A Slot Machine in Every Pocket
Dr. David Greenfield on the addictive nature of tech—and what we can do about it
By David Grabowski
The following is an interview with Dr. David Greenfield, Clinical Professor of Psychiatry at the University of Connecticut School of Medicine and founder of the Center for Internet and Technology Addiction, who I interviewed for “The Particular Sadness of Tech.”
In our interview, Dr. Greenfield went deep on why our personal tech is so addictive, what makes it similar and different from other forms of addiction, and how not all is lost when it comes to managing our tech-addled lives.
“If you check your phone two to three hundred times a day, which most of us do, that means you have some degree of addiction.”
“Two to three hundred?”
“That’s the average.”
“That’s insane.”
On the Exponential Growth of Addictive Tech
David Grabowski: What led you to specialize in technology-related addictions?
Dr. David Greenfield: It was, like many things in life, somewhat serendipitous. In the late 1990s, I went on the internet and found that I was spending a little bit more time on it than I would’ve thought was expected. It seemed like it had a hold on me, and that I noticed what I later labeled after doing research something called dissociation, or time distortion, which is when you spend time on a screen, you lose track of time and space. At the same time, I was already a doctor with a specialty in addiction medicine, but the field of technology and internet addiction didn’t really exist at that time. This is in probably 1997, ’98, maybe even a little earlier.
At the same time, there was a small pilot study that was done in a medical journal comparing heavy internet users to gambling addicts. What we found is that heavy internet users look a lot like gambling addicts. We started to posit that the same neurobiological process in the mesolimbic pathways of the brain were responsible for excessive internet use, just like they did with gambling addiction.
That led me to do a study, which I did in conjunction with ABC News, which I later published. That study was published in a medical journal, and I presented at a medical conference in 1998, I believe. Later became the basis for a book called Virtual Addiction. My beginnings in the area of internet and technology addiction as a sub-specialty in my addiction medicine career were really somewhat serendipitous. It was never intended, it was really, I thought it was a flash in the pan, honestly. I did not expect this to have the kind of legs it has had. Since then, I’ve done five to six hundred interviews, lectured all over the world, and continue to write and publish on this topic. That was over twenty years ago. This clearly has gone nowhere but up, or at least continued to be a huge issue, and I suspect it will continue to be a huge issue.
David Grabowski: Compared to when you started, what developments in technology—or different ways of interacting with our technology—are causing this to become a larger issue? Is it because the technology has evolved and so we’re more likely to become addicted, or is it something else?
Dr. Greenfield: Well, there are a lot of variables. Obviously the technology has increased in its ease of access and speed and availability. There’s been a norm shift in our culture that makes this technology so integrated into our daily life that the fact is that there’s a greater risk of people using it and abusing it, simply because of the ease of access and the accessibility. Everything is, in addiction medicine, the shorter the latency between the ingestion of a drug or the activation of the behavior and the subsequent intoxication from that drug or behavior, the more addictive that drug or behavior is. In other words, the shorter the time between the click and the hit that you get from whatever content you’re consuming, the more addictive that use of that technology is going to be.
The ability to consume content in 1997 was nothing, is nothing compared to what it is now. I suspect a part of the reason why we’re seeing more of it now is that we have higher-speed internet, we have greater accessibility, we have WiFi, which we did not have. We have smartphones, which we did not have.
All of these technologies basically put a digital hypodermic needle in your pocket or in your pocketbook. It increases the accessibility and decreases that latency between the access, or ingestion or consumption, intoxication. When I say intoxication, I’m talking about neurobiologically. I’m talking about the elevation of dopamine, changes in stress hormones, and other neurochemicals, but particularly dopamine.
David Grabowski: Got it. What is it that sets technology addiction apart from other addictive behavior, besides the very short latency in between the action?
