6 Signs of Internet Gaming or Gambling Addiction

Foreign. I'd like to welcome everybody to today's presentation on Internet and gaming addiction. And we're also going to touch a little bit on gambling addiction, specifically as it relates to online gambling and day trading. Foreign we're going to define Internet and gaming addiction, explore the metamorphosis of Internet use and video games into addictive behaviors, and discuss day trading and some of the online gambling and how that may lead to gambling issues as well. The Internet provides an immense amount of information, although not all of it is credible. The constant novelty of the Internet can serve as an escape for people, and that, that's not necessarily, you know, if they are gambling or if they are gaming. Some people log on to Facebook or log on to Twitter, and before they know it, four, five hours have passed. I've worked with more clients than I would would care to recount who have lamented that social media is a problem in their relationships because their significant other spends too much time on it. They, their significant other gets home in the evening, pretty much just plops down on the sofa, gets on Facebook, and, you know, that's all she wrote. So it is important to recognize that Internet addiction and, and there's, you know, that it's not really actually a diagnosis, but compulsive Internet use or problematic Internet use is related to a lot of different behaviors, and we want to look at the characteristics of the behavior. Is it causing the person to forego important activities that they used to enjoy? Is it causing the person problems in one or more areas of their life? Is it taking more time? Are they spending more time engaging in that behavior, thinking about that behavior, or recovering from that behavior than they anticipated? Have they been unable to quit? If they've tried? Now the caveat here is if they've tried. Not everybody who is developing a problem with certain behaviors recognizes it yet as a problem. So we do want to, to recognize that there are going to be some people that are in denial. But those are the things that we really look for to decide whether a person has crossed the line, so to speak, from recreational use to compulsive or problematic use. Video games, online gambling, online shopping, and pornography all have the potential to become problematic, as does, in some cases, social media. Social media also has an addictive quality that can cause withdrawal and exacerbate mood disorders and, or addictions. I've done several videos on social media and how it can be helpful, you know, if people are plugged into supportive groups, but it can also be contribute to depression and anxiety because people go on and they See all of their friends posting all these wonderful things and it seems like everybody else has a perfect life. Well, you know, most people are not going to post pictures of themselves from the worst day of their life. So it's important to help people get perspective that they are seeing a very cherry picked selection of experiences from a person's life. So it is important to recognize that social media can be helpful and people can find a lot of support there. But it also can be very toxic and very harmful to relationships. It's all about how it's used and the extent to which it's used. Going back again to what we were talking about with the criteria for addictive or problematic behaviors, if it starts causing problems in one or more areas of their life and they continue to do it anyway, then we are probably talking about some level of compulsive behavior. What do we see when we are interacting with someone who may have problematic Internet use? They often downplay and are defensive about how much time they spend playing games on the computer or spending time on the computer. They often have a sense of a lack of control. They spend more time on in the games or in the virtual reality in order to get the same enjoyment or they just get lost in it and completely, you know, forego other aspects of life. They may withdraw from friends, family or their significant others to the point of disrupting those relationships. They may experience feelings of anger, depression, moodiness, anxiety or restlessness when they are not engaging in that behavior. Whether it's gaming or any of those other escape related Internet behaviors, they often find they're spending significant sums of money for online services, computer upgrades or gaming systems. Now this isn't so much true when we're talking about social media, but when we're talking about gaming or we're talking about online gambling or day trading. People can spend a crap ton of money really quickly and then there's preoccupation. The person thinks obsessively about being on the computer and engaging in that behavior. They have a sense of incompleteness when they are not engaging in it. They feel very anxious, very restless. And in the case of gambling or multiplayer computer games, they may even have a sense of fomo, fear of missing out fomo. So what are the consequences of Internet gaming and potentially gambling addiction? Well, physically there are some, you know, basic things that we find. Carpal tunnel syndrome and actual problems with the joints in the hand. Because of the way people are using their mobile devices or their joysticks or their or their mice. I find people actually do develop problems with their thumbs. If they are typing too much, they can develop overuse injuries. So we do need to recognize that our bodies really haven't evolved to deal with some of the pressures that we're putting them under. Some people develop migraines when they are