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BEIJING—World of Warcraft was Sun Jiuqing's undoing. It began to take over his life last autumn, after the 18-year-old had transferred to a new high school with higher academic standards than his previous one. He struggled from the start. "I couldn't catch up to the other students," he says. Sun chose instead to escape. Before long, he was spending 10 hours a day playing World of Warcraft, an online game. Sun spurned pleas to stop. Finally, in late March, his father drove the young man a few hours from their home in Tianjin to a People's Liberation Army barracks in south Beijing and admitted him to the General Hospital of Beijing Military Region's Addiction Medicine Center (AMC).

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http://www.sciencemag.org/cgi/content/full/324/5935/1630#

http://www.sciencemag.org/cgi/content/full/324/5935/1630#

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    SCIENCE IN SOCIETY:
    China Reins in Wilder Impulses in Treatment of ‘Internet Addiction’
    Richard Stone
    BEIJING—World of Warcraft was Sun Jiuqing's undoing. It began to take over his life last autumn, after the 18-year-old had transferred to a new high school with higher academic standards than his previous one. He struggled from the start. "I couldn't catch up to the other students," he says. Sun chose instead to escape. Before long, he was spending 10 hours a day playing World of Warcraft, an online game. Sun spurned pleas to stop. Finally, in late March, his father drove the young man a few hours from their home in Tianjin to a People's Liberation Army barracks in south Beijing and admitted him to the General Hospital of Beijing Military Region's Addiction Medicine Center (AMC).
    
    
    
    
    
    Boot camp. For youth diagnosed with "Internet addiction disorder" at the Addiction Medicine Center, psychiatrist Tao Ran (inset) prescribes everything from drugs to military-style discipline.
    CREDITS: R. STONE/SCIENCE
    
    [Larger version of this image]
    
    No one doubts that logging long hours on the Internet can erode quality of life and on occasion can lead to ruinous consequences. "It's a global phenomenon," says AMC director Tao Ran, a psychiatrist and senior colonel. In China alone, Tao estimates, 5 million of the country's 300 million Internet users are "Internet addicts." Adolescents are especially vulnerable. "Youth who compulsively seek social contact on the Internet at the expense of offline activities may be finding it difficult to establish sufficiently gratifying social ties in their regular lives," says sociologist Zeynep Tufekci of the University of Maryland, Baltimore County.
    
    But there is no meeting of the minds on whether Internet addiction (IA) is a genuine disorder. "Labeling these behaviors as deviant is being done by older generations who have very different experiences with technology," argues Shelia Cotten, a sociologist at the University of Alabama, Birmingham. Overlooking or ignoring social factors can result in unnecessary medical interventions for behaviors that "do not fit into the structure of our society as it happens to be now," adds Tufekci.
    
    An American Psychiatric Association panel is now weighing whether to include IA in the fifth edition of the field's practices bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), planned for release in 2012. In an editorial in the March 2008 issue of The American Journal of Psychiatry, Jerald Block, a psychiatrist in Portland, Oregon, argued that IA "appears to be a common disorder that merits inclusion." But Cotten, for one, disagrees. She thinks it is premature to include IA in DSM-V given the lack of consensus about what constitutes IA or "whether Internet addiction disorder even exists."
    
    In China, the official view appears to be that Internet addiction is a genuine disorder, but attitudes are shifting about how aggressively it should be treated. Last year, CCTV-12, a central government channel, ran a series of glowing reports on a clinic in Shandong Province in eastern China that has used electric shocks on unanesthetized IA patients as part of what the clinic's director, Yang Yongxin, has called a "holy crusade" to cure IA. Earlier this month, the state-owned newspaper China Daily ran an article raising questions about Yang's methods, indicating an official about-face on the use of electric shocks as a valid IA treatment.
    
    Sizing up the beast
    Several years ago, when parents started showing up at AMC claiming that their adolescent children were Internet junkies, "at first I was skeptical we were seeing a true disorder," says center psychologist Huang Xiuqin. But as cases accumulated, she and Tao, her boss, became convinced that IA is an authentic disorder. Of the more than 3000 cases they have chronicled, patients were spending on average 9 hours a day on the Net.
    
