I’ve been practicing psychiatry for 25 years. Starting in the early 2000s, I began seeing more patients for pornography and gambling addiction. By 2010 it was video games, shopping, and social media addiction. It is not a coincidence that the prevalence of such addictions spiked around the time that the first mobile phone was released in the 1990s and the first smart phone in the early 2000s, as these technologies provide 24/7 access to highly potent, highly reinforcing behaviors. What the invention of the hypodermic needle was to morphine addiction, the invention of the smart phone was to behavioral addictions (addictions involving a behavior rather than a drug): pornography, gambling, gaming, shopping, tweeting, Facebooking, doomscrolling … the list goes on.
Addiction is the continued, compulsive use of a drug or behavior, despite harm to self and/or others. The difference between drugs/behaviors that are addictive and those that are not is how much dopamine they release in the brain’s reward pathway. Highly addictive drugs release a lot more dopamine, often very quickly, thereby causing the ‘high’. But it is not our natural state to remain intoxicated, so our brain responds with its own intrinsic re-regulating homeostatic mechanisms to bring us ‘down’ again. We reduce production of dopamine and dopamine receptors. The result is a dopamine deficit state: We need more of the drug in more potent forms to get the same effect; when we’re not using, we feel depressed.
Social media too has the potential to be an addictive drug by tapping into our intrinsic need to connect with other humans. We are social animals: Moving in groups protects us from predators, optimizes allocation of material resources, and enhances pair bonding and procreation. Our brains incentivize us to connect by releasing a spike of dopamine when others ‘like,’ validate, or praise us.
When my patients come into my office seeking help, they are compulsively engaging in behaviors on the Internet for hours each day, days at a time, to the exclusion of many other activities, including basic self-care. They derive little or no pleasure from these activities yet are unable to stop even when they want to. Everything else in their life has gone gray. They feel unreal, anxious, depressed, and in some cases suicidal. They are typically alone and lonely, a paradox since many of the behaviors they’re engaging in online are presumably about connecting to other people. What is happening here is they’re in a dopamine deficit state – clinically analogous to a deep depression – and they’ve lost the ability to choose not to use. Hacking of the mind indeed.
What is the antidote to this malady? Regenerate our own depleted dopamine stores. How to do this? First abstain.
When they first come to see me, my patients anticipate I will prescribe them anti-anxiety or anti-depressant medication. I seldom do. I ask of them instead to abstain from their drug of choice for one month. Delete the app, or if need be put away the iPhone and/or computer for a while. Simply abstaining from our drug of choice gives our brains time to heal, restoring baseline homeostasis and reconnecting our frontal lobes to our limbic-lizard brain. We regain the capacity to take joy in more mundane pleasures, and most importantly, to choose to use … or not.