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Problematic Smartphone Use: Addiction or Compulsion?

Opinions are strong, but the science is far from settled

Photo: Jens Johnsson/Unsplash

SSmartphone use has gotten out of hand. So say a lot of smartphone users, anyway. In a Pew Research Center survey, 54% of teens ages 13–17 say they spend too much time on their phones, 31% say their phone use sometimes or often distracts them in class or at work, and 40% say they feel anxious when they don’t have their phone with. Interestingly, only 36% of parents see their own phone use as excessive, yet 39% admit their phones distract them.

Smartphones have been blamed for everything from social isolation to cutting into teen sleep time. The mere presence of one ties up cognitive resources, even when a person is trying to ignore it, one study found. In other research, heavy smartphone use was associated with reduced functionality in a part of adolescent brains related to decision-making and rational thought.

Many studies like these describe heavy users as addicted to smartphones.

But the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the official guidebook for psychiatric diagnoses released in 2013, does not view smartphones as addictive. The manual separates behavioral and substance-use problems for the first time, but online gambling is the only behavioral addiction recognized by the DSM-5, as it’s called.

Adding further confusion, a handful of researchers refer to nomophobia — described as the irrational fear of being without your mobile phone (no-mobile-phone-phobia). It’s in the dictionary, but it’s not in the DSM-5, though some researchers did propose adding it. And the word creeps into studies. “Smartphone addiction is known as nomophobia,” a paper earlier this year claimed. It remains to be seen whether the term will endure, but it’s not used in the majority of the literature on the topic.

Impulsive tendencies

One new study cuts through much of this confusion, avoiding the word “addiction” entirely and instead examining impulsive tendencies related to smartphone use. Researchers surveyed 3,425 U.S. university students, who answered 156 questions and were given a score ranging from 10 to 60, with 32 or above being considered “problematic smartphone use.” Among the self-described characteristics contributing to the score:

  • Using their phones too much
  • Trying unsuccessfully to cut back
  • Feeling fretful or impatient without their phone
  • Neglecting other areas of life in favor of phone use
  • Light-headedness or blurred vision related to excessive use

About 20% of the students met the criteria for problematic smartphone use, which was also linked to increased incidence of ADHD, depression, anxiety, and PTSD, mirroring results in similar but smaller previous studies, the researchers report this month in the Journal of Behavioral Addictions. The problem users also had slightly lower GPAs, on average.

Based on the DSM-5, problematic smartphone use can’t be called a disorder or an addiction, says study team member Sam Chamberlain, a University of Cambridge researcher who collaborated with scientists at the University of Minnesota and study leader Jon Grant, a professor in psychiatry and behavioral neuroscience at the University of Chicago.

All studies have their shortcomings, and one that plagues many psychological investigations is self-reporting. People sometimes lie or exaggerate. Other people just don’t remember correctly.

“We avoid using the term ‘addiction’ because there is not yet enough evidence to consider problematic smartphone use as this,” Chamberlain explains in an email. “While problematic smartphone use has elements similar to addiction, it also has other aspects in common with other types of problems such as being impulsive or compulsive. So we need a lot more research to address these issues before deciding if problematic smartphone use should be considered a disorder, and if so, what type.”

Rather, Chamberlain says, people who use their smartphones to excess suffer “trait impulsivity.”

“This is a tendency towards hasty, risky acts, done without thinking through the consequences,” he explains. “Impulsivity can have a negative effect on many areas of life, including academically, socially, and in employment. Also, we found problematic smartphone use was linked with lower self-esteem and more mental health problems, which would also be expected to have a negative effect on several areas of life too.”

More drinking, more sexual partners

In the survey, students ranked as problematic smartphone users reported roughly the same level of sexually active as others. But 37.4% of the problem users had two or more sexual partners in the past year, compared to 27.2% of their peers. The number of students reporting six or more partners was more than double among problem users, at 6.8% versus 3.0% for other students. The researchers suggest heavy smartphone users who may feel isolated are perhaps using apps to connect with others, leading to sex.

Based on questions about alcohol use, and a standard scale called the Alcohol Use Disorders Identification Test, 33.3% of problem users misuse alcohol, compared to 22.5% of their peers.

