Internet Addiction: From Gaming & Porn to News & TikTok

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Today we have the privilege of chatting with Dr. David Greenfield, who is recognized worldwide for his expertise in online addictions. He is the Clinical Director and founder of the Center for Internet and Technology Addiction. So thank you so much for joining us today, David.

You're welcome.

I'm very excited because it's a timely chat for us to have with you today because the pandemic has put all of us online for so long. You know, it's now the new normal to be online all the time.

Well, it is the new normal. And one of the things that I, I'm going to be talking about in an upcoming TED Talk is that In the new world, we're all a bit of an internet addict. This is not just a pathological condition, but one that is a new normal.

All right. Now, let me ask you 2 questions from that, though. One, is it actually an addiction? Do we recognize this?

Sure.

So it is recognized by— certain aspects of it are recognized by the World Health Organization as an addiction, more relating to the use of video games. The, the recognition of general internet use is sort of still up in the air in terms of whether it is considered an official diagnosis, but really screen use has been recognized as an official problem.

All right, and then how big of a problem do we have right now, would you say?

You know, it's— it depends on what you define as a problem. You know, is a problem that you're spending 3, 6, 7 hours, 8 hours a day of your 16 waking hours on a screen for non-productivity purposes. If that— if you can maintain a balanced life and during— and still do that, then I guess it's not a problem. My, my tenet is, is that it's pretty hard to have a balanced life if you're wasting that much time on screen. That doesn't mean that We shouldn't use it. It doesn't mean that it's not useful or fun, but it does mean that it really is imbalancing us. And in certain cases, it actually interferes with people's ability to function.

Okay. And that's when you would consider it a problem?

Well, that's when, that's when the people would seek help professionally. That's when they would see someone that's got a specialty in addiction medicine or, or in some area to help them manage it. It's not, This is not something that'll respond to just general therapy or counseling. You have to sort of target it as a specific issue. But I think the vast majority— that's a minority, and maybe 3% of the population would fall into that category. The vast majority of us are just probably overusing it to a point that we might want to be a little bit less connected.

OK. And what is it, though? Because I find myself, I'll say I just want to log on for a minute to check things, and then I get sucked into this rabbit hole. And I never come out. How does that happen?

It's funny, I fall down a rabbit hole. The reason for that is because of dopamine. Because the internet is essentially the world's largest slot machine. Every time you go on, you don't know what you're going to find, when you're going to find it, or how good it's going to be. But you know, at some point, you're going to see something that's going to interest you. When you get that thing, whatever it is, you'll get a little hit of dopamine. And when it comes to a smartphone, that gives you notifications that there might be something waiting for you. And the brain is very, very susceptible to maybe, to the possibility of finding something. That's why we keep scrolling and looking, because we want to see something that feels good. And again, this part of the brain that's controlling this is not the cortex. This is the limbic system, the animal part of the brain. And these reward circuits are millions of years old. They don't know what the internet is. They just know It likes dopamine.

Ah, I see. You start that route, it's pretty hard to stop, I take it.

One of the things— I did a study, uh, I published the study back in the late '90s, and one of the things we looked at, about 17,000 people, and one of the things we found was that almost all of us lose track of time when we're online. In other words, we're unable to really, like you just said, figure out how much time we've been spending. And I think that's because we are dopaminergically innervated, and it creates this artificial sense of dissociation. And, you know, by the way, that's not abnormal. I mean, if you watch a good movie, you'll dissociate, you'll feel like you lose track of time. So it's not an unpleasant feeling. The problem is, you know, if you're rushing to get ready for work and you're scrolling through your TikTok feed, you're, you're wasting time that you really don't have.

Now, it's interesting you did that survey back in the '90s because that was way early. That makes you quite the pioneer.

I was very early. I might have been the second doctor in the world to really look at this. And my book was, I think, the second book on the subject in the world. And now we have dozens and dozens and literally hundreds and hundreds of studies now looking at this. So this has like reached a level of, um, real official science at this point.

But now what made you pursue it way back then?

You know, like, like anything, you know, some of it is serendipity. I, I had a good friend that, that was looking at the interface between the internet and sex, which was of course an early peanut butter and chocolate phenomenon, as you, as you can imagine.

Yeah.

