder. Computers in
Human Behavior. 2012; 28: 1954-1959
24. Bernardo DellOsso, Salliejo Hadley, Andrea Allen, Bryann Baker, William F
Chaplin, Eric Hollander: Escitalopram in the Treatment of Impulsive-
Compulsive Internet Usage Disorder: An Open-Label Trial Followed by a
Double-Blind Discontinuation Phase. J. Clin Psychiatry. 2008; 69(3): 452-

This article is protected by copyright. All rights reserved.

 456
25. Stefan G. Hofmann, Anu Asnaani, Imke J.J. Vonk, Alice T Sawyer, Angela
Fang, et al: The Efficacy of Cognitive Behavioral Therapy: A Review of Meta
Accepted Article
analyses. Cognit Ther Res. 2012; 36(5): 427-440
26. Kimberly S. Young: Cognitive Behavioral Therapy with Internet Addicts:
Treatment Outcome and Implications. CyberPsychology and Behavior.
2007; 10(5): 671-679
27. Kimberly S Young: CBT-IA: The First Treatment Model for Internet
Addiction. J. of Cognitive Psychotherapy. 2011; 25(4): 304-312
28. Alexander Winkler, Beate Dorsing, Winfried Rief, Yuhui Shen, Julia A
Glombiewski: Treatment of internet addiction: A meta-analysis. Clinical
Psychology Review. 2013; 33: 317-329
29. Jong Un Kim: The Effect of a R/T Group Counseling Program on The
Internet Addiction level and Self-Esteem of Internet Addiction University
Students. International J of Reality Therapy. 2008; 27(2): 4-12
30. Michael P. Twohig, Jesse M, Crosby: Acceptance and Commitment Therapy
as a treatment for Problematic Internet Pornography Viewing. Behavior
Therapy. 2010; 41(3): 285-95
31. Qin-Xue Liu, Xiao-Yi Fang, Ni Yane et al: Multi-family group therapy for
adolescent Internet addiction: Exploring the underlying mechanisms.
Addictive Behaviors. 2016; 42: 18
32. Daniel T. L. Shek, Vera M. Y. Tang, C. Y. Lo: Evaluation of an internet
addiction treatment program for Chinese Adolescents in Hong Kong.
Adolescence. 2009; 44(174): 359-373
33. Gabriel Thorens, Sophia Achab, Joel Billieux, Yasser Khazaal, Riaz Khan,
Edward Pivin, et al: Characteristics and treatment response of self-identified
problematic Internet users in a behavioral addiction outpatient clinic. Journal
of Behavioral Addictions. 2014; 3(1): 71-81
34. Doug Hyun Han, Jun Won Hwang, Perry F Renshaw: Bupropion Sustained
Release Treatment Decreases Craving for Video Games and Cue-Induced
Brain Activity in Patients with Internet Video Game Addiction. Experimental
and Clinical Psychopharmacology. 2010; 18(4): 297-304

This article is protected by copyright. All rights reserved.

