Overuse of social media, smartphones sign of addiction – Psychiatrist

Dr Adedapo Oni, a senior registrar at Lagos University Teaching Hospital, talks to ALEXANDER OKERE about addiction, the signs, treatment and management

What is an addiction?

An addiction is a brain disorder whereby individuals have a strong desire or compulsion to exhibit some behaviour or use some particular substances in a way that it is difficult for them to control such behaviour.

Is it a disease?

Generally, there are different schools of thought regarding that but as psychiatrists, we know that an addiction is a chronic brain disorder whereby the brain has been rewired to the extent that the brain only responds to a particular stimulus which eventually leads to an addiction problem. Those in the religious circle may not agree that addiction is a disorder; they may think that those facing addiction can take steps in faith to stop it. Medically, people look at it as a brain disorder.

A reward system, cravings and tolerance, disinterest in other activities, and loss of control are considered major elements of addiction that show how it works. Can you explain each of them?

A reward system is used to explain the biology of addiction. It explains what happens to the brain of an addict. Different aspects of the brain control motivation and other things. A part of the brain controls the activities we engage in. There are neurotransmitters and one of them is dopamine, which carries information and helps to give us motivation for our actions. When people take up a behavior, that part of the brain gets a pleasure sensation and makes them repeat that behavior. So, when a person loves doing something, a pleasure sensation is involved and that is why they love that thing. If a person loves music, for instance, the pleasure sensation is involved, so they keep listening to music. The same thing applies to someone who abuses a substance or gambles. So, that part of the brain responds to that thing. So, a reward system simply means that the brain is rewarded by an action. The brain controls a human being, so it keeps telling the person to continue doing the thing that gives them pleasure even when the activity could be dangerous and become an addiction.

Craving is just an intense urge to take a substance. Craving is generally used for psychoactive substances like cannabis and cocaine. It is one of the clinical features seen when people are addicted; they have an intense urge to take such substances and lose interest in other actions or activities. A person, who is supposed to be a student, for instance, may prefer to take cannabis than go to school because cannabis gives their brain a stronger pleasure sensation than going to school.

Loss of control is similar to some of the things that I explained earlier. When people have cravings and intense urges to take such substances, another thing closely linked to cravings is loss of control. What that means is that the person can no longer control their use of that substance. When people are addicted to beer, they cannot set a limit. The frontal cortex of the brain helps us to regulate what we do so that we don’t do it in excess but people become addicted to something, they can no longer control the behaviour or use of the substance.

Why do people often think more about substance abuse when they talk about addiction?

Addiction is a broad term and one of the common things people get addicted to are psychoactive substances.

Is there a classification for addiction?

Yes. Addiction can be chemical (substances) or behavioural, like gambling, sex addiction, and other types of behaviour.

From your observation, what are the common forms of addiction among Nigerians?

The most common form of addiction is the use of psychoactive substances. Other behavioural addictions are not as common as the use of psychoactive substances. I can tell you that in the last three or four years, we have seen cases of people gambling to the extent of incurring huge debts; so, gambling addiction is common and the prevalence is lower when compared to substance abuse.

At what point can a person be said to be addicted to sexual intercourse?

A person can be addicted to sexual intercourse if the person engages in sexual activities to the extent of limiting other activities that use to be of paramount importance to them. The person will also not be able to function at home work as he would normally.

With the continuous rise in the use of smartphones for consumer digital content on social media, can people be addicted to their smartphones?

In psychiatry, there is a manual called the Diagnostic and Statistical Manual. It is used to examine mental and behavioural disorders. It helps us to look at behavioural problems. In the United States, for example, internet and social media addiction has been identified as something that is coming up and research is ongoing to understand how people can have this addiction. I am sure that in a few years, we will have many people with this addiction in Nigeria.

What are the signs that show that a person may have smartphone addiction?

Some of the likely signs are persistent and continuous use of the gadget to the extent that the use is limited in other activities. A phone addict may, for instance, prefer to be with their phone than engage in more productive activities like exercises. The person has an intense urge to constantly be on their phone. The person starts gradually and becomes progressively dependent on their phone or social media. It gets to a point where the person is not interested in any other thing than social media.

However, in Nigeria, we still have some limitations like poverty. So, people who do have 24-hour internet access may not have that kind of addiction but in Europe when things are better, internet addiction has been observed and that is why research is ongoing on it. Overuse of social media may be a sign of smartphone addiction. Regarding internet addiction, the brain also derives pleasure from the reward system such that the person spends a lot of time using the internet, avoids other activities and cannot control the way they use the internet.

Some people feel miserable or feel they lost a part of their lives when they lose their phones. Is this a sign of addiction?