in doing a lot on the computer because of the glare from the screen, because of the blue light, because of, you know, they may be sitting in a room that's dark and the screens are really bright. So there's contrast issues. They may have vision problems, they may have dry eyes. They can, that can happen when, when they're having more difficulty, when they're using their eyes a lot. There's also sleep disturbances. People who engage in these behaviors often because the computer is there. Computers are everywhere. If it's not your mobile device or your tablet, it's your desktop and we have them and computers. Somebody is awake somewhere in the world at all times of day. And when you're engaging with things that aren't even human based, like online gambling or single person gaming, then you know, obviously it doesn't even matter if people are awake. So you may spend too much time engaging in that and that you, in that you forego sleep. You know, you look up and all of a sudden it's four in the morning and you've got to be up at 5 to start getting ready for work. So sleep is really important to make sure that you're getting quality sleep, but also to make it make sure you're actually going to bed. And it can cause circadian rhythm disruption. We've talked in other classes before about how blue triggers our brain to be awake. When we have too much blue light coming in. When we have blue light at night, which is why they say don't sleep with your TV on. It can keep you awake and disrupt your circadian rhythms, impairing your sleep quality. Your circadian rhythms are involved in just about every system in your body. So when those circadian rhythms get disrupted, it can cause a lot of physical health problems as well as mental health problems. So yes, making sure that blue light is minimized one to two hours before bed. They have apps on mobile devices that are blue light filters. Those are so important. You can get blue light filters for your desktop, you can get blue light filters for your television for that matter. But blue light filters are very important. And if you, you know, somebody doesn't believe that that's important. You can get blue light filtering like sunglasses and encourage them to wear those for a week at night or when they're the last couple hours that they're on the computer and see if it reduces eye strain and helps them sleep better. Being on the computer all the time can and, and engaging in Internet type behaviors can increase depression and neurotransmitter imbalances and just ergonomic aches and pains from not moving around enough, from having poor posture, from sitting in a chair that's not supportive. All of those things can contribute to increases in inflammation which can contribute to depression, contribute to poor sleep. So we see that there are physical consequences of compulsive Internet behavior or compulsive online behavior that can contribute to physical as well as mental health issues. And remember, when you don't get good quality sleep, when you don't get that deep restorative, restful sleep, your brain isn't able to clear out the adenosine, which is what causes the foggy headedness, the sleep pressure as they call it, that makes you want to go to sleep. So when you wake up the next day, you have often, if you haven't gotten those, you know, that good restorative sleep, you're often going to feel foggy headed, have difficulty making decisions, have difficulty concentrating, all of those cognitive symptoms that we see with depression. Sometimes. 50% of people who have difficulty or problematic Internet use report a strain in their relationships as a result of their behaviors. They also, if they engage in these behaviors early in life, may fail to develop effective face to face in interpersonal skills. There are a lot of youth today who have a lot more social anxiety because they haven't had to talk to people face to face and they haven't developed some of those interpersonal niceties, so to speak, because even when they're texting back and forth, if they're trying to be nice, they're still abbreviating, deviating everything. So there are a lot of nuances that occur in face to face interactions that don't occur as much online. And people may have agitation and difficulty sitting still and difficulty being at peace with themselves. There's also challenges because online you literally have the world at your fingertips. People tend to not devote as much energy than to their relationships now than maybe they would have back then because it's so easy to, to use the expression, swipe left when things get a little bit difficult. So compulsive Internet use can apply and ripple out to a lot of different areas. So let's go back to video games though, because that's one of those things that the DSM does recognize as a problem. What makes a video game addictive you know, I remember back in the day and I will age myself again. Kind of like with WKRP Pac man. And that was when Tetris and we had this game called Pong and we thought that was the stuff. So the high score is one thing that makes a video game addictive. If you are constantly trying to beat your own high score or beat someone else's high score, if you're trying to beat the game, you're trying to learn the game. And both of those, I remember, even with Pac man, would keep me playing over and over and over again. I'm like, oh, I, I, I was almost there. I can get there again if there's no end to the game. And this is especially true in massive multiplayer online role playing games or, or MMORPGs. It's an ongoing saga, so to speak, so there is no final resolution. It's not like you want to get, not like Survivor, where you want to get