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Chapter 4

      Discovering What Makes the Internet and Smartphones So Addictive

      IN THIS CHAPTER

      The Internet is no longer new. When I started researching and treating Internet addiction, it was the mid- to late 1990s and the Internet was still the digital Wild West. Twenty-five years ago, few understood that this new, miraculous modality of communication and commerce could be addictive, but we did understand that it was very appealing.

      My clinical and academic medical background is in addiction medicine; I was trained in the diagnosis and treatment of addiction, and I’ve also developed an expertise in sexual medicine and human sexuality — including compulsive sexual behavior. As the Internet burst across the globe, I began seeing patients who appeared to be having some difficulty with various aspects of their Internet use. Because the Internet was so new (and Wall Street was in love with its financial promise), most people did not see that all was not perfect in cyberspace.

In the early to mid-1990s, we were still using dial-up Internet that worked at a snail’s pace, but I still recall getting my first decent computer hooked up to the Internet and the welcome allure of those beeps and buzzes it made as our modem connected to the World Wide Web. I felt as if I were taking a trip somewhere and connecting to faraway people and places. It was exciting. Back then, online shopping and commerce were barely in their infancy; these were pre-Amazon days (if you can imagine that), and there wasn’t a lot happening online back then. But even before social media, Wi-Fi, smartphones, and high-speed Internet, you could feel how captivating this technology was.

      In this chapter, you discover the common features and factors that make this technology so addictive. Although this problem is now largely accepted in the medical field, I want to offer what I’ve learned over the last 25 years of researching and treating it.

Eyes on the Prize: Factors Involving Focus on a Screen

      Why do we like looking at our screens so much? It may seem intuitively obvious why video gaming is addictive. After all, it is stimulating, endlessly variable, rewarding (the fancy medical term is dopaminergic), easily accessible — and fun. But in both my research and clinical practice, I find many areas of Internet screen use to be addictive as well. These include video platforms like YouTube, social media, video gaming, Reddit, online shopping, online gambling, information scrolling and surfing (kind of equivalent to TV channel surfing from the old days), and, of course, pornography. This section looks at the main reasons why people can’t help focusing on their screens.

      Examining ease of access and near-constant availability

      Ease of access has always been an enabling factor in addiction. In substance-based addictions, the availability of certain drugs or alcohol could often predict use, abuse, or relapse. With Internet and screen use, this is also a significant factor in that the Internet has become ever-present and easily accessible. Wi-Fi, high-speed Internet, smartphones, fast mobile service, tablets, and smart TVs have all brought the Internet to our fingertips. My prediction is that 5G (the next generation of mobile service networks) will only increase the addiction potential of the Internet and our devices, but especially the smartphone. The smartphone is essentially an always-on Internet portal that allows the Internet to be easily accessible, which I believe accounts for some of the Internet addiction cases over the last ten years.

      WHAT IS GAMING DISORDER?

      According to the WHO, gaming disorder is a subcategory of addictive behavior and is defined in the 11th revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming; increasing priority is given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and there is a continuation or escalation of gaming, despite the occurrence of negative life consequences.

      For gaming disorder to be diagnosed, the behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning and would normally have been evident for at least 12 months.

Availability is like ease of access, but it speaks to the fact that Internet access is nearly always available, as smartphones, hardwired broadband home or office access, LAN, Wi-Fi, or access through your cell service makes the Internet nearly always available. More rural areas may be an exception to this unfettered access, but with satellite and fiber optics, this is also changing. In fact, many of us will soon rarely be without access to the Internet, which just increases the allure and temptation of checking that app or website, viewing that post, sending a text, or playing the latest version of your favorite game. It seems that there is no easy way to avoid easily accessing this digital drug.

      Talking about time distortion

Perhaps one of the most powerful drug-like effects of screen use is the time distortion that occurs online. One of the hallmarks of any substance or intoxicating behavior is that it can alter mood or consciousness, thus creating a time-distorting experience. In my 1999 study, I found that a large majority of users reported the time-distorting effect of the Internet. Perhaps you yourself have noticed losing track of time when you’re online? The immersive and dopamine rewarding experience of the Internet clearly impacts our perception of the passage of time.

      THE FIRST LARGE-SCALE STUDY OF INTERNET ADDICTION — AND WHAT HAPPENED NEXT

      I worked my way through 12 years of college and professional training as an electronics technician, and I always had an affinity

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