Q: Hi, Dr Fung, can you please tell us about Internet addiction from a psychiatrist’s point of view, and also from a Christian perspective?

A: We are now living in a digitally enabled world that has greatly affected the way we work, play and worship. This pandemic has made us pivot to online platforms so much that we might say we are “addicted” to technology for work and everything else.

Many socially acceptable behaviours such as shopping, watching movies or even eating durians can, in extreme situations, be misconstrued as addictions. “Addiction” has become a pejorative term to describe any behaviour that is seen as excessive and unnecessary to some. But to the shopaholic, the movie buff or the durian lover, these are merely jealous folks who don’t know what they are missing. However, we would not say the same for someone who chain-smokes, drinks in excess every day or enjoys “chasing the dragon” with heroin.

So how do we differentiate an addiction from other social behaviours? For anything to qualify as a medical condition, some basic tenets must be met—it must first be harmful to the individual and cause some dysfunction. Next, it should cause cravings for the addictive behaviour that can be triggered by some cues; for example, at a party when people are smoking and drinking, these addictive behaviours can be aroused. It subsequently requires an increasing dose to get the same good feeling associated with it. This is described as tolerance. As the addiction develops, it will make other interests diminish and one may become disinterested and no longer enjoy what one used to. Finally, there will be loss of control resulting in all kinds of problems such as school failure, job loss, family breakup, etc.

Q: Do addictions only occur with harmful substances like alcohol and drugs of abuse?

A: Let us first understand the mechanism of addictions that is linked to a brain chemical called dopamine. Dopamine is released when an enjoyable activity occurs in what is termed as the “reward system” in our brains. This dopamine-related activity links pleasurable experiences to an internal motivation to re-experience the behaviour. This will create the cravings to release more dopamine until the brain is saturated with it, and what used to be triggers for release of dopamine may not produce the same amount. This means higher doses of the behaviour are needed to satisfy the need for dopamine, which leads to tolerance.

This mechanism is believed to be the underlying cause of addictive behaviours, whether it is to drugs and alcohol or other social behaviours like shopping or sex.

Editor: Wait a minute. Didn’t you just say that shopping, movie watching and eating durians couldn’t be addictions?

Writer: Based on the mechanisms associated with dopamine, they can become addictions if they fulfil some of those elements of dysfunction, cravings, tolerance disinterest in other activities and loss of control. In fact, compulsive buying disorder is described in the scientific literature. But addiction as a disorder must be problematic. Normal shopping, movie-watching and durian-eating are part of the human experience, but they should not become the centre of everything. In other words, a good principle for most social behaviours is for the Christian to be in the world but not of the world (John 15:19).

Q: What about Internet addiction?

A: By the same token, use of computers is fairly ubiquitous. Like television did several decades before when it first arrived, all technology offers new benefits as well as problems. In the 1980s, computer addiction was described using most of the five behaviours I explained earlier. There was even a book by Margaret Shotton describing the lives of 106 individuals spending inordinate amounts of time with the computer.¹ Later, video gaming in the form of game machines in video arcades became all the rage and, in Singapore, the government placed a ban on such gaming, citing worries and concerns by parents. With the widespread advent of Internet usage from the 1990s, the same concerns about addictions arose.

Like compulsive buying disorder, addiction to Internet gaming is being considered for American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, 5th Edition (DSM-5) which is a classification system used by psychiatrists. It uses the tenets that I have mentioned in which the person is preoccupied with gaming, experiences withdrawal when the game is taken away and needs to increase gaming to satisfy the urge with an inability to stop. Other activities become less important, and this may affect school, jobs or relationships.

Q: What can we do about this? We can’t ban the use of the Internet!

A: We are all now living in the digital world with more digital natives than digital migrants. The young person and video gaming is part of this world. A parent needs to determine when a child should be introduced to computers and the Internet, and how to monitor the responsible use of it.

A local study in Singapore also showed that addiction to games is inversely proportional to adult supervision. This means that in some youths, gaming can become addictive if there is not sufficient parental monitoring and involvement. Train the child in the way he should go, and when he is old, he will not depart from it (Prov 22:6).

Q: What should Christian parents do?

Q: The age-old idiom that “prevention is better than cure” is an important first principle. For addictions, it is also very scientific since it is overindulging in a particular activity, like playing video games non-stop, can create that dopamine saturation which leads to addiction. If there was supervised monitoring by responsible adults—especially parents—this behaviour would not have occurred in the first place. Parents should decide when children get hold of computers, including mobile phones. These are not just phones but extremely powerful devices that work as miniaturise computers that can become addiction enablers.

An OECD study from 2018 showed that many developed nations have increasingly had their children exposed to inappropriate sexual and aggressive content online. Other studies have shown that without training, children can fall prey to these negative influences. My advice to parents is to keep a close eye on your children and make yourself a digitally literate migrant. Learn about gaming and understand terms like MMOG, RPG and FPS. Only when you understand the technology can you learn to use it positively in beneficial games that can train memory, organisation and even social skills. The technology is not the enemy; it is how it can be used or abused.

Editor: What can I do if my child is already addicted? Is it too late?

Writer: No, but some intervention will be needed. Because of each individual’s unique family and social situation, a variety of treatments may be needed that are catered to the child, such as individual counselling, group support and family therapy. The most important aspect of treatment is to identify the internal motivation of the individual to change and appeal to the rational thinking of the young person.

Behavioural strategies in terms of rewards and punishments can be additional measures. A well-known psychological intervention called cognitive behavioural therapy (CBT) has been shown to have good short-term gains. The focus of CBT is to help the young person understand that their thinking (or cognitions) dictate how they feel and what behaviours will occur. Some of the problematic thinking revolves around over-valuing the benefits of gaming such as the rewards within the game and the online character (or avatar). At the same time, the youth may develop maladaptive rules for playing the games such as playing for long periods and not keeping regular hours. This will often lead to becoming over-reliant on the game and success within the game as a source for self-esteem and social acceptance. CBT attempts to help the young person increase their awareness of their problematic behaviour, work through these issues and find healthy alternatives. Family and social settings would also need to be helped to create a supportive environment. But this will take time and effort.

There is no instant solution and in a volatile, uncertain, complex and ambiguous world, we need to make an effort to help our children and adolescents find harmony. This cannot be done by surrogate parents such as teachers or coaches. Parents must step in and spend time understanding their children and their needs for love. They need to hold their children’s hands when they are young, walk with them as they reach the cusp of adulthood and share with them the love of their heavenly Father.

¹ Margaret Shotton, Computer Addiction? A Study of Computer Dependency (London: Taylor & Francis, 1989).

Dr Daniel Fung is the CEO of the Institute of Mental Health and the President of the International Association of Child and Adolescent Psychiatry and Allied Professions. He worships at Pentecost Methodist Church.