Wednesday, February 19, 2020

Scientific American Created Confusion about 5G's Safety: Will They Clear It Up?

In September 2019, Scientific American, the oldest, continuously published monthly magazine in the U.S., published an opinion piece on its website entitled, “5G Is Coming: How Worried Should We Be about the Health Risks? So far, at least, there’s little evidence of danger.”

The piece was written by Kenneth Foster, an emeritus professor of bioengineering at the University of Pennsylvania. Foster is a member of a committee that sets exposure limits for wireless radiation and consults for industry and government. His article discussed the controversy about the rollout of 5G based upon widespread concerns about the adverse impact of this technology on our health. Foster argued that exposure to radio frequency radiation (RFR) from 5G will be similar to, or lower than, current levels because of the deployment of many “small cell” antennas. Hence, 5G exposure will comply with current RFR exposure limits that protect against “excessive heating of tissue.” 

Although Foster admitted that research on the effects of long-term exposure to 5G millimeter waves was lacking, he restated the FDA’s position that "[t]he available scientific evidence to date does not support adverse health effects in humans due to exposures at or under the current limits.” Thus, “the request to ‘stop the distribution of 5G products appears too drastic a measure. We first need to see how this new technology will be applied and how the scientific evidence will evolve.’”

In October, Scientific American published an opinion piece which I wrote entitled, “We Have No Reason to Believe 5G Is Safe:The technology is coming, but contrary to what some people say, there could be health risks,” that rebutted Foster’s article. My piece is reprinted on my Electromagnetic Radiation Safety website.

In the eleven years that I have been writing about the effects of RFR exposure, I anticipated that my response to Foster would provoke an attack by industry-affiliated scientists so I began my piece as follows:

“The telecommunications industry and their experts have accused many scientists who have researched the effects of cell phone radiation of "fear mongering" over the advent of wireless technology's 5G. Since much of our research is publicly-funded, we believe it is our ethical responsibility to inform the public about what the peer-reviewed scientific literature tells us about the health risks from wireless radiation.”

I laid out the evidence that rebutted many points in the Foster piece and concluded:

“We should support the recommendations of the 250 scientists and medical doctors who signed the 5G Appeal that calls for an immediate moratorium on the deployment of 5G and demand that our government fund the research needed to adopt biologically-based exposure limits that protect our health and safety.”

About two weeks later, Scientific American published an opinion piece that attacked me and my article: “Don’t Fall Prey to Scaremongering about 5G: Activists cite low-quality studies in arguing radio-frequency radiation is dangerous, but the weight of evidence shows no risk.” This piece was written by David Robert Grimes, a science writer, cancer researcher, and physicist.

Shortly after Grimes’ piece was published, the International EMF Alliance sent a 5-page letter to the editor of Scientific American that critiqued Grimes’ flawed interpretation of the science. Subsequently, Microwave News published a story entitled, “Open Season on 5G Critics: First NY Times, Now Scientific American,” reprinted by TruePublica, that criticized Grimes’ ad hominem attacks and explained why “it’s Grimes who gets the science all wrong.” The article raised the question “Why Did Scientific American Publish Grimes’s Hit Piece?"

Scientific American originally informed me that they would not publish a rebuttal to Grimes, but in January 2020 they invited me to submit a rebuttal. Two weeks after submitting my rebuttal, Scientific American sent me the following message:

“Thanks again for your recent submission, but we’ve decided against running it. You raise some valid points, but this is clearly a field where we’re a long way from definitive answers and the editors here have agreed that continuing this point-counterpoint argument in our opinion section is not the best way to serve our readers.

What we’ve decided to do instead is to commission an independent journalist to look at all of the evidence gathered so far and give readers an objective sense of what we know, what we don’t know, why uncertainty exists, and how scientists are trying to gather the evidence that governments and consumers need to make the most informed decisions possible.”

My unpublished rebuttal to Grimes, “5G, Public Health and Uncomfortable Truths” appears below.


5G, Public Health and Uncomfortable Truths

Joel M. Moskowitz, Ph.D.
School of Public Health
University of California, Berkeley
February 19, 2020

“So there really is no research ongoing. We’re kind of flying blind here, as far as health and safety is concerned,” proclaimed U.S. Senator Richard Blumenthal, chastising the Federal Communications Commission (FCC) and the Food and Drug Administration (FDA) in a Senate committee hearing on the future of 5G last year. This quote captures the reason why more than 270 scientists and medical doctors have signed the 5G Appeal, a petition calling for a moratorium on the deployment of 5G technology until we can establish safe exposure limits.  It is also one reason why I wrote about the status of the research and government and industry spin in “We Have No Reason to Believe 5G Is Safe.”

In an opinion piece that attacks my article, David Robert Grimes, a physicist, claims the research that finds radio-frequency radiation (RFR) is harmful is based on “low quality studies,” and that the weight of the evidence shows “no risk.” He repeats the mantra I have heard from other physicists in the ten years I have been studying the effects of cell phone radiation: “there is no known plausible biophysical mechanism of action for harm.” Grimes argues that my article “pivots on fringe views and fatally flawed conjecture, attempting to circumvent scientific consensus with scaremongering.”

Grimes’ arguments suffer the same biases he projects onto others (e.g., cherry-picking). His narrow perspective on the “mechanism of action for harm” seems shaped by a physics paradigm that can explain health risks from ionizing radiation (e.g., X-rays), but not from RFR (e.g., microwaves or cell phone radiation) which is non-ionizing. However, biologists have proposed various mechanisms that explain RFR effects. If not for his gaslighting and misrepresentations of published data, I might be charitably inclined to appreciate this debate. But Grimes aims to deny reality and discredit the preponderance of peer-reviewed science which finds low-intensity RFR can be harmful to our health.

The differences between the physicist’s and biologist’s perspectives could have been resolved decades ago had military and Telecom industry interests not interfered to ensure that RFR would be minimally regulated by policy makers. Microwave News has reported about these influences on scientific and policy developments since 1981. A recent Harvard monograph exposes how industry controls the FCC, the agency responsible for regulating RFR exposure from wireless technology in the U.S.

It is untrue, as Grimes argues, that RFR from cell phones cannot harm us because there is no mechanism. Numerous scientific studies provide evidence about mechanisms by which low-intensity RFR causes biological effects, including DNA damage in humans as well as animal models. For example, scientists who study RFR acknowledge that oxidative stress, an imbalance between free radicals and antioxidants, is a common mechanism by which RFR harms living cells. The uneven number of oxygen-containing electrons in free radicals allows them to react easily with other molecules. A review of 100 experimental studies on the oxidative effects of low-intensity RFR found that in 93 of these peer-reviewed studies “RFR induces oxidative effects in biological systems” leading to “cancer and non-cancer pathologies.” The review concluded, “the oxidative stress induced by RFR exposure should be recognized as one of the primary mechanisms of the biological activity of this kind of radiation.”

In an ideal world, I would agree with Grimes that “science is not conducted by petition or arguments to authority; it is decided solely on strength of evidence.” However, health authorities and policy makers have for decades relied upon industry-funded scientists who provide them with biased analyses that dismiss the peer-reviewed evidence unless it supports their sponsors. This is why independent scientists have sanctioned collective action.

