Dr Anna Lembke does not hold back when it comes to describing the impact of the smartphone on society, describing it as “the modern-day hypodermic needle, delivering digital dopamine 24/7”.
As a professor of psychiatry and medical director of the addiction medicine clinic at Stanford University, Lembke knows all about the impact of addiction, and was one of the first in the US medical community to sound the alarm regarding the country’s opioid epidemic, publishing a book on the subject in 2016.
Now in her book, she examines how the internet and in turn the smartphone has increased accessibility and exposure to potentially harmful and addictive activities.
“We’ve transformed the world from a place of scarcity to a place of overwhelming abundance: Drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting... the increased numbers, variety, and potency of highly rewarding stimuli today is staggering... If you haven’t met your drug of choice yet, it’s coming soon to a website near you,” she writes.
Dopamine is a neurotransmitter that drives motivation, reward and pleasure — as well as pain. “When we do something that is rewarding, we get an increase in the release of dopamine in a particular part of our brain called the reward pathway, a part that has been conserved over millions of years of evolution and across species. The reason it can be so hard to quit addictive behaviours, even something as simple as checking our smartphones, is because right after we check it and we get that little dopamine hit, our brain over-corrects and puts us in a state of dopamine deficit and we experience the universal symptoms of withdrawal from any addictive substance — anxiety, irritability, restlessness, a little bit of depression, and intense mental preoccupation with using again. It is that cycle that traps us,” says Lembke.
, she uses case studies from her own practice to explore how we can moderate the see-sawing effects of dopamine and find our way back to a more balanced life.
Lembke says our dependence on smartphones can feed addictive behaviour while also resulting in isolation and a lack of connection. “The device itself is addictive, the way it requires us to tend to it, it almost mimics a living thing. It has become a way in which we are meeting all of our needs on the surface but I really think it is a counterfeit replacement in many ways.
I see devastating consequences in my practice, in that people become very isolated, they run into trouble with their relationships, parents are not able to be really present for their children, they neglect their children and their spouses. They are also unhappy. That is the irony of it, that we are engaged in this activity which feels good in the moment but actually makes us more depressed.”
Recent whistleblower revelations about Facebook has once again focused attention on the impact of social media in particular on mental health, with big tech being described as the next big tobacco. It is an analogy backed up by Lembke.
“I think that’s accurate. These are corporations that do not have our best interests in mind, no matter what they might say and they are peddling a highly addictive drug. What is so devastating about social media is the invidious comparison to other people that it incites. When you think about how we lived 100 years ago, you compared yourself to your siblings, your neighbours, to other kids at school. Now people are comparing themselves to people all over the world, that is a very big sample size," she says.
"Much of what they are comparing themselves to online is not even real, it is a curated representation of somebody’s life. So this constant comparison leads to feeling less than, diminished, that you couldn’t possibly accomplish anything or live up to anything. That is, number one, not true, and number two, a really terrifying feeling.”
In terms of regulating smartphone usage by children, Lembke says they should not have unsupervised access to any devices before the age of ten. “Up to the age of 12 is when we still have control over our kids, after that they are going to do what they are going to do. But if you can lay the foundation early on, building other healthy habits, teaching them moderation, talking about the risks of use, the risks of addiction, the neuroscience and what happens with repeated stimulation of the reward pathway, as I do in the book, then at least they’re armed with some defences against the onslaught of dopamine that is going to come their way when they do pick up these devices.”
While there is a lot of focus on the potential harms of social media, Lembke says many other forms of digital consumption can also become addictive or obsessive.
“I don’t think that social media stands out as more pernicious or evil than all of the other digital products — YouTube, video games, even, frankly, online news sites. News has been drugified too. For people for whom social media is particularly rewarding, appealing, or reinforcing, that will be their drug but there are people who obsessively watch news shows and who addictively play video games. Most people will be able to use these media and not get addicted but a vulnerable subset will and it is important to honour that.”
She cites the example of gambling addiction, which has become even more problematic since the introduction of the smartphone.
“Gambling has been around forever, and gambling addicts have been around forever but in the first decade of the 2000s, I started seeing more and more patients coming in with gambling problems and they all said it was because of the invention of the smartphone and the increased accessibility to the behaviour. This is really the point of— one of the biggest risk factors for addiction is access. The easier it is to get, the more likely you are to get addicted. The other factor is potency — these online digital products are incredibly potent in reinforcing [addictive behaviour] because they have all been gamified.”
According to the Global Mobile Consumer Report carried out by Deloitte in 2019, Irish people check their phones on average 50 times a day, with 66% trying to limit their phone usage. So could we be addicted to our smartphones without realising it?
Lembke says we often have to stop doing something before we can gauge its possible negative effects. “When we are in this vortex of addiction, we can’t objectively see cause and effect. It is really only once we have a period of abstinence away from it that we can see it.
"There is something very insidious about this pleasure/pain balance and about dopamine that our brains so much want us to go for the reward that it will block our ability to see some of the unintended consequences of our behaviour. That is why in the book I recommend a period of abstinence, not just as a way to reset reward pathways and restore dopamine levels but also because we need that time in order to be able to see the true impact of that behaviour on our lives because we can’t see it when we are in it.”
In terms of her own experience, Lembke has gone from not even owning a smartphone until a few years ago to having to make a conscious effort to limit her use.
“I try very hard not to go any screen until 9am in the morning or after 5pm. I try to have one day a week where I don’t go online. I basically use intermittent fasting with digital products. That works for me because I know I have to set these limits. I’m not always successful but I am striving for that.”
- Dopamine Nation: Finding Balance in the Age of Indulgence by Dr Anna Lembke is published by Headline