across. Well, I don't. Maybe survivors not it. What's the one where they travel all over the world? The Amazing Race. There you go. It's not like the Amazing Race where there's an ultimate destination in MMORPGs. It is, it can go on for indefinitely, and that can make it addictive because people feel like it almost becomes a second life for them and they feel detached when they're not engaging in it. Role playing can make video games addictive because like the sagas in MMORPGs, when people take on a fictional role and they really embrace it, which a lot of people do when they embrace their, when they embrace their characters, it can feel like a part of you is being left online if you, you may feel actually disconnected with a part of you when you're not playing that game, when you're not engaging with that, with that role. Novelty and discovery also makes a video game addictive. A good portion of World of Warcraft, which, you know, that's not as popular anymore, but it's spent exploring imaginary worlds. Minecraft is spent designing new worlds. And my son, I always forget the one he's in right now, but there's one that my son's in that he is regularly exploring new worlds. And now he has a VR headset so he can explore it in all of its 3D reality, which can be kind of cool. I mean, I've put on his little headset before, and I've been able to explore the towns and there's a lot of beautiful graphics that you can explore, but you can also get caught up in the, in the escape of being in that world, they are becoming so incredibly realistic in their graphics that it, it can start causing problems. People sometimes have difficulty separating. Relationships are also forged. In some video games and in some online activities, these relationships are generally forged around a similar goal. If it is day trading, you know, obviously it's playing the stock market. If it is gambling with, you know, sport betting against sports teams or betting on esports, you know, a lot of times you start to talk with one another and you engage with each other. It's not like something like online poker where you're playing against a machine, but you join together or you unite with this similar goal, with these similar interests and it produces a sense of acceptance that's not necessarily bad. But if that is the only place the person is getting acceptance, it can be much more problematic. And online, especially in games where, you know, MMORPGs, role playing, where people can try on different Personas, it gives them the opportunity and this can be very cathartic. Don't get me wrong, it can be great for people to try on different Personas, especially if they've got social anxiety. So there are times when these characteristics can actually be useful and therapeutic. But again, if it crosses over that line and it becomes all encompassing, consuming, the person prefers to live in that virtual world than in the real world, then we start having more problems. And, and that's very true. When people put their whole identity into something, whether it's social media or whether it is a role playing video game, they may start feeling like they are not worthy because they've created this grand Persona that' not who they are. And that Persona has gotten acceptance, whereas they may not feel like they've gotten acceptance. So it's important to process these things because that can, as Jennifer points out, that can contribute to low self esteem. We need to understand, remember, all behavior has meaning. So we want to ask the person, you know, why are you engaging in this game? You know, there is nothing wrong with having the occasion. You know, even if it's every day for a brief, a constricted period of time where they are escaping. You know, when I go to the gym for an hour, I am in my little la la land and I am, I've cleared my mind and I am in my happy place. Okay, there's nothing wrong with that because it is confined, it's not ongoing, it's an hour every day. But if it starts to become something that encroaches into you, time that normally should be spent with other hobbies, people you Enjoy or heaven forbid, hygiene, then we start to have problems with it. Researchers at Hammersmith Hospital in London conducted a study all the way back in 2005 which found that dopamine levels in players brains doubled when they're playing. Now remember, dopamine is not your pleasure chemical. Dopamine is your motivation and perseverance chemical. It keeps you playing that game, it keeps you hitting that button. So yes, I want to play again, I want to try it again. And, and the dopamine, when we release that high levels of dopamine also increase levels of serotonin. And oftentimes if there's rewards associated with the game, even you know, going back to Pac man, even if it's just getting those, chomping those little fruits, there are, there are endorphins that are released. So there is brain chemistry that supports the rewarding behavior of video games as well as, as gambling. Jeffrey points out that one of the more insidious video game innovations has been mobile video gaming and the use of gambling to attain characters, cards or items. These are gacha games or loot boxes. The dopamine, dopaminergic activation is quite intoxicating because they receive that reward for progress. So we want those endorphins, which means we've got to persevere in order to get those rewards. So let's, you know, talk a little bit about gambling as we're talking about rewards. You know, in video games, sometimes it's getting, you know, imaginary loot or tokens or something. In gambling, a lot of times it's actual, actual money. Gambling problems can co occur with other behavioral