 35. Rajshekhar Bipeta, Srinivasa Srr Yerramilli, Ashok Reddy Karredla, Srinath
Gopinath, et al: Diagnostic Stability of Internet Addiction in Obsessive
Compulsive Disorder: Data from a Naturalistic One year Treatment Study.
Accepted Article
Innovation in Clinical Neuroscience. 2015; 12(3-4): 14-23
36. C.-H. Ko, J.Y Yen, C.-F. Yen, C.-S. Chen, C.-C. Chen, et al: The
association between Internet Addiction and psychiatric disorder: A review of
the literature. European Psychiatry. 2012; 27: 1-8,
37. Ahyoung Paik, Daeyoung Oh, Daeho Kim: A Case of Withdrawal Psychosis
from Internet Addiction Disorder. Psychiatry Investigation 2014; 11(2): 207-
209
38. J Michel Bostwick, Jefferey A Bucci: Internet Sex Addiction Treated with
Naltrexone. Mayo Clinic Proceeding. 2008; 83(2): 226-230,
39. Moshe Phillip, Tadej Battelino, Eran Atlas, Olga Kordonouri, Natasa Bratina,
Shahar Miller, et al: Nocturnal Glucose Control with an Artificial Pancreas at
a Diabetes Camp. The New England Journal of Medicine. 2013; 368: 824-
33
40. Kelly CS, Shield SW, Gowen MA, Jaganjac N, Andersen CL, Strope GL:
Outcomes analysis of a summer asthma camp. J Asthma. 1998; 35(2): 165-
71
41. Chulmo Koo, Yulia Wati, Choong C. Lee, Hea Young Oh: Internet-Addicted
Kids and South Korean Government Efforts: Boot-Camp Case.
CyberPsychology Behavior and Social networking. 2011; 14(6): 391-394
42. Masaki Maezono, Hideki Nakayama, Satoko Mihara, Takuma Hashimoto,
Daishi Kitamura, Hiroshi Sakuma, et al: The situation and countermeasure
in Korea. Japanese Journal of Psychiatric Treatment. 2014; 29(9): 1205-
1211 (in Japanese)
43. Hideki Nakayama, Daishi Kitamura, Satoko Mihara, Hitomi Koshino,
Takuma Hashimoto, Masaki Maezono, et al.: A description of visiting
Rescue School for internet addiction adolescents in Taegu. Japanese
Journal of Clinical Psychiatry, 2013; 42(9): 1161-1165 (in Japanese)
44. National Institution for Youth Education: report on The treatment study for
adolescents with internet addiction that utilized a youth education

This article is protected by copyright. All rights reserved.

 institution, 2015 (in Japanese)
45. National Institution for Youth Education: report on The treatment study for
adolescents with internet addiction that utilized a youth education
Accepted Article
institution, 2016 (in Japanese)
46. Toshiro Tsuruta, Eiichiro Nojima: Practice of Prevention Education for
Internet Addiction in High School and the Effectiveness on Annual Changes
of Students Internet Addiction Tendency. Japanese Journal of Educational
Technology. 2015; 39(1): 53-65 (in Japanese)
47. Mun So Youn, Lee Byoung Sook: Effects of an Integrated Internet Addiction
Prevention Program on Elementary Students Self-regulation and Internet
Addiction. J Korean Acad Nurs. 2015; 45(2): 251-261 (in Korean)
48. Johansson A, Grant JE, Kim SW, Odlaug BL, Gtestam KG, et al: Risk
factors for problematic gambling: a critical literature review. J Gambl Stud.
2009; 25(1): 67-92
49. Sun-Mi Cho, Min-Je Sung, Kyong-Min Shin, Ki Young Lim, Yun-Mi Shin:
Does Psychopathology in Childhood Predict Internet Addiction in Male
Adolescents? Child Psychiatry Hum Dev. 2013; 44: 549-555.
50. Yi-Lung Chen, Sue-Huei Chen, Susan Shu-Fen Gau: ADHD and autistic
traits, family function, parenting style, and social adjustment for Internet
addiction among children and adolescents in Taiwan: A longitudinal study.
Research in Developmental Disabilities. 2015; 39: 20-31.
51. Chih-Hung Ko, Ju-Yu Yen, Cheng-Sheng Chen, Yi-Chun Yeh, Cheng-Fang
Yen, et al: Predictive Values of Psychiatric Symptoms for Internet Addiction
in Adolescents, A 2-Year Prospective Study, Arch Pediatr Adolesc Med.
2009; 163(10): 937-943
52. Chengfu Yu, Xian Li, Wei Zhang: Predicting Adolescent Problematic Online
Game Use from Teacher Autonomy Support, Basic Psychological Needs
Satisfaction, and School Engagement: A 2-Year Longitudinal Study.
CyberPsychology Behavior and Social networking. 2015; 18(4): 228-33
53. Chih-Hung Ko, Ju-Yu Yen, Cheng-Fang Yen: Factors Predictive for
Incidence and Remission of Internet Addiction in Young Adolescents: A
prospective Study. CyberPsychology and Behavior. 2007; 10(4): 545-551

This article is protected by copyright. All rights reserved.