Dr. Greenfield: That’s not unique to technology addiction, because heroin, IV heroin use has got a very short latency. Snorted cocaine has a short latency. Lots of drugs and behaviors have short latencies between the action and the subsequent intoxication. All addictions follow the same neurobiological processes. There’s activation of the reward circuits in the mesolimbic pathways of the limbic system of the brain, particularly in the nucleus accumbens, ventral tegmental area, striatum, prefrontal cortex. There are no differences, and then there are differences. Obviously, the negative physiological consequences of heroin addiction are different than internet addiction, although there are negative physiological consequences of all addictions. Mostly it’s lifestyle and behavior and quality of life that are addicted, and internet is no different, although people are not dying from internet addiction, although some people, there’s a small number of people who have died from video game addiction, and a small number, well, not a small number, actually a much larger number now dying from smartphone use while they’re driving. In that sense, the addictive propensity of the smartphone, which is just a “portablized” internet portal has created a new problem, because people aren’t stopping that addictive behavior when they get in the car.
David Grabowski: Is that your main concern with technology addiction on the mass sociological level?
Dr. Greenfield: I’m not a sociologist. I approach this more from a perspective of quality of life, that life balance. I mean, obviously there are huge sociologic issues involved in what technology has done to our society. The jury’s out on whether we’re moving in a better direction or a worse direction, but from a psychological perspective, I’m concerned about just life balance, the ability to make good decisions, the ability to have quality relationships and quality lifestyle as impacted by the effect of technology.
It’s not that I’m against technology or I’m a Luddite or I think that we should stop using technology. We should be mindful of technology and create a sustainable, conscious use of it, as opposed to this automated pattern that we have found ourselves spiraling into, and there’s a bit of a backlash, obviously, now. We saw the letter to Apple computer, written by the investors, that’s a huge backlash. If you have a $2 billion investor asking Apple to take responsibility for the addictive nature of their technology, that’s an indication that society is now starting to backlash. On a sociologic level, that’s probably a good thing. Not unlike other addictive substances, like alcohol and cigarettes. We had the same issue with both of those substances.
On Kids , Social Media, and Video Games
David Grabowski: Right, right. Regarding quality of life, and to pivot and talk a little bit about development, what effects does technology use have on a child’s development, and how can we set a good example?
Dr. Greenfield: Well, there’s a lot of preliminary data on the impact of technology on overall learning capacity, on complex problem solving, on delay of gratification, on impulse control, on attention span, on the ability to create empathy, having empathetic responses. There’s different studies on each one of those areas, which I couldn’t really go into in detail at this point, but there’s good data on all of them, including changes in white matter and gray matter functioning neurologically, whether those changes are permanent or whether they are short-lived based on the impact of the technology in the short term, it is unclear. It’s clear that this technology does impact general neurological and psychological functioning. There’s no question about that.
What do you do when you have an addictive substance or behavior that we need to live, like food, for instance? In fact, these are both potentially addictive behaviors. You have to learn moderated, healthy, mindful, sustainable use. It’s re-educating your patterns of use, so that you can use the technology without the technology controlling your patterns of behavior. That’s not a simple thing to do, because we have spent the last 10 years or 15 years using it like we used water without any consciousness that there might be a shortage of water, or when we were throwing garbage out. I remember when I was young, when I was growing up, we had this concept, which now you’d think of it as foreign, which is you’d throw something away. There is no “away.” This concept of away doesn’t exist, because we now know, where is away? Everything you throw out goes somewhere or stays somewhere or degrades somewhere or ruins the environment.
The whole concept of using technology without it having an impact I think is an idea that has now fallen into disfavor. We now know that yeah, this stuff is addictive. It affects various neurologic and psychological areas of functioning. It’s not life or death, but it is, like many other aspects of living, an area that we have to modify and modulate in order to life a balanced life. There’s many things that we have to do that with, exercise and diet and many other things. It just is part of the complex living in today’s society.
“People are actually experiencing their lives through what I call reflective self-esteem. If they don’t post it and it’s not reviewed, it has no value.”
David Grabowski: Mm-hmm. With regards to social media use, what kind of effects have you see from social media use in your practice?
Dr. Greenfield: I don’t treat social media use, per se. I treat various forms of internet technology addiction. I can tell you, back to your comment about the sociological impact of social media use is people feel literally controlled by social media, even though they’re posting it, they feel—so what we’ve created is this concept that I call broadcast capacity, which is, or another word that I call it is broadcast intoxication, this idea that if you do something, if you don’t list it and have it rated or ranked or liked, it didn’t happen. People are actually experiencing their lives through what I call reflective self-esteem. If they don’t post it and it’s not reviewed, it has no value. People are again, starting to backlash against that, because that’s very limiting. If everything you do doesn’t really fulfill you unless somebody else sees it or reviews it, then you’re not really living your life. You’re performing your life.
