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Whenever I speak at a conference, someone always asks me to weigh in on the controversy surrounding whether or not to label excessive cyber behaviors as addiction.  I usually begin to tackle such questions by sharing conversations I have had with video game designers, marketing strategists, and industry executives.  These people understand how the brain works, and they use this knowledge to design games and various applications in such a way that they easily embed themselves into the reward circuitry of the brain.  This means that the dopamine circuits of the frontal brain, those most closely associated with reward and pleasure, become so highly active when playing a certain game or application, that these activities frequently become preferred.  In an increasing number of cases, this preference is so strong that individuals begin to turn away from friends and family, career opportunities, and even activities that were once a source of enjoyment.

News outlets focus on sensational and outlandish stories, like the 16-hour-a-day World of Warcraft devotees, or death from deep vein thrombosis after a 40-hour gaming binge.  The more troubling reality, however, is that the average American child spends close to five hours a day in front of a screen.  Excessive screen time correlates with obesity, attention issues, sleep troubles, poor performance in school, and social issues. America’s board rooms are even starting to become aware that employees’ screen habits can hurt the bottom line.  In a series of interviews with executives for a recent article in the New York Times, the consensus was “that the lure of constant stimulation — the pervasive demand of pings, rings and updates — is creating a profound physical craving that can hurt productivity and personal interactions.”  Realizing the potential for harm, many of the giants of Silicon Valley have begun encouraging mindfulness classes, exercise programs, and simply providing ideas to balance and integrate screen time in healthier ways. It is of course a great irony that many of the developers of these alluring cyber amusements are now realizing the potential downside.  The rest of society lags far behind, however.

While it is heartening that companies like Facebook, Zynga, Microsoft, and eBay have begun to address this problem within their own organizations, I wish they would take some responsibility in the wider world.  The Times article also pointed out that many companies view their activities through the “Fast-food Paradigm,” that while they may provide cyber “junk food,” they are not responsible for the choices people make.

As I have in the past, I call on the companies who profit from technology to spend more resources in public service campaigns to alert citizens to the dangers of excessive use of technology.  Parents need to understand age appropriate levels of screen time, and must be educated on how to properly guide their children, so that lives do not get swallowed up by the screen.  Even mental health professionals lack basic information needed to recognize cyber-related problems.  The solution lies not in eliminating these technologies, but rather in a drastic increase in awareness of how to use them responsibly.

Video games, smart phones, social networking, the Internet, and computers are powerful tools.  People adept with these technologies can use them to advance and succeed.  Controlling predator drones and monitoring battlefield activity are now achieved through video-game-like interfaces.  Facebook and Twitter are essential to sales and marketing.  Smart phones can radically increase worker productivity.  People who play moderate amounts of video games increase visual-spatial acuity and hand-eye coordination.  But we need much more consciousness about how to benefit from these technologies without diminishing our social skills.  We need more research to understand how increasing “screen dependence” is rewiring our brains.  We need to learn to use the offerings of the cyber world to increase our opportunities for fulfillment, not restrict them.

ADHD, Substance Abuse, and Impulsivity

A  recent study from the journal Nature Neuroscience suggests that teens who struggle with substance abuse and those with ADHD have somewhat different cerebral profiles, specifically in terms of impulsivity, a feature of both conditions. Both groups exhibit impulsivity, but that trait appears to derive from different areas of the brain. Among the teens who had tried alcohol, cigarettes or other drugs, like marijuana, brain scans showed different patterns of brain activity in the right inferior frontal gyrus and in the orbital frontal cortex compared to teens who had not touched these substances before. These differences showed up in self-control tests during which activity in their brains was monitored. Prior research has found that the right inferior frontal gyrus is involved in the ability to control, or inhibit, impulses. People with head injuries that damage that area of the brain have problems with inhibition. The orbital frontal cortex has been known for years to be involved in drug use.

What’s interesting is that the ADHD teens who were administered this self-control test also showed difficulties with controlling impulses, but their patterns of brain activation were quite distinct. The teens with ADHD exhibited differences in the bilateral frontal lobe and the basal ganglia, both of which are known to play a significant role in ADHD symptomology. So the same end behavior, impulsivity, appears to be linked to different parts of the brain.

The reason this study is important is that ADHD people have a significantly increased risk for substance abuse. The data from this research effort strongly suggest that atypical functioning of certain cerebral networks, those involved in impulse control, underlies addiction.  But impulsivity in addiction, as opposed to ADHD, appears to be a different animal. The study did not examine ADHD people who also were substance abusers. What will be interesting to see is if ADHD people with substance issues look more cerebrally similar to the ADHD group or to the substance abuse group.

Overall, this study shows us that the brain is an incredibly complex organ that we are just beginning to understand. Also, we see that impulse control does not always indicate the presence of ADHD. While it is easy to judge others who show what appears to be a lack of “willpower,” this study points to the underlying biology that is involved, and thus invites us to consider addiction as a bona fide disease.

With ADHD and addiction, many people who are not afflicted presume that a lack of willpower is to blame. “I know when to stop,” they will righteously declare. “They just need to learn their limits.” This scientific information gives us reason to pause and reflect, and perhaps reevaluate how we view both ADHD and addiction, and to consider having more compassion for people who deal with these challenging conditions. So many people presume expertise when dealing with mental health conditions. If you really want to understand mental health, go to school on the brain. I recommend the following books to help you in that endeavor:
1.  Howard, P. (2007). The Owner’s Manual for the Brain. Austin, TX: Bard Press.
2.  Nigg, J. (2006). What Causes ADHD?: Understanding What Goes Wrong and Why. New York: Guilford Press.
3.  Stoehr, James D. 2006. The Neurobiology of Addiction. 1st ed. Philadelphia: Chelsea House.

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