More than 240 scientists from over 40 countries have signed the International EMF Scientist Appeal, a petition that raises concerns about the public health impacts of non-ionizing electromagnetic fields (EMF), especially from wireless technology. All have published peer-reviewed research on EMF and biology or health – totaling over 2,000 papers and letters in professional journals. Based upon solid evidence of harmful effects, these global experts urge public health leadership organizations, such as the World Health Organization (WHO), to establish more protective EMF guidelines and precautionary measures, and perform public education about health risks, particularly to children and developing fetuses.

Grimes cites the WHO’s current position that “no adverse health effects have been established as being caused by mobile phone use.” Setting aside the politics and limitations of that specific WHO declaration, note that the WHO’s own cancer research agency, the International Agency for Research on Cancer (IARC), classified RFR as “possibly carcinogenic to humans” in 2011. Last year, an IARC advisory group of 29 scientists examined the peer-reviewed research for RFR cancer risk published during the previous eight years and prioritized RFR for re-review. Hence, the IARC will likely upgrade the carcinogenic classification of RFR in the next five years.

Cited by Grimes is the one major cell phone radiation study conducted in the U.S. since the 1990’s. In 1999, the FDA recommended that the National Toxicology Program (NTP) research the carcinogenicity of cell phone radiation. The results of this $30 million study were published in 2018 after extensive peer review by EMF and toxicology experts. The NTP found “clear evidence” that cell phone radiation caused heart cancer and “some evidence” that it caused cancer in the brains and adrenal glands of male rats. The study also found significantly increased risk of DNA damage in rats and mice of both sexes exposed to cell phone radiation.

Whereas, most toxicologists consider the NTP methods the “gold standard,” Grimes erroneously implies that the NTP study’s “methodology and low power” would increase the likelihood that the study obtained spurious results. Statistically, a “low power” study has the opposite effect. Low statistical power means a study would be less likely to detect a real effect, not more likely to yield spurious effects. Grimes has thus repeated an industry-promoted canard about the study which reflects a complete misunderstanding of this basic statistical concept.

Characterizing the Interphone study among “large and robust trials, with careful controls and large sample groups” Grimes nevertheless misrepresents the study’s results. Careful reading of Interphone reveals a statistically significant increased risk of glioma and acoustic neuroma  among long-term heavy cell phone users. The researchers found that the excess glioma risk held up when the data were subjected to many different analyses (Appendix 1). Additional analyses that corrected for a bias in the study demonstrated a dose-response relationship between glioma risk and mobile phone use (see Appendix 2). 

Followup papers using the Interphone study data found that the excess tumors were primarily located on the side of the head where people held their phones, and in the part of the brain where cell phone radiation exposure was greatest, the temporal and frontal lobes.

Although three sources of case-control data  have found an association between ten years of heavy mobile phone use and glioma risk, glioma incidence may no longer be the best potential correlate of increased mobile phone use as Grimes implies. Long-term heavy mobile phone use is associated with various head and neck tumors in case-control studies including acoustic neuroma, meningioma, and tumors of the thyroid and parotid glands. In some countries glioma rates have increased in certain subgroups (e.g., older age groups, specific types of tumors or anatomic locations), if not overall. In many countries, including the U.S., thyroid tumor incidence has increased in recent years, and two case-control studies provide evidence that cell phone use may be responsible.

Bigger is not necessarily better. Besides the large Interphone study, Grimes cites the Danish cohort study as evidence that cell phone use is safe. However, this study has serious methodologic problems due to a wholly inadequate exposure assessment. Hence, the results from this study are not reliable.

The Telecom industry claims that their cellular technology is safe; yet, there are no safety studies on exposure to 4G or 5G cell phone radiation. Moreover, the weight of research evidence regarding exposure to 2G and 3G radiation finds harm including sperm damage in males, reproductive harm in females, neurological disorders, DNA damage and increased cancer risk.

There is room to disagree about the implications and quality of scientific studies, but it is disingenuous to disparage other scientists and employ industry talking points in the process, as Grimes does. The public has a right to know about the health risks of RFR. As Senator Blumenthal argued: “I believe that Americans deserve to know what the health effects are, not to pre-judge what scientific studies may show, and they also deserve a commitment to do the research on outstanding questions.”

Wednesday, February 12, 2020

Research on Smart Phone and Internet Addiction

Smart Phone/Cellphone Dependence/Addiction

Horvath J, Mundinger C, Schmitgen MM. Wolf ND, Sambataro F, Hirjak D, Kubera KM, Koenig J, Wolf RC. Structural and functional correlates of smartphone addiction. Addictive Behaviors. Volume 105, June 2020, 106334.


• We investigate brain function and structure in persons with “smartphone addiction” (SPA).
• Persons with SPA showed lower gray matter volume in insula and temporal cortex.
• Persons with SPA showed reduced resting-state activity of the anterior cingulate cortex.
• Anterior cingulate cortex volume and activity was associated with SPA-severity.
• The data suggest aberrant neural integrity of the salience network.


Popularity and availability of smartphones have dramatically increased in the past years. This trend is accompanied by increased concerns regarding potentially adverse effects of excessive smartphone use, particularly with respect to physical and mental health. Recently, the term “smartphone addiction” (SPA) has been introduced to describe smartphone-related addictive behavior and associated physical and psychosocial impairment. Here, we used structural and functional magnetic resonance imaging (MRI) at 3 T to investigate gray matter volume (GMV) and intrinsic neural activity in individuals with SPA (n = 22) compared to a control group (n = 26). SPA was assessed using the Smartphone Addiction Inventory (SPAI), GMV was investigated by means of voxel-based morphometry, and intrinsic neural activity was measured by the amplitude of low frequency fluctuations (ALFF). Compared to controls, individuals with SPA showed lower GMV in left anterior insula, inferior temporal and parahippocampal cortex (p < 0.001, uncorrected for height, followed by correction for spatial extent). Lower intrinsic activity in SPA was found in the right anterior cingulate cortex (ACC). A significant negative association was found between SPAI and both ACC volume and activity. In addition, a significant negative association between SPAI scores and left orbitofrontal GMV was found. This study provides first evidence for distinct structural and functional correlates of behavioral addiction in individuals meeting psychometric criteria for SPA. Given their widespread use and increasing popularity, the present study questions the harmlessness of smartphones, at least in individuals that may be at increased risk for developing smartphone-related addictive behaviors. 


Kobayashi K, Hsu M. Common neural code for reward and information value. PNAS. June 25, 2019 116 (26) 13061-13066.