 54. Lu Yu, Daniel Tan lei Shek: Internet Addiction in Hong Kong Adolescents: A
Three-Year Longitudinal Study. J Pediatr Adolesc Gynecol. 2013; 26: S10-
17
Accepted Article
55. Guangheng Dong, Jiangyang Wang, Xuelong Yang, Hui Zhou: Risk
Personality traits of internet addiction: A longitudinal study of internet
addicted Chinese university students. Asia Pacific Psychiatry. 2013; 5: 316-
321
56. Chih-Hung Ko, Tai-Ling Liu, Peng-Wei Wang, Cheng-Sheng Chen, Cheng-
Fang Yen, Ju-Yu Yen: The exacerbation of depression, hostility, and social
anxiety in the course of Internet addiction among adolescents: A
prospective study. Comprehensive Psychiatry. 2014; 55: 1377-1384
57. Chih-Hung Ko, Peng-Wei Wang, Tai-Ling Liu, Cheng-Fang Yen, Cheng-
Sheng Chen, Ju-Yu Yen: Bidirectional associations between family factors
and internet addiction among adolescents in a prospective investigation.
Psychiatry and Clinical Neuroscience. 2015; 69: 192-200
58. Ju-Yu Yen, Cheng-Fang Yen, Cheng-Sheng Chen, Yi-Hsin Chang, Yi-Chun
Yeh, Chih-Hung Ko: The bidirectional interactions between addiction,
behavior approach and behavior inhibition systems among adolescents in a
prospective study. Psychiatry Research. 2012; 200: 588-592

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 Table1 Psychological treatment of Internet Use Disorders (IUDs)
Accepted Article
Authors Definition of IUDs n Subjects Age Exclueded morbidity

Any comorbid medical

Treatment
1. Group CBT
(8
a)
Main outcomes

IUD level significantly decreased in both groups, while CBT

Beard's Diagnostic Secondary
Y Du et al.17 Questionnaire for Internet 56 school 12-17
disorder; Pre-existing sessions)+parents was particularly effective in improving time management
(2010) psychiatric disorder; Taking training+psychoeduc skills and alleviating emotional, cognitive and behavioral
Addiction students
psychoactive medication ation for teachers symptoms
2. Control
b)
1. Group R/T
J U Kim29 Internet Addiction
25
University
Average 24.2 Not reported
Group R/T group significantly improved IUD condition and
Disorder students (10 sessions) enhanced self-esteem related to internet use
(2008) 2. Control
Mean ages for CBT was effective at ameliorating the common symptoms
K S. Young26 Screened using IATc) 114 Clients
males and
High risk behaviors
1. CBT of online addiction (motivation to quit, online time
(2007) (score not specified) females were (12 sessions) management, social isolation, sexual dysfunction and
38 and 46. abstinence from problematic online applications)

CBT was greatly effective in reducing online time and

Under the age of 17
improving IUD condition, some problems (school/job, family
K. Wolfling et Severe comorbid disorders
conflicts, health problems, denial of recreational activities,
AICA-Sd) and Male 18-47 Currently medicated due to
al.18 AICA-Ce)
37
outpatients Average 26.1 psychiatric disorder
1. CBT conflict with friends), self-efficacy expectancy and
(2014) psychopathological symptoms (obsessive-compulsive,
Receiving psychotherapeutic
social insecurity, depression, anxiousness, aggressiveness,
treatment
phobic anxiety, psychotic behavior).