What are the implications of that on a medical level? I don’t know. I can tell you it makes for a very stressful life that you’re not really experiencing, and ultimately I think it’s somewhat dissatisfying. I think that’s what people are feeling right now. They feel controlled by the fact that they have to post everything—and not only to one, but they have to post it to four or five different applications.
David Grabowski: There has been a lot of concern about not just video game addiction, but specifically ultra-violent video games, like Grand Theft Auto. Are games like this more psychologically damaging, and are the effects of long-term usage of a video game permanent?
Dr. Greenfield: Well, probably of all the different forms of content on the internet that is most addictive, probably with the only exception of pornography, video games are probably right up there, if not number one, followed very closely by pornography. In terms of seeking treatment, again, we’re talking first on a social or sociologic level, and then secondly we’re talking on a medical or psychiatric level, and those are two different things. On a sociologic level, we could argue about the validity or lack of validity about the use or abuse of video games. Hands down in terms of the number of issues that are created as a result of video game use, that is the number one disruptive form of content currently. It’s simply because the amount of time that it consumes.
David Grabowski: What is it specifically about video games that’s so addictive, apart from the time consumed? Is it the design?
Dr. Greenfield: Well, they design the games to be addictive, of course, and they’re proud of that. Video game designers, first of all, you have to understand the way the internet works, so let’s talk about the internet. The internet is the world’s largest slot machine. The smartphone is the world’s smallest slot machine. Any content that’s on the internet falls under this same category, so let me explain what that means.
The internet operates on a variable ratio reinforcement schedule, meaning that any time you go online, whether it’s to a video game or just search something on Google or social media update, it doesn’t matter. Even email, texting, it’s irrelevant what the actual content is. You don’t know what you’re going to find, when you’re going to find it, and how good, salient, or desirable it’s going to be. That’s how a slot machine operates. That scheduled reinforcement in the brain elevates dopamine both in an anticipatory form as well as a reactive form. The anticipatory expectation that you’ll find something pleasurable or experience something pleasurable, it increases dopamine significantly. Then followed by whether that is pleasurable or not in actuality, also elevates dopamine.
Dopamine is the same neurochemical that’s elevated from food, sex, gambling, pornography, cocaine, drugs, alcohol, anything addictive. That’s the same pleasure neurochemical that’s elevated. Video games elevates dopamine just like cocaine does. Now, not quite at the same level, but pretty close. The problem with video games is that’s the variable ratio reinforcement. Anything that’s a variable ratio is very resistant to extinction, which is another way of saying it’s addictive. If you sit in front of a slot machine and every once in a while you get a payout, but you don’t know when you’re going to get that payout and what it’s going to be and how desirable it’s going to be, you’re going to keep pushing that button, because every once in a while, you’re going to find something you want, but there’s an unpredictability as to what it’s going to be and when it’s going to happen. That’s why you’ll do it endlessly, because brain loves the anticipation of the possibility of having that hit, not that it’s definite. It’s definite that it’s going to happen, but you can’t predict when it’s going to happen. This is why things that are reinforced variably and intermittently are far more addictive than things that are reinforced regularly.
Back to video games. On a video game, what do you do? You design rewards that are intermittent, unpredictable, variable, changeable. That’s what keeps people compelled. There are many other reasons that make it addictive too. The mastery that people experience, the social interaction, the challenge, there are many, many, many factors that make video games addictive. The chief hallmark neurologic thing that makes it addictive is the variable ratio reinforcement, this unpredictable elevation of dopamine due to rewards that are not consistent. They’re changeable. They change the game up so it doesn’t, so if a game functioned exactly the same way all the time, you would get bored.
David Grabowski: Are there long term psychological damages that can be done because of video game addiction? I’m thinking specifically of ultra-violent video games like Grand Theft Auto.