Adaptive information seeking is critical for goal-directed behavior. Growing evidence suggests the importance of intrinsic motives such as curiosity or need for novelty, mediated through dopaminergic valuation systems, in driving information-seeking behavior. However, valuing information for its own sake can be highly suboptimal when agents need to evaluate instrumental benefit of information in a forward-looking manner. Here we show that information-seeking behavior in humans is driven by subjective value that is shaped by both instrumental and noninstrumental motives, and that this subjective value of information (SVOI) shares a common neural code with more basic reward value. Specifically, using a task where subjects could purchase information to reduce uncertainty about outcomes of a monetary lottery, we found information purchase decisions could be captured by a computational model of SVOI incorporating utility of anticipation, a form of noninstrumental motive for information seeking, in addition to instrumental benefits. Neurally, trial-by-trial variation in SVOI was correlated with activity in striatum and ventromedial prefrontal cortex. Furthermore, cross-categorical decoding revealed that, within these regions, SVOI and expected utility of lotteries were represented using a common code. These findings provide support for the common currency hypothesis and shed insight on neurocognitive mechanisms underlying information-seeking behavior.


It is more important than ever to seek information adaptively. While it is optimal to acquire information based solely on its instrumental benefit, humans also often acquire useless information because of psychological motives, such as curiosity and pleasure of anticipation. Here we show that instrumental and noninstrumental motives are multiplexed in subjective value of information (SVOI) signals in human brains. Subjects’ information seeking in an economic decision-making task was captured by a model of SVOI, which reflects not only information’s instrumental benefit but also utility of anticipation it provides. SVOI was represented in traditional value regions, sharing a common code with more basic reward value. This demonstrates that valuation system combines multiple motives to drive information-seeking behavior.

Raising questions about digital addiction
While the research does not directly address overconsumption of digital information, the fact that information engages the brain’s reward system is a necessary condition for the addiction cycle, he says. And it explains why we find those alerts saying we’ve been tagged in a photo so irresistible.
“The way our brains respond to the anticipation of a pleasurable reward is an important reason why people are susceptible to clickbait,” he says. “Just like junk food, this might be a situation where previously adaptive mechanisms get exploited now that we have unprecedented access to novel curiosities.”


O'Donnell S, Epstein LH. Smartphones are more reinforcing than food for students. Addict Behav. 2018 Oct 18;90:124-133. doi: 10.1016/j.addbeh.2018.10.018. 


• College students engage in high frequency smartphone use despite consequences.

• Comparing smartphones to food may establish their relative reinforcing value.
• Students were deprived of food and smartphones before working for both reinforcers.
• Phones were more reinforcing than food, and smartphone reinforcement was related to smartphone use.
• Smartphones are potent reinforcers, which may be why people use smartphones excessively.


College students engage in high-frequency smartphone use, despite potential negative consequences. One way to conceptualize this behavior is to consider it a highly reinforcing activity. Comparing motivation for smartphones to a powerful primary reinforcer, such as food, can establish their relative reinforcing value. This study investigated whether smartphones were more reinforcing than food, as well as the relationships between smartphone reinforcement, texting use, and smartphone motives. Participants were 76 college students (50% female, Mage = 18.9, SD = 0.99) who had no access to food for three hours and to their smartphones for two hours. After this modest deprivation period, participants worked for time to use their smartphones and 100-cal portions of their favorite snack food concurrently, with the work to obtain portions of both commodities increasing. The amount of smartphone use earned during the task was manipulated across groups (20, 30, 60, 120 s) to establish what amount of smartphone use was needed to motivate responding. Additionally, reinforcing efficacy of smartphones and food using a hypothetical purchase task and motivations for smartphone use was collected. Smartphones were more reinforcing than food using either measurement methodology (p's < 0.001). Smartphone reinforcement predicted number of text messages, controlling for age, sex, and family income. Positive smartphone use motives were associated with reinforcing efficacy of smartphones. These data show that smartphones are potent reinforcers, and are more reinforcing than food given modest food deprivation. These methods provide one important reason why people may use smartphones.


College students share a perception that smartphone ownership is beneficial; however smartphone use has been linked to increased anxiety (Jenaro, Flores, Gómez-Vela, González-Gil, & Caballo, 2007), social dysfunction (Jenaro et al., 2007) insomnia (Jenaro et al., 2007), low self-esteem (Bianchi & Phillips, 2005; Smetaniuk, 2014), emotional instability (Roberts, Pullig, & Manolis, 2015; Smetaniuk, 2014) and depression (Ezoe et al., 2009; Smetaniuk, 2014). Temporarily removing cell phones from high frequency cell phone users increased self-reported anxiety over a 75 min time period in comparison to less frequent users (Cheever et al., 2014). Despite the negative outcomes associated with problematic smartphone use, college students are highly motivated to use their smartphones.


Kates AW, Wu H, Chris LSC. The effects of mobile phone use on academic performance: A meta-analysis. Computers & Education. 127:107-112. Dec 2018.


• Study purpose is to further examine any relationships that may exist between mobile phone use and educational achievement.
• A meta-analysis on the relationship between mobile phone use & academic outcomes over 10 years (2008–2017) was conducted.
• Results indicate the summary effect of mobile phone use on student outcomes is r = −0.16 with 95% CI of −0.20 to −0.13.


Purpose  Although the mobile phone has been conspicuously proliferated in the past decades, little is known about its influence; especially its effect on student learning and academic performance. Although there is a growing interest in mobile devices and their correlates and consequences for children, effects vary across related studies and the magnitude of the overall effect remains unclear. The purpose of this study is to further examine any relationships that may exist between mobile phone use and educational achievement.

Research design  A meta-analysis of research conducted on the relationship between mobile phone use and student educational outcomes over a 10-year period (2008–2017) was conducted. The operational definition of cell phone use to guide the implementation of this study is: any measure of mobile phone use, whether considered normative or problematic, that quantifies the extent to which a person uses a phone, feels an emotional or other dependence on a phone, or categorizes the types of uses and situations in which use occurs. Studies examining use for the express purpose of educational improvement are not included, as the aim of this study is to ascertain the effects of normal smartphone use. The operational definition of academic achievement to guide the implementation of this study is: any measure that quantifies the extent to which a student or group of students is performing or feels he or she is performing to a satisfactory level, including but not limited to letter grades and test scores, knowledge and skill acquisition, and self-reported measures of academic ability or difficulty.

Findings  The overall meta-analysis indicated that the average effect of mobile phone usage on student outcomes was r =  −0.162 with a 95% confident interval of −0.196 to −0.128. The effect sizes of moderator variables (education level, region, study type, and whether the effect size was derived from a Beta coefficient, and mobile phone use construct) were analyzed. The results of this study and their implications for both research and practice are discussed.


The results of this study indicate that, overall, mobile phone use has a small negative effect (r = −0.16) on educational outcomes which is consistent with the previous literature (Lepp et al., 2015; Li et al., 2015). However, the results caution against coming to hasty conclusions based on these findings. The summary effect size is relatively small, even in the educational sphere. Hattie (2012), for example, conducted over 900 educational meta-analyses and found the largest summary effect for a classroom intervention to be a Cohen's d of 1.44. Taking this into account, it is not surprising that something so ubiquitous and increasingly integral to students' lives would have some influence on educational outcomes. Additionally, although the publication bias analysis suggests that these results are not greatly biased by a systematic exclusion of studies, it should be noted that the effects observed could be indicative of an association rather than causation. For example, those who are predisposed to overuse mobile devices may simply be less likely to achieve academically in the first place. That the summary effect is derived from studies involving experimental groups as well as cross-sectional studies, however, brings this possibility into question....

