Some lessons we learn the hard way, as individuals and as a society. Early in her career, Dr. Anna Lembke says she made some mistakes treating patients because she “didn’t know anything about addiction.” It wasn’t a major subject in medical school or even her residency. So she switched her focus. Now, 25 years later, she’s a leading expert in that field, a professor of psychiatry and addiction medicine at Stanford University and author of “Dopamine Nation: Finding Balance in the Age of Indulgence.”
In that book, a New York Times bestseller released in 2021, she raised alarms about a new epidemic that is reshaping modern life: addiction to smartphones and social media. “Our modern ecosystem,” she argues, “conspires against us when it comes to compulsive overconsumption.” She made that case appearing in the 2020 Netflix documentary “The Social Dilemma,” and is an expert witness in litigation against social media companies. Recently, she released “The Official Dopamine Nation Workbook,” a practical guide for families working together to change compulsive behaviors.
Previously, Lembke studied the mechanics behind the overprescription of opioids, stimulants and benzodiazepines, and in 2016, published “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.” In that process, she learned about the nature of dependency, and found there are many ways to lose oneself in a habit.
What does it mean to be addicted?
Broadly defined, addiction is the compulsive use of a substance or behavior despite harm to self or others. You can look into ancient texts written thousands of years ago and find that same phenomenon. What’s different today is we know it is a brain disease, and there are distinct changes that characterize the addicted brain. And it’s easier to get addicted, not just to drugs and alcohol, but to all kinds of behaviors: pornography, sex, social media, shopping, gambling, even food.
Does that mean some of us have a deficiency that feeds into addiction? Or do we create a deficiency through our choices?
A bit of both. People come into this world with differing degrees of vulnerability based on their genetics. There are also psychological risk factors, like childhood trauma. And there are sociological factors like access. If you live where certain drugs are available, you’re more likely to use them and to get addicted. We have 24/7 access to digital media, and that, too, is a drug, a potent reinforcer of the human brain. So we’re all struggling with compulsive overconsumption.
How does digital addiction work?
Four factors make something addictive: potency, quantity, novelty and access. The more dopamine gets released and the faster it does, the more a substance or activity is “reinforcing” to the human brain. The more we are exposed to it, the more likely we will build a tolerance and need more potent forms to get the same effect. When we’re not using, we experience symptoms of withdrawal: anxiety, irritability, insomnia, depression and craving. One way to overcome tolerance is with novelty, slight changes so the brain sees the drug as something new. And if you can get something anytime, anywhere, you’re more likely to use it. Digital media has all those features. Even a slight change to a video can engage our hunting or treasure-seeking function, and TikTok never runs out. Our brains love it, and once we get a little bit, we want more.
Is dopamine the real problem? It’s part of us, right?
We need dopamine. It’s the neurotransmitter that tells us to pay attention to something right now, because it’s important for your survival. But drugs release more dopamine at once than our brains have evolved for, without any up-front work. And that’s confusing. Our brains try to adapt but lose the ability to self-correct when the stimulus is no longer available or stops working.
Society seems to think this is a bigger problem for young people. Is that true?
Child and adolescent exposure are different. Kids are more sensitive to comparisons, validation and influence from their peers. And their brain’s prefrontal cortex — which allows planning, delayed gratification and awareness of future consequences — is not yet fully connected to its reward pathways. That doesn’t mean it’s not harmful for adults; older people get addicted to their smartphones, too. But we need guardrails that protect kids until their brain is more developed. We don’t let them go into casinos or buy cigarettes, right? Any child under 13 should not have unmonitored access to the internet. Their use of screens should be infrequent, of short duration and carefully curated. And with teenagers, there needs to be an open and vibrant discussion about use, etiquette, opportunity costs, ways to monitor each other, and to be self-accountable.
We’ve added a lot to parents’ job descriptions just by bringing these devices into our homes.
I agree, and it cannot be left up to parents alone. That’s unfair to them and to the kids. And it shouldn’t be left up to teachers. Kids can’t learn with a smartphone in their pocket. Even during breaks, they need to socialize without them. The corporations that profit from these devices need to change design elements that keep people on their phones. States and countries around the world are experimenting with turning off notifications during school hours and at night, or preventing algorithms from tracking kids and using their data. Infinite scroll, auto play, pull to refresh, likes, notifications and ranks, all that should just go away on a kid’s device.
Should we be holding companies responsible? Even as an adult, I’m free to put down my phone, but that doesn’t mean I’m free to put down my phone.
Exactly right, because of the hijacked brain. If we just ask, companies are not going to do it. We have to hold them financially accountable for preventing new cases and impacts like eating disorders, body dysmorphia and self-harm; for identifying folks who are at risk and doing something about it; then finally, for treating those cases. It’s like the tobacco companies. We have to get in there with a surgical knife and get out the toxic elements. That’s going to require all hands on deck.
In your book, you discuss some measures that can help to break a digital addiction. Can you share the key points?
The interventions need to be biopsychosocial, like the ailment. Medications can help, as can therapy, joining a 12-step group or getting a sober social network. But the heart of recovery is a dopamine fast – enough time away to get out of that cycle. That doesn’t mean no screens ever; for most people, that’s impossible. So identify the problem. Is it video games? Shopping sites? YouTube shorts? Then abstain from that for four weeks, not replacing it, but enduring the withdrawal. By then, most craving abates, and people can see their behavior with new insights, appreciate the consequences of their use and make better decisions going forward.
Some kids say we’re just overreacting to a new medium, the way other generations responded to the TV or rock and roll. Is there any validity to that?
I got addicted to romance novels. They’re a form of escape, but 30 years ago, they couldn’t be accessed with the push of a button. Anything that’s reinforcing or pleasurable, including learning, can be addictive, if technology allows the drugification of that experience. We know how to do that. We’ve studied the human motivational system. A video game is much more potent, novel, bountiful and accessible, and we’re spending all day, every day, every available moment playing, and changing our brain reward pathways as a result. More modest rewards, like sitting and talking with a family member, watching a sunset, going out for a good meal? They’re sort of blah now. We’re all zombies to this stuff.
Tell us more about drugification.
It’s turning everyday activities into drugs, even those we once associated with healthy human flourishing. Like playing chess! They have short versions online, integrated with social media, gamified and monetized. It’s all video games now. You’ve got rankings, treasure chests, notifications. Kids aren’t going to sleep. They don’t want to do anything else. They don’t want to leave their rooms. None of that is good.
What’s your last word on the subject?
As parents, we tend to fluctuate between screaming at our kids in a dysregulated, unproductive fashion or just throwing up our hands and saying, “It’s hopeless.” Neither extreme is good. Open up a conversation. Look at your own behavior. Look at your children in the broader context and make an effort. Try to intervene in small steps that are practically feasible.
This story appears in the December 2024 issue of Deseret Magazine. Learn more about how to subscribe.