    Tao has been trying to put diagnosis and treatment of IA on a more solid footing. Last November, his group released the first diagnostic criteria for IA; a paper outlining the guidelines is under review at the journal Addiction. The group classifies sufferers in three categories: simple IA (about 40% of cases), IA with accompanying symptoms such as anxiety or depression (30%), and IA with a second disorder, such as attention deficit hyperactivity disorder (30%). About 80% of patients are teenage boys.
    
    Tao's group has defined seven IA symptoms, including preoccupation with the Internet, disregard of harmful consequences of spending too much time online, and loss of interest in other activities. "Only being on the Internet makes them happy," says Tao. To qualify for diagnosis as an Internet addict, they have proposed that a person must spend at least 6 hours a day on the Internet (for reasons other than business or academic work) for at least 3 months after showing symptoms.
    
    In the vast majority of cases, Tao says, the culprit is online games, although female patients also often get hooked on online chat rooms. After arriving at AMC, "almost all" patients suffer withdrawal symptoms, Tao says, including anger, irritation, and restlessness, that fade after a few weeks. (Those reactions may not be too surprising: Adolescents are usually taken against their will to AMC, whose dormitory's entrance has steel bars—a state requirement of psychiatric wards.)
    
    AMC's treatments include behavioral training, drug therapy for patients with mental symptoms, dancing and sports, reading, karaoke, and elements of the "12 step" program of Alcoholics Anonymous. A "very important" part of the regimen is family therapy, says Tao. "Internet addiction occurs because the parents are doing something wrong," he asserts. Patients tend to have parents who are strict authoritarians or demand perfection, or come from single-parent households or homes in which the parents are frequently fighting, Tao says. In the beginning, parents tend to blame their children, he says, but after treatment they recognize their failings.
    
    
    
    
    
    Beyond the pale. As documented in a CCTV-12 program last year, Yang Yongxin administered electric shocks to "H" (top) with an electroconvulsive therapy machine (bottom).
    CREDIT: PHOTO COURTESY OF JERAMIAH SMITH
    
    [Larger version of this image]
    
    In the absence of guidance from China's health ministry, which is considering but has not yet adopted the military hospital's IA definition, dubious clinics have sprouted up throughout the country. Some force IA patients to go on kilometers-long hikes day after day as therapy. "That's unscientific. It doesn't treat the nature of the disorder," says Tao.
    
    The most infamous, perhaps, is the Yang Yongxin Center for IA Treatment at public hospital number four in Linyi, Shandong. Last year, a CCTV-12 segment recounted how the parents of a young man, "H," drugged him with a dozen sleeping pills and brought him to Yang's clinic. After "H" had woken up, he protested to Yang that he was over 18 years old and therefore they could not force him to stay without his consent. Yang bundled "H" into a room, and other patients restrained him on a bed, after which Yang administered shocks—for more than 1 hour, the narrator claimed—with a DX-IIA electroconvulsive therapy (ECT) machine, clearly shown in the program. In an 8 May article in China Youth Daily, Yang explained that he uses a weaker current than standard ECT and that the shocks, although "very painful," are "harmless."
    
    After months of appeals from Tao and colleagues, last month three government entities—the central government's information ministry, Shandong Province government, and the Communist Youth League—launched an investigation of Yang's clinic. A Linyi hospital spokesperson declined to comment. She stated that as Science went to press, Yang was occupied with a CCTV interview and would not be available to speak with Science.
    
    Cracking down on extreme treatments is unlikely to alter views in China that IA is a disorder. At the barracks in Beijing's Daxing district, Sun has taken a break from drills in AMC's courtyard. It was difficult, he says, adapting to waking at sunrise, lights out at 9 p.m., and other elements of the center's strict regimen. But after nearly 3 months, he says, "I feel normal now," and adds that he and his father, who has stayed in Beijing the whole time, are communicating much better with each other.
    