Despite the variability between studies, there appears to be a consistent negative, albeit small, effect on educational achievement. This suggests that avoidance of mobile phones in educational settings, or for those who are currently in school, could be beneficial for academic achievement..... 


Kuss DJ, Kanjo E, Crook-Rumsey M, Kibowski F, Wang GY, Sumich A. Problematic mobile phone use and addiction across generations: the roles of psychopathological symptoms and smartphone use. J Technol Behav Sci. 2018;3(3):141-149. doi: 10.1007/s41347-017-0041-3.


Contemporary technological advances have led to a significant increase in using mobile technologies. Recent research has pointed to potential problems as a consequence of mobile overuse, including addiction, financial problems, dangerous use (i.e. whilst driving) and prohibited use (i.e. use in forbidden areas). The aim of this study is to extend previous findings regarding the predictive power of psychopathological symptoms (depression, anxiety and stress), mobile phone use (i.e. calls, SMS, time spent on the phone, as well as the engagement in specific smartphone activities) across Generations X and Y on problematic mobile phone use in a sample of 273 adults. Findings revealed prohibited use and dependence were predicted by calls/day, time on the phone and using social media. Only for dependent mobile phone use (rather than prohibited), stress appeared as significant. Using social media and anxiety significantly predicted belonging to Generation Y, with calls per day predicted belonging to Generation X. This finding suggests Generation Y are more likely to use asynchronous social media-based communication, whereas Generation X engage more in synchronous communication. The findings have implications for prevention and awareness-raising efforts of possibly problematic mobile phone use for educators, parents and individuals, particularly including dependence and prohibited use.


Kim J-H. Psychological issues and problematic use of smartphone: ADHD's moderating role in the associations among loneliness, need for social assurance, need for immediate connection, and problematic use of smartphone. Computers in Human Behavior. 80:390-398. Mar 2018.


• Examined the mechanism linking loneliness with problematic use of smartphone.
• ADHD increased levels of loneliness, NSA, NIC, and problematic use of smartphone.
• FtF interaction decreased the association between NSA and NIC for those with ADHD.


Going beyond looking at the direct association between psychological issues (loneliness and ADHD) and problematic use of media (smartphone), the present study examined the covert mechanism connecting the two. NSA (need for social assurance) and NIC (need for immediate connection) were selected as mediating steps between the two. A total of 615 U.S. American participants were recruited nationally for survey participation. Research findings suggest that individuals who are lonely would rely on smartphone hoping to be connected with and get assurance from others, but might end up struggling with problematic use of smartphone. Those with ADHD showed higher levels of loneliness, NSA, NIC, and problematic use of smartphone, and also showed stronger associations linking loneliness, NSA and NIC compared to those without ADHD. Face-to-face (FtF) interaction decreased the association between NSA and NIC for those with ADHD.


Carbonell X, Chamarro A, Oberst U, Rodrigo B, Prades M. Problematic Use of the Internet and Smartphones in University Students: 2006-2017. Intl J Environ Research Publ Health. 15(3). Article 475. Mar 2018.


It has been more than a decade since a concern about the addictive use of the Internet and mobile phones was first expressed, and its possible inclusion into the lists of mental disorders has recently become a popular topic of scientific discussion. Thus, it seems to be a fitting moment to investigate the prevalence of this issue over time. The aim of the present study was to analyze the prevalence of the perception of problematic Internet and smartphone use in young people over the period 2006-2017. To this end, a questionnaire on Internet use habits and two questionnaires on the negative consequences of Internet and smartphone use were administered to a sample of 792 university students. The scores were then compared with the results of former studies that had used these questionnaires. The perception of problematic Internet and mobile phone use has increased over the last decade, social networks are considered responsible for this increase, and females are perceived to be more affected than males. The current study shows how strong smartphone and Internet addiction and social media overlap. Participants from 2017 report higher negative consequences of both Internet and mobile phone use than those from 2006, but long-term observations show a decrease in problematic use after a sharp increase in 2013. We conclude that the diagnosis of technological addictions is influenced by both time and social and culture changes.


Zou Z, Wang H, d'Oleire Uquillas F, Wang X, Ding J, Chen H. Definition of Substance and Non-substance Addiction. Adv Exp Med Biol. 2017;1010:21-41.


Substance addiction (or drug addiction) is a neuropsychiatric disorder characterized by a recurring desire to continue taking the drug despite harmful consequences. Non-substance addiction (or behavioral addiction) covers pathological gambling, food addiction, internet addiction, and mobile phone addiction. Their definition is similar to drug addiction but they differ from each other in specific domains. This review aims to provide a brief overview of past and current definitions of substance and non-substance addiction, and also touches on the topic of diagnosing drug addiction and non-drug addiction, ultimately aiming to further the understanding of the key concepts needed for a foundation to study the biological and psychological underpinnings of addiction disorders.


Gao T, Xiang YT, Zhang H, Zhang Z, Mei S. Neuroticism and quality of life: Multiple mediating effects of smartphone addiction and depression. Psychiatry Res. 2017 Dec;258:457-461. doi: 10.1016/j.psychres.2017.08.074.


The purposes of this study were to investigate the mediating effect of smartphone addiction and depression on neuroticism and quality of life. Self-reported measures of neuroticism, smart-phone addiction, depression, and quality of life were administered to 722 Chinese university students. Results showed smartphone addiction and depression were both significantly affected neuroticism and quality of life. The direct effect of neuroticism on quality of life was significant, and the chain-mediating effect of smartphone addiction and depression was also significant. In conclusion, neuroticism, smartphone addiction, and depression are important variables that worsen quality of life.


Kim HJ, Min JY, Kim HJ, Min KB. Accident risk associated with smartphone addiction: A study on university students in Korea. J Behav Addict. 2017 Nov 3:1-9. doi: 10.1556/2006.6.2017.070.


Background and aims: The smartphone is one of the most popular devices, with the average smartphone usage at 162 min/day and the average length of phone usage at 15.79 hr/week. Although significant concerns have been made about the health effects of smartphone addiction, the relationship between smartphone addiction and accidents has rarely been studied. We examined the association between smartphone addiction and accidents among South Korean university students.

Methods: A total of 608 college students completed an online survey that included their experience of accidents (total number; traffic accidents; falls/slips; bumps/collisions; being trapped in the subway, impalement, cuts, and exit wounds; and burns or electric shocks), their use of smartphone, the type of smartphone content they most frequently used, and other variables of interests. Smartphone addiction was estimated using Smartphone Addiction Proneness Scale, a standardized measure developed by the National Institution in Korea.

Results: Compared with normal users, participants who were addicted to smartphones were more likely to have experienced any accidents (OR = 1.90, 95% CI: 1.26-2.86), falling from height/slipping (OR = 2.08, 95% CI: 1.10-3.91), and bumps/collisions (OR = 1.83, 95% CI: 1.16-2.87). The proportion of participants who used their smartphones mainly for entertainment was significantly high in both the accident (38.76%) and smartphone addiction (36.40%) groups.

