During the Albatros International Congress of Addiction 2026 held in Paris on June 9-11, speakers highlighted the need for clearer diagnostic criteria, stronger evidence to guide treatment, and broader public health measures to address the growing burden of problematic use of the internet (PUI).

Zsolt Demetrovics, PhD, professor in Mental Health and Wellbeing and director of the Flinders University Institute for Mental Health and Wellbeing in Adelaide, Australia, discussed that recognizing internet-related disorders as addictions is a relatively recent development.

For many years, research on addiction focused exclusively on substance use disorders, whereas excessive behaviors such as compulsive gambling, shopping, sexual activity, exercise, and eating have been classified as impulse control or compulsive disorders. Over time, researchers recognized that many of these behavioral disorders share fundamental features with substance addiction, including craving, loss of control, and dysregulation of the brain’s reward system. Although theories differ across behavioral addictions, alterations in the reward circuitry appear to represent a common biologic mechanism.

According to Demetrovics, the field changed during the mid-1990s with the rapid expansion of computers and the internet. Digital technologies have created new opportunities for communication through social media, gaming, gambling, online shopping, and access to pornography. At the same time, they have facilitated the emergence of behavioral addictions, which have become an increasingly important public health concern.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, recognized gambling disorder as a behavioral addiction and identified internet-related addictive behaviors as a key area for further research. The International Classification of Diseases, 11th Revision, recognizes both gambling and gaming disorders as disorders due to addictive behaviors. Today researchers must examine both the shared characteristics and differences among addictive behaviors while adapting to the rapid changes driven by AI.

Need for Clear Clinical Criteria

Naomi A. Fineberg, MD, professor of psychiatry at the University of Hertfordshire, Hatfield, England, noted that PUI encompasses several forms of problematic online behavior, including gaming, gambling, pornography, shopping, and social media use.

These behaviors share several common traits associated with addiction, including an inability to reduce use, craving, neglect of other responsibilities and needs, continued engagement despite harmful consequences, and tolerance and withdrawal symptoms in some cases.

Several studies have reported associations between PUI and suicide risk, depression, anxiety disorders, and attention-deficit/hyperactivity disorder. According to Fineberg, these psychiatric conditions often develop as consequences, rather than causes, of PUI, particularly among adolescents.

Fineberg also highlighted the important limitations of clinical trials evaluating interventions for PUI, including small sample sizes, lack of randomization, poorly defined inclusion criteria, and limited information on treatment adherence.

She said that evaluating treatment strategies first requires robust, standardized, and widely accepted diagnostic criteria. However, implementing such criteria also depends on healthcare systems with sufficient capacity to provide appropriate care, which remains a major challenge in many countries.

Fineberg is the principal investigator of the BootStRaP: Boosting Societal Adaptation and Mental Health in a Rapidly Digitalizing, Post-Pandemic Europe multinational research project involving researchers from 14 countries across Europe and Australia.

The project aimed to identify risk profiles and prevention strategies to improve the mental health of young individuals. Preliminary unpublished findings suggest that poor emotional regulation and impaired impulse control are important contributors to PUI. The findings also indicate that PUI is associated with psychiatric disorders, stigma, and reduced quality of life.

Fineberg concluded by calling for stronger public health measures to reduce the risk associated with problematic internet use. She advocated interventions such as warning messages on digital platforms, age-based restrictions on access, and other measures designed to reduce exposure among children and adolescents.

This story was translated from Univadis France, part of the Medscape Professional Network.