To understand technology addiction (or any addiction for that matter) you need to understand the Q-tip. Perhaps you’ve never noticed there’s a scary warning on every box of cotton swabs that reads, “CAUTION: Do not enter ear canal…Entering the ear canal could cause injury.” How is it that the one thing most people do with Q-tips is the thing manufacturers explicitly warn them not to do?
“A day doesn’t go by that I don’t see people come in with Q-tip-related injuries,” laments Jennifer Derebery, an inner ear specialist in Los Angeles and the past president of the American Academy of Otolaryngology. “I tell my husband we ought to buy stock in the Q-tips company; it supports my practice.” It’s not just that people do damage to their ears with Q-tips, it’s that they keep doing damage. Some even call it an addiction.
On one online forum, a user asks, “Anyone else addicted to cleaning their ears with Q-tips?…I swear to God if I go more than a week without sticking Q-tips in my ears, I go nuts. It’s just so damn addicting…” Elsewhere, another ear-canal enterer also associates ear swabbing with dependency: “How can I detox from my Q-tips addiction?” The phenomenon is so well known that MADtv based a classic sketch on a daughter having to hide Q-tip use from her parents like a junkie.
Q-tip addiction shares something in common with other, more prevalent addictions like gambling, heroin, and even Facebook use. Understanding what I call, the Q-tip Effect, raises important questions about products we use every day, and the responsibilities their makers have in relation to the welfare of their users.
Addiction Doesn’t Mean What You Think it Means
The word “addiction” is used quite a bit these days. We might say an avid runner is “addicted” to the sport or call our cell phones an “addictive technology.” The shoe retailer, DSW, goes as far as printing, “highly addictive-contents inside,” on the boxes it sends customers. However, as Inigo Montoya said, “You keep using that word, I do not think it means what you think it means.”
Addiction is defined by clinicians as a harmful, persistent, and compulsive dependency to a behavior or substance. But unlike other vices, addiction implies self-inflicted damage. Simply doing something a lot, like checking Facebook or watching television, wouldn’t qualify as addiction unless the user has difficulty stopping the activity, despite it doing them harm.
According to Dr. Marc Lewis, a developmental neuroscientist at Radboud University, addiction is another form of learning. “It’s the brain taking the shortest route to get what it wants, repercussions be damned,” he explains to me.
Lewis knows addiction well. Though the grey-bearded Lewis looks every bit the professor today, he was once a junkie. Lewis documented his experiences with heroin, ketamine, cocaine and a cocktail of other psychotropics in his book Memoirs of an Addicted Brain.
Through his journey from addict to academic, Lewis has come to some startling conclusions about the nature of addiction. For one, Lewis doesn’t believe addiction is a disease, at least not in the way we think of cancer or glaucoma as a disorder in the structure of an organism. Rather, Lewis believes addiction is the brain’s rewards system channeling attention to just one single, solitary stimulus.
We typically think of addictive substances having powerful chemical hooks to which anyone could succumb, but that’s not really true. “What’s interesting,” Lewis told me, “is that not everyone responds the same way to a drug. Some people don’t like heroin, for example. It just doesn’t feel good to them.” Millions of people are given high-potency opiates after surgery but only an unfortunate few form a dependency. Many people drink alcohol but a tiny fraction become alcoholic. We all eat, work, and have sex but don’t necessarily become compulsive eaters, workaholics, or sex addicts.
What accounts for the difference? “It could be that what feels good is what you’ve been missing,” Lewis explains. In other words, an addictive behavior has to scratch a specific itch, physical or psychological. Addiction (as opposed to moderated use) requires that lingering itch.
That Lingering Itch
The itch brings us back to the humble Q-tip. For Q-tip users, it starts with an unpleasant sensation, perhaps some excess wetness from the shower. Using soft white cotton on the end of an ear canal-sized stick seems like a reasonable solution to the problem, despite the manufacturer’s warning.
Of course, the problem isn’t really a problem. “Ear wax is good. It is supposed to be there,” Dr. Derebery explains. “You don’t need to clean your ears.” Just being patient will resolve the sensation of wetness. However, as is so often the case when attempting to solve life’s dilemmas, patience is difficult and people do what they can rather than what they should.
