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PIU has much in common with substance addiction but is less studied.

• PIU is commonly defined by symptoms associated with addiction, including excessive and compulsive use, tolerance, withdrawal, and impairment.
• At this time, there is no consensus that PIU constitutes a distinct clinical diagnosis.
• The prevalence of PIU is difficult to gauge.

Official diagnosis or not, PIU is a mental health issue and can have serious consequences.

• It is unclear whether excessive Internet use results in the social and psychological issues associated with it or whether those issues make an individual vulnerable to PIU.
• PIU can be harmful to marriages, family relationships, finances, educations, careers, and even physical health.

Emerging prevention and treatment strategies are similar to those for substance abuse.

• Comprehensive prevention and treatment strategies include individuals at risk for PIU, their employers, and their clinicians.
• Self-regulation strategies are likely to be the front line of PIU prevention.
• Most employers already have Internet policies in place aimed at keeping workers productive, but these may be more focused on discipline and less geared toward acknowledgment and treatment of a larger mental health issue.
• Over the past 25 years, clinicians have developed treatments for PIU based on existing and proven treatments for depression, anxiety disorders, and substance use disorders, but their efficacy with PIU is untested.

This report reviews the scientific literature on the epidemiology, prevention, and treatment of problematic Internet use (PIU) with the goal of informing Air Force policies aimed at mitigating PIU's negative impact on operations and the mental health of Airmen. The report is motivated by a recent RAND study estimating that 6 percent of Airmen have PIU. Individuals with PIU, similar to people with substance addictions, suffer from excessive and compulsive online activities, symptoms of tolerance and withdrawal, and functional impairment. PIU is also strongly associated with other mental health problems including major depression. However, at present there is no single accepted definition of PIU, and no up-to-date estimates of the prevalence of PIU in the general U.S. population are available. A range of prevention and treatment approaches have been developed, but none has been rigorously tested in clinical trials. Prevention programs rely on workplace Internet policies and strategies to help individuals self-regulate their Internet use. Treatment approaches that have proven feasible and acceptable to patients with PIU include adaptations of cognitive-behavioral therapy, an evidence-based treatment for depression and anxiety, to the specific symptoms of PIU. Based on our findings, we recommend: (1) increasing awareness of PIU among organizational leadership and mental health professionals, (2) incorporating content related to PIU into existing trainings related to mental health, (3) providing support for self-regulation of Internet use on the job by incorporating PIU management principles into Internet use policies, and (4) continuing monitoring of the emerging scientific literature on PIU.

• Chapter One

  Introduction

• Chapter Two

  Understanding the Emerging Science of PIU

• Chapter Three

  Prevention and Treatment Strategies

• Chapter Four

  Implications and Recommendations