The media is full of reports of addiction to pornography, gambling, video games, phones and even the internet. Parents are concerned that they can’t drag their kids away from their tablets, while on any bus journey you can see dozens of people mindlessly scrolling. But are we as hooked on these behaviours as the stories make out? And most importantly: are levels of addiction on the rise, as technological advances put these enjoyable temptations in our pockets?
Certainly, data collected by government body the Gambling Commission suggests that problem gambling behaviours are on the rise, estimating in 2017 that approximately 430,000 individuals in the UK had a serious gambling problem, a rise of more than one-third over the previous three years. It’s perhaps not surprising: whereas once you’d have to go down the betting shop or off to a bingo hall if you fancied a flutter, now you can simply download an app.
Addiction is a term that we hear all the time, but it’s a surprisingly tricky concept to pin down. Colloquially, we might say things like: “Oh, I downloaded this new game on my phone and I’m totally addicted to it”.
But from a clinical perspective, we think of addiction as occurring when someone has found that their life – whether it’s their relationships with friends or family, their ability to perform their job, or something else – has been knocked off-kilter by a compulsion to perform a behaviour.
In the past, the perception has been that addiction only occurs due to regular heavy use of a substance, like tobacco, alcohol or an illegal drug. But a lot of what causes dependence to a drug is psychological rather than biological.
Prof Robert West, director of tobacco studies at UCL and editor-in-chief of the journal Addiction, defines addiction as “a psychological condition that involves repeated powerful motivation to engage in a behaviour that’s learnt through experience, and that has either actual or potential harmful consequences”. Under this definition, it is possible to be addicted to anything – not just substances – if it turns from a want for it to a need for it, and it puts a person at risk of harm.
© Joe Waldron
Yet much like with substance use, the vast majority of people who play games online, watch pornography, or use the internet will not experience problems from doing so.
Dr Henrietta Bowden-Jones, a consultant psychiatrist and researcher based at Imperial College London, highlights how little we know about the prevalence of behavioural addictions – in particular, gaming.
So how do we tell the difference between just really liking something – what we might colloquially call addiction – and a behaviour that is becoming problematic? For Bowden-Jones it’s about loss of control.
She mentions a colleague of hers who regularly binge watches Netflix, for hours at a time. But his Netflix binging doesn’t impact his work, or his relationship – he is choosing to do it. And Bowden-Jones sees nothing wrong with this. “If there’s no harm to us or to others, we should be free to choose how to spend our time,” she says.
It becomes a problem, however, when someone tells themselves they will stop at midnight, but finds they’re still watching when the Sun rises, and starts missing work or school, or isolates themselves from friends or family. She also suggests that the joy from the behaviour reduces. “It’s not fun any more, it’s not pleasant, and it leaves them distressed,” she says of people she has treated for behavioural addiction.
If someone struggles to control their impulses, they might find it harder to resist temptation, making them more vulnerable to addiction. An inability to limit themselves could make a person more likely to constantly reach for their phone, or place another bet when they know they should stop. All of this could lead to dependence.
Addiction problems also seem to run in families, which might indicate the involvement of genetics. But genetic variants alone don’t cause addiction, though they might tip the scales. West points out the importance of society and culture, highlighting smoking prevalence in China.
“In China, 60 per cent of men smoke, and about 3 per cent of women,” he says. “There’s nothing different about those Chinese women than British women to make them less susceptible, it’s just taboo [for women to smoke in China]”.
A person’s support network, their upbringing, the level of deprivation in which they live and a host of other social and cultural factors will also strongly predict whether a person is at risk of developing addiction.
Body and brain
There’s also the question of whether addiction leads to changes in the brain. The neurotransmitter dopamine has long been implicated in addiction. But it’s implicated in pleasure generally, from the feeling of winning on a scratchcard, to enjoying a delicious piece of chocolate cake.
