Problematic Internet use is associated with other risk behaviors

Responses to a questionnaire administered to more than 3000 young adolescents in Switzerland indicate that problematic Internet use is associated with the use of legal and illegal substances, especially tobacco. Problematic Internet use is a disorder characterized by symptoms such as restlessness or irritability when not online or feeling the need to spend more time online.

The anonymous self-administered questionnaire, the French version of the Internet Addiction Test, consists of 51 questions to appraise problematic Internet use (such as, “How often do you find that you stay online longer than you intended?”) and substance abuse (such as, “Have you been drunk during the previous 30 days?”) Each answer is scored on a scale of 1 to 5. Based on participants’ total test score, investigators divided respondents into 2 groups-those who were regular Internet users and those who were problematic users. They then ascertained whether there was a link between problematic Internet use and substance use after controlling for potential confounding variables known to be linked to risky behaviors, such as age, gender, family, type of student (good, average, or below average), family structure, main purpose for Internet use (education, work, or leisure), and emotional well-being.

Problematic users were more likely to be female; to use any of the studied substances (tobacco, alcohol, cannabis, and other drugs); to use the Internet for leisure rather than for work; to have parents who did not live together; to report poor emotional well-being; and to be below-average students. The relationship of problematic Internet use with substance use was not the same for all substances, however. Whereas there was a direct link between problematic users and smoking, the link between problematic users and alcohol, cannabis, and other illegal drugs was only via tobacco use, which was a gateway for other substances. The researchers concluded that these findings suggest that Internet addiction could be an important predictor of adolescent substance abuse (Rücker J, et al. Acta Paediatr. 2015;104[5]:504-507).

Commentary: The researchers are not claiming cause and effect but rather that Internet overuse is associated with these other behaviors and therefore might be a useful screen for identifying high-risk patients. Longitudinal studies of this association might be able to reveal whether Internet addiction is the chicken or the egg. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.