March 2019

The Nation Reviewed

Screen addiction

By Marina Kamenev

As more of our lives are lived online, more people aren’t coping

The courtyard outside The Cabin, Australia’s self-proclaimed “leading outpatient addiction treatment centre”, is a mixture of pale brick and concrete. Beige bleeds into grey and then into cream. There’s a smattering of meticulously sculpted plants and well-groomed senior citizens in the vicinity – unremarkable given the Edgecliff location, in the marrow of Sydney’s eastern suburbs.

The white walls in the waiting room display photos from a resort-like rehabilitation centre in Chiang Mai, Thailand – one of The Cabin’s numerous locations in Asia and Australia. One woman is being stretched by another, perhaps mid massage or yoga, while a bunch of (presumably staged) normcore-clad patients look immersed in their group therapy session.

“It’s not sterile like a regular rehab clinic,” says Josh Rosenthal, The Cabin Australia’s clinical manager. He has been working in rehabilitation facilities for 12 years and sees patients across the spectrum of addictions: substance, sex, shopping and gambling. But in recent years, as the internet has infiltrated every corner of our lives, The Cabin has seen a corresponding increase in people who have not coped with this new reality. Rosenthal estimates that 10 per cent of his patients have some kind of internet-related addiction, and as public awareness grows, the number is rising.

Australians spend a lot of time online: 21.9 billion hours a year, according to Roy Morgan. Developers of phone-use-monitoring app AntiSocial told the ABC that Australians allocate approximately two hours a day to their phone apps (the statistic did not account for music, video streaming or phone calls). A separate survey found that on average Australians used the internet for five hours and 34 minutes a day, with one hour and 39 minutes dedicated to social media alone. Another survey said that we unlock our phones every 12 minutes.

The phone-checking habit has permeated our routines to the point where we need reminders about how to engage in basic human interactions. My child’s preschool had a poster (which looked incomplete without a glaring illustration of Uncle Sam) calling on parents to put their phones away during pick-up and drop-off: “Your child is happy to see you! Are you happy to see your child?”

The telco amaysim has a list of etiquette recommendations on its website. It suggests that you don’t use your phone on a date and don’t have social media notifications chime through your work day. “If you’re in a group of four or more, there is a mobile manners rule that you could try out. So long as at least three people are engaged in the conversation, you can duck out to check your phone. This means that eventually everyone gets a turn to phone check, while the conversation goes along relatively undisturbed.”

But addiction is not necessarily measured by the amount of substance consumed or, in this case, the time spent in front of a screen. “One person could be using it for 10 hours and be fine, and another could be accessing the internet twice a day but it could be impacting their relationship,” Rosenthal says.

True addiction – the kind that lands you at The Cabin for rehabilitation treatment – is defined by whether the behaviour alters mood or consciousness, tolerance to the time being spent online is building, withdrawal is occurring if internet access is unavailable, and the subject is unable to stop accessing the web or whatever aspect of the web that they are addicted to.

Dr David Greenfield, founder and chief medical officer for the Center for Internet and Technology Addiction and the assistant clinical professor of psychiatry at the University of Connecticut School of Medicine, says in a phone interview that the fifth and most important marker of addiction is whether it’s having a negative impression in at least one major sphere in a person’s life.

“The percentage of people who meet that level of criteria is relatively small,” Greenfield notes.

Rosenthal has had parents bring their 21-year-old son to the centre after they switched off the wi-fi in the house in a bid to curtail his gaming. “The impact was similar to someone hooked on heroin: it’s like this fear, this intense fear, followed by a barrage of threats.”

In December 2018, Luke Munday from south-west Sydney was charged after he allegedly assaulted his pregnant girlfriend when she requested that he stop playing Fortnite. He had inadvertently livestreamed the argument while playing the game, and viewers of the feed called the police. In the same month, Manly Sea Eagles centre Dylan Walker allegedly hit his fiancée during a dispute over a video game.

In 2016, Daniel Chapman, a 20-year-old man from Sydney’s outer west, stabbed his father to death after he disconnected the internet cable. Internationally there has been a spate of similar incidents related to online gaming.

The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies internet gaming disorder as a condition for further study. When the manual was released in 2013, the words describing addiction had changed. The previous edition’s chapter on “substance-related disorders” was replaced with one on “substance-related and addictive disorders”, making way for the notion of behavioural addiction. Gambling disorder (previously known as pathological gambling) was moved to this chapter – further supporting new clinical and neurobiological research on other behavioural addictions, including internet and video game addiction. In 2018, the World Health Organization officially introduced “Gaming Disorder” as a medical diagnosis in its International Classification of Diseases.

However, internet addiction in its own right is not yet listed as a disorder, and is a challenging compulsion to isolate. “There are a lot of cross addictions,” Rosenthal says, explaining that there’s often a nexus between internet addiction and addictions to shopping, gambling, gaming, pornography and social media – all of which are accessed online.

In an email, Adam Alter, the New York Times bestselling author of Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked, described screens and smartphones as a syringe, and thus the available content as the actual drug. The dopamine released by an Amazon purchase, the flash of light when candies in Candy Crush Saga align, or an Instagram picture getting 1000 likes hijacks the prefrontal cortex.

While patients can work on strategies to avoid gambling or substances such as cocaine or alcohol, cutting out the internet is virtually impossible. “Someone with a smartphone addiction or an internet addiction can be triggered on a daily basis,” Rosenthal says.

“The smartphone is the world’s smallest slot machine,” Greenfield says. “The notifications let you know that there is a drug waiting for you; it may be good, it may be bad … this is why people feel the need to compulsively check their phone 200 to 300 times a day.” This does not bode well for Australia, the poker machine capital of the world.

For those who cannot get offline, The Cabin’s Sydney centre offers a combination of cognitive behavioural therapy, one-on-one sessions, and group therapy in which the patients discuss everything from the 12 steps to the mechanisms of denial.

The treatment takes place in a warm but flavourless space. Brown armchairs are arranged around a coffee table, and in a case of art imitating life there is a framed image hanging on the wall that depicts empty chairs placed in a circle. If these settings don’t inspire patients to go offline, there’s the 120-bed inpatient facility in Chiang Mai. The program there, which looks like a combination of luxe summer camp and intensive therapy, is $14,900 for four weeks – and clients stay for an average of two months.

“We look at the reasons behind the addictions,” says Rosenthal. When people use social media it’s often for validation. “We are looking at addressing the underlying issues and the underlying core beliefs, and a lot of them are ‘I’m unworthy’ or ‘I’m unnoticed’.”

Rosenthal recalls asking one 17-year-old male about his social life. “He said, ‘Yeah, I’ve got friends. I’ve just never met them in person.’” The patient had dropped out of school in order to pursue gaming.

In almost all of the internet addiction cases that The Cabin has seen, it’s a parent or partner dragging their loved one to the clinic for help. “There’s always a large element of denial,” Rosenthal notes.

Marina Kamenev

Marina Kamenev is a Sydney-based journalist.

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