    In a few days, Sun will return to the real world. Tao's statistics show that there is a 40% chance the teenager will relapse. But for now, Sun is eager to get back to school—and face down the temptation of losing himself, once again, to the Internet.

    SCIENCE IN SOCIETY:<br />China Reins in Wilder Impulses in Treatment of ‘Internet Addiction’<br />Richard Stone<br />BEIJING—World of Warcraft was Sun Jiuqing's undoing. It began to take over his life last autumn, after the 18-year-old had transferred to a new high school with higher academic standards than his previous one. He struggled from the start. "I couldn't catch up to the other students," he says. Sun chose instead to escape. Before long, he was spending 10 hours a day playing World of Warcraft, an online game. Sun spurned pleas to stop. Finally, in late March, his father drove the young man a few hours from their home in Tianjin to a People's Liberation Army barracks in south Beijing and admitted him to the General Hospital of Beijing Military Region's Addiction Medicine Center (AMC).<br /><br /><br /><br /> <br /><br />Boot camp. For youth diagnosed with "Internet addiction disorder" at the Addiction Medicine Center, psychiatrist Tao Ran (inset) prescribes everything from drugs to military-style discipline.<br />CREDITS: R. STONE/SCIENCE<br /><br />[Larger version of this image]<br /><br />No one doubts that logging long hours on the Internet can erode quality of life and on occasion can lead to ruinous consequences. "It's a global phenomenon," says AMC director Tao Ran, a psychiatrist and senior colonel. In China alone, Tao estimates, 5 million of the country's 300 million Internet users are "Internet addicts." Adolescents are especially vulnerable. "Youth who compulsively seek social contact on the Internet at the expense of offline activities may be finding it difficult to establish sufficiently gratifying social ties in their regular lives," says sociologist Zeynep Tufekci of the University of Maryland, Baltimore County.<br /><br />But there is no meeting of the minds on whether Internet addiction (IA) is a genuine disorder. "Labeling these behaviors as deviant is being done by older generations who have very different experiences with technology," argues Shelia Cotten, a sociologist at the University of Alabama, Birmingham. Overlooking or ignoring social factors can result in unnecessary medical interventions for behaviors that "do not fit into the structure of our society as it happens to be now," adds Tufekci.<br /><br />An American Psychiatric Association panel is now weighing whether to include IA in the fifth edition of the field's practices bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), planned for release in 2012. In an editorial in the March 2008 issue of The American Journal of Psychiatry, Jerald Block, a psychiatrist in Portland, Oregon, argued that IA "appears to be a common disorder that merits inclusion." But Cotten, for one, disagrees. She thinks it is premature to include IA in DSM-V given the lack of consensus about what constitutes IA or "whether Internet addiction disorder even exists."<br /><br />In China, the official view appears to be that Internet addiction is a genuine disorder, but attitudes are shifting about how aggressively it should be treated. Last year, CCTV-12, a central government channel, ran a series of glowing reports on a clinic in Shandong Province in eastern China that has used electric shocks on unanesthetized IA patients as part of what the clinic's director, Yang Yongxin, has called a "holy crusade" to cure IA. Earlier this month, the state-owned newspaper China Daily ran an article raising questions about Yang's methods, indicating an official about-face on the use of electric shocks as a valid IA treatment.<br /><br />Sizing up the beast<br />Several years ago, when parents started showing up at AMC claiming that their adolescent children were Internet junkies, "at first I was skeptical we were seeing a true disorder," says center psychologist Huang Xiuqin. But as cases accumulated, she and Tao, her boss, became convinced that IA is an authentic disorder. Of the more than 3000 cases they have chronicled, patients were spending on average 9 hours a day on the Net.<br /><br />Tao has been trying to put diagnosis and treatment of IA on a more solid footing. Last November, his group released the first diagnostic criteria for IA; a paper outlining the guidelines is under review at the journal Addiction. The group classifies sufferers in three categories: simple IA (about 40% of cases), IA with accompanying symptoms such as anxiety or depression (30%), and IA with a second disorder, such as attention deficit hyperactivity disorder (30%). About 80% of patients are teenage boys.