A phone is a part of people’s daily lives. There is a part of the brain that controls our activities. For example, it is common for people not to use their phones very late in the night so that they can go to sleep because sleep is needed for work the next day. However, when people are addicted, they find it difficult to do that; they always want to be on the phone or social media.

If someone becomes withdrawn when they lose their phone, it could mean that the person is getting addicted. Addiction starts gradually. People don’t move from zero to addiction in one day. It takes time.

Why is it difficult for addicts to overcome their addiction despite several efforts?

It is difficult because the brain has already been wired to the activity or behaviour for higher pleasure. So, the brain only reacts to that behaviour and the behaviour increases dopamine, which is one of the pleasure neurotransmitters in the brain. However, it is not impossible to end addiction. Some people get addicted but can control it but some become addicted for life.

Apart from mental health risks, how does addiction affect physical health?

Psychoactive substances like cannabis affect the lungs and heart. Excess alcohol consumption affects the liver. It has also been shown that when people spend a lot of time staring at the screen of their phones can come down with health problems.

What is the nature of the diagnosis of addiction?

Addiction can be diagnosed by a psychiatrist. When people are addicted, a second or third party is always needed to look at the addiction.

Why is that important?

It is important because the brain is affected. If the brain is affected, it is a big problem because all the activities a person does is controlled by the brain. A person may not know when they are addicted because the brain makes them feel that their action is normal. That is why an outsider is needed to help the addict understand that they are spending a lot of time on an activity, having cravings or withdrawal symptoms.

What are the common ways of treating addiction?

Whoever diagnosed the addiction can recommend the best way to treat it. There are many ways of treating addiction. Treating addiction involves a lot of factors. If it involves the abuse of certain substances, the addict can be detoxified. This means measures are taken to reduce the abuse of the substance in a way that doesn’t harm the person and take the person off the substance over a period.

Another way is to help the patient understand that they can stop the addiction if they want to. The psychiatrist guides the patient to help them stop the addiction. The psychiatrist can also look at the occupation and social problems that may be contributing to the addiction and address them. If the person’s place of work gives them access to a substance they abuse, that access can be controlled. If peer pressure is responsible for the addiction, the person needs to find a way to control or be more assertive in such a situation or alienate themselves from the supposed peer. These measures are gradual and require a lot of therapy. That is why when patients go for rehabilitation, they discuss many things. In some instances, the patient can say they want to stop the addiction and will have a clear plan about how to do that.

How long does rehabilitation last?

Rehabilitation takes about six to nine months. I need to add that addiction is also a chronic relapsing condition, meaning that even when people have been addicted and have gone through rehabilitation, some of them go back to the addiction due to some factors that may come up in their lives. That is why some people go for rehabilitation on more than one occasion.

What kind of help can people battling addiction to sexual intercourse, masturbation, and pornography get?

They can start by seeing a psychiatrist and psychologist where an evaluation of the behavior will be done. The evaluation will determine the next step. For instance, some of them may have a comorbid depressive disorder that will need to be treated. Appropriate psychological therapy will also be done based on the individual case by the psychologist as well.

What are withdrawal symptoms and what are the signs?

Withdrawal symptoms are found when people are addicted to a substance. They occur when the person abstains from the substance for some time and is characterised by some uncomfortable symptoms such as sweating and tremors and which, in most cases, make the person go back to the substance use.

How can they be treated?

They can be treated by seeing a psychiatrist where medications may be given to control the symptom and gradually withdraw the effect of the substance on the body

Where does the use of drugs for treating addiction come in?

The use of drugs is at the discretion of the psychiatrist. It depends on the psychiatrist’s mode of treatment.

How can addiction be prevented?

Addiction is preventable but it is better to identify it early when the person is still young. We know from research that addiction is stronger among adolescents. So, when adolescents are exposed to substance abuse and the internet excessively, they can get addicted and their brain is not fully developed to be able to control what they take in. So, more education is needed in secondary schools on the need to avoid the use of substances.

Phone addiction can be prevented through education. People need to know that they can become addicted to their phones and social media and that they may not be able to bear the consequences of such addiction. When there is awareness, people know that they need to have control and when they can no longer control it, they need to see a therapist or psychiatrist for help. With that, they can quickly nib the problem in the bud or prevent an addiction that will be difficult to treat.

What complications can result from delayed treatment of addictions or the lack of it?

The complications can be looked at in different ways – as they affect the individual, their family and society. A person addicted to psychoactive substances or gambling will spend and borrow a lot of money to fuel the addiction. So, individually, the person is in a financial loss. This problem gets to their family in the form of indebtedness. If the addicts are not fully rehabilitated, they can become vagrants and psychotic. When young people are affected by this problem, you can imagine what it does to society.

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