Addictive products always provide the brain with a temporary fix — but the solution creates more of the problem. Repeatedly rooting out the ear canal dries out the skin and can scratch the eardrum, causing inflammation. Inflammation feels a lot like the blockage that incited the ear prodding in the first place. The more you prod, the worse the itch becomes, and the more you scratch. The cycle continues until medical attention is needed.
This is what I call, the Q-tip Effect: when, in the course of using a product, the perceived solution becomes the source of the problem. Problem gambling leads to financial stress, increasing the allure of escaping into a mindless zone state where the weight of the gambler’s troubles can’t be felt. The social isolation and guilt that comes with opiate abuse makes the warm, love-like embrace of a heroin high even more desirable. The more people binge-watch television, the more lonely and bored they become, increasing the need to turn to a screen for something to do. The Q-tip Effect arises when the solution becomes the source of the problem, eventually leading from use to abuse.
This itch-scratch cycle isn’t exclusive to products. We see the same pattern with habits like nail biting or face-picking, where irritation exacerbates the underlying problem and prompts more of the self-harming behavior. But there’s something unique and unsettling about addictions to manufactured goods and services. When it comes to addictive products, someone profits from the harm done.
Profiting from Addiction
There are two types of addictive products. The first is the kind where the manufacturer does not know the user. Alcohol, cigarettes and even Q-tips fall into this category. These products are bought off store shelves, leaving the manufacturer with little information about who uses their wares, how, and how much.
In the second type of addictive product, the maker knows their users’ behaviors well. Casinos know their players through loyalty cards. Gaming and social media companies track every user’s click. And drug dealers know each of their clients.
Both manufacturers who know and who don’t know their addicts can help dampen the addictive effects of their products in different ways. Companies that don’t know their users have an obligation to warn potential buyers if there’s a high likelihood of harm. The more visible and ominous the warning, the more effective they are at preventing abuse.
In Australia, for example, where cigarette cartons come plastered with a grisly image of a swollen cancerous mouth or a young man on his deathbed accompanied by large text reading, “SMOKING KILLS,” smoking among adolescents has hit an all–time low. A manufacturer of cotton swabs could make the warning label more prominent, include an image of potential ear damage, or even print “DON’T STICK THIS IN YOUR EAR!” on the side of every swab.
But makers of these kinds of products can only do so much. People potentially abuse all sorts of things. Watching an episode of the television show My Strange Addiction spotlights people suffering from addictions to eating paint, smelling pine cleaner, and even “balloon loving.” It’s hard to justify asking the makers of every product to warn every possible user against every conceivable misuse.
However, there’s a difference between accepting the unavoidable edge cases among unknown users and knowingly promoting the Q-tip Effect. When it comes to companies that know exactly who’s using, how, and how much, much more can be done. To do the right thing by their customers, companies have an obligation to help when they know someone wants to stop, but can’t. Silicon Valley technology companies are particularly negligent by this ethical measure.
How to Ensure Silicon Valley Doesn’t Become Las Vegas
Two years ago, I published a book on how to make products more habit-forming. The book became a bestseller and I’m frequently asked to consult with companies — particularly tech companies — looking to make their goods and services stickier and harder to stop using.
Unfortunately, making things more engaging also makes them more potentially addictive. The techniques I describe in the book, intended to help product designers build healthy habits in their users (like using a wellness app, keeping better track of personal finances, or staying in touch with family and friends) are the same tactics used by some to keep people un-healthfully hooked.
The solution is not stripping out what makes these products engaging; rather, it’s helping the addicts. Luckily, the two-way nature of Internet-connected services means companies can identify, message, and assist people who want to moderate use.
For example, instead of auto-starting the next episode on Netflix or Amazon Video, the binge-inducing video streaming services could ask users if they’d like to limit the number of hours they watch in a given weekend. Online games could offer players who cancel their accounts the option of blacklisting their credit cards to prevent future relapses. Facebook could let users turn off their newsfeeds during certain times of the day. And rather than making it so fiendishly difficult to figure out how to turn off notifications from particularly addictive apps, Apple and Android could proactively ask certain users if they’d like to turn off or limit these triggers.