Discussion and conclusions: We suggest that smartphone addiction was significantly associated with total accident, falling/slipping, and bumps/collisions. This finding highlighted the need for increased awareness of the risk of accidents with smartphone addiction.


Wolniewicz CA, Tiamiyu MF, Weeks JW, Elhai JD. Problematic smartphone use and relations with negative affect, fear of missing out, and fear of negative and positive evaluation. Psychiatry Res. 2017 Sep 25. pii: S0165-1781(17)30901-0. doi: 10.1016/j.psychres.2017.09.058.


For many individuals, excessive smartphone use interferes with everyday life. In the present study, we recruited a non-clinical sample of 296 participants for a cross-sectional survey of problematic smartphone use, social and non-social smartphone use, and psychopathology-related constructs including negative affect, fear of negative and positive evaluation, and fear of missing out (FoMO). Results demonstrated that FoMO was most strongly related to both problematic smartphone use and social smartphone use relative to negative affect and fears of negative and positive evaluation, and these relations held when controlling for age and gender. Furthermore, FoMO (cross-sectionally) mediated relations between both fear of negative and positive evaluation with both problematic and social smartphone use. Theoretical implications are considered with regard to developing problematic smartphone use.


Han S, Kim KJ, Kim JH. Understanding Nomophobia: Structural Equation Modeling and Semantic Network Analysis of Smartphone Separation Anxiety. Cyberpsychol Behav Soc Netw. 2017 Jul;20(7):419-427. doi: 10.1089/cyber.2017.0113.


This study explicates nomophobia by developing a research model that identifies several determinants of smartphone separation anxiety and by conducting semantic network analyses on smartphone users' verbal descriptions of the meaning of their smartphones. Structural equation modeling of the proposed model indicates that personal memories evoked by smartphones encourage users to extend their identity onto their devices. When users perceive smartphones as their extended selves, they are more likely to get attached to the devices, which, in turn, leads to nomophobia by heightening the phone proximity-seeking tendency. This finding is also supplemented by the results of the semantic network analyses revealing that the words related to memory, self, and proximity-seeking are indeed more frequently used in the high, compared with low, nomophobia group.

Lee H, Kim JW, Choi TY. Risk Factors for Smartphone Addiction in Korean Adolescents: Smartphone Use Patterns. J Korean Med Sci. 2017 Oct;32(10):1674-1679. doi: 10.3346/jkms.2017.32.10.1674.


With widespread use of the smartphone, clinical evidence for smartphone addiction remains unclear. Against this background, we analyzed the effect of smartphone use patterns on smartphone addiction in Korean adolescents. A total of 370 middle school students participated. The severity of smartphone addiction was measured through clinical interviews and the Korean Smartphone Addiction Proneness Scale. As a result, 50 (13.5%) were in the smartphone addiction group and 320 (86.5%) were in the healthy group. To investigate the effect of smartphone use patterns on smartphone addiction, we performed self-report questionnaires that assessed the following items: smartphone functions mostly used, purpose of use, problematic use, and parental attitude regarding smartphone use. For smartphone functions mostly used, the addiction group showed significantly higher scores in "Online chat." For the purpose of use, the addiction group showed significantly higher "habitual use," "pleasure," "communication," "games," "stress relief," "ubiquitous trait," and "not to be left out." For problematic use, the addiction group showed significantly higher scores on "preoccupation," "tolerance," "lack of control," "withdrawal," "mood modification," "conflict," "lies," "excessive use," and "loss of interest." For parental attitude regarding children's smartphone use, the addiction group showed significantly higher scores in "parental punishment." Binary logistic regression analysis indicated that "female," "use for learning," "use for ubiquitous trait," "preoccupation," and "conflict" were significantly correlated with smartphone addiction. This study demonstrated that the risk factors for smartphone addiction were being female, preoccupation, conflict, and use for ubiquitous trait; the protective factor was use for learning. Future studies will be required to reveal the additional clinical evidence of the disease entity for smartphone addiction.

Kuss DJ, Griffiths MD. Social Networking Sites and Addiction: Ten Lessons Learned. Int J Environ Res Public Health. 2017 Mar 17;14(3). pii: E311. doi: 10.3390/ijerph14030311.
Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.


De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-Phone Addiction: A Review. Front Psychiatry. 2016 Oct 24;7:175.


We present a review of the studies that have been published about addiction to cell phones. We analyze the concept of cell-phone addiction as well as its prevalence, study methodologies, psychological features, and associated psychiatric comorbidities. Research in this field has generally evolved from a global view of the cell phone as a device to its analysis via applications and contents. The diversity of criteria and methodological approaches that have been used is notable, as is a certain lack of conceptual delimitation that has resulted in a broad spread of prevalent data. There is a consensus about the existence of cell-phone addiction, but the delimitation and criteria used by various researchers vary. Cell-phone addiction shows a distinct user profile that differentiates it from Internet addiction. Without evidence pointing to the influence of cultural level and socioeconomic status, the pattern of abuse is greatest among young people, primarily females. Intercultural and geographical differences have not been sufficiently studied. The problematic use of cell phones has been associated with personality variables, such as extraversion, neuroticism, self-esteem, impulsivity, self-identity, and self-image. Similarly, sleep disturbance, anxiety, stress, and, to a lesser extent, depression, which are also associated with Internet abuse, have been associated with problematic cell-phone use. In addition, the present review reveals the coexistence relationship between problematic cell-phone use and substance use such as tobacco and alcohol.


Bragazzi NL, Del Puente G. A proposal for including nomophobia in the new DSM-V. Psychol Res Behav Manag. 2014 May 16;7:155-60. doi: 10.2147/PRBM.S41386.


The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered to be the gold standard manual for assessing the psychiatric diseases and is currently in its fourth version (DSM-IV), while a fifth (DSM-V) has just been released in May 2013. The DSM-V Anxiety Work Group has put forward recommendations to modify the criteria for diagnosing specific phobias. In this manuscript, we propose to consider the inclusion of nomophobia in the DSM-V, and we make a comprehensive overview of the existing literature, discussing the clinical relevance of this pathology, its epidemiological features, the available psychometric scales, and the proposed treatment. Even though nomophobia has not been included in the DSM-V, much more attention is paid to the psychopathological effects of the new media, and the interest in this topic will increase in the near future, together with the attention and caution not to hypercodify as pathological normal behaviors.

Open source paper:


Hussain Z. Smartphone Use, Addiction, Narcissism, and Personality: A Mixed Methods Investigation.International Journal of Cyber Behavior, Psychology and Learning. 5(1):17-32. 2015.


There are increasing numbers of people who are now using smartphones. Consequently, there is a risk of addiction to certain web applications such as social networking sites (SNSs) which are easily accessible via smartphones. There is also the risk of an increase in narcissism amongst users of SNSs. 
The present study set out to investigate the relationship between smartphone use, narcissistic tendencies and personality as predictors of smartphone addiction. The study also aimed to investigate the distinction between addiction specificity and co-occurrence in smartphone addiction via qualitative data and discover why people continue to use smartphones in banned areas. A self-selected sample of 256 smartphone users (Mean age = 29.2, SD = 9.49) completed an online survey. The results revealed that 13.3% of the sample was classified as addicted to smartphones. Higher narcissism scores and neuroticism levels were linked to addiction. Three themes of; social relations, smartphone dependence and self-serving personalities emerged from the qualitative data. Interpretation of qualitative data supports addiction specificity of the smartphone. It is suggested smartphones encourage narcissism, even in non-narcissistic users. In turn, this increased use in banned areas. Future research needs to gather more in-depth qualitative data, addiction scale comparisons and comparison of use with and without SNS access. It is advised that prospective buyers of smartphones be pre-warned of the potential addictive properties of new technology.

