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When Technology Usage Becomes an Addiction
Elevate Session Will Explore Ways to Curb Problematic Use
![Steven Chan](https://s3.amazonaws.com/HMP/hmp_ln/imported/inline-images/Chan%20headshot_0.jpg)
With a boyhood preoccupation with video games and a psychiatry career specializing in addiction, Steven Chan, MD, MBA, appreciates the lure of technology. A clinical informaticist and medical director for addiction consultation and treatment practices at Palo Alto VA Health, Palo Alto, California, Dr. Chan is cochair of the 2020 virtual Psych Congress Elevate conference. He will present a session during the meeting on the growing phenomenon of technology addiction and ways mental health providers, patients, and even tech industry giants are seeking to curb problematic use.
In this Q&A, Dr. Chan explains his interest in the topic, explores signs of technology addiction, and describes possible interventions and treatment tools.
Q: What drew you to present on the topic of technology addiction?
A: I remember growing up and being absolutely hooked on playing video games and surfing the Internet on the computer—to the point where I would think about it frequently, avoid getting sleep at night, and even wake up from game-playing dreams! So it's certainly a personal topic that I'm interested in.
I now see patients in my practice who are working on reducing their addictions, primarily substance use and alcohol use, but some have also had problematic technology use. They have used a combination of techniques to reduce their technology use: withholding credit cards to cut in-app purchases, marriage therapy that also helped address overuse of smartphone games, and post-traumatic stress disorder (PTSD) therapy to also help reduce their use of video games.
Q: How big of a problem is technology addiction? When we think of the stereotype of young adults constantly looking at their phones, is that an accurate picture of technology addiction?
A: We can think of technology addiction as "frequent and obsessive technology-related behavior increasingly practiced despite negative consequences to the user of the technology," according to the Hazelden Betty Ford Foundation. This can encompass things like excessive use of the internet, excessive video game play, overuse of smartphones, and overuse of social media. The stereotype of young adults constantly looking at their phones can extend to older generations' habits of television viewing or video game play: if it's excessive and negatively impacts one's life, it's an addiction.
But the majority of folks who excessively use technology may also face other psychiatric issues, such as depression, anxiety, and substance use disorders. It can be difficult to tell if the technology causes these issues. There’s correlation, not causation. And many technology products are designed to encourage repeat use, with smartphone notifications, social ranking leaderboards, and alerts.
Q: Many of us use technology for work, play, and staying in touch. How do you differentiate making the most of the technology available to us from actual technology addiction?
A: It's important to think of our virtual lives as fulfilling many functions in work and play. We use technology for work: our day jobs, organizing nonprofits, and assembling volunteer efforts. We use technology for play: we send e-mails to family, message funny animated GIFs to friends, and we immerse ourselves in video game worlds.
Thinking about regular use versus problematic use versus addiction to technology is helpful if you think about it on a spectrum. There can be a variety of impairments—like withdrawal, loss of control, mood imbalance, conflicts with others, financial difficulties, occupational issues—more of which occur with the severity of addiction. A casual gamer, for instance, may play several minutes a day and obtain a positive benefit from it. In contrast, in countries like South Korea, it's measured that up to 50% have Internet Gaming Disorder.
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Q: What are some of the signs and symptoms of actual technology addiction?
A: Technology addiction is not, in itself, a diagnosis. But the use of technology excessively can be a symptom of another disorder, such as bipolar disorder in a manic state, hoarding disorder if it's related to online shopping, and perhaps social isolation and avoidant behaviors in PTSD.
The closest disorders related to technology addiction are included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The proposed criteria for Internet Gaming Disorder are very similar to gambling disorder (see Table). What is interesting is that more elements of gambling are moving toward internet and offline games: online casino games, loot boxes with lottery-like functions, obfuscation of currency, and daily prizes. I anticipate there can be a lot of overlap.
Q: Do patients generally recognize they have a problem and seek treatment?
A: While there are no specific studies on the insight of folks recognizing they have a problem with technology, it appears that overuse of technologies are enough of a concern that big tech companies have enacted ways to control use. Google's Digital Wellbeing tools and Apple's Screen Time functions allow us to set daily limits on app use, reduce notifications, and monitor how much we use an app. Parental controls also allow us to control the use of our children’s gadgets and even limit access to content that may be harmful or addictive. There have been proposals to do away with how many "likes" we see on our social media posts.
One person's journey towards recovery from hours of video game play was recently featured in the The New York Times Magazine.
Q: With the prominent role of technology in modern life, how can clinicians address this issue?
A: There have been limited studies on the impact of gaming, and even less so on the generic overuse of technology addiction. But what clinicians can do is explore with patients whether their use has any benefits versus problems, give them time and space to understand any consequences resulting from their use, and determine whether there are comorbid issues such as attention-deficit/hyperactivity disorder (ADHD), or other psychosocial issues such as relationship conflicts.
Different treatments can include the following (but in general, the evidence has been minimal because the studies show variations in results or had small sample sizes):
• medications (such as those used to treat depression, anxiety, or ADHD);
• psychotherapy (cognitive behavioral therapy, motivational interviewing, or family therapy); or
• a combination of the two.
The Centre for Addiction and Mental Health has some excellent patient handouts on problematic technology use.
— Jolynn Tumolo