Dr. Greenfield: There is significant data, and this is controversial. You’ll hear in the literature an argument in both sides, but there is significant data that exposure to violence does desensitize our feeling about violence. I think that’s pretty well-accepted. The jury’s out on whether exposure to violence increases the likelihood of acting on that violence. There’s a mixed amount of research in both directions on it, but there’s no doubt that exposure to violence, including the violence in a video game like a first-person shooter game, does desensitize your feeling about violence, because it would have to. If you keep seeing people’s heads explode, your feeling about that person, both empathetically and in terms of your shock and horror from that violence just is going to desensitize.
We argue that we’re training a generation of kids that are less sensitive to violence. I don’t think that we’ve changed a generation of psychopathic zombies that are going to annihilate the world and not care about it. I think that’s an overreaction, and I think most people probably use the technology in a rather healthy way, and only a small percentage end up using it addictively to a point where it impacts their life. The vast majority of people use it as it’s intended, which is a form of entertainment. We’re talking about small percentages, small numbers. Depending on the study, half a percent to a percent on the low end, up to six, eight, ten, twelve percent on the high end.
David Grabowski: When someone becomes addicted to a video game in that small percentage, what are the factors that contribute to them being more susceptible to being addicted to video games?
Dr. Greenfield: Honestly, we do not know what makes one person more susceptible to video game addiction, versus other addictions versus no addiction. There seems to be an increased incidence and prevalence among younger individuals, high school, college age, probably because of their familiarity and exposure to the technology. I would say that that’s probably the case, although we don’t know for sure. We don’t even know what makes some people susceptible to addiction and some people not. There seems to be about a 50 percent genetic predisposition for addiction, but that means 50 percent of the predisposition to addiction is behavioral and epigenetic, meaning that it has nothing to do with your genes, it’s just being exposed to the right circumstances and the right reward contingencies, if that makes any sense.
David Grabowski: Yeah, that absolutely makes sense. How long does it take to treat, let’s say a video game addiction, on average, and are the effects of being addicted to that somewhat permanent, or how long do they take to dissipate?
Dr. Greenfield: Addiction is a treatable problem, but it’s probably not cured in the sense that you cure anything in medicine. It’s a chronic situation that you can teach the person to manage and learn a healthier way to manage the technology. In some cases, you could return the person to a moderated use. Most of the time, particularly with video games, our goal is for them not to use video games at all, because it becomes too much of a trigger for them. Most of the time, our goal is abstinence, because it’s easy for them to trigger their use or abuse.
David Grabowski: It is, so to speak, the substance itself that is a trigger for them, not external psychological factors?
Dr. Greenfield: Well, it becomes a circuitous loop in terms of, it impacts your quality of life, it impacts your desire to self-medicate, which then impacts your use, which then impacts the impact on your life, and it becomes a cycle. The addictive cycle has behavior and shame and abuse all linked together, and it becomes an overlapping, overarching pattern.
David Grabowski: What kind of long-term treatment does someone who, let’s say is addicted to video games again, seek? Do they consult with group therapy regularly to keep that addiction at bay?
Dr. Greenfield: There are support groups. There aren’t a lot of them in real time. Most of them, believe it or not, are online. There’s just not that many of them that exist in AA formats. It’s mainly about teaching them an alternate pathway to manage their emotions that would normally trigger their use, because once you change the pattern of behavior, you have to treat the underlying issue that they were trying to numb or medicate. Addiction is really a symptom. It’s a symptom for finding something in your life that you want to manage, and then that symptom becomes a problem unto itself later.
On Ethical Design, Liability, and New Norms
David Grabowski: Makes sense. I wanted to pivot a little bit and talk about design, specifically when it comes to devices themselves. The iPhone’s out-of-the-box default settings include pop-up notifications with sounds for every application. It just seems like they assume that you want all of those things. Is there anything that an app or device designer should be doing differently to encourage healthier use of technology?
Dr. Greenfield: Well, the things that would make the use of technology healthier are going to make the application less robust in its use. This is the inherent conflict that we have right now is that Apple wants you to have your eyes on the phone all the time. They never want your eyes off the phone. Unfortunately, your eyes are on the phone when you’re driving too. We did a study with AT&T a couple years ago, in 2014 and ’15. We found that although 70 to 90 percent of people know that using the smartphone while they drive is dangerous, 75 percent of those still do it. 75 percent of us use the data stream on our smartphones while we drive, so the number of deaths due to smartphone-related driving distraction have exceeded deaths due to alcohol at this point. When somebody’s swerving on the road, you don’t know whether they’re drunk or looking at their screen, because it takes three to five, six seconds to process something on a screen, which you can travel five or six hundred feet at highway speeds.