health conditions. Unfortunately, only about 10% of people with a gambling problem seek treatment. And a lot of this. I did a interview with a man who specializes in gambling problems and he pointed out that a lot of people don't recognize that what they're doing actually qualifies as a gambling problem. You know, if they're spending half of their allotment, their food, food budget on lottery tickets every week, you know, that's a problem. A variety of other problems can be related to gambling, including victimization, criminalization, social problems, health issues, and higher risk for contracting sexually transmitted diseases and HIV and aids. When gambling gets out of hand and people are trying to figure out how to fund, can cause, put them at risk for other types of, you know, health problems. It can put them at risk for victimization. And it can also just even before that point, it can cause social problems because their loved ones get scared for them, get frustrated with their behaviors. Gambling Is defined as risk risking something of value, usually money, on the outcome of an event decided at least partially by chance. Action gamblers are typically men and gamble because it's stimulating. They enjoy the rush, they enjoy the power that they, they, they feel when they, when they win. Action gamblers require some type of skill or knowledge like poker or sports. They need to feel like they have some level of control in what's going on. Relief gamblers, on the other hand, are often female, gamble for escape and often gamble using games of chance like bingo, the lottery, slot machines, games that don't require, require any particular skill. Now why this occurs, I, I don't know. But the research has indicated that there is definitely a different set of activities that the different genders tend to gravitate toward. In the DSM 5, pathological gambling was renamed gambling disorder and is categorized under substance related and addictive disorders. Problem gambling does not meet the criteria for pathological gambling. And it's important to remember that with any addictive behavior, the addictive, the behavior itself is not the problem. It is when people start using it. And it causes the neurochemical changes that result in the development of tolerance, the development of withdrawal, the challenges and the, the after effects from what's going on. Alcohol, for example. People can drink alcohol and not develop alcoholism. People can gamble and not develop pathological gambling there. Which is why I talked earlier about that fine line between recreational use and pathological or compulsive use. Problematic gambling behavior is defined as leading to clinically significant impairment or distress as indicated by four or more of the following in a 12 month period. Now you can generalize these. You know, they, they just kind of changed the word gambling when they applied this as opposed to applying it to other addictive behaviors. But they gamble with increasing amounts of money to achieve the desired excitement. They're restless or irritable when attempting to cut down or stop gambling. They've made repeated efforts to cut back or stop gambling, but have been unsuccessful. They're often preoccupied with gambling and gamble. When they feel distressed after losing money, they often return another day to get even. They may lie to conceal the extent of their involvement with gambling. Gambling itself has jeopardized or caused them to lose a significant relationship, job or career. And they often rely on others to provide money to relieve financial problems. Now again, like with all addictive behaviors, the behavior is not better accounted for by a manic episode or a hypomanic episode. So we do want to recognize that. But thinking about each one of these, when we're thinking about somebody who gambles online poker or online slot machines or. I, I don't know a whole lot about gambling, but. But then you've also got all of the, the Robin Hood craze and all of the people who are now day trading. And day trading, the way it's being done right now is essentially gambling. People are using increasing amounts of money to try to get the desired excitement or outcome. A lot of times when the market's closed, they get restless or irritable. You can go into any of these forums and, you know, 24 hours a day and there's somebody that is doing stock research. There's somebody that's talking about what the next big, big Wall street bets, Robin Hood craze is going to be and what they're going to try to push up. I mean, it has become an almost an obsession with a lot of people. So it's interesting to apply these criteria to day trading. And just like gambling, you know, my daddy used to go, every year he would go to Las Vegas. He and my stepmother would go to Las Vegas and they had a certain amount of money that they set aside and they would go gamble. And if they won, great. And if they lost, okay. But they had a very defined amount of time and money they were going to spend doing it. So for them, for example, gambling wasn't a problem because it was an activity that they enjoyed that did provide relief and escape, but it didn't meet these criteria. It didn't cause them problems in their daily life. It did not cause them problems in psychosocial functioning. So we do want to recognize that the same thing is true for day traders. I mean, there are people who actually go to school to learn how to be traders. And you know, I'm, I think that's a degree in finance or something. But their whole goal is to be able to work on Wall Street. So there is, you know, there's a fine line there between, you know, whether it is something that's productive