<br /><br />Tao's group has defined seven IA symptoms, including preoccupation with the Internet, disregard of harmful consequences of spending too much time online, and loss of interest in other activities. "Only being on the Internet makes them happy," says Tao. To qualify for diagnosis as an Internet addict, they have proposed that a person must spend at least 6 hours a day on the Internet (for reasons other than business or academic work) for at least 3 months after showing symptoms.<br /><br />In the vast majority of cases, Tao says, the culprit is online games, although female patients also often get hooked on online chat rooms. After arriving at AMC, "almost all" patients suffer withdrawal symptoms, Tao says, including anger, irritation, and restlessness, that fade after a few weeks. (Those reactions may not be too surprising: Adolescents are usually taken against their will to AMC, whose dormitory's entrance has steel bars—a state requirement of psychiatric wards.)<br /><br />AMC's treatments include behavioral training, drug therapy for patients with mental symptoms, dancing and sports, reading, karaoke, and elements of the "12 step" program of Alcoholics Anonymous. A "very important" part of the regimen is family therapy, says Tao. "Internet addiction occurs because the parents are doing something wrong," he asserts. Patients tend to have parents who are strict authoritarians or demand perfection, or come from single-parent households or homes in which the parents are frequently fighting, Tao says. In the beginning, parents tend to blame their children, he says, but after treatment they recognize their failings.<br /><br /><br /><br /> <br /><br />Beyond the pale. As documented in a CCTV-12 program last year, Yang Yongxin administered electric shocks to "H" (top) with an electroconvulsive therapy machine (bottom).<br />CREDIT: PHOTO COURTESY OF JERAMIAH SMITH<br /><br />[Larger version of this image]<br /><br />In the absence of guidance from China's health ministry, which is considering but has not yet adopted the military hospital's IA definition, dubious clinics have sprouted up throughout the country. Some force IA patients to go on kilometers-long hikes day after day as therapy. "That's unscientific. It doesn't treat the nature of the disorder," says Tao.<br /><br />The most infamous, perhaps, is the Yang Yongxin Center for IA Treatment at public hospital number four in Linyi, Shandong. Last year, a CCTV-12 segment recounted how the parents of a young man, "H," drugged him with a dozen sleeping pills and brought him to Yang's clinic. After "H" had woken up, he protested to Yang that he was over 18 years old and therefore they could not force him to stay without his consent. Yang bundled "H" into a room, and other patients restrained him on a bed, after which Yang administered shocks—for more than 1 hour, the narrator claimed—with a DX-IIA electroconvulsive therapy (ECT) machine, clearly shown in the program. In an 8 May article in China Youth Daily, Yang explained that he uses a weaker current than standard ECT and that the shocks, although "very painful," are "harmless."<br /><br />After months of appeals from Tao and colleagues, last month three government entities—the central government's information ministry, Shandong Province government, and the Communist Youth League—launched an investigation of Yang's clinic. A Linyi hospital spokesperson declined to comment. She stated that as Science went to press, Yang was occupied with a CCTV interview and would not be available to speak with Science.<br /><br />Cracking down on extreme treatments is unlikely to alter views in China that IA is a disorder. At the barracks in Beijing's Daxing district, Sun has taken a break from drills in AMC's courtyard. It was difficult, he says, adapting to waking at sunrise, lights out at 9 p.m., and other elements of the center's strict regimen. But after nearly 3 months, he says, "I feel normal now," and adds that he and his father, who has stayed in Beijing the whole time, are communicating much better with each other.<br /><br />In a few days, Sun will return to the real world. Tao's statistics show that there is a 40% chance the teenager will relapse. But for now, Sun is eager to get back to school—and face down the temptation of losing himself, once again, to the Internet.

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