The manufacturers first have to admit that the technology’s addictive, which they are loath to do, because that opens liability. My understanding is that Apple has denied any wrongdoing and they will continue to deny it until they no longer can. Obviously, they’re worried about financial liability, which is understandable, but this is not going to go away. People’s focus on the technology—and the other thing is, Apple has the ability to make technology that shuts the data stream off of the phone when the driver is driving. That’s never been activated. It’s actually been hardwired into the phone since the iPhone 5, but they never turned it on.
“. . . the number of deaths due to smartphone-related driving distraction have exceeded deaths due to alcohol at this point.”
David Grabowski: Yeah, I did notice, I updated my phone recently, and there is some application now with the iPhone that will detect if you’re driving and give you the option to block notifications, and then you have to tell it that you’re not driving if you want to look at your phone again. But of course you can do that while you’re still driving. What else can Apple or another technology designer do to encourage healthier use, let’s say when we’re not behind the wheel?
Dr. Greenfield: On a very simplistic level, every time you open your phone, there could be a statement that says, “Warning, use of smartphone can be highly distracting and has addictive potential, please use responsibly.” That’s kind of basic, but just educating people. Most people already know that, but I think having that reminded all the time is similar to what we did with alcohol and tobacco ads. Why do we have those warnings on packages? Because that’s what you need to do to educate people. Far less people are smoking now than ever because of that education. That’s the simplest thing they could do.
The other thing they could do is put in better parental controls and self-monitoring controls that limit your accessibility and use of the technology more readily. They have the capacity to do that. They’re actually fairly complicated right now in terms of trying to set limits. The purpose of that letter was to really put Apple on notice that they have a responsibility to make it simpler. Now, it’s not just Apple, obviously, it’s the people that make Android, it’s all the phones and it’s all the technology, but Apple is one of the largest technology manufacturers. This is the first of many, many, many attempts to hold these companies responsible.
They could also educate consumers. Apple spends a lot of money promoting their products. Why not spend a little bit of that money on the overuse or abuse or misuse of technology? That’s socially responsible to me. I even think it’s good business, to be honest with you. The read on companies that are socially responsible is that it is good business, but then you’re admitting to potential liability. Now that people have died, that’s a big issue.
David Grabowski: When you say died, do you mean from car-related deaths?
Dr. Greenfield: Yes, yeah. I don’t mean two people, you’re talking about hundreds and hundreds of people that are dead. Think about the legal precedence and the legal liability.
David Grabowski: Right, right, yeah. That’s tricky maybe, but I agree with you. I think, especially a company like Apple, which pride themselves on leading the way. I think they should be stepping forward and encouraging some healthier use.
Dr. Greenfield: It seems that way to me, but we could argue it from both directions.
David Grabowski: Understandable. It seems that a lot of us are at the very least distracted by our phones. I was at dinner with my parents the other weekend and I literally had to make them stack their phones in the middle of the table face down, because they kept nervously ticking, checking them.
Dr. Greenfield: That’s the addiction, by the way. That’s the variable ratio reinforcement. That’s the slot machine operating, and that’s why I call it the world’s smallest slot machine. The other thing is—because if you put a smartphone in the room with you, even if it’s face down and off, your cortisol levels are elevated. The way to lower those cortisol levels is to check your phone.
“Apple spends a lot of money promoting their products. Why not spend a little bit of that money on the overuse or abuse or misuse of technology?”
David Grabowski: What can we do to self-monitor our own technology use? Is there a litmus test to know if we’re technically addicted to it? Are we all addicted?
Dr. Greenfield: If you check your phone two to three hundred times a day, which most of us do, that means you have some degree of addiction.
David Grabowski: Two to three hundred?
Dr. Greenfield: That’s the average.
David Grabowski: That’s insane.
Dr. Greenfield: Well, you don’t know it. You don’t notice it, because how many times do you pick it up and look without processing it?