and helpful and healthy, or it is something that is used as, as an escape or starts causing problems in your life. Casino gambling versus day trading versus online gambling. You know, I think it's interesting to kind of consider some of the nuances in casino gambling. You know, we've all heard that you, you can't win against the house in, in casino gambling because there are often they set the odds in the, in in the favor of the house. That way, you know, they can keep the casino opening. That totally makes sense. So casino gambling has its own little nuances. Day trading is almost like betting against the house because a lot of the retail day traders are betting against or gambling against if you will, the hedge funds and the big money movers. And then online gambling can be just completely computer driven and completely available 24, 7. All of these provide one. Well, they provide escape, they provide excitement and they also provide the lure of freedom. And a lot of people, when they hate their life, when they hate their job, when they are struggling financially, which we know a lot of people are, the allure of these activities can be very intoxicating. So we do need to examine again, what is the meaning behind what this person is doing and are there other ways that we can help them achieve that goal? Are they trying to get that rush of endorphins because they're depressed? Are they trying to escape because their life is just, you know, crumbling with stress right now? Are they trying to find an out because you know, financially they feel that they're struggling all the time and, and they're hoping that they can achieve more money and, and sometimes people are doing it to gain more wealth because they see the influencers going back to online. They see the influencers online that have, you know, 20, 000 square foot homes and 14 cars and whatever. And instead of focusing and noticing what they do have and recognizing when appropriate that all of their basic needs are being met, they focus instead of on all the things that they don't have and they hope, they think that oh, when I get that bigger house or when I get that nicer car, then I'll be happy. So they're living in the future instead of in the present. Now obviously people need to get their basic needs met and if they're not getting their basic needs met, that's a big issue. But we can help them with that, that there are a lot of services out there. Call United Way Information and Referral. If you're not familiar with some of the services in your area to help people with their electric bill, with their food, with their, you know, whatever those needs. Are risk factors for gambling a need to escape? Well, you know, when you've got stress sometimes and this is also a risk factor for, for Internet and gaming addiction. You want to get out of your life. So you may go to social media and live vicariously through others. You may get into a role playing game and live vicariously through that avatar. You may get go online and engage in gambling or day trading in order to focus your attention on something that increases dopamine and increases endorphins. Poor interpersonal relationships have also been found to be a risk factor for online problematic behaviors. Well, that makes sense. If you have poor interpersonal relationships, you may feel like you need to escape more. When we have, when we have positive interpersonal relationships, they serve as a great buffer against stress. People who are easily bored. And in today's society, somebody Meg was mentioning earlier, our need for instant gratification and contributes, I think, a lot to this and this sense of restlessness these days. My. I'll put something in the microwave, you know, I'll put my coffee, water in the microwave to heat it up. And I get impatient because it's taking too long. And I know that makes no sense. Back in the day, we used to have to put it in a kettle. But we have become much more impatient and much more restless because we've been sort of programmed that way. We watched, during the pandemic, we watched several old movies with our kids. And you know, when I say old movies, I mean movies from the 80s when my husband and I were in high school. And those movies just seem to drag on so slowly. We have. Our brains have been reprogrammed throughout the last 20, 30 years to expect more action, more movement, more of, of everything. So those movies that we used to think were, you know, Terminator, for example, were just the bomb back in, you know, the 80s. Now we watch them and we're like, eh, you know, I'm getting bored, gotta do something else. So we, we can. Identify the fact that our culture has created a sense of restlessness and people do get easily bored and sensation seeking or quote adrenaline junkies. And Marie points out, and you know, a very good point, that there's often a lot of overlap with other compulsive behaviors or problematic behaviors. And this is one of those things that I harp on when I teach the addiction counselor certification track because it's really important to explore the meaning behind the behaviors. I worked in residential treatment for 14 years, and I would so often see people who weren't able to access their drug of choice, whatever that was, but they were able to access all kinds of pastries and donuts and coffee and cigarettes. Oh, and. And sex. It was a co educational facility. And let me tell you, it's amazing how sturdy drop ceilings can be. I had no idea you could crawl through them. But anyhow, I digress. People would. In order to get that dopamine, in order to get that serotonin and those endorphins that their body had developed a tolerance to, they