Internet Addiction

Sussman CJ, Harper JM, Stahl JL, Weigel P. Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology. Child Adolesc Psychiatric Clin N Am 27 (2018) 307–326.

Key Points

  • Proposed criteria for diagnosis of Internet gaming disorder and other digital technology addictions are analogous to those for substance use or gambling disorders.
  • Diagnosis of Internet and video game addictions should include both screening tools and clinical interview for “red flags,” such as academic decline, sleep disruption, and changes in real-life activities and relationships.
  • Epidemiologic studies, limited by variation in diagnostic methods, yield prevalence estimates ranging from less than 1.0% to 26.8%.
  • Internet and video game addictions are associated with psychological and social comorbidities, such as depression, attention-deficit/hyperactivity disorder, alcohol use, anxiety,and poor psychosocial support.
  • Neurobiological evidence suggests a dual processing model of digital technology addictions characterized by an imbalance between the reactive reward system and the reflective reward system

In spite of the lack of a consensus on diagnosis, and the resulting variations in epidemiologic, comorbidity, and neurobiological research, these studies provide overwhelming evidence of similarities between IVGA and SUD. Taken as a whole, the research presented here strongly suggests that IVGA is a clinically relevant and valid syndrome. Like other addictions, it is better understood when incorporating a neuro-biological perspective. Our field must successfully address IVGAs to meet the needs of a society that is increasingly enmeshed in digital technology. Research in this area should continue to accelerate, allowing clinicians to better screen for, diagnose, psycho-educate, and provide multimodal treatment for our patients with IVGA. Treatment of IVGAs is explored in David N. Greenfield’s article, “Treatment Considerations in Internet and Video Game Addiction: A Qualitative Discussion,” in this issue.

Significant limitations in the current body of research include the difficulty in determining causality among many epidemiologic correlations, the limited knowledge of brain changes occurring in IVGA, including whether they are reversible, and the absence of animal model studies. These weaknesses will likely continue to encourage challenges to the validity of IVGA from critics. Some argue that digital technology use is so pervasive that the diagnosis may overpathologize behavior that is normative and acceptable in our culture.105 On the other hand, modern society’s excessive engagement with technology risks falsely normalizing addictions to technology, in what may be a culture of “functional tech-oholics.” It seems difficult to walk down a public street without seeing multiple passersby engaged with smartphones, or to partake in a group conversation with no mention of digital media in some form. It seems evident that the human brain cannot evolve fast enough to adapt to the progress of digital technology, and that even the most powerful prefrontal cortex may be unable to resist the allure of instant stimulation in the ocean of digital screens that our world is becoming. Regardless of where we place the diagnostic cutoff for IVGA, our patients suffering the most profound dysfunction from their use of digital technology need better resources to recognize, understand, and treat their condition. If IVGA proves to be more abundant than a collection of a few extreme cases, it will be even more vital for our psychoeducational interventions to reach not only affected individuals, but their families and the communities as well. Ironically, social media and other forms of screen-based education may prove the best platforms for reaching out to those suffering IVGA without the insight, knowledge, and resources to address it.a This fact reminds us that learning more about the benefits of digital technology as well as its risks represents a challenge for modern providers and an opportunity for contemporary researchers.


Cheng YS, Tseng PT, Lin PY, Chen TY, Stubbs B, Carvalho AF, Wu CK, Chen YW, Wu MK. Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761.


OBJECTIVE: To perform a systematic review and meta-analysis of observational studies that investigated the putative association between internet addiction and suicidality.

DATA SOURCES: Major electronic databases (PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, Science Direct, and were searched using the following keywords (internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use) AND (suicide OR depression) to identify observational studies from inception to October 31, 2017.

STUDY SELECTION: We included 23 cross-sectional studies (n = 270,596) and 2 prospective studies (n = 1,180) that investigated the relationship between suicide and internet addiction.

DATA EXTRACTION: We extracted the rates of suicidal ideation, planning, and attempts in individuals with internet addiction and controls.

RESULTS: The individuals with internet addiction had significantly higher rates of suicidal ideation (odds ratio [OR] = 2.952), planning (OR = 3.172), and attempts (OR = 2.811) and higher severity of suicidal ideation (Hedges g = 0.723). When restricted to adjusted ORs for demographic data and depression, the odds of suicidal ideation and attempts were still significantly higher in the individuals with internet addiction (ideation: pooled adjusted OR = 1.490; attempts: pooled adjusted OR = 1.559). In subgroup analysis, there was a significantly higher prevalence rate of suicidal ideation in children (age less than 18 years) than in adults (OR = 3.771 and OR = 1.955, respectively).

CONCLUSIONS: This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression. However, the evidence was derived mostly from cross-sectional studies. Future prospective studies are necessary to confirm these findings.


Fumero A, Marrero RJ, Voltes D, Peñate  W. Personal and social factors involved in internet addiction among adolescents: A meta-analysis. Computers in Human Behavior. 86:387-400. Sep 2018.


• Internet addiction (IA) was associated with psychosocial factors in adolescents.
• The risk factors had a greater effect on IA than protective factors.
• Personal factors showed a greater association with IA than social factors.
• Hostility, depression and anxiety showed the greatest link with IA.


Background and Aims  The growing popularity and frequency of Internet use has resulted in a large number of studies reporting various clinical problems associated with its abuse. The main purpose of this study is to conduct a meta-analysis of the association between Internet addiction (IA) and a number of personal and social psychological factors in adolescents.

Methods  The search included cross-sectional, case-control and cohort studies which analyzed the relationship between IA and at least one of the following personal variables: (i) psychopathology, (ii) personality features and (iii) social difficulties, as well as (iv) self-esteem, (v) social skills and (vi) positive family functioning. These variables were classified as protective and promoting factors of the risk of developing IA.

Results  A total of 28 studies with adequate methodological quality were identified in the primary medical, health and psychological literature databases up to November 2017. Of the 48,090 students included in the analysis, 6548 (13.62%) were identified as excessive Internet users. The results highlight that risk factors had a greater effect on IA than protective factors. Also, personal factors showed a greater link with IA than social factors.

Conclusions  The data provide relevant information for those developing programs for the prevention of IA and the enhancement of protective factors.

Social Networking Site Disorder

Hunt MG, Marx R, Lipson C, Young J. No More FOMO: Limiting social media decreases loneliness and depression. Journal of Social and Clinical Psychology. 37(10): 751-768. 2018.


Introduction: Given the breadth of correlational research linking social media use to worse well-being, we undertook an experimental study to investigate the potential causal role that social media plays in this relationship.

