Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 10, 2019; 9(3): 55-64
Published online Jun 10, 2019. doi: 10.5498/wjp.v9.i3.55
Problematic Internet use in drug addicts under treatment in public rehab centers
Stefano Baroni, Donatella Marazziti, Federico Mucci, Elisa Diadema, Liliana Dell’Osso
Stefano Baroni, Donatella Marazziti, Federico Mucci, Elisa Diadema, Liliana Dell’Osso, Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa 56100, Italy
Author contributions: Baroni S and Marazziti D planned and organized the implementation of the study, contributed to the creation of the interactive platform on external server, carried out statistical analyses, and wrote the manuscript; Dell’Osso L planned and organized and supervised the implementation of the study and wrote the manuscript; Mucci F and Diadema E contributed to the implementation of the study, checked the arriving questionnaires, organized the data for statistical analyses, and wrote the manuscript; All authors approved the final form of the manuscript.
Supported by A grant from “ Regione Calabria” , Italy.
Institutional review board statement: The study was approved by the Ethics Committee of Pisa University.
Informed consent statement: The study was approved by the Ethics Committee of Pisa University, and the participants decided to take part in it on a voluntary basis and in an anonymous way, so that it was not possible to identify them.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Donatella Marazziti, MD, PhD, Adjunct Professor, Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Via Roma 67, Pisa 56100, Italy. dmarazzi@psico.med.unipi.it
Telephone: +39-50-2219768 Fax: +39-50-2219787
Received: April 26, 2018
Peer-review started: April 26, 2018
First decision: June 15, 2018
Revised: January 30, 2019
Accepted: May 15, 2019
Article in press: May 15, 2019
Published online: June 10, 2019
Research background

Problematic Internet use (PIU) is a novel behavioral addiction characterized by excessive Internet use that is becoming an increasing problem worldwide. Although no agreement exists on precise diagnostic criteria, PIU is considered a behavioral addiction sharing with substance use disorders (SUDs) and other addictions several features and perhaps neurobiological under-pinnings.

Research motivation

Unfortunately, no information is available on the prevalence of PIU amongst drug-addicted subjects, in spite of the given evidence, that these individuals tend to be affected by polydrug use and also by behavioral addictions, as if the presence of one or more addictions would represent a sort of vulnerability towards a worsening of the clinical picture through the onset of other kinds of these disorders.

Research objectives

The investigation of the possible existence and prevalence of PIU amongst drug-addicts under treatment in rehab centers would permit the implementation of specific treatments to prevent the onset of other kind of addictions that could worsen the clinical picture and the rehabilitation programs.

Research methods

A specific questionnaire to be filled online, the so-called Questionario sull’Utilizzo delle Nuove Tecnologie (QUNT), was developed to explore the prevalence and characteristics of both Internet use and PIU. The QUNT consists of two sections, one for demographic data and another consisting of 101 items grouped in factors built according to a priori criteria extrapolated from the data available in scientific literature. All subjects who volunteered to participate in the study (n = 183) reported that the QUNT was useful and were satisfied with it. The factor scores were calculated as the sum of the scores obtained in each item divided by the maximum score in percentage. We chose the answer 4 (between 4 and 6 hr/d), and the answer 5 (> 6 hr/d) of item 2 “time spent online”. In order to identify the body mass index (points for, respectively, the possible or certain (and severe) presence of PIU.

Research results

The time spent online was more than 4 hr/d in the total sample, with a slight, although not significant, prevalence amongst male subjects. Cocaine and cannabis users spent more than 6 hours online, significantly more than opioid and alcohol users. The distribution of the QUNT factors was not different in both sexes. Cocaine users showed higher scores at the “loss of control”, “pornography addiction”, and “addiction to social networks”, probably because of the stimulant effect of this substance. Moreover, 15 out of the total 17 cocaine users were also pathological gamblers. Positive and statistically significant relationships were also observed between some QUNT factors and body mass index (BMI). These results, while showing that PIU is common amongst stimulant drug abusers, require to be replicated in larger samples from other countries. Nevertheless, they underline the risk of behavioral addictions in drug addicts, a problem that should be taken into account when planning prevention and intervention strate-gies.

Research conclusions

The new findings of this study are represented by the large percentage of PIU amongst drug addicts, especially if they use cocaine or cannabis. This suggests that, although the abuse of Internet is present in all drug addicts, PIU is less common in subjects taking sedative substances, such as heroin/opioids and alcohol, while it may become a sort of “stimulant” trigger in cocaine and cannabis users, as supported by the high prevalence of pathological gaming amongst cocaine abusers. Further, PIU is more frequent in single subjects or subjects living alone, a result stressing the protective effects of loving or social relationships in general against the onset of addictions. Those subjects who spent more time online, as shown by the higher score of the “time spent online”, “social withdrawal”, “abstraction from reality”, and “addiction to social network” factors, had a higher BMI. Therefore, the excessive use of the Internet can be considered as another factor increasing sedentary behaviors that may be particularly risky in drug addicts, subjects already prone to different medical diseases. Reduced sleeping time and disrupted circadian rhythms due to PIU are other factors that may increase the probability of metabolic, medical, and psychiatric disorders as well as the impairment of work, family, social, or school performance.

Research perspectives

The findings of the present study indicate that behavioral addictions, such as PIU, can broaden polydrug use, especially in subjects taking stimulants or cannabis. In addition, PIU may be considered another factor increasing negative life habits, already impaired in drug addicts, while promoting sedentary behaviors and maladjustments in different individual’s domains. Future studies should take into consideration the impact of PIU on drug addicts by means of specific instru-ments to assess it, in order to prevent, not only its detrimental consequences, but also those related to a broadening of addictive behaviors.