need the, they needed the rush. So they would find another way to get them. So we do need to look for substitute addictions or concurrent addictions. Even if they're not, you know, substances or behaviors you see, you often see both of them co occurring or multi occurring. Warning signs that somebody may be having a problem with gaming or gambling. Financial problems exist despite adequate income. Money has gone missing from a bank account. Wallet or valuables have disappeared. There's a lot of borrowing. Cash advances, living off credit cards, retirement or insurance policies have been cashed in or allowed to lapse. The person avoids family functions or other social events. They neglect responsibilities or make excuses. They may drop other leisure activities to focus on gambling. They disappear for large blocks of time and arrive late to work or for other commitments. They may appear deceptive or secretive, particularly as it involves money or their use of the Internet. They may seem edgy, reactive, or defensive and often have changes in their sleeping, eating, and sexual behaviors. So these are things that we can use as sort of a checklist for people. Have you experienced any of these signs? And, you know, if so, okay, let's talk about that. Let's talk about what that means. Maybe they did a lot of borrowing and cash advances because they just had a run of bad luck. They got really sick, they ended up in the hospital, and then their car died and then their computer died and their kid needed new shoes. I mean, it happens to people who have no problem with gambling. So we don't want to assume that just because there's one or two signs that the person has a gambling problem. But we do. We may want to explore what brought about that symptom or that sign to, you know, figure out if it's a problem or not. In treatment, our goals are abstinence from the problematic applications or sites, which can be challenging sometimes because no matter how good you put your firewalls and restrictions on your home Internet, even on the person's person's mobile devices, they have what I call nanny apps that will prevent them from going to certain sites. It will report to a, a guardian or sponsor if they go to certain sites. But there are also computers that people can go to that aren't theirs. They can use somebody else's phone, they can use somebody else's computer. They can go to the library and use the computer. So where there's a will, there's a way when it comes to computers. So that is important to recognize that complete abstinence can be challenging for people, especially people who are not super motivated. Think about, again, the person who has alcoholism. You know, there Is alcohol out there, there's alcohol at Walmart, there's alcohol at the 7 11, there's alcohol out there. So they need to have tools to be able to deal with the cravings and urges when they arise. Unfortunately, a lot of our life is online now, especially since the pandemic and people working from home, a lot of our life is conducted online, whether it's talking with friends or doing our work, paying our bills, balancing our our bank accounts. So sometimes it is not realistic to expect someone to just not use a computer. And we may need to strive for what I call balanced Internet usage where they identify what they need to do, they set time limits for how long they're going to be on there. And again, they have blocks set up so they can't go to certain websites. Some people in the early phases of recovery opt to unplug when they are not at work. So they leave their computer, they leave their mobile device, they leave all that stuff at work. So they are plugged in during the workday when they have to be, but during the evening they are not, so they can focus on mindfulness and their relationships and those sorts of things. Now that for a lot of people that's overwhelming. The thought of being without their mobile device for 8 or 12 hours is more than they can even fathom. So it's, it's going to be an independent or an individualized goal. Interventions we want to help them prevent use of the sites that are problematic for them. You can have parental control set on your home router that turns the Internet off for the entire house at a certain period of time. Firewalls, like I've talked about, timers, and this is not online timers. This is getting an egg timer or something and putting it across the room. So just like getting out of bed, the person has to get up and go across the room to turn it off, which can help them recognize that, okay, my time online is done. And look for and accentuate exceptions. What are you doing when you're not on the Internet? You know, taking a bath, reading a book, talking to a friend, playing with the dog. What is it that you're doing when you're not engaging in that behavior that that helps make you happy? Remember when we're talking about preventing use, that it's important not to forget tablets, smartphones, any kind of mobile device. Those also need to have firewalls and parental controls of some sort installed. We can also encourage people to use decisional balance exercises, identifying the benefits to use, whether it's going on Facebook or playing their role playing game or day trading, gambling, whatever it is. What are their benefits? What benefit do they do they get from. From using. From using. And with people who gamble, it's really important that they keep a accurate diary or log of their wins and losses. Because a lot of times they'll say, well, I'm making money, I can make $2,000 a day or something. And it's important to be able to say, well, okay, you know, last Tuesday, Yeah, you made $2,000, but then