When does the social media spider web become more than just excessive time spent on devices? When is it an addiction?
While variations of this question are explored in all 3 Screenagers films, I just released a podcast episode that is all about this question.
In it, I speak with Anna Lembke, head of addiction medicine at Stanford and author of Dopamine Nation, as well as a young woman who was formally an aspiring influencer and driven by all the likes and such that come with social media.
I’d love for you to listen to the podcast. OR, I’ve included the transcript here for you to read it.
Listen to the full episode here: Apple Podcasts // Spotify // Website
Lars May (00:00):
As soon as you know what it feels like to get affirmations, a brand deal, hundred thousand followers, you want to be in that space. And I think my brain just quite literally, if it wasn't high, it was low, and I was constantly chasing the highs of the likes.
Delaney Ruston, MD (00:23):
I'm Delaney Ruston, physician and the creator of the three Screenagers movies, and this is The Screenagers Podcast. Today, we're gonna explore addiction to social media. What does that mean? What are the ways it plays out in people's lives? This topic is particularly timely as we know that many state attorney generals are in the midst of suing Meta, which owns Facebook and Instagram, over harm done to young people, particularly concerning the addictive features built into Meta's platforms. What is key to note is that the lawsuits are not about creating addictive products per se because actually people can produce things that can cause addiction, think alcohol and so on. Rather, it has to do with the discovery that Meta spokespeople lied about what they knew in terms of the addiction potential of their products and young people. This is why these lawsuits against Meta, along with congressional hearings looking at other social media companies and other harms, is being called a big tobacco moment.
Delaney Ruston, MD (01:28):
Because what happened with the tobacco companies is that they ultimately got in trouble because lawmakers were able to prove that the spokespeople of the tobacco companies were lying about the safety of their products. So keep all of that in mind as we delve into today's episode. I'm excited to talk with psychiatrist Anna Lembke, who is the head of addiction medicine at Stanford and the author of the New York Times bestselling book, dopamine Nation. We'll also hear from media researcher Douglas Gentile, who is at Iowa State University, and Lars May, the woman you heard at the start of the show who really struggled with social media's hold over her. So, Dr. Anna Lembke, can you speak about social media? The power it has to keep people on it for so long?
Anna Lembke, MD (02:21):
There are many drivers that invite people into social media and that keep them there. And one of the drivers is that's where everybody is, right? So, this is not just an individual issue, this is a collective issue. If all of your friends are getting together online, then, of course, that's where you want to go because that's where they are. The problem is that social media itself can hijack these reward pathways in our brains to keep us there beyond whatever the initial reason for engagement was. And, I think that's the piece that people need to learn more about, that initially we may start out using social media to connect with others, and that's a real positive thing. But because of the way that social media has been engineered, which is expressly to keep us engaged, to keep our attention we can stay on the platform far beyond what our initial reason for engagement was. And then we can get to a point ultimately where we're trapped there, and we're trapped there because it is manipulating the dopamine in our reward system to the point where now we have to keep engaging to prevent the comedown, which occurs when we stop, which is exactly why people keep smoking cigarettes or keep drinking alcohol or keep taking a hit of cannabis
Delaney Ruston, MD (03:52):
For tweens and teens. Social centrality is developmentally where they're at. And attention on social media provides some of that wanting that attention likes, and for some of them, wanting to build the attention to the level of influencer is a real thing with this influence, things can happen like brand deals. And this leads us to Lars. Lars, tell me about what drew you to social media.
Lars (04:23):
I just, I think that I became my normal was stimulation and like dopamine hits from lights. The moment that social media walks into your life, that balance, that state of just peace, no longer exists. As soon as you know what it feels like to get affirmations, a brand deal, a hundred thousand followers, you want to be in that space. And I think a lot of young people nowadays when we leave it aside and we really have to sit with our emotions, it's so much easier to feel low because we don't know what it feels like to be unstimulated. We're so stimulated all the time, and it's just not normal. So, anything outside of that felt depressing.