And I saw a small study that looked at gambling addiction and compared it to heavy internet use. And at the same time, I had just gone online myself. And this is back when we had dial-up. So we're talking, you know, I mean, it's not that long ago, but it seems like ages ago. And I remember getting on and feeling— and there was nothing on the internet, by the way, in those days. I remember getting on and looking like— and not wanting to get off. I'm like, what is going on here? Like, why am I not wanting to turn this thing off? And there's nothing really important on here. So all of those things coalesced. And I had a background in electronics myself before I did my professional training. And they just sort of coalesced into this thing. And I did— I decided to do some research on it. And that research led to some publications and a book. And really what happened was the media picked this up, and once the media picked it up, they kept coming to me and saying, okay, well, what do you think about this? I'm like, well, we don't really know that much. So it's sort of, you know, if people treat you like an expert, you had better become one. So I think that's really what ended up happening. And I never expected it would become my career, but it really has become my career at this point.

What did you think your career would be?

I don't know. I knew it would have something to do with psychiatry or addiction, but I didn't know. I mean, my background was in addiction medicine. I was trained in that area. So I always had an interest in addiction, but I had no idea that I would end up here. So who knows? You know, I mean, some, you know, what's that old expression? Man plans and God laughs or something. You know, we don't always, know where we're gonna end up.

So what do you spend most of your days today doing then?

So it's a mixture. I obviously, I do some direct treatment with patients. I run an intensive outpatient program. So we do a one-on-one intensive program specifically for patients looking for that experience. I've been a medical director of a residential treatment program which is now in Florida. Originally it was in Massachusetts. I write. I just published a new book that came out about a month and a half ago called Overcoming Internet Addiction. And I prepare talks and I teach and I supervise some. And I don't know, I'm always busy, but it's, it's sort of a mix of, of things that I do every day. It's— but I still do a fair amount of direct patient care.

Okay. So when people find you, what is the most common reason? What's bringing them to you?

Well, if it's not for general psychiatric stuff, if it's, if it's for the internet, and I would say about 70% of the work I do is for the internet-related issues. And that could be they're overusing pornography or video games, or they're having issues with social media. And those are the 3 biggies in terms of content areas. And typically, they— if they're coming in for treatment or their parents are bringing them, and that's often— it's usually a loved one that is facilitating the process. They, they're having some impact, some deleterious impact in their life. They're not getting their schoolwork done. They're having issues in their job. There may be legal issues. I do get involved in a number of legal cases, particularly when people get into trouble online. Either in a marital situation or unfortunately in a pornographic situation, and where there's some pretty serious charges. So I do a lot of legal defense work and expert witness work in that area. But typically there's a problem. In other words, they're not getting things done, they're not living their life because they're spending upwards of 8, 10, 12, 15 hours a day You know, there's only 164 or 168 hours a week, I can't remember which, and if you subtract 40 of that for sleep, you know, if you're spending 80 or 90 of that on a screen, that doesn't leave you much time to do much else.

Yeah, yeah, I'm wondering, it seems to me with other addictions, the addicted one tends to hide the addiction.

Oh, oh yes, absolutely.

And do you find that holds true with online?

Absolutely.

There, I mean, for the most part, all of my patients are somewhat reluctant, from reluctant on the high side to incomplete abject denial on the other side.

Yeah.

So yeah, they're not, they're not looking for, you know, some of them think it's their parents are crazy or their friends are crazy or whomever. If they get in trouble with the law or they have some really significant issues in their life, their denial is generally a little bit lower because they've hit a little bit of a bottom on that end. But I think a lot of people don't think they have a problem. They think, you know, they don't— they think they should be able to spend most of their life on a screen. And then there's a battle, obviously, within the family around that issue. But I think rarely, except in cases where the circumstances are severe, Like people losing their job is a common reason why they would seek treatment. You know, if you've been fired because you violated the internet use policies at work, either because you're on too much or you're making personal— you're using it for personal reasons or looking at porn, for instance, it's pretty hard to deny that you have an issue.

Okay. All right. Comparatively speaking, do we have a bigger issue with porn or with gaming around here? What is it?

That's a good question. That porn, if you really look at the statistics, my guess is porn is bigger, but in terms of seeking treatment, we probably see more people coming in for gaming. I think porn is like the sort of last taboo that we have not addressed. I developed a whole training module on online pornography treatment. And even when I present it to the medical community or to the addiction community, there's a real, very significant level of discomfort around the topic. I think people just don't know what to do and say and feel around the issue of pornography. And part of that is because our culture is very ambivalent about sex.

