Sunday, October 12, 2014
"Generation D" and the Neurological Basis for Digital Addiction
Increasing evidence shows that texting and internet addiction can negatively affect lives. It's time to treat digital dependence as a real diagnosable disorder.
A recent LA Times article named texting the “addiction du jour” for teens, surpassing more traditional ones, like smoking and sex. The statistics are very sobering as they reinforce the dangers of texting while driving. An astonishing 40% of all American teenagers report having been in a car when the driver used a cell phone in a way that put people in danger, according to a Pew survey.
It’s not just teens, either. The National Highway Traffic Safety Administration reported that in 2010, 18% of all fatal crashes as well as crashes resulting in an injury were caused by driver distraction. According to the Virginia Tech Transportation Institute, text messaging makes it 23 times more likely that drivers will get into a crash.
Digital media is empty calories. We have to create a digital diet.
It’s an obvious problem that we can’t put our smartphones down long enough to make sure we don’t kill ourselves or someone else while driving. But, why is it such a problem?
Dr. David Greenfield, a pioneer in the field of virtual addiction and founder of the Center for Internet and Technology Addiction in Connecticut, believes that texting is simply a subset of the larger Internet addiction disorder. Internet addiction disorder is not listed in the latest DSM manual (DSM-5, 2013)—however, Internet gaming disorder is listed in the appendix as a disorder requiring further study. According to Greenfield, Internet addiction disorder encompasses everything that uses the Internet—surfing, social media, texting, gaming, porn, and other activities. And while sexting and online sex addiction are still the most prevalent forms of Internet addiction, all types of excessive use can lead to addictive behavior.
“Everyone feels like they lose track of time and space when they use the Internet,” Greenfield says. “That means that it’s psychoactive—in other words, it’s a digital drug.”
“We use it to numb out,” says Nancy Colier, a psychotherapist who writes a blog at the Huffington Post and recently published a book, Inviting a Monkey to Tea: Befriending Your Mind and Discovering Lasting Contentment. “It’s just that we’re addicted to getting out of the moment,” Colier says. “You’re distracting yourself from where you are.” Colier believes that information gathering falls into this realm. While information used to be something “we gathered to create change,” she says, now we use it to “shore up our own identity.” In the quest to constantly feed our desire for information, “we use it to keep people at bay, or to fill ourselves up with something. At the end of all of it, we feel more and more empty.”
“[Texting] helps us to switch off our thoughts about our problems and if we are not thinking about our problems, we are not feeling anything negative,” says Liz Karter, addiction therapist and author of a new book called Working with Women’s Groups for Problem Gambling. “This sense of escapism can become addictive.”
Behaviors that define Internet addiction, according to the Center for Internet Addiction, include compulsive use, a preoccupation with being online, lying or hiding the extent or nature of the Internet use, and an inability to control or curb it. “The symptoms of texting addiction are preoccupation with the digital device, craving to spend more and more time online [or] texting, secretive behavior, [and] mood swings,” Karter says.
Alongside Greenfield, Dr. Kimberly Young is another pioneer in the field. She founded the Center for Internet Addiction in 1995 and she has written multiple books on the disorder, including Caught in the Net, the first to identify Internet addiction. While other countries seem to be ahead of the game in treating and preventing Internet use disorder—Young recently returned from the first International Congress on Internet Addiction Disorders, where Korea, Japan, Germany, China, Italy, and France are leading the way in addressing what they consider to be a significant mental health issue—Young is working to change that here in the US. She has developed the “first empirically-based treatment plan for Internet addiction, showing that [Cognitive Behavioral Therapy - Internet Addiction] is effective for curing various forms of Internet-related problems.”
Who is affected?
Studies suggest that one in eight Americans suffers from problematic Internet use. Those estimates are higher in China, Taiwan, and Korea, where 30% or more of the population may experience problematic use, according to Young’s Center for Internet Addiction.
Teens and young adults under 25 are most susceptible, mainly because the Internet and digital devices are embedded in their culture. Karter calls them “digital natives” while Greenfield refers to them as Generation D. “To them, it’s like a toaster is to me, that’s how they view digital technology,” says Greenfield, who has two sons that are of Generation D. “It’s become that generation’s defining point that separates them from previous ones.”