Delaney Ruston, MD (05:11):
Anna, a lot of young people on social media wanna garner attention, be it someone like Lars who wants to be an influencer and get brand deals or just teens wanting likes. What are your thoughts on this? I
Anna Lembke, MD (05:24):
See a lot of teens who get into trouble with digital content, whether it's social media or video games, that often what they're doing is they're chasing a number. And for reasons that we don't fully understand, giving something a number is very reinforcing. It really engages this reward pathway and quantifies the human desire to get ahead. And what can happen to young people that can become a justification for staying online longer is, “I need to get my ranking up,” or “I need to get more likes,” or for video gamers, I need to get my ranking up. This is often how the narrative goes. These kids will come in, and they'll say, I want to be a professional video game player, so this is not a problem. This is me preparing for my future life as a professional video game player. So, I need to get my ranking up or with people who use social media. I'm gonna be a social media influencer.
Lars (06:22):
My obsession started when I was 18 and I was in college. So, I would say that I was obsessively engaged for social media for about 16 months before it really took a toll. I think it was an addiction to success and results. Ever since I was a really young person, I always had aspirations to, you know, get out of Chicago and move to New York and, you know, saw the possibility of what life could be. And I've always been a dreamer in that sense. In a lot of ways, that dream-like mindset mixed with anxiety has led me to be an overachiever. But, I've coped with a lot of things in my life through productivity and through work until I couldn't and then had to face some of the deeper problems, headon, in the mirror. And I think, you know, there's so many things I was addicted to at that point.
Lars (07:13):
It was like addicted to validation from other people, addicted to getting brand deals. Like when I was in college, I made money to pay for my life by having a fashion blog. And I got into that when I was 18 at a really young age, because I saw that I could make money and that I could support myself while simultaneously building a career before I was out in the real world. It was this, it wasn't just purely for social reasons; it was also because I think I almost saw myself as a commodity at that point, and I didn't realize it, but social media was brainwashing me to believe that I was, every part of me could be monetizable to the point where when I was going to the gym doing the elliptical, I was so excited to go because I knew that if I was on the elliptical, I could spend my whole time trying to get followers or likes and engaging in hashtags. That's truly an obsession, always thinking about those opportunities for that
Anna Lembke, MD (08:09):
To be an influencer, you have to be online. But, of course, the reality is that the vast majority of these kids are neither going to be social media influencers nor professional gamers. It's a game that's stacked against them. And when they cannot objectively see the odds and cannot project themselves in the future and realize that's very unlikely to happen, and even if it did, it's an exhausting burnout kind of profession that has many downsides that then becomes the narrative that essentially propels and justifies some of the addictive behaviors. And that's true across addictions. So we have these amazing frontal lobes that are story-making machines. And so we will tell ourselves stories that justify even irrational toxic behaviors.
Lars (09:00):
When I was at my darkest moment, my best friend moved out of my dorm room. I was depressed. And when the people in your life abandoned you, when you're going through something, and you lose yourself, you go to places where you can just numb a lot of those emotions. And technology was a way for me to numb the emotions of what I was experiencing in the real world and feel the high of the digital world. And during that period, I used this thing to cope, and it was a really negative coping mechanism. And when I put that away, everything crumbled because I didn't have a way to escape. For me, it was a struggle with mental illness paired with a complicated relationship with technology.
Delaney Ruston, MD (09:53):
I know from talking with plenty of teen patients in my clinic that when many of them aren't doing well, they often retreat into their tech worlds, be it video games or social media, and it can keep them really stuck. It's like a quick fix over and over, but it's not what's really needed to restore mental wellbeing. And then meanwhile, things that happen on social media, such as a peer conflict that goes viral, can initiate mental health problems that weren't really there beforehand. And then there's the issue of just the sheer amount of time on social media that can really start to cause problems because things needed for health are being displaced, such as sleep time for hobbies and time with family. And then, often, it's some combination of these things that contributes to problems, just as Lars mentioned. So now, with social media, with excessive compulsive use of it, how to think about the idea of addiction. Doug Genteel has spent decades researching media's effects on people, and I talk with him. So Douglas, talk to me about tech-related addiction, be it social media or video games and so forth.