David Grabowski: Right. More times than I want to admit, probably.
Dr. Greenfield: You would have, unless you counted, you would have no way of knowing how many times you’re looking at it.
David Grabowski: What kind of habits can we form around our technology use to keep it healthy?
Dr. Greenfield: You could start by not sleeping with your phone, not sleeping with it next to your bed or under your pillow, which 70 to 80 percent of people do. Charge it in another room, buy an alarm clock. Whenever you have a meal, keep your phone put away. Turn off the notifications on your phone, most of them are not necessary. Set a certain number of parameters in terms of how often you want to check your phone. Have family rules in your home about how much technology you’re going to consume and when it’s okay to have your phone out. When you’re socially interacting over a meal or some other quality activity, have it be not okay to have your phone out. In other words, have a new norm that your phone being out is not considered okay. In other words, it’s changing what I call the electronic etiquette, creating a new norm about when to use it and when not to use it. We’ve never done that. We just assume, we just allow them to encroach on our quality of life, without any consciousness or awareness or behavior change. Ultimately, that doesn’t work.
David Grabowski: What do I say if I’m out to dinner, let’s say with my friends, and they’re compulsively checking their phone? Should it be the social norm to actually call them out and say something along the lines of, “You should look into this, because I think you’re actually addicted to your phone?”
Dr. Greenfield: I think most people don’t need treatment, but I think it’s perfectly reasonable, somebody sitting there picking their nose, you might say something to them. If they’re picking their nose and they’re grossing you out, you might say something. You might say, “Hey, dude. Go get a tissue or something.” Why wouldn’t you say to them, “Hey, your use is a little bit troubling and it’s bothering me that you keep checking your phone. I feel like you’re not here.” Because when somebody’s on their phone or looking at their phone, the message to the other people in the room is that they’re not present. You feel that too. If you’re with somebody and they pick up their phone, they’re gone for that moment. We all assume that that’s okay, but is that okay? I guess if it is, if everybody’s okay with it, then really, there’s nothing to talk about. Maybe I’m the only one that’s bothered by all this.
David Grabowski: I don’t think so.
Dr. Greenfield: It bothers me when I’m with somebody, especially somebody who I care about having attention from when they pick up their phone. It’s very annoying and very distracting.
“. . . it’s changing what I call the electronic etiquette, creating a new norm about when to use it and when not to use it. We’ve never done that. We just assume, we just allow them [smart phones] to encroach on our quality of life, without any consciousness or awareness or behavior change.”
On the Challenge of Making Things Better
David Grabowski: Is it getting better, I guess is my next question? Are we becoming better about cell phone use, are we moving in a direction to set us up for a healthier relationship with our devices?
Dr. Greenfield: I think we are. I think there’s a greater consciousness and a greater etiquette, electronic etiquette developing. Certainly the letter that went out to Apple, as well as a lot of consciousness in the media around the use and abuse of technology is really moving at an exponential rate. I’m doing more interviews today than I was 20 years ago. I’m doing four to five a week.
David Grabowski: Wow.
Dr. Greenfield: Yeah, and that’s nonstop. There’s no end to it. It’s great, but it’s actually a bit exhausting at times.
David Grabowski: I can imagine.
Dr. Greenfield: I think overall, we’re moving in a positive direction. I don’t think the answer to technology is always more technology, which is the tendency in our culture: When you have a problem, throw more technology at it. I think sometimes the answer to a problem is less technology and more social interaction and more consciousness, and more discussion of how it impacts each other. I think there is a positive movement afoot, and there are more doctors specializing in this.
When I started, I was one of two doctors in the world that was focusing on this. Now, there’s dozens and dozens. When I started, I think I wrote the second book on the subject in the world. Now we have hundreds of books on the subject and thousands of medical journal articles on the subject. The World Health Organization just declared video game addiction an official medical diagnosis, which is a huge shift. That’s basically saying that we now know scientifically that we have a problem that is unequivocal. I do think it’s getting better. I think that’s true of everything though. What happened with junk food? Junk food existed for a long time, and now we know it’s not so good. People are making better choices. Not everybody, not all the time, but in general, the movement is towards healthier eating.