“Drinking and drugs are the outcasts; this is the ‘in-cast,’” says Colier in reference to teens who buy the latest iPhone instead of beer or drugs. Teens are more affected by peer pressure—as well as having unhealthy role models in many parents who “have drunk the Kool-Aid,” she says.
There’s also the trend of not being able to live in the moment—without broadcasting every detail in text, tweet, or social media share. It speaks to a larger issue, in internet-speak FOMO, also known as the dreaded Fear Of Missing Out. “I can’t say it’s a pathology but it’s an interesting social phenomenon,” Greenfield says. The problem becomes, “you’re not really living [life], you’re transmitting it.”
There is also evidence of co-morbidity. According to the Center for Internet Addiction, national surveys showed that over 70% of Internet addicts also suffered from other addictions: drugs, alcohol, smoking, and sex. Trends show that the majority of Internet addicts suffer from emotional problems like depression, mood disorders, social disorders, and anxiety disorders. Almost 75% of Internet addicts also suffer from relationship problems, and they “use interactive online applications such as social media, virtual communities, video games or online gaming as a safe way of establishing new relationships and more confidently relating to others through the virtual world.”
While there is loads of behavioral evidence for the disorder—Greenfield says that in any given week, he’ll see 30 clients, and half of them are being treated for some kind of excessive Internet use—there is also increasing neurological proof that indeed, this is an actual, diagnosable disorder along the lines of any other behavioral addiction, like gambling, for instance.
And once again, dopamine is at least partly culpable.
“The main kernel of what I believe is responsible for excessive Internet use—whether it be surfing, gaming, sex, texting, social media—operates on variable-ratio reinforcement,” Greenfield says. Essentially, you never know what you’re going to get, and that keeps you coming back for more. “So what happens is, you hear a sound [alerting you to an incoming text message], and your brain says, ‘There might be something good there, I’m going to check it.’” At that point, the mesolimbic dopamine circuits are activated, and a small surge of the neurotransmitter is released in the brain. “What you’re getting addicted to is the dopaminergic hit.”
“With texting addiction, there is an added element of waiting for a response,” Karter says. “It is the anticipation that hooks us.”
Research suggests that dopamine malfunction is involved, and it makes sense. In other drugs of abuse, taking a hit causes dopamine levels in the brain to surge, followed by an experience of withdrawal—negative affect, craving—once the excessive levels of dopamine decrease. In essence, baseline levels are no longer adequate because the addict’s neurocircuitry has been altered.
In a recent literature review, 18 neuroimaging studies on Internet addiction disorder were compiled to support the claim that the disorder may share similar neurobiological abnormalities with other addictive disorders. Says the abstract: “These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains.”
How to turn it off
Statistics show that only about 10% of people will actually become addicts, Greenfield says. Among this smaller group, Greenfield uses four defining criteria to determine addiction: tolerance, withdrawal, change of mood as a result of using—the psychoactive component—and most importantly, “it has to have some deleterious impact in their lives.”
He treats it the same way he would treat other addictions. He might start with a digital detox, and then develop strategies to monitor use, identify triggers, and prevent relapse. He sometimes uses medications, but behavioral approaches are more common. “It’s very important to develop real-time living skills.”
Less severe is probably what affects nearly all of us—the inability to turn it off, which can result in a mild form of the disorder. Greenfield says that among that group, learning how to manage use is key. “The idea is to educate people as to not carry their phones everywhere they go—in other words, creating a healthier relationship to [the] technology so they’re not controlled by it.”
Colier counsels people on ways to find validation, meaning, and ultimately, happiness, in the offline world. She says that parents should play a larger role in showing their children and teens how develop awareness around usage. “It’s so important that parents point their kids’ attention to, how do I feel after a day of texting?”
Karter encourages her clients to take a month off—remove the device and the ability to text, and begin to explore why the texting or other excessive Internet use got out of hand. Make sure friends and loved ones are in on the change. “Accountability is a key,” she says. “Text addiction thrives on secrecy.”
The Internet—and the ability to communicate instantaneously and continuously—is here to stay, so people can’t be expected to abstain from technology. Greenfield recommends experimenting with moderation—text-free hours, or days, where you “go on a text-vacation,” he says.
“Digital media is empty calories,” he says. “We have to create a digital diet.”