Interview with Prof. Naomi Anne Fineberg, Consultant Psychiatrist at Hertfordshire Partnership University NHS Foundation Trust (HPFT).
There is consensus on the need for more study of Problematic Use of the Internet.
Can you tell me about the background to establishing the COST Action ‘European Network for Problematic Usage of the Internet’ and writing the Manifesto itself?
Naomi Anne Fineberg: We were established as a research network by the EU, under its Horizon 2020 initiative, in October 2017, as a result of the increased recognition that PUI in its various forms represents a growing public health problem. We comprise over 120 experts – psychiatrists, psychologists, neuroscientists and academics – from around 40 different countries worldwide. We receive funding over four years as a vehicle for multidisciplinary scientific cooperation and intercommunication. PUI is an umbrella term for many different forms of problematic behaviour, including addiction to gaming, video streaming, viewing pornography, shopping, using social media, etc. As the existing research in this area is patchy and inconsistent, our first step was to reach consensus on the key areas to study, with a view to improving public health.
How much of a public health issue has PUI already become and do you predict the problem will grow in the future? How much is known about its prevalence in the population?
Naomi Anne Fineberg: One of the key research goals is to define the extent of the different forms of problematic usage – different age groups, cultures and genders are affected differently – but to date we have no reliable global or even national figures on the prevalence, costs and societal burden. Estimates of the prevalence of gaming disorder vary widely, from 5-25 %, depending on the definition used and the sample of individuals tested. So, you can see the issue requires further work.
How advanced are the diagnostic criteria, health intervention and prevention programmes?
Naomi Anne Fineberg: The World Health Organisation has reached agreement on the diagnosis of gaming disorder, to be included with disorders of behavioural addiction in the forthcoming revision of the International Classification of Diseases (ICD-11). Other defined disorders involving PUI include gambling disorder (also classified as a disorder of behavioural addiction in the ICD-11), and compulsive sexual behaviour disorder (currently classified as an impulse-control disorder in the ICD-11).
How is PUI different from other addiction disorders?
Naomi Anne Fineberg: We have much less research data for disorders involving PUI compared to other disorders of substance addiction. Of the different forms of PUI, gambling disorder probably most closely compares with substance addiction in terms of symptoms, such as: loss of control; preoccupation with thoughts about gambling; priority given to gambling over other important activities; needing to gamble with increasing amounts of money to achieve the desired excitement; continuation despite recognition of the risks and experiencing losses; concealment of the severity of the problem; symptoms akin to withdrawal on stopping; significant relationships, job, or educational or career opportunity jeopardised or lost as a result of gambling. There is also evidence of similarities in changes in brain structure and function involving brain pathways that mediate reward on gambling disorder and substance abuse.
For other PUI disorders, the similarities with substance abuse are less clear-cut, not least because there is much less research to go on. For example, the need to engage in the activity more to get the same effect is less clearly demonstrated, and the brain changes are less well understood. In the case of gaming disorder, for example, there is some evidence to suggest similarities with addiction, but there are also other similarities with obsessive compulsive disorder.
Can PUI be predicted from the recognised forms of impulsive and compulsive traits and symptomatology and how much influence does the internet itself and features like AI profiling programs have on ‘feeding’ the addiction?
Naomi Anne Fineberg: The extent to which forms of AI designed to increase the time spent online ‘feeds the problem’ is not clearly understood. In general, however, a positive correlation between the time spent online and difficulty to control internet use appears to exist.
Bio-express: Naomi Anne Fineberg is a Consultant and Visiting Professor at the University of Hertfordshire, where she leads the HPFT centre, a specialised service for Obsessive Compulsive and Related Disorders (OCRD). Action Chair of the European Cooperation in Science and Technology (COST) Action Programme on a ‘European Network for Problematic Usage of the Internet (EU PUI Network)’, and the leading author of the network’s Manifesto on PUI.