the rest of the week you lost 9,000. So, you know, it's important to be able to focus on the big picture, not just the wins, but helping them identify what they see as the benefits to use can help you identify issues that they have which may need attention, whether it is self esteem, acceptance, interpersonal skills, dealing with social anxiety, meeting basic biopsychosocial needs. We need to understand why are you engaging in this or addressing depression and neurochemical imbalances. And then we can also identify areas where we target alternate rewards. So when you're not online, you know, what other things do you enjoy doing? What other things do you find enjoyable and rewarding? We want to try to magnify those rewards. So if they enjoy spending time with their best friend, well, what, what do you really enjoy doing with that person? Is it maybe going rock climbing or going hiking or something? Encouraging them to engage in real life activities that will similarly stimulate dopamine and endorphins because they're enjoying what they're doing. We want to talk about their drawbacks to use. You know, what it, what are the downsides to engaging in this behavior? And this is the one that people have always lectured them about. So they probably will have a litany of these. What are the benefits to stopping? And there are some overlaps in these quadrants. The drawbacks to use and the benefits to stopping. There are some overlaps, but we want to help them identify, you know, why might I want to stop? And using all of the dimensions of motivation, physical how will, how will it make you feel physically better, reduce your pain, improve your energy, improve your immunity? Affectively, how will it make you feel emotionally less stressed? Cognitively, how will it help you focus on the things that are important to you? Environmentally, it may or may not change the environment, and relationally, how will it improve your relationships when you are no longer engaging in that behavior? And then talking about drawbacks to abstinence, which will overlap a little bit with benefits to use, that's fine, but this is where we start identifying People's fears about stopping using. What are the drawbacks? What are the things that you dread about changing this behavior? And then we can start addressing those and mitigating that, that fear or that dread, whether it's, you know, not knowing what to do with their time or whatever it is. Cognitive behavioral therapy has been found to be super helpful with addressing a lot of these issues. From interpersonal skills to coping skills. Distress tolerance, problem solving. Likewise, dialectical behavior therapy has been shown to be really effective to help people develop distress tolerance. Instead of feeling like they need to escape with the by engaging in the online behavior, they can develop alternate skills to help them tolerate distress in the moment and control their impulses. Motivational enhancement therapy is really helpful. And if you have done any addictions counseling, you're familiar with the stages of readiness for change. Pre contemplation, I don't have a problem. Contemplation, eh, I might have a problem, but it, it's all good preparation. Okay, I got a problem, I might think about doing something about it. And action is when the person says okay, I've got a problem, I need help. And then maintenance. But knowing those stages, there are different techniques that can be really helpful in each of those stages in developing rapport and helping advance a person forward towards a greater level of readiness for change. And along with CBT and dbt, I would be remiss if I didn't mention CBT or ACT Acceptance and commitment therapy. And this is another cognitive behavioral approach that some people find very effective. I have videos on all of these approaches on the YouTube channel. Not going to go into depth with them right now. Psycho education as we've talked about, a lot of people who engage in these online gaming compulsive behaviors often have problems with their self esteem, either that led to this problem or as a result of this problem. So we do need to help people examine and enhance their self esteem. Interpersonal skills, including communication skills, assertiveness, mindfulness and basic relationship skills may be important because they may have never developed those skills because they spent their their formative years engaging in virtual worlds. Coping skills training and goal setting can also be really helpful. Adulting can be daunting even for people who are fully adults. And when people learn how to set smart effective goals, then they often start to feel a lot less overwhelmed and they see a path to coping with life on life terms. Medications are available that tempo temporarily can help rebalance neurotransmitters. SSRIs like Lexapro and Wellbutrin are the ones that have been most studied in relation to Internet and gaming addiction. Now, trexone, which is an opioid agonist, has also been studied and as has, interestingly enough, dexmethylphenidate, which is an ADHD medication. So we want to examine. And each of these would be a little bit different. You know, think about it. SSRIs. What are we doing? We're increasing serotonin levels. Now you're also slightly increasing norepinephrine and dopamine, but mainly serotonin. So somebody whose serotonin is low, who tends to have depression or even high levels of anxiety, may respond with better to SSRIs for addressing their behavioral issues. People who respond better with naltrexone may have a dopamine imbalance. Because what we're doing is we are altering the receptors that are engaged when someone activates their