Douglas Gentile, Ph.D. (11:11):
A lot of people use the word addiction, and it's worth asking, what do we mean by that? It comes from Latin. It's actually a legal term in Latin that if you perhaps owed someone money, you would be addicted to them. That is, you are made their slave. So, it actually means to become the slave of something else. A lot of people use the word addiction to mean something very colloquial, like you do it a lot. Can social media be an addiction? What we're really concerned about isn't how much someone likes it or even how much someone does it. What we're talking about is does it become dysfunctional where you start damaging other areas of your life because of the way or how much you're using it when it's damaging your social functioning and your family functioning and your educational functioning, your psychological or emotional functioning. Now, it doesn't have to damage all of those, but it has to damage multiple ones of those. And at that point, that's when we know we actually have a clinical-level problem.
Delaney Ruston, MD (12:12):
Right now, social media addiction has not been recognized as an official disorder. Actually, the term addiction is not what we use in medicine or psychiatry. Instead, we have moved to talk about use disorders such as alcohol use disorder. So, we would talk about social media use disorder if it officially existed. And if it did, it would be in the book that lists all official psychiatric disorders called the DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders. And we're currently in the fifth edition. Doug, what do you think is going to happen around this issue of recognizing social media as a use disorder?
Douglas Gentile, Ph.D. (12:53):
It may be, perhaps, when the DSM six comes out, but I expect social media is probably going to be DSM 7. I think we'll get gaming disorder in DSM 6. So we're talking about a disorder where things are so far out of balance that you can't just fix it yourself. And again, that's a hallmark of an addiction, right? That you've lost some sense of control and you probably need help to be able to get things back into balance.
Delaney Ruston, MD (13:19):
I know there's talk about having an overarching category called tech use disorder, and then all of the things, such as social media and gaming, could all be under there. And I think that is a really interesting umbrella, and I think it's a good idea.
Anna Lembke, MD (13:40):
So addiction, it's not either or. It's really a spectrum disorder, right? People have mild, moderate, and severe forms of addiction. And then there's also this pre-addiction state, which probably encompasses most humans living in rich nations on the planet today. That state in which we're engaging in some degree of compulsive overconsumption of some substance or behavior. We're not yet addicted. But gee whiz, I wish I hadn't eaten so much chocolate cake or hadn't spent so much time on YouTube or Instagram or Snapchat, or hadn't smoked quite as much cannabis. We're all struggling with that again because we are really not wired for a world of immediate, instant access to highly potent drugs and behaviors, which is the world we live in now,
Delaney Ruston, MD (14:30):
I like what Anna says about thinking about addiction on a spectrum. I think that can be really useful. And I hadn't heard of the idea of pre-addiction before. Anna's book, Dopamine Nation goes into the reality of addiction in terms of pleasure and pain. And I ask her to elaborate on this.
Anna Lembke, MD (14:51):
One of the most interesting findings in neuroscience in the past hundred years or so is that pleasure and pain are co-located in the brain, which means that the same parts of the brain that process pleasure also process pain. And they work like opposite sides of a balance. So if you imagine that in your brain, in that particular circuit that we call the reward pathway, there's a beam on a central fulcrum, like a teeter-totter in a kid's playground. And when that balance is at rest, the beam is level with the ground. And that's what we call homeostasis. That's our baseline physiology. When we do something that's pleasurable or reinforcing, we get a little release of dopamine, our reward neurotransmitter in that circuit of the brain. And then the balance tips to the side of pleasure. One of the overarching rules governing this balance is that it wants to remain level, and our brains will work very hard to restore a level balance with any deviation from neutrality. So what happens is with that increase in dopamine, immediately our brains start to downregulate dopamine transmission to bring us back down to baseline. But if we don't just go to baseline, we actually go below baseline into the dopamine deficit state.
Delaney Ruston, MD (16:08):
So Anna, tell me more. Why do you think that is?