Mm-hmm.

And, you know, we kind of celebrate it on the overt side, but on the COVID side, I think we still have some shame and discomfort around our own sexuality and around sexuality in general. And pornography certainly falls into that category.

Yeah. Now, when you, when you talk about gaming though, I'm imagining that really is something that targets a much younger audience and we're talking about kids, right?

Yeah. So we're talking about people, uh, well, although I've seen people with porn issues as young as 12, Oh wow, okay. You know, the average age of children seeing porn now has dropped to about 10 years old. So, and I don't know if you've ever— I'm not going to put you on the spot, but if you've ever seen online pornography, it's pretty intense. And can you imagine being 10 and seeing that? It's pretty hard to, to not think that that's blowing some circuits in there, or prematurely or precociously stimulating those children. So we do see issues with porn, but typically gaming, I'd say the sweet spot will be 14, 15 on the low end and well into the mid to upper 20s on the high end. That's the, that's the range where we see it, but gaming is targeted to that, to that age group.

I think a lot of people justify it though, as parents saying, what's the difference if he's gaming online or going outside to play?

Yeah, well, huge difference. Huge difference. I mean, I've never treated anybody for addiction to going out and playing. Never seen anybody not do well in school or have health issues related to going out and playing. But I have seen a whole lot of that from video gaming. They're just not in the same ballpark. Even television is not in the same ballpark as a video game. And you have to remember, video games are designed with that same behavioral conditioning that the internet really has, which is variable reinforcement. It's designed to intermittently reinforce you, which keeps your eyes on screen. They want you to stay on screen, and we're being manipulated neurobiologically. And the gaming industry is, you know, they're relatively okay with that. They don't admit that overtly, but they do say, I mean, their code word for addictive is to have an engaging experience.

Ah, okay.

Um, so, but you know, that's what they said about cigarettes too.

Okay. Now, what's the personality traits of someone who's spending too much time online gaming in particular?

Um, you know, I don't know that there is one personality trait, and as you know, there's no such thing as an addictive personality in the sense that We all have susceptibility to be addiction— to be addicted to something, because addiction is a neurobiological disorder. It's not really about personality. It's about our susceptibility. It's what we get addicted to. There may be some variability, but invariably, almost all video game addicts that I see do have a history, not all, but almost all, of ADHD. So there is a predisposition when you have that dopamine deficiency in the prefrontal area of the brain to seek out, I think, highly stimulating content that can get across that threshold. In other words, you know, if you've ever seen a video game, they are like in your face and they are very potent. And that overcomes that sort of stimulatory inhibition that people with ADHD have. So they're also dopaminergically deprived, and, and video games is all about dopamine.

Okay. A lot of what you're talking, I can't help but think also applies to news today.

Yes, because news has become gamified and news has become intermittently reinforcing. Uh, the news is designed now to keep us online, whether you take it on your smartphone or you see it on television. It's always been that way on television, but now online, It's so easy to do that, that they want you to— they don't want you to read the news. They want you to keep your eyes on screen so they can capture your data and sell you things.

Okay. Does anyone come to you saying, I'm addicted to news, please help me?

No, I actually have never seen anybody. I've seen people mention it in the process of other things that I'm doing with them. I mean, I know just for myself, When I get up in the morning and I'll look at the news, the feed on my phone, I have to fight the urge to keep looking at it. And it's annoying. In fact, I deleted TikTok from my phone because I found it too addictive.

Now, do you see a real difference with TikTok versus the other types of apps?

TikTok is the, is the, is a perfect addiction machine. It is unbelievably well-designed to be addictive. I mean, it is— it may be the most addictive form of social media right now out there.

Now break that down for me. What qualities does it have? Or, you know, what should I be on the lookout for?

What it is, is that it has algorithms that intermittently show you things that it either knows you'll like or thinks you might like. And because it does it intermittently, it really is a slot machine for you. And because you can't predict what the next video clip will be, there's a natural tendency to just keep swiping. And you keep swiping and swiping and swiping. And, and each time you find something you kind of like, you get a little hit of dopamine. But the anticipation of maybe finding it actually elevates dopamine even higher. So it becomes this reciprocal loop that that you get stuck on. And it's, it's really a digital drug. Hmm.

Okay. Is there anything in real life that compares to that?

Gambling.

Okay.