The study cannot prove cause-and-effect, the researchers point out. Further research would be needed, to get beyond this snapshot in time, to show for example whether alcohol use might contribute to excessive smartphone use, or vice-versa, or whether both stem from some other issue. For now, the latter is what the researchers figure is going on.

“One possible explanation for these results is that people develop excessive smartphone use because of other mental-health difficulties,” Chamberlain explains. “For example, people who are socially isolated, those who experience depression or anxiety, or those who have attention problems (as in ADHD) may be more prone to excessive smartphone use, as well as to using alcohol. Smartphone use likely develops earlier in life — on average — than alcohol use problems and so it is unlikely that alcohol use itself leads to smartphone use.”

The survey also found women were more apt to use smartphones excessively than men, by a roughly 3:2 ratio. The researchers don’t know why. “One possibility is that women might be more prone to developing excessive smartphone use, whereas men might be more prone to over-using other types of technology, such as computers for online role-play gaming,” Chamberlain speculates.

Though this study is one of the largest of its kind, it’s not the only one, by far. A similarly designed but smaller study last year reached similar, if narrower, conclusions: “Age, impulsiveness, excessive reassurance-seeking, and depression were all significantly related to problematic smartphone use,” researchers wrote in the journal Behavioral Sciences, while acknowledging the scientific discussion of behavioral addictions is a “contentious topic.” Several other small studies have generated similar findings.

How smartphone use might affect teens is a separate question. It’s well-established that young minds are shaped by experiences, with the brain’s underlying hardware and software being developed up to age 25. Researchers find that what kids see, feel and do can tend to hardwire them for life in terms of impulsivity and decision-making.

A two-year study reported in JAMA last year followed 2,500 teens ages 15 and 16, none of whom showed any signs of attention deficit hyperactivity disorder (ADHD) at the start. At the end of the study, 4.6% of the teens who did not self-report any high-frequency involvement in any of 14 digital media activities had developed symptoms of ADHD. But 10.5% of those who reported lots of activity in each of the categories — including texting, posting to social media, and gaming — had developed ADHD symptoms. The researchers describe the association as “statistically significant but modest” and say the study does not reveal whether digital-media use contributes to ADHD, or if a tendency toward ADHD fuels digital-media use.

A history of moral panic

All studies have their shortcomings, and one that plagues many psychological investigations is self-reporting. People sometimes lie or exaggerate. Other people just don’t remember correctly.

David Ellis, a lecturer in computational social science at Lancaster University, says the surveys used to identify problematic smartphone use or addiction, including the one in Chamberlain’s study, are inherently flawed. He also sees smartphones as one in a long line of technological advances that initially seem more dangerous than they turn out to be.

In new research published in the International Journal of Human-Computer Studies, Ellis and co-author Brittany Davidson at the University of Bath examined 10 different surveys used to gauge smartphone use, then compared the self-reported results to data provided by Apple Screen Time.

“People estimated on average, that they picked up their phone around 40 times a day,” Ellis says. “In reality it’s closer to 85.” That’s not inherently bad, he says, it’s just reflective of the fact that smartphones are highly integrated into our daily lives, and estimating usage is difficult.

In a straw poll of Facebook friends and family over whether the smartphone is useful, perhaps invaluable, or pure evil, a theme emerged: It can be any or all of the above.

“Our view is that repeated attempts to associate everyday technology use with a clinical pathology are unhelpful,” Ellis says in an email. “Smartphones are certainly not the first technology to be associated with potentially ‘addictive’ or negative societal effects, nor will they be the last. Moral panics about new technology (the printing press, the telephone, microwaves, the internet, social media) are, historically speaking, either overblown or demonstrably false. It’s important that we learn from these mistakes going forward.”

“I welcome Dr. Ellis’ research into the limitations of existing scales, and the potential role for other types of measurement,” Chamberlain tells me. Meanwhile, he figures the existing surveys are likely to “remain the gold standard,” and he notes that time spent is just one of many factors used to determine if a given behavior is problematic. “There is a large volume of evidence, including from meta-analysis, linking excessive use of some forms of technology to mental health problems,” he says.