Anna Lembke, MD (16:12):
Okay, so that's a great question, right? Why is it that our neural circuitry has evolved such that for every pleasure we pay a price, which is to say whenever, once that balance tips to the side of pleasure, why doesn't it just go back to the level position? Why is it that first, it tips to the side of pain and then goes back to the level position? And that's really a key piece to understand. And I speculate that from an evolutionary perspective, this pleasure, pain balance with this opponent process mechanism to the side of pain is really the very best type of circuitry to keep us eternal strivers, right? No matter what pleasure we experience, it's transient or passing, it's elusive. Not only that but it's followed by this by pain, right? By its opposite, what better way to keep us striving, walking, and fighting for that next natural reward that keeps us alive in a world of scarcity? So I think that's really why we evolve that way. We are the ultimate strivers. The rules of the balance keep us striving. They ensure, number one, for every pleasure, we pay a price. And that's pain. And that pain then motivates us to continue to get, try to get that reward again. And with repeated exposure to that reward, we can get into the stoke, main deficit state.
Delaney Ruston, MD (17:37):
Anna, can you explain more about the teeter-totter, fulcrum of pain and pleasure that you talk about in your book Dopamine Nation?
Anna Lembke, MD (17:45):
One of the ways to imagine that is to imagine there are these little neuroadaptation gremlins hopping on the pain side of the balance to bring it level again, but they like it on the balance, so they don't get off as soon as the balance is level, they stay on until the balance is tipped in equal and opposite amount to the side of pain. But of course, there's a very natural impulse when we're in that dopamine deficit state with gremlins on the pain side of the balance to want to reach for our drug again. And in this world of overwhelming overabundance, it's very easy to do that, which brings us to the second rule of the balance, which is with repeated exposure to the same or similar intoxicate or drug. That initial deviation to pleasure gets weaker and shorter, but that after-response to pain gets stronger and longer. In other words, the gremlins multiply. Pretty soon, they're camped out, their tents and barbecues in tow. So, two really important rules. For every pleasure, we pay a price, and that price is pain. And with repeated pleasures, we essentially change our hedonic or joy set point so that we're chronically tilted to the side of pain. Once that happens, we need more and more of our drug not to get high but just to level the balance and feel normal. And when we're not using, we're experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, dysphoria, and craving.
Delaney Ruston, MD (19:17):
Our world is full of things that can give us instant gratification, and there are a lot of downsides to this.
Anna Lembke, MD (19:23):
What are the implications for living in the modern world? We are seeing rates of depression, anxiety, and suicide go up all over the world in the last 30 years, but especially in rich nations. So the richer people are, the more unhappy they are. We have lots of theories for why that might be everything from trauma to socioeconomic disparity to geographic dislocation, all of those things probably play a role. But I think what is underappreciated is the extent to which overabundance itself is a major stressor and actually works on this fundamental reward pathway to put us into a dopamine deficit state, which is really akin to a clinical depression.
Delaney Ruston, MD (20:10):
So, Anna, can you speak about what you recommend to people who are excessively using something that is reinforcing to them, such as social media?
Anna Lembke, MD (20:20):
What we need to do is not reach for more pleasures but actually avoid those pleasures and intentionally do things that are hard so that we can begin to reset our pleasure-pain balance back to that level position. The intervention is gonna be something different than what we've been advocating for in mental health. And slightly counterintuitive, which is to say that when you are feeling very unhappy, like most of us feel now, instead of reaching for a donut or a Netflix video or your phone, instead, avoid those highly pleasurable substances and behaviors for long enough for those neuroadaptation gremlins to hop off of the pain side of the balance so that homeostasis can be restored. And in fact, in my clinical practice, this is what I do now. First line, when folks come in seeking help with depression, anxiety, insomnia, irritability, and inattention, I do a screening for what kinds of drugs and drugified behaviors they're engaging in. And I actually ask them to abstain from those drugs or behaviors for 30 days in order to allow the neuroadaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored,
Anna Lembke, MD (21:38):
I warn them that they're going to feel worse before they feel better. Because you can imagine if you have a weighted balance and you take something off one side, it's gonna slam down to the pain side. So I always warn folks, you're gonna feel more pain, more anxiety, more depression in the first couple of weeks, but if you can just hang with it, eventually your brain will readapt to the absence of that drug. You will restore dopamine homeostasis. And when that happens, you will naturally feel better without us having to do anything else. The other thing I talk about is things they can do to speed up the process of returning to homeostasis. And again, counterintuitively, what they can actually do is press harder on the pain side of the balance. Because when we press on the pain side of the balance with things like exercise, ice, cold water, maybe intermittent fasting, mind-body work, prayer, meditation, martial arts, cognitively challenging, creatively challenging endeavors of value-based endeavors that are hard, then those neuro adaptation gremlins hop on the pleasure side of the balance in order to bring us level again. And so we can speed up that process of restoring homeostasis by inviting challenging activities into your life.
