1. Introduction

From the present European literature review encompassing the period between 2013 and 2018, the following four policy options have been developed based on the included 19 studies (see Figure 1).

Figure 1. Policy options derived from the present literature review.

2. No Action

The first policy option concerns all stakeholders involved and should be considered with caution. In a few studies, contradictory findings have emerged which have highlighted it is not worth taking action if treatment is not sought^[1] or if the problem does not emerge^[2]. Thus, the first policy option is related to the following preventive actions:

• Internet addiction, Internet gaming, and gambling addictions can be hazardous (e.g., they can appear temporarily and last less than a year and then disappear). These respective problems are associated with a variety of internal and individual factors and are not always associated with the same comorbidity or associated symptom experiences. Environmental factors may also contribute to the emergence of different online addictions. Thus, Internet use-related addiction problems can appear temporarily and disappear spontaneously before they can be considered a disorder.
• This option should probably be considered when the period of the problem affecting users is less than a year, with no comorbidity or other associated severe symptoms and problems. However, if there is a suspicion of chronification (e.g., with a length of at least six months), preventive measures should be taken to avoid the development of the disorder and future disorder diagnosis.
• At present, this option seems to be unsustainable because the public health concern is growing and health practitioners are reporting increasing numbers of cases (e.g., more clinical papers than non-clinical) and interventions.

This option refers to natural recovery, which seems to exist but has not been studied much. However, due to the precautionary principle (i.e., which encourages policies that protect human health and the environment in the face of uncertain risks) it may jeopardize Europe’s ability to prevent Internet use-related problems from emerging in the first place, and to take advantage of the instruments, therapeutic, and of preventive opportunities that the scientific literature on generalized and specific Internet addiction problems has recently provided.

3. Promote and Disseminate Applied Research on Responsible Internet Use and Prevention

The second policy option mainly addresses support organizations, professionals, and practitioners. Applied research is present in almost all reviewed studies, as research seeks to find solutions to the problems in European community and clinical settings. Only a couple of studies described models of GIA^[3] and Internet gaming addiction^[4] to provide an understanding about which factors contribute to the problems, their phenomenology, and therapy components to clinically address them. Moreover, providing information and interventions seem to be the key public health strategies to prevent and address the problem in all settings. Early preventive actions can:

• Promote evidence-based information and tools and are supported by applied research outcomes for professionals who can help to prevent and intervene in Internet use-related addiction problems. For instance, information can be available through an EU webpage with public resources (e.g., containing validated scales which exist for non-clinical measures), contact details for support organizations across the respective European countries, a list of experts, and information provided in the different EU languages.
• Include other scientific European initiatives disseminating the state of the art of research into these problems across Europe, especially if these technological problems have associated risks, such as comorbidity (e.g., anxiety and depression) and other associated psychosocial problems (e.g., cyberbullying).
• When these problems are present, self-screen tools and other test actions can be offered as a package to different professional groups and settings (e.g., clinicians in hospitals and teachers in schools), especially to those who are close to and/or work with children and adolescent populations.

There is a need to improve this research field to diversify the methodologies used and translate them to the professional sector, and to promote joint clinical and educational research. It is also crucial for standardized measures to assess problems and compare them in order to support diagnosis and treatment success (e.g., cross-culturally and trans-diagnostically). These preventive actions can provide support for decision-makers to better understand the problems from a European public health perspective, and to promote responsible Internet use and media literacy.

4. Promote Education on Offline and Online Health Behaviors in Young Populations

The third policy option addresses all Internet users, especially those who have appeared as more at risk for developing Internet use-related addiction problems. All reviewed studies have highlighted common aspects related to promoting healthy Internet use, especially in adolescents and young adults, as some gaming genres are very demanding regarding competition and social involvement (e.g., MMORPGs). The following options are preventive actions which can be introduced:

• To encourage alternative motivations, engagement in alternative entertainment behaviors (also those including Internet use), new coping skills, cognitive and emotional skills, healthy attachment styles to reduce the risk of Internet use-related problems and to reduce Internet usage, if needed (e.g., through alerts and notifications) and to provide alternative options of relaxation (e.g., reading, meeting people, and engaging in physical activities).
• To detect the risk of experiencing other comorbidities or problems and address them with professional support and the support of significant others (e.g., caregivers in the case of adolescents), and to embrace systemic approaches.
• If a problem with Internet usage is present, all Internet use-related addictions should be simultaneously assessed, as many of the reviewed studies were clinical studies on gaming addiction, which together with gambling in young adults seemed to indicate the worst-case scenario regarding these problems.

In the EU, there is a need for programs and campaigns addressing children and youth to promote awareness of the risks of online behaviors at an individual person’s level. Studies have shown school interventions are usually effective, even more so if they include a psychological component (e.g., impulsivity management techniques when gaming). Young individuals should be engaged in conversations and activities concerning offline and online health, potential positive and negative implications of excessive online behaviors, and provided with information on alternative pastime activities and alternative coping strategies not involving Internet use.

The usual problem user is an adolescent who increasingly spends time gaming alone at home, usually plays MMORPGs, and experiences co-occurring problems and negative impacts in their daily life. Thus, problem cases should be treated on a case-by-case basis when detected with tailored psychological and educational interventions, including CBT, whilst ensuring treatment encompasses interventions for comorbidities. The young user should be able to determine which functions the maladaptive Internet use fulfils in his or her life, and which other options are available to him or her with professional support. These actions can be supported by other initiatives in educational and health settings, which require resources and action plans (e.g., providing funding and resources).

5. Support Communities and Significant Others of Problematic Internet Users

In addition to supporting professionals (i.e., the second policy option) and users (i.e., the third policy option), communities (i.e., the fourth policy option) also need attention. The preventive actions for this group are the following:

• Enhanced family, partner, and peer communication and caretaking (e.g., through parents, siblings, partners or friends) can prevent the problems from emerging when risk indicators appear and develop progressively (e.g., excessive time spent playing online games, lack of sleep due to constant online connection, irritability and mood changes when disconnecting, neglecting school or relationships). Thus, ‘keeping an eye’ on time spent and having conversations about online uses can be the first measure of prevention in families and friendship groups.
• Information should also be available for users’ environments (e.g., for families, schools and communities) about the risks of habitually engaging in online role-playing games or online gambling applications which can be out of control and cause negative health consequences (i.e., functional impairment and distress) or financial problems (i.e., online gambling).

These problems usually affect families, education or workplace organizations, and communities. Thus, basic information, education, social, and clinical support can help individuals in the immediate context of problem users with community support. The EU should consider facilitating information provision to healthcare providers to support general practitioners when taking care of communities in health settings. Moreover, the implementation of actions, programs, and services for information, early detection, and facilitation of support and treatment routes for future problem users and their significant others are options to develop. For instance, at a school and community level, actions to promote prevention can be provided together with those for other related problems (e.g., substance use disorders and cyberbullying).