Method: After a week of baseline monitoring, 143 undergraduates at the University of Pennsylvania were randomly assigned to either limit Facebook, Instagram and Snapchat use to 10 minutes, per platform, per day, or to use social media as usual for three weeks.

Results: The limited use group showed significant reductions in loneliness and depression over three weeks compared to the control group. Both groups showed significant decreases in anxiety and fear of missing out over baseline, suggesting a benefit of increased self-monitoring.

Discussion: Our findings strongly suggest that limiting social media use to approximately 30 minutes per day may lead to significant improvement in well-being.


Most of the prior research that has been done on social media and well-being has been correlational in nature. A few prospective and experimental studies have been done, but they have only focused on Facebook. Our study is the first ecologically valid, experimental investigation that examines multiple social media platforms and tracks actual usage objectively. The results from our experiment strongly suggest that limiting social media usage does have a direct and positive impact on subjective well- and depression. That is, ours is the first study to establish a clear causal link between decreasing social media use, and improvements in loneliness and depression. It is ironic, but perhaps not surprising, that reducing social media, which promised to help us connect with others, actually helps people feel less lonely and depressed. 


Pontes HM. Investigating the differential effects of social networking site addiction and Internet gaming disorder on psychological health. J Behav Addict. 2017 Nov 13:1-10. doi: 10.1556/2006.6.2017.075.


Background and aims: Previous studies focused on examining the interrelationships between social networking site (SNS) addiction and Internet gaming disorder (IGD) in isolation. Moreover, little is known about the potential simultaneous differential effects of SNS addiction and IGD on psychological health. This study investigated the interplay between these two technological addictions and ascertained how they can uniquely and distinctively contribute to increasing psychiatric distress when accounting for potential effects stemming from sociodemographic and technology-related variables.

Methods: A sample of 509 adolescents (53.5% males) aged 10-18 years (mean = 13.02, SD = 1.64) were recruited.

Results: It was found that key demographic variables can play a distinct role in explaining SNS addiction and IGD. Furthermore, it was found that SNS addiction and IGD can augment the symptoms of each other, and simultaneously contribute to deterioration of overall psychological health in a similar fashion, further highlighting potentially common etiological and clinical course between these two phenomena. Finally, the detrimental effects of IGD on psychological health were found to be slightly more pronounced than those produced by SNS addiction, a finding that warrants additional scientific scrutiny.

Discussion and conclusion: The implications of these results are further discussed in light of the existing evidence and debates regarding the status of technological addictions as primary and secondary disorders.

Internet Gaming Disorder/Addiction

Gaming disorder

World Health Organization, January 2018
What is gaming disorder?
Gaming disorder is defined in the draft 11th Revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
What is the International Classification of Diseases?
The International Classification of Diseases (ICD) is the basis for identification of health trends and statistics globally and the international standard for reporting diseases and health conditions. It is used by medical practitioners around the world to diagnose conditions and by researchers to categorize conditions.
The inclusion of a disorder in ICD is a consideration which countries take into account when planning public health strategies and monitoring trends of disorders.
WHO is working on updating of the ICD. The 11th revision of the International Classification of Diseases (ICD-11) is scheduled for publication in mid-2018.
Why is gaming disorder being included in ICD-11?
A decision on inclusion of gaming disorder in ICD-11 is based on reviews of available evidence and reflects a consensus of experts from different disciplines and geographical regions that were involved in the process of technical consultations undertaken by WHO in the process of ICD-11 development.
The inclusion of gaming disorder in ICD-11 follows the development of treatment programmes for people with health conditions identical to those characteristic of gaming disorder in many parts of the world, and will result in the increased attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures.
Should all people who engage in gaming be concerned about developing gaming disorder?
Studies suggest that gaming disorder affects only a small proportion of people who engage in digital- or video-gaming activities. However, people who partake in gaming should be alert to the amount of time they spend on gaming activities, particularly when it is to the exclusion of other daily activities, as well as to any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behaviour.

Park CH, Chun JW, Cho H, Kim DJ. Alterations in the connection topology of brain structural networks in Internet gaming addiction. Sci Rep. 2018 Oct 11;8(1):15117. doi: 10.1038/s41598-018-33324-y.


Internet gaming addiction (IGA), as the most popular subtype of Internet addiction, is becoming a common and widespread mental health concern, but there are still debates on whether IGA constitutes a psychiatric disorder. The view on the brain as a complex network has developed network analysis of neuroimaging data, revealing that abnormalities of brain functional and structural systems are related to alterations in brain network configuration, such as small-world topology, in neuropsychiatric disorders. Here we applied network analysis to diffusion-weighted MRI data of 102 gaming individuals and 41 non-gaming healthy individuals to seek changes in the small-world topology of brain structural networks in IGA. The connection topology of brain structural networks shifted to the direction of random topology in the gaming individuals, irrespective of whether they were diagnosed with Internet gaming disorder. Furthermore, when we simulated targeted or untargeted attacks on nodes, the connection topology of the gaming individuals' brain structural networks under no attacks was comparable to that of the non-gaming healthy individuals' brain structural networks under targeted attacks. Alterations in connection topology provide a clue that Internet gaming addicted brains could be as abnormal as brains suffering from targeted damage. 

Open access paper:


Wang HR, Cho H, Kim DJ. Prevalence and correlates of comorbid depression in a nonclinical online sample with DSM-5 internet gaming disorder. J Affect Disord. 2018 Jan 15;226:1-5. doi: 10.1016/j.jad.2017.08.005.


BACKGROUND: We investigated the prevalence and correlates of comorbid depression among patients with internet gaming disorder using the Internet Gaming Disorder scale (IGD-9) and the Patient Health Questionnaire-9 (PHQ-9) among nonclinical online survey respondents.

METHODS: Korean adolescents and adults from 14 to 39 years of age were selected. We compared internet gaming use patterns and sociodemographic and clinical variables between patients with internet gaming disorder who had depression and those without depression.

RESULTS: In 2016, 7200 people participated in an online survey. Respondents with internet gaming disorder that was comorbid with depression were older, more often female, had greater Internet Addiction Test total scores, Alcohol Use Disorder Identification Test total scores, Generalized Anxiety Disorder Scale-7 total scores, Fagerstrom Test for Nicotine Dependence total scores, and higher Dickman Dysfunctional Impulsivity Instrument dysfunctional subscale scores than those without depression. The binary logistic regression analysis revealed that female gender, problematic alcohol use, anxiety, and a past history of psychiatric counseling or treatment due to internet gaming use were significant predictors for comorbid depression among participants with internet gaming disorder.

CONCLUSION: Depression was a common comorbidity of internet gaming disorder. Internet gaming disorder with comorbid depression was related to more serious psychiatric phenomenology and a greater psychiatric burden.


Stockdale L, Coyne SM. Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls. J Affect Disord. 2018 Jan 1;225:265-272. doi: 10.1016/j.jad.2017.08.045.