Shifts in culture and behavior are very slow, but the adoption of this technology happened at a pace that is unrivaled in the history of the industrial revolution. In 10 years, we have a 90 plus percent penetration of the smartphone in the United States. That’s unheard of, to have a form of technology that’s in the hands of every person in the country. That’s unheard of. That’s never happened before.
David Grabowski: That’s troublesome, a little.
Dr. Greenfield: It tells you how potent it is. My thesis is not that technology’s bad, it’s just powerful, and we need to understand its power, just like we need to understand the power of lots of things in order to manage it more effectively and more healthfully.
“I think sometimes the answer to a problem is less technology and more social interaction and more consciousness, and more discussion of how it impacts each other.”
David Grabowski: Absolutely. In a 2012 interview that you gave, you were talking about 4G technology and the speed of addictive behavior. Of course now we have even—are we up to 5G now? Or no, it’s LTE.
Dr. Greenfield: I’m sure we’ll have 5G. Internet speeds and wireless access speeds are only going up. The reason why they want faster speed is so you can carry more data so that you can encourage more use. The idea really is to make the technology so streamlined and so impactful that you never have it off. That’s the whole movement behind these internet access portals, the Echo and the Alexa. Now they’re making video versions of them, which I think are going to be very, very addictive.
David Grabowski: Video versions? So you’ll have a . . .
Dr. Greenfield: They’re making Alexa and whatever the other one is, the Google version and the Amazon version—they’re making them into a video screen. You’ll have a little video screen, instead of a round can with a speaker. There’ll be something on that screen that you’ll be talking to.
David Grabowski: Wow. Can you comment on that a little bit more? We have all these even more immersive technologies arriving, virtual reality gaming is about to really explode, and now we have Apple watches. What future technology-related social challenges are you anticipating?
Dr. Greenfield: I think the speeds will increase. The interface between us and the technology will decrease, or rather increase. The idea is to make the technology so integrated with your daily clothing or your daily accessory that you won’t even have to pick up your phone. It’ll be woven into your clothing or in a piece of jewelry, or eventually implantable, I’m assuming. I think that’s only a matter of time, not in the next five or ten years, but I think that’s where we’re headed.
David Grabowski: What do you mean by implantable?
Dr. Greenfield: You know, you’ll have a chip that will upload you to the internet, or create some kind of interface that you’ll hear or see, or it’ll be a screen that’ll be embedded under your skin. I don’t know how it’ll look, but it’s going to be something like that. Why not? Why wouldn’t they do that? If they could do it, why wouldn’t they do it?
David Grabowski: Ethical concerns, maybe?
Dr. Greenfield: You could argue why would they do it, and I’m saying, why wouldn’t they do it?
David Grabowski: Right.
Dr. Greenfield: Because again, the more easily accessible something is, the more likely you’re going to use it. Of course, the more likely you’ll abuse it.
“The idea is to make the technology so integrated with your daily clothing or your daily accessory that you won’t even have to pick up your phone. It’ll be woven into your clothing or in a piece of jewelry, or eventually implantable, I’m assuming.”
David Grabowski: Sounds like an episode of Black Mirror.
Dr. Greenfield: It does sound like an episode of Black Mirror. Black Mirror’s obviously a bit of an exaggeration. If you look at the science fiction and the dystopian science fiction that was published before, like 1984 and some of the other stuff, all that’s happened. This concept of people listening in on you, that all exists now. The internet is listening in on you all the time. If you’re not Alexa, don’t forget, the way these companies make their big money is on the data they collect about you. That’s the real power. The more you talk to that stupid box or your phone, the more data they have on you or the more valuable that data is.
David Grabowski: What kind of ethical concerns do you have about the arrival of some of these technologies, and how is it going to impact your practice?
Dr. Greenfield: Well, my practice is a general psychiatric practice. About 50, 70 percent of my patients have addiction issues, large percentage being internet based, but I treat all forms of psychiatric addiction issues. Again, the largest percentage is internet. I think again, obviously the numbers are going to keep increasing in terms of the number of people that are seeking treatment. I think there are bigger issues, because I think the vast majority of people don’t require medical or psychiatric or addiction treatment. I think the vast majority of people need to change lifestyle and behavior, which is true about many things. Does everybody need to go to a doctor because they’re eating unhealthfully, and they’re eating to a point where they’re obese, which 70 percent of Americans are? No, I think people need to adopt better lifestyles and behavior. The same thing applies to technology, that this is a social force that needs to be changed in its direction, and society can make different choices about how we norm something and how accessible alternatives are. If it’s normal to go to a party now, and everybody to be standing around on their phone, then people will do it. If it’s normal to go to a party and you put your phone in a box or a basket, and you take it at the end of the day, then that’s what people will do. If we create new norms that are healthier, people will do them.