D T.L. Shek et Young's 10item scale4 56 clients were 1. Multi-model

g) Multi-model counseling was significantly effective at
Young's 8item scale5 aged 11-18, counseling (MI +
al.32 Young's 7item scale3 59 Clients
and 3 were
Not reported
Family based
improving the IUD condition, as well as some parenting and
(2009) f) family functioning.
CIAS 3 over 18 counseling + Others)
Both groups did not significantly differ in terms of the
Excessive online gameplay pre/post IAS score, but did significantly improve on the
Li Huanhuan 1. CBT
timeh), Other comorbid psychiatric OGCAS score.
et al.19 OGCASi)35,
28 Male patients 12-19
disorders
(12 sessions) CBT group showed significant improvement in the pre/post
(2013) 2. Basic counseling k)
IAS-CRj)3 and others total CDC score, all or nothing score, and online comfort
score.
University
students (39
YDQl)5 or high risk were under Taking psychotropic medicine 1. HOSC-LE
m)
internet dependence All groups significantly reduced online time.
W Su et al.20 with a 3-4 YDQ score, 65
graduate
Not reported
or accepting another 2. HOSC-NE
n)
HOSC-LE, HOSC-NE, and NI group significantly improved
(2011) students and psychological intervention for 3. NIo)
and being online for more online satisfaction and IUD level.
26 were their internet behavior 4. Control
than 14 hours per week graduate
students)
a) CBT: Cognitive Behavioral Therapy
b) R/T: Reality Therapy
c) IAT: Internet Addiction Test
d) AICA-S: Scale for the Assessment of Internet and Computer Game Addiction
e) AICA-C: Checklist for the Assessment of Internet and Computer Game Addiction
f) CIAS: Chinese Internet Addiction Scale
g) MI: Motivational Interviewing
h) More than 4 hours per day or 30 hours per week
i) OGCAS: Online Game Cognitive Addiction Scale
j) IAS-CR: Young's Internet Addiction Scale Chinese Version
k) CDC: Cognitive Disortions Scale (CDC can assess all-or-nothing thinking, rumination, online comfort, and short-term thinking and has demonstrated its
useful psychometric properties in a sample of Chinese adolescents)
l) YDQ: Young's Diagnostic Questionnaire
m) HOSC-LE: Healthy Online Self Helping Center (the online expert system for intenet addiction which was based on motivational interviews and client centered
conversation style) within a laboratory environment group
n) HOSC-NE: Healthy Online Self Helping Center within a natural environment (e.g. home or dormitory)
o) NI: Non-interactive group NI group participants use a non-interactive system, which was a modified version of the HOSC

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Table2 Medical treatment of Internet Use Disorders (IUDs)
Authers Definition of IUDs
D.H, Hun, Internet video
et al.21 game player
Internet video game (StarCraft)
player,
D.H, Hun, Game play time > 30
hours/week, YIATa)50
et al34
Modified DSM-IV substance
abuse criteria for internet
videogame addiction
Internet video game (StarCraft)
D. H. Hun
et al22
player,
Game play time > 30 hour/week,
YIAT50
Modified DSM-IV substance
abuse criteria for internet
57
videogame addiction
IC-IUD (1. uncontrollable, 2.
B Dell'Osso
distressing, 3. time consuming, 4.
et al24 resulting in social, occupational,
and/or financial difficulties)
Game play time > 30
S. M. Kim hours/week, YIAT50
Modified DSM-IV substance
et al23 abuse criteria for internet
videogame addiction
R Bipeta
et al35 YDQ5
(2015)
a) YIAT: Young's Internet Addiction Test
b) BDI: Beck Depression Inventory
c) Bupropion SR: bupropion sustained release
d) CGI-S: Clinical Global Impression Severity
e) IC-IUD: Impulsive compulsive internet usage disorder
f) OCD: Obsessive compulsive disorder
g) SSRI: selective serotonin reuptake inhibitor
Comorbid other
N Subjects Age psychiatric Treatment Main outcomes
disorders
Methylphenidate IUD level and inattention/hyperactive symptoms
Drug naive 8-12
62 ADHD (DSM-IV) (ConcertaR) for 8 weeks significantly improved.
children Average 9.3
Average dose was 30.5mg/day Average internet use time was significantly reduced.
IUD level significantly improved.
Average of total playing game time and craving for playing
Patients(n=11)
16-29 Subclinical Depression Bupropion SRc) 300mg/day for StarCraft significantly reduced.
19 Healthy control(n=8) 6 weeks
b)
(BDI <17) There was no significant change in the BDI score.
Fo
The cue-induced brain activity in the dorsolateral
prefrontal cortex had also decreased in patient group.
Bupropion group: bupropion SR
Patients
rR 13-42
Major depressive
disorder
(DSM-IV)
150-300mg/day for 8 weeks
and education of IUDs
Placebo group: placebo for 8
weeks + education of IUDs
IUD level and mean time of online game playing in
bupropion group were significantly reduced to a greater
extent than that of the placebo group.
The BDI scores and the CGI-Sd) scores in the bupropion
group were significantly better than those of placebo group.
ev All subjects took Escitalopram -
iew
20mg for 10 weeks. (open
IUD level and average internet time were significantly
phase)
The adults were reduced in open phase.
12 subjects had at least Subjects who completed the
recruited through CGI-I score and BIS non-planning subscale" were
19 Average 38.5 1 comorbid psychiatric first Escitalopram trial were
advertisements and
disorder randomly assigned to receive
significantly improved in open phase.
other media. No significant difference between groups in any pre/post
Escitalopram or placebo for 9
measures in double blind phase.
additional weeks (double blind
phase)
On
CBT+MED group: 8 sessions
group CBT for problematic
online game play +bupropion
During the active treatment phase, the level of IUD and
depressive state in the CBT-MED group were significantly
ly
Male adolescents Major depressive
SR 150-300mg/day for 8 improved, compared to those of the MED group.
65 were recruited by 13-18 disorder
advertisements. (BDI19)
weeks The mean online game playing time in the CBT+MED group
was significantly reduced compared with those in the MED
CBT group: bupropion SR 150- group.
300mg/day for 8 weeks
All the OCD subjects received
18 years of clonazepam, which was tapered
38 OCD patients The level of IUDs and OCD symptoms were significantly
72
and 34 controls
age OCD (DSM-IV) off after three weeks, in
improved from baseline by 1 year after.
or older addition to either a SSRI or
clomipramine for 1 year.
Table3 Risk factors for future Internet use disorders (IUDs) identified by prospective studies
Definition Number at Subjects at Age at first Follow-up Main risk factor for future IUDs
Authors
of IUDs first survey first survey survey duration incidence
C.H. Ko Lower reward dependence
12-16
Junior high Lower self-esteem
et al 53 CIASa)64 517
school students
mean age 13.62 1 year
Lower family function
(2007) Online game playing
C.H. Ko Grade 7 junior Male
et al 56 CIAS64 2293 high school mean age 12.36 1 year Depressive symptoms
(2014) students Hostility symptoms
C.H. Ko Grade 7 junior Male
6, 12, 24
et al51 CIAS64 2293 high mean age 12.36 ADHD symptoms