Delaney Ruston, MD (22:58):
Douglas Gentile goes on to say things that parents can look for if they're concerned about their child's relationship with social media.
Douglas Gentile, Ph.D. (23:06):
So, what are some of the things parents might notice? They might notice that their children are getting moodier, that their children are giving up activities that they used to previously enjoy, that their grades are slipping, and that they're having a harder time managing their emotions than they used to be able to do. These are things that are going to have long-term impacts on that child's health and development. They're giving up things that actually benefit them in the long term and then are instead spending their time with something that's perhaps giving them some short-term benefit on social media. Now, when does it rise to the level of being a pathology? That's for a clinician to decide. Honestly, normal parents are not going to really know when they've crossed that line.
Delaney Ruston, MD (23:51):
Let's get back to Lars, who eventually was able to get treatment for her mental health and also, at the same time, work to really change her relationship with social media.
Lars (24:02):
I had to really get real with my own relationship with technology. I was able to develop a healthier relationship with technology because I started using it for very different reasons. I shut down my fashion blog. I walked away from all of that because I realized that it was probably gonna do more harm than good. And if I continued on that path, I might not have been here today because of how dark and upset I was feeling. Getting real with my own tech use meant a lot of different things and, a lot of different experiments, and a lot of different understanding. I had to really retrain my mind and the way that I used it and have an intention for every time I picked up my phone and, you know, start adding these small things into my life like you would do for any other type of journey and any other thing that you were trying to get away from. I had to take that same approach to my relationship with Tech.
Delaney Ruston, MD (24:54):
Lars decided she wanted to help other girls who have struggled with unhealthy relationships with social media and started an organization called Half The Story.
Lars (25:04):
Half the Story is a nonprofit on a mission to help empower the next generation's relationship with technology. We're really serving teens who have been negatively impacted by technology and are looking for a community and skills to help thrive in the digital world, rather than be in a place of survival mode.
Delaney Ruston, MD (25:23):
Lars has taken her hard times and used it to take on an incredible challenge of creating and building a wonderful organization. Today, we touched on a lot. We've explored the science around addiction. We know that while there are good things about social media, there are real risks. And the whole work we are doing here at Screen Majors is helping parents and youth ensure the healthiest use possible, which means making sure kids have time off of screens. We're also advocating that social media and other tech companies really adopt more responsible approaches in their product development and implementation. When adults are worried about young people's relationship with social media or other tech activities, getting help is incredibly important. Reaching out to other parents, school counselors, mental health professionals, pediatricians, coaches, and relatives getting a support team in place takes work, but it is so worth it. It was great to hear from Lars today. And Anna Lembke and Douglas Gentile.
Delaney Ruston, MD (26:30):
Thanks for listening today, and if you can tell one friend about The Screenagers Podcast, that really helps spread the word and helps people find the show. Also, if you can like it and rate it, that would be excellent. Be sure to visit ScreenagersMovie.com to find the show notes from this episode and other episodes, learn about the screenings of our movies, and sign up for my weekly blog about parenting in the screen age. This Screenagers Podcast episode was produced by me, your host, Delaney Ruston, Lisa Tab, Rebecca Tollen, and Alan Gofinsky. Alan also is our sound editor.
I encourage you to listen to the podcast with your kids. And, here are some questions to get a conversation started:
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While variations of this question are explored in all 3 Screenagers films, I just released a podcast episode that is all about this question.
In it, I speak with Anna Lembke, head of addiction medicine at Stanford and author of Dopamine Nation, as well as a young woman who was formally an aspiring influencer and driven by all the likes and such that come with social media.
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