BACKGROUND: The Internet Gaming Disorder Scale (IGDS) is a widely used measure of video game addiction, a pathology affecting a small percentage of all people who play video games. Emerging adult males are significantly more likely to be video game addicts. Few researchers have examined how people who qualify as video game addicts based on the IGDS compared to matched controls based on age, gender, race, and marital status.
METHOD: The current study compared IGDS video game addicts to matched non-addicts in terms of their mental, physical, social-emotional health using self-report, survey methods.
RESULTS: Addicts had poorer mental health and cognitive functioning including poorer impulse control and ADHD symptoms compared to controls. Additionally, addicts displayed increased emotional difficulties including increased depression and anxiety, felt more socially isolated, and were more likely to display internet pornography pathological use symptoms. Female video game addicts were at unique risk for negative outcomes.
LIMITATIONS: The sample for this study was undergraduate college students and self-report measures were used.
CONCLUSIONS: Participants who met the IGDS criteria for video game addiction displayed poorer emotional, physical, mental, and social health, adding to the growing evidence that video game addictions are a valid phenomenon.


Paik SH, Cho H, Chun JW, Jeong JE, Kim DJ. Gaming Device Usage Patterns Predict Internet Gaming Disorder: Comparison across Different Gaming Device Usage Patterns. Int J Environ Res Public Health. 2017 Dec 5;14(12). pii: E1512. doi: 10.3390/ijerph14121512.


Gaming behaviors have been significantly influenced by smartphones. This study was designed to explore gaming behaviors and clinical characteristics across different gaming device usage patterns and the role of the patterns on Internet gaming disorder (IGD). Responders of an online survey regarding smartphone and online game usage were classified by different gaming device usage patterns: (1) individuals who played only computer games; (2) individuals who played computer games more than smartphone games; (3) individuals who played computer and smartphone games evenly; (4) individuals who played smartphone games more than computer games; (5) individuals who played only smartphone games. Data on demographics, gaming-related behaviors, and scales for Internet and smartphone addiction, depression, anxiety disorder, and substance use were collected. Combined users, especially those who played computer and smartphone games evenly, had higher prevalence of IGD, depression, anxiety disorder, and substance use disorder. These subjects were more prone to develop IGD than reference group (computer only gamers) (B = 0.457, odds ratio = 1.579). Smartphone only gamers had the lowest prevalence of IGD, spent the least time and money on gaming, and showed lowest scores of Internet and smartphone addiction. Our findings suggest that gaming device usage patterns may be associated with the occurrence, course, and prognosis of IGD.


Du X, Yang Y, Gao P, Qi X, Du G, et al. Compensatory increase of functional connectivity density in adolescents with internet gaming disorder. Brain Imaging Behav. 2017 Dec;11(6):1901-1909. doi: 10.1007/s11682-016-9655-x.


Behavioral studies have demonstrated visual attention bias and working memory deficits in individuals with internet gaming disorder (IGD). Neuroimaging studies demonstrated that individuals with IGD presented abnormalities in brain structures and functions including resting-state functional connectivity (rsFC) disturbance. However, most previous studies investigated IGD-related rsFC alterations by using hypothesis-driven methods with priori selection of a region of interest, which cannot provide a full picture of the rsFC changes in IGD individuals. In this study, we recruited 27 male IGD adolescents and 35 demographically matched healthy controls (HCs) to investigate abnormal connective property of each voxel within whole brain of IGD adolescents using resting-state functional connectivity density (rsFCD) method, and further to evaluate the relationship between altered rsFCD and behavioral performances of visual attention and working memory. The results exhibited no significant intergroup difference in behavioral performance (visual working memory and attention). The IGD adolescents exhibited higher global/long-range rsFCD in the bilateral dorsal lateral prefrontal cortex (DLPFC) and the right inferior temporal cortex (ITC)/fusiform compared with the HCs. Although no significant correlation survived after Bonferroni correction, higher global/long-range rsFCD of the bilateral DLPFC was correlated with the Young's internet addiction test (IAT) score and/or behavioral performance in IGD adolescents using an uncorrected threshold of P < 0.05. In conclusion, IGD adolescents demonstrated increased rsFCD in the brain regions involved in working memory, spatial orientation and attention processing, which indicated that increased rsFCD may reflect a compensatory mechanism for maintaining the normal behavioral performance in IGD adolescents compared with the HCs.


Zhai J, Luo L, Qiu L, Kang Y, Liu B, et al. The topological organization of white matter network in internet gaming disorder individuals. Brain Imaging Behav. 2017 Dec;11(6):1769-1778. doi: 10.1007/s11682-016-9652-0.


White matter (WM) integrity abnormalities had been reported in Internet gaming disorder (IGD). Diffusion tensor imaging (DTI) tractography allows identification of WM tracts, potentially providing information about the integrity and organization of relevant underlying WM fiber tracts' architectures, which has been used to investigate the connectivity of cortical and subcortical structures in several brain disorders. Unfortunately, relatively little is known about the thoroughly circuit-level characterization of topological property changes of WM network with IGD. Sixteen right-hand adolescents with IGD participated in our study, according to the diagnostic criteria of IGD in DSM-5. Meanwhile, 16 age and gender-matched healthy controls were also enrolled. DTI tractography was employed to generate brain WM networks in IGD individuals and healthy controls. The 90 cortical and subcortical regions derived from AAL template were chosen as the nodes. The network parameters (i.e., Network strength, clustering coefficient, shortest path length, global efficiency, local efficiency, regional efficiency) were calculated and then correlated with the Internet addiction test (IAT) scores in IGD. IGD group showed decreased global efficiency, local efficiency and increased shortest path length. Further analysis revealed the reduced nodal efficiency in frontal cortex, anterior cingulate cortex and pallidium in IGD. In addition, the global efficiency of WM network was correlated with the IAT scores in IGD (r = -0.5927; p = 0.0155). We reported the abnormal topological organization of WM network in IGD and the association with the severity of IGD, which may provide new insights into the neural mechanism of IGD from WM network level.


Zajac K, Ginley MK, Chang R, Petry NM. Treatments for Internet gaming disorder and Internet addiction: A systematic review. Psychol Addict Behav. 2017 Dec;31(8):979-994. doi: 10.1037/adb0000315. Epub 2017 Sep 18.


Problems related to excessive use of the Internet and video games have recently captured the interests of both researchers and clinicians. The goals of this review are to summarize the literature on treatment effectiveness for these problems and to determine whether any treatments meet the minimum requirement of an evidence-based treatment as defined by Chambless et al. (1998). Studies of treatments for Internet gaming disorder (IGD) and Internet addiction were examined separately, as past studies have linked IGD to more severe outcomes. The systematic review identified 26 studies meeting predefined criteria; 13 focused on treatments for IGD and 13 on Internet addiction. The results highlighted a paucity of well-designed treatment outcome studies and limited evidence for the effectiveness of any treatment modality. Studies were limited by methodological flaws, including small sample sizes, lack of control groups, and little information on treatment adherence, among other problems. In addition, the field is beset by a lack of consistent definitions of and established instruments to measure IGD and Internet addiction. The results of this review highlight the need for additional work in the area of treatment development and evaluation for IGD and Internet addiction. Attention to methodological concerns identified within this review should improve subsequent research related to treating these conditions, and ultimately outcomes of patients suffering from them.