These services know the usage patterns of each and every user. They don’t need to bother everyone, just those people showing patterns of behavior indicative of a problem. For example, setting a trigger based on the number of hours spent using an online service could prompt the company to reach out to suggest ways to cut back or deprecate certain features.
Indeed, the benefit of all the data being collected about us these days is that companies could use this information to help people who may be harmed by their products’ overuse. Clearly, there are many things tech companies could do to help users break the cycle of addiction. Whether they actually do anything however, is another matter.
There are some industries and companies that can’t and won’t help addicts. It’s not just dealers of illegal drugs who benefit from harmful addictions. Legitimate industries depend on addicts as well. For example, those ubiquitous ads for online games like Clash of Clans and Candy Crush are fishing for what the industry calls “whales” — the 0.15 percent of players who bring in 50 percent of revenue. In an industry where the cost of acquiring a player is just barely less than the revenue made per user, whales tip the scales to profitability. Without these extreme customers, their businesses aren’t viable. Similarly, the casino industry depends on a disproportionate share of revenue coming from a small group of likely addicted gamblers, some of whom are known to wear adult diapers to avoid having to stop playing.
Many industries earn an outsized proportion of their revenue from their most loyal customers. The fast food industry for example, amusingly calls the 20 percent of diners who account for 60 percent of their revenue, “heavy users,” according to the Wall Street Journal. While there’s nothing unethical about being a patron’s favorite brand, a line is crossed when a company knowingly exploits people with addiction problems the way the gaming and gambling industries do.
For example, though most American casinos are required by law to have “self-exclusion” programs for gamblers who wish to stop their addiction, casinos have been known to welcome problem gamblers back with open arms. A similar situation revealed itself during a discussion on ethics I recently led at a publicly-traded online gaming company. The product managers confessed that they also allow people to play even when the players have explicitly asked to be cut off.
Casinos escape liability through a legal loophole protecting them from prosecution. Nevertheless, it is unethical to accept patronage from someone a company knows wants to stop using your product but can’t. This moral standard should apply to all industries that collect personal usage data on individuals and therefore have the ability to identify, message, and help problem users.
The trouble is, gambling and gaming companies are as addicted to their addicts as their addicts are to the companies’ products. Doing the right thing is an existential threat since luring whales can mean the difference between the success and failure of a game or casino. Without outsized proceeds from the few addicted players, these industries would have a hard time making a profit.
Thankfully, not all companies are as dependent on addicted users as the casino and online gaming industries. Helping addicts wouldn’t much hurt Facebook or Reddit, for example.
In fact, some tech companies are already limiting overuse, albeit in rudimentary ways. Stack Overflow, a technical question and answer site used by 6 million coders, was designed with breakers built-in. “The current system is designed to reward continued participation, but not to the point that it creates obsession,” according to a post on the site by co-founder Jeff Atwood. “Programmers should be out there in the world creating things too,” Atwood noted, stressing that Stack Overflow should be a utility, not an addiction.
Unlike Q-tips and cigarettes — potentially addictive products where the manufacturer does not know the user — online services intimately aware of their users’ online behaviors have an opportunity to intervene. Of course, tech companies won’t be able to “cure” addictions, nor should they attempt to do so. Nor should they act paternalistically, turning off access after arbitrarily determining that a user has had enough. Rather, tech companies owe it to their users simply to reach out and ask if they can be helpful, just as a concerned friend might do. If the user indicates they need assistance cutting back, the company should offer a helping hand. With the data these companies collect, identifying and reaching out to potential addicts is a relatively easy step. A harder one, it seems, is caring enough to do the right thing.
Here’s the Gist:
- The Q-tip Effect occurs when a perceived solution to a problem becomes the problem, resulting in a cycle of self-harm.
- Many products can trigger a Q-tip Effect but the vast majority of people stop using the product when they discover the negative consequences.
- However, some people can’t stop. People suffering from addiction abuse the product despite the harm.
- Companies who are able to identify individuals likely to suffer from addiction have an ethical responsibility to help them quit.
Originally published at www.nirandfar.com on May 3, 2017.