How taking pleasure from something can lead to dependence is less well understood, though there is some evidence that dopamine interacts with another neurotransmitter in the brain called glutamate, which can lead to a growing feeling of needing something, rather than wanting it. Over time, sensitisation to dopamine might develop, reducing the feeling of pleasure that something brings.
While using substances like drugs or alcohol will directly alter brain chemistry – at least during intoxication – behaviours can also induce pleasure (and therefore dopamine) in much the same way, so the processes of developing addiction to a behaviour are likely to be broadly the same as for a substance.
In 2008, Bowden-Jones set up the National Problem Gambling Clinic. To date, this is the only NHS-funded treatment centre for people with problem gambling. Despite seeing some of the most severe cases of gambling addiction in the country in her clinic, she is keen to point out that the scale of the problem might not be as extreme as some would think. Despite lots of people gambling and the pervasive nature of gambling advertising, problem gamblers make up less than 1 per cent of the population.
Yet she wonders whether there is something about how ubiquitous technology has become that increases risk. “The more you have availability, the more you uncover vulnerability,” she says.
And there’s concern among researchers from several different countries that online games and apps are taking inspiration from gambling to keep people playing, and paying. These include what are known as ‘loot boxes’. These are prizes, paid for with real money, where the contents are not known until they’re purchased.
Recent research has suggested purchase of these prizes is linked to higher levels of problematic gambling behaviour. And this link gets even stronger when the games employ another device used by the gambling industry – the near miss, showing people what they could have won alongside what they did win.
However, Bowden-Jones points out that technological advances have also improved support for some people with problematic gambling. Software now exists to block gambling-related websites across people’s devices. Banking apps can allow a person to disable any ability to spend money on gambling, discreetly, by just toggling a switch.
She believes that this is a big step forward – historically people were encouraged to hand their finances to their partners. This can put pressure on relationships and there is strong evidence to show it can increase domestic violence.
While public attention is turning to behavioural addictions like gambling and gaming, it’s worth highlighting that substance use, particularly smoking and drinking, seems to be going down among young people in the UK. West thinks that it’s possible that they might be moving from one risky behaviour to another.
So is addiction on the rise? It’s hard to tell, partly because as yet there aren’t standardised measures by which to assess things like problematic gaming, and large-scale surveys have not been done. But just because we might see people glued to their phones while they’re on buses or trains, while they’re socialising, or even while walking down the street, it doesn’t mean we’ve become a nation who are addicted to the internet. We aren’t all losing our jobs because we are playing Angry Birds, or becoming isolated from those closest to us because we’re on Twitter.
Nonetheless, in 2018 the World Health Organization announced that it was classifying gaming disorder as a mental health condition, a decision they based on a review of the evidence and after discussion with experts. However, some researchers worry that this classification will lead to overdiagnosis and a pathologising of gaming.
The NHS does not offer treatment for gaming disorder, and a pilot treatment clinic has been delayed. It’s clear that we know very little about how many people have gaming disorder, and it’s likely that the vast majority of people who play games do so with no detriment to their health whatsoever.
Having said that, for those who are worried, it is possible to spot the warning signs of a pleasurable activity becoming a compulsion, either in yourself or in those around you.
Bowden-Jones highlights behaviours such as isolation, a loss of interest in previously enjoyed activities, removing oneself from previously enjoyable family moments, or a worsening of school grades as being potential causes for concern. Though some of these sound a little like normal teenage behaviour, Bowden-Jones says that it’s the negative consequences that you need to look out for, particularly when it comes to isolation. “People stop having meals with parents or peers. They stop going to school,” she says.
West has some final words of advice for those individuals who are trying to reduce their need for a behaviour. “Self-control is much easier when you set fixed boundaries than when you leave the rules more flexible,” he explains. Be strict with yourself and don’t allow your boundaries to slide, then even if you do slip up, you can get back on track.
- If you, or people you know, are affected by addiction, visit bit.ly/addiction_support for information and support.
- This article was first published in BBC Science Focus in April 2019 – subscribe here
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