Fo
months
(2009) school students Hostility symptoms

Male
C Yu et al Gentile's pathological Higher sensation seeking
Video-Game Use Junior high mean age 14.83 Lower self-esteem

rR
52
356 1, 2 years
Questionnaire5criteria school students (final participants) Higher teacher autonomy support
(2015) (Pathological game use) Lower basic psychological needs
satisfaction
Higher Neuroticism/ Stability scores
G Dong YDQb)5 (baseline Higher Psychoticism/ Socialization

ev
Freshmen
survey) 19.6-22.3 scores
et al 55 YIATc)80 (2 years later
868 university
mean age 20.8
2 years
Lower Lie scores
(2013) students
survey) (Eysenck personality questionnaire for
adult)

iew
J Y Yen, Grade 7 students
et al58 CIAS64 2293 at junior high mean age 12.36 12 months Higher BASd) score
(2012) schools

50 Male
Y L Chen CIAS64 1153
Grade 3, 5 and 8
Not reported 3-4 months Protective parenting style
(2015) students
Poor academic performance

S M Cho, et
al.49
(2013)
YIATc)46 1112
1st grade
students at
primary school
mean age 6.85 7-8 years
Withdrawal symptom
Anxiety/depression symptom
On
L Yu et al. 54 10 items YIATe)4
(2013)
3325
Secondary school
students
mean age 12.59 2 years
Higher level of positive youth
development,
Higher academic school competence
Better family functioning,

Male
ly
C.H Ko et Grade 7 junior Inter-parental conflict
al57 a)
CIAS 64 2293 high school mean age 12.36 1 year Not living with mother
(2015) students Allowed to use Internet for more than 2
hours per day by parents or caregiver.

a) CIAS: Chen Internet Addiction Scale

b) YDQ: Young's Diagnostic Questionnaire
c) YIAT: Young's Internet Addiction Test

d) BAS: Behaviour Approach System (BAS scale includes subscales of rewards leading to positive emotions, a persons
tendency to actively pursue appetitive goals and the tendency seek out and impulsively engage in potentially rewarding
activities, respectively.)

e) 10 items YIAT: Young's 10 items Internet Addiction Test