Useful or evil?

In a straw poll of Facebook friends and family over whether the smartphone is useful, perhaps invaluable, or pure evil, a theme emerged: It can be any or all of the above, given a phone’s necessity for many people amid today’s always-on work schedules, the upside (or downside) of connecting with family and friends, and the incredible number of tools and information sources it replaces, from flashlights to maps to newspapers. What differs is how people view and balance all that.

Some who have the luxury (read: retired) simply turn their phones off much of the time. One friend who spent years working at tech companies has reverted to a flip phone (15% of Americans own a cellphone but not a smartphone). Other people are merely thrilled by the usefulness of the smartphone and don’t seem bothered in the least. A friend in mid-life with ADHD calls it “a vital tool in keeping my life in order.” And still others fret over the attention-grabbing black hole they’ve been sucked into. One friend, a former colleague in the media business, takes the long view: “It’s like asking if the horseless carriage is a boon or bane; at some point, it just is.”

The many uses of smartphones raise another nuance to the addiction question: The device is merely a conduit to useful and potentially rewarding behaviors known to stimulate the release of dopamine, a feel-good chemical triggered by potentially addictive behaviors, like drug use or gambling, but also by other pleasurable experiences, from eating to love and sex.

“Smartphones have provided us with a virtually unlimited supply of social stimuli, both positive and negative,” writes Trevor Haynes, a neurobiology research technician at Harvard Medical School. “Every notification, whether it’s a text message, a ‘like’ on Instagram, or a Facebook notification, has the potential to be a positive social stimulus and dopamine influx.”

Perhaps that’s why, in the Pew survey, about 40% of teens say they feel anxious when they don’t have their phone with them.

Whatever you call it…

Problematic smartphone use is a “public health problem” marked by “an inability to regulate one’s use… which eventually involves negative consequences in daily life,” according to an article last year in the journal Digital Health, written by University of Oxford researcher Michelle van Velthoven and others. Unfortunately, the authors conclude, there are no proven detox methods, digital or otherwise.

While experts may disagree on how to describe dependence on technological devices and related behaviors, and how to tell if someone is dependent, the personal and social consequences of heavy smartphone use range from annoying to costly to devastating:

  • In the Pew survey, 51% of teens say their parents are sometimes or often distracted by their phones during in-person conversations, and 72% of parents say the same about their teens.
  • A survey by the staffing firm OfficeTeam found professionals squander nearly an hour of every workday using their phones for non-work activities (one might argue that similar amounts of time were once wasted on inter-office chatter, back when people actually talked to each other in person).
  • In 2017, the most recent year analyzed by the National Highway Traffic Safety Administration, 434 deaths on U.S. roadways involved drivers distracted by their phones (whether they were texting, talking or doing something else is not detailed).

Consequences like these were on the mind of James Roberts, a professor of marketing at Baylor University and author of a book on consumerism called Shiny Objects, when he conducted a small online survey in 2014 of 164 college students, characterizing their smartphone use.

The results were an early glimpse of the things found in the study by Chamberlain and his colleagues. About 60% of the students self-identified as being addicted to their phones, with some saying they felt agitated when it was not in sight. On average, women said they spent 10 hours a day on their smartphones (eight for men).

“That’s astounding,” Roberts says. Smartphone use is a paradox that can be “both freeing and enslaving at the same time,” he and his colleagues write in the Journal of Behavioral Addictions.

Roberts says he agrees with Chamberlain’s view that heavy smartphone use is a function of impulsivity. But Roberts notes that impulsivity “is an essential element of addictive behavior,” which in his view is “any type of behavior that is continued despite its negative consequences.”

“People are dying on the road just so they can use their smartphone while they are driving,” Roberts says. “An enormous amount of time at work is wasted while people check their feeds. I am not concerned how we characterize smartphone use, whether it be an addiction, a compulsion, or simply a bad habit — its impact is enormous and people need to take a close look at how their own smartphone use is impacting the quality of their lives.”

Independent health and science journalist, former editor-in-chief of LiveScience, writing about how we age and how to optimize your mind and body through time.

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