dopamine and their endogenous opioids. So when we give give them medications, then we are helping them alter that system. Now, this should say antagonist. Naltrexone is an opioid antagonist, not an agonist. But what naltrexone does is basically it blocks the pleasurable feeling from the gaming and then dex methylphenidate. If somebody is engaging in online behaviors as a coping mechanism to deal with their adhd, that can be helpful. And dexmethylphenidate is more involved in increasing norepinephrine levels. So you see that there are three primary medications that they've studied. Each one of those alters a different neurotransmitter. So what causes the compulsive behavior differs between people. And I think that's a really important point to remember. And the same thing is true when we talk about depression or anxiety as well. You know, it is not one size fits all for medications. Exercise has been found to be helpful with online compulsive behaviors. Exercise increases serotonin and dopamine. And the sunlight also can help regulate neurotransmitters, including melatonin, and which can improve sleep and mood and help regulate those circadian rhythms. Nutrition. Water is important. A lot of people who engage in on a lot of online gaming don't drink enough water. They don't drink enough, period. And sometimes they don't drink intentionally because if they drink, they've got to get up and pee, and that means they're going to miss something. So water is really important because dehydration can cause symptoms of depression. Oats, bananas, chicken, dairy products, green leafy vegetables and nuts are all chock full of the vitamins, minerals and amino acids that are necessary for the development of neurotransmitters, Particularly dopamine and serotonin. Like other addictions, Internet addiction can have physical, social, financial and emotional consequences. In our digital age, it is highly unlikely that people can compl can completely unplug. Similar to other behavioral addictions like eating and sex, it's necessary to identify the motivations behind the person's use of the Internet sites. Additionally, by its very rewarding nature, Internet addiction will cause neurochemical imbalances which can lead to depression and apathy. Remember, we've talked about addictive behaviors before in when the brain, when the tissues are regularly exposed to high levels of dopamine, they start becoming less reactive to that dopamine. So the person develops a tolerance to those dopamine surges. So in order to feel normal, you know, basically the tissues have. Have adjusted to 10 times normal level levels of dopamine. And I'm just, just pulling out random numbers for the example. But when the body gets used to having 10 times normal level of dopamine and then it's not getting that anymore, then the person starts to experience withdrawal and agitation. So even the dopamine surges that are caused by gambling and gaming and those sorts of things can alter the responsiveness of the receptors, can alter the dopamine and serotonin systems. So we do need to recognize this is not just a willpower sort of thing. Just because it's behavioral and not chemical doesn't mean that there's not an underlying neurochemical imbalance. Recovery involves addressing underlying mood, self esteem and coping issues, Identifying triggers for use and ways to deal with them, and creating a relapse prevention plan. There are a lot of resources that are online. OLG Anon, which is Online Gamers Anonymous is an interesting site. If you've got someone who is struggling with online gaming. The challenge with it is it's mainly online. So for someone who is struggles with choosing healthy behaviors online, that can be a problem. A lot of the online Gamers anonymous chapters actually don't have in person meetings. So that might be something if you see a demand in your area to consider, you know, talking with your clients, maybe about starting a Olga non chapter that actually has face to face meetings in your area. And it is important to recognize that there are a lot of people who, especially people who are not auditory learners who get antsy when they are having to sit still. Whether it's a zoom meeting or a sermon in church or a lecture at school. Some People have a really hard time sitting still for that length of time. So we don't want to necessarily pathologize that right away. But we do want to recognize that there are some people that do need additional tools to help them deal with their restlessness, whether that's fidget spinners or whatever it is they do. Whenever I go somewhere and I'm going to have to sit for a while, I always bring my crochet with me because at least I'm able to do something with my hands. Marie has has identified the Social Dilemma, which is a documentary on Netflix, is a movie about addiction to social media. So that might be something to explore a little bit. And I'm with you on that one, Mark. I. I don't like losing money either. I don't like messing with. With monies. But I do need to have something generally. I mean, you see, even when I teach, I. I move around a lot. I'm not one of those people that, that can sit still very well. So it is important to help people figure out tools that they can use to help them cope when they're in a setting that they have to sit still for a little while. All right, everybody, have a wonderful day and I will see you on Thursday when we were talking something about eating disorders. Have a great day. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand ceus for this podcast is@allce.com podcastceus that's allceus.com podcastceus to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor. Thank you.