Gambling does. Yeah. I mean, eating, I mean, food is very dopaminergic. In fact, that's the original food and procreation where the original dopamine— that's why dopamine was created, so to speak, is to make sure that we ate and we procreated. Um, and it would make sense from a biological perspective to have pleasure— to have 2 things that are linked to our survival to be very pleasurable. So all addictions piggyback those original survival pathways.

I see. Now, from your perspective, though, with where we are now as a society spending so much time online, where do you see this going?

Yeah, I've been asked that a lot. You know, I— my first book in '99, I wrote a whole chapter on sort of the future of the internet, and I went back not too long ago and reread it. And unfortunately, pretty much everything I predicted 22 years ago has come true. I think unfortunately what we're looking at is implantation eventually of the devices. Certainly we're going to move from carrying this little box around to wearables to, you know, woven or integrated into clothing. It's already being integrated into our cars. But I think the ultimate endgame, I mean, is an interface between us neurologically and the internet. And that's where it's headed. Now, I don't think that's in the next 5 or 10 years. But I think that's really to do away with the interface, which right now is the smartphone. And the smartphone has really become almost the dominant way that we access the internet. By the way, the smartphone would be absolutely unappealing if it wasn't connected to the internet.

Okay, that makes perfect sense.

Yeah, you would lose interest in it. You know, it's a— it basically takes pictures, and you could talk on it and send some text messages. How much can you do that?

Yeah, I don't even know why we have the phone component anymore, because I don't know anyone who actually makes the calls.

I do. Because I'm a boomer. I mean, I much prefer a call because it's a much more rewarding and personal connection. But I use text all the time. And, you know, and it— I don't like it when my children want to communicate. I have 2 millennial children. And that's how they want to communicate. And I find it very dissatisfying.

Yeah. Now, do you find stark differences between the generations?

Sure. I think that, you know, like my children who are 27 and 25, they were essentially raised on this technology, not quite, but almost their whole lives. And, you know, they have an almost innate acceptance of it. It's just sort of, they don't know how to live the world without it. But I call myself— so they are digital natives.

Mm-hmm.

I call myself a digital half-native. Because half my life was really without these technologies. So I do think there's a difference in the way they see the world and the way— and their need for that social connect. I mean, we all are biologically wired for social connection and social approval and social interaction. That's pretty much hardwired. But how we feed that may be different with this, the next— with Generation X and X— what's the one after the millennials? Z.

The Zs?

Zs, or yeah, the one right after the Millennials and the Millennials. They may see it a bit differently. And they have a greater acceptance of it. I'm still— now, in all defense, they said the same thing about television and radio and the telephone. You know, there were a bunch of curmudgeons who said, this is going to destroy the human race. And, you know, we shouldn't do this. You know, they said that about lots of things.

And rock and roll, right?

I remember when Elvis Presley came out, they thought it was going to destroy society. And so, you know, there's a little bit of that going around. But I do think this is very potent stuff. And it's not bad. It's just amoral. And it's really my whole thesis is that it's powerful. And you have to respect that power. And if you don't use the technology mindfully, And with some consciousness, it will just envelop your life. I mean, there's no— I mean, if you can't walk your dog without your smartphone, you've got a problem.

Yeah, it kind of sounds like you're talking about the days when alcohol and tobacco, before they had the warnings, right? But now, you know, in defense of the big tech companies, they'll say, well, listen, we do have tools out there that parents can use or kids can use. But how effective are they?

Yeah, well, you know, they call those digital wellness tools. They have all these like kind of fancy— they know that the jig is up, that, that there's a growing amount of evidence medically for the impact of these technologies. So they know that there's a little bit of heat on them now, which wasn't the case until fairly recently. So I mean, the tools are good if you use them. I think part of the issue is parents often don't know how to use them, or they're kind of afraid of them. And though I think a bigger problem is because of— because kids grow up with this digital native mentality, they know how to undo most of this stuff very quickly. So unless and until we have software that is much better at being hack-proof, it's a problem. Now, you know, we— our clinic employs an IT person, just to help us put up stuff on people's systems. And even then, we're constantly having to, you know, upgrade things in order to prevent them from being hacked. It's a problem. So if you're asking me, is what the tech industry doing enough? The answer is an unresounding no. Because they're not doing what the, what the gaming or gambling industry has already done, which is, look, we know gambling is addictive. Gamble responsibly. Here's the warning. Here's education. We're going to help fund treatment. We're going to help fund research. They're not doing any of that.