David Grabowski: Are you optimistic about our ability to integrate some of those practices?
Dr. Greenfield: Yeah, I think that people are doing some of these things. You’re talking about a very, very compelling form of technology that is very captivating. Another way of saying it’s very addictive. Addicted doesn’t mean that you’re medically ill, it means that your brain has been hijacked, particularly the frontal lobes of your brain have been hijacked by the intensity of that dopamine hit. You have to take back your brain. Really, what I’m promoting is take back your brain. Don’t let this screen or any screen run your life and run your brain. Own your brain, that’s our mantra, because if you don’t own it and don’t take control over it, the technology will inadvertently control you.
“Addicted doesn’t mean that you’re medically ill, it means that your brain has been hijacked, particularly the frontal lobes of your brain have been hijacked by the intensity of that dopamine hit. You have to take back your brain.”
David Grabowski: In your practice, when you treat someone with a technology related addiction or dependency issue, how do you treat it?
Dr. Greenfield: We treat it very much like we treat any addiction, which is you look at the behavioral patterns of the use of the addictive substance or behavior. You teach them to manage urges, cravings, and triggers for that use. You develop a relapse prevention plan, in other words, how to develop a normal or healthy or sustainable use pattern. You then address the loss of some of the elevation of dopamine and the reward deficiency that occurred from elevating your dopamine. What happens is you are so stimulated dopaminergically that real life looks flatter without it. If you don’t check your phone a lot or play a video game, you don’t really feel good, because your receptors are out of whack. You’ve increased the number of post-synaptic dopamine receptors, so if you’re not feeding those, you feel deprived. You don’t feel as much pleasure. You have to reboot the normal pleasure responses that we get from life and from other aspects of life, what I call real-time living as opposed to virtual living.
It’s not much different than treating other addictions, obviously the main difference being that we’re not trying to achieve abstinence, we’re trying to achieve moderated, mindful, or sustainable use, because this technology is not—you can’t live without it anymore. When I started studying this in the late ’90s, the internet was still dialup, and it really wasn’t all that great. There wasn’t a lot on it, and it didn’t work all that well. We actually didn’t know that it was going to end up where it is now.
David Grabowski: Is that the biggest challenge with it? That it is always going to be, to some degree, integrated in a modern person’s life, and if they have an addiction to it, they still have to have it?
Dr. Greenfield: Yes. Is McDonald’s going to stop selling Quarter Pounders or Big Macs? I doubt it. They’ll add other things to the menu, which is both socially responsible and good business, but I bet you a lot of people are still eating those Quarter Pounders. It’s about choice. It’s about healthy choice, and the more healthy choices that exist and the more consciousness you have about those healthy choices, the more likely you’ll be able to choose them. That doesn’t guarantee you’ll choose them, but if the choices don’t exist at all, you definitely won’t choose them.
David Grabowski: Last question: What areas of research are you focusing on going forward?
Dr. Greenfield: I think that the last research that I did was really on distracted driving. I really have a strong interest in it, because driving is where people, to avoid the pun, where rubber meets the road. This is where people are dying. I have a very strong interest in education of addiction of the smartphone, particularly because it is so powerful when you put it in the car. It’s not a matter of if something will happen, it’s a matter of when. A lot of my research lately has focused on the use of smartphones while driving. I also have an interest in the general education of the use of technology in society, not so much treating it as an addiction, but how we can learn to create a more happy, sustainable relationship with technology, as opposed to using it in an unconscious way. I would say that that’s really where my interest lies, in other words, to reach a broader audience.
I don’t want to just reach the people that are addicted, I want to reach all of us, including me. I’m as susceptible to the use of this technology as anybody else, even though I have awareness of it.
