Jon. O. Ebbert, MD

All of us in clinical practice are challenged with scenarios that take us out of our comfort zones, allowing our art to move front and center. Perhaps some of us have had a similar experience of a mother presenting with her teenage son who is performing poorly in his costly collegiate studies because of a profound inability to stop playing this year’s most popular MMOG (massively multiplayer online game).

The existence of Internet addiction disorder (IAD), also referred to as pathologic computer use, is a controversial area. Complex behaviors, such as gambling, are sometime referred to as "process addictions," because the experience is complex and multifaceted – it’s not a single rewarding stimulus such as cocaine. Much of the challenge with IAD is defining what the reinforcing stimulus is: Is it the online or Internet experience, the gambling component if money is spent to "power-up" players, or the social interaction with other human players?

Estimates of Internet users who have some form of dependency have been proposed to be as high as 5%-10%. Some have defined heavy Internet use as a compulsion rather than a dependency. Detractors have proposed that IAD is not a real clinical entity, but rather a manifestation of other psychiatric illnesses.

Human laboratory data published in 2010 suggested that bupropion, a dopaminergic and norepinephrine reuptake inhibitor, may be helpful for decreasing Internet video game addiction (Exp. Clin. Psychopharmacol. 2010;18:297-304). After a 6-week period of bupropion treatment, craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex were decreased.

Last year, Dr. Doug Hyun Han and colleagues published a study evaluating the effect of bupropion on depressed patients who played online games excessively (J. Psychopharmacol. 2012;26:689-96). In this study, 50 males were randomized to bupropion or placebo, with both groups receiving an educational intervention for 12 weeks. Bupropion was associated with reductions in online game play time, which was sustained during the post-treatment follow-up phase despite the recurrence of depressive symptoms.

So, sometimes we must choose between refusing to accept the existence of a disorder – in this case, telling the mother to practice "tough love" – or accept the fact that we do not know everything and, weighing the risks and benefits, try a therapy and see how it goes.

Dr. Ebbert is professor of medicine and primary care clinician at the Mayo Clinic in Rochester, Minn. The opinions expressed are solely those of the author. 

All of us in clinical practice are challenged with scenarios that take us out of our comfort zones, allowing our art to move front and center. Perhaps some of us have had a similar experience of a mother presenting with her teenage son who is performing poorly in his costly collegiate studies because of a profound inability to stop playing this year’s most popular MMOG (massively multiplayer online game).

The existence of Internet addiction disorder (IAD), also referred to as pathologic computer use, is a controversial area. Complex behaviors, such as gambling, are sometime referred to as "process addictions," because the experience is complex and multifaceted – it’s not a single rewarding stimulus such as cocaine. Much of the challenge with IAD is defining what the reinforcing stimulus is: Is it the online or Internet experience, the gambling component if money is spent to "power-up" players, or the social interaction with other human players?

Estimates of Internet users who have some form of dependency have been proposed to be as high as 5%-10%. Some have defined heavy Internet use as a compulsion rather than a dependency. Detractors have proposed that IAD is not a real clinical entity, but rather a manifestation of other psychiatric illnesses.

Human laboratory data published in 2010 suggested that bupropion, a dopaminergic and norepinephrine reuptake inhibitor, may be helpful for decreasing Internet video game addiction (Exp. Clin. Psychopharmacol. 2010;18:297-304). After a 6-week period of bupropion treatment, craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex were decreased.

Last year, Dr. Doug Hyun Han and colleagues published a study evaluating the effect of bupropion on depressed patients who played online games excessively (J. Psychopharmacol. 2012;26:689-96). In this study, 50 males were randomized to bupropion or placebo, with both groups receiving an educational intervention for 12 weeks. Bupropion was associated with reductions in online game play time, which was sustained during the post-treatment follow-up phase despite the recurrence of depressive symptoms.

So, sometimes we must choose between refusing to accept the existence of a disorder – in this case, telling the mother to practice "tough love" – or accept the fact that we do not know everything and, weighing the risks and benefits, try a therapy and see how it goes.

Dr. Ebbert is professor of medicine and primary care clinician at the Mayo Clinic in Rochester, Minn. The opinions expressed are solely those of the author. 

All of us in clinical practice are challenged with scenarios that take us out of our comfort zones, allowing our art to move front and center. Perhaps some of us have had a similar experience of a mother presenting with her teenage son who is performing poorly in his costly collegiate studies because of a profound inability to stop playing this year’s most popular MMOG (massively multiplayer online game).

The existence of Internet addiction disorder (IAD), also referred to as pathologic computer use, is a controversial area. Complex behaviors, such as gambling, are sometime referred to as "process addictions," because the experience is complex and multifaceted – it’s not a single rewarding stimulus such as cocaine. Much of the challenge with IAD is defining what the reinforcing stimulus is: Is it the online or Internet experience, the gambling component if money is spent to "power-up" players, or the social interaction with other human players?

Estimates of Internet users who have some form of dependency have been proposed to be as high as 5%-10%. Some have defined heavy Internet use as a compulsion rather than a dependency. Detractors have proposed that IAD is not a real clinical entity, but rather a manifestation of other psychiatric illnesses.

Human laboratory data published in 2010 suggested that bupropion, a dopaminergic and norepinephrine reuptake inhibitor, may be helpful for decreasing Internet video game addiction (Exp. Clin. Psychopharmacol. 2010;18:297-304). After a 6-week period of bupropion treatment, craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex were decreased.

Last year, Dr. Doug Hyun Han and colleagues published a study evaluating the effect of bupropion on depressed patients who played online games excessively (J. Psychopharmacol. 2012;26:689-96). In this study, 50 males were randomized to bupropion or placebo, with both groups receiving an educational intervention for 12 weeks. Bupropion was associated with reductions in online game play time, which was sustained during the post-treatment follow-up phase despite the recurrence of depressive symptoms.

So, sometimes we must choose between refusing to accept the existence of a disorder – in this case, telling the mother to practice "tough love" – or accept the fact that we do not know everything and, weighing the risks and benefits, try a therapy and see how it goes.

Dr. Ebbert is professor of medicine and primary care clinician at the Mayo Clinic in Rochester, Minn. The opinions expressed are solely those of the author.