Nothing. What will it take for that to happen?

Really good lawsuits.

Yeah.

Some really good lawsuits, just like what happened with the tobacco industry. I mean, tobacco up until right at the last minute was saying, you know, there's nothing wrong with tobacco, but they had 25 years of data that showed that it was cancer-causing and highly addictive. I mean, nicotine is perhaps the most addictive substance on the planet. I mean, people say it's more addictive than opiates. It's very hard to get off of. And they, they had that data. They've known that for a long time. Tobacco's old. It's been around a long time.

Mm-hmm.

So, um, I think that's what it'll take, you know, and there have been attempts and I've, I've dealt with, You know, they just have to come to grips with taking responsibility. If they're going to make— if the gaming industry, let's say the video gaming industry, which is only one part of the tech industry, is going to make $100 billion a year, $120 billion a year, should they spend a little bit of that in public education and awareness? I think so. That's the socially responsible thing to do.

Okay, so If we can't really rely on forces bigger than ourselves to take control of this issue, how do you do it? What are some of the, maybe the warning signs that we should, that should click in our minds to say, okay, I see a problem either happening with me or my child?

Well, I think whether it's with your child or yourself, I mean, the first thing is you can't have a problem unless you're spending a fair amount of time on your screen. So You know, if you're spending an hour a day on all your screens, you're— I think it's highly unlikely you're gonna have a problem.

Okay.

So the first warning sign is that hours are going by. And when you check your usage on your phone or on your other devices and you see you've spent 7 or 8 hours that day, you know, that's an indication that there may be something going on and you might wanna— like when I look at my phone and I see I pushed 3 hours, I'm like, oh, that's not okay with me. And I put— I try to get more conscious of it, not unlike, you know, getting on the scale, because you get that feedback that lets you know. And remember, we all dissociate and time distort when we're on these screens.

Right.

So, you know, the fact that you're spending a lot of time on it, and then of course, if you feel like you're not getting a lot done or not getting what you need to get done, or you're late, or you're having issues at work, or if you're a student, it's affecting your academics or your social performance. That's usually what we see is that there's a reduction in academics. And we'll see kids go off to either in high school or college. And, you know, they'll go off to college and they'll flunk out once or twice, because they go in their room and they're just on video games all day. And they're not reading or doing their homework or going to class. And, and then their parents, you know, at the end of the semester get the grades and they've got 4 Fs and a D. And, um, and the reason why is they were on games all the time, you know, they were playing games. So, you know, some of it is self-monitoring, but ultimately it's about life balance.

Okay.

And the ability to have some degree of balance. That's true of eating, that's true of exercise, that's true of work. But, but screens are really, really potently addictive because they're so dopaminergic. They are so dopaminergic.

Now I'm wondering if there's any kind of cheat or hack that you advise for if I'm spending time online and I'm enjoying that, how do I get rid of the online component, but I should be replacing it with something else I enjoy, or— That's—

no, that's exactly right, um, because nature abhors a vacuum. So if you're going to reduce all of that pleasure you're getting from your game, from your screen, You do need to substitute with a real-time living skill. So we actually encourage people to develop a list of real-time behaviors that they want to substitute and then to start pairing their— in other words, the next time they get that itch to go online, Yeah. before they scratch it, they substitute a real-time behavior. It's not so easy always to do, but it does work. It does work when you say, okay, I'm not going to do that, I'm going to do this instead. And, you know, because it's very hard, you know, when we're pleasure-driven, we're very present-focused. And, you know, deleterious consequences, negative consequences are often future-based. In other words, so you have to sort of pare it down to the present and really do something in the present that can be substituted.

Okay. What do you, what do you think is the biggest misconception people have about being online?

That it's just, you know, that it's benign.

No.

It's not evil. It's not, you know, it's not like big bad tech is, you know, behind the scenes manipulating us. Although there is some of that. I mean, this is, this is a, this is a money machine. And I mean, if you think Facebook is free, look again, it's your eyes that are paying for it. You know, nothing on social media is free. You're, you're the dollars, you know, we are the currency that keeps this whole thing running. And so that's not benign in my mind, not just from a privacy perspective, but in terms of the, the one thing that we can't get back more of, or that we can't buy, which is our time. Like, how precious is that? And do you know anybody at the end of it all? that would say I have wished I spent more time on my screens.

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