Social Media Potentially Addictive, Linked to Substance Abuse

Veronica Hackethal, MD

December 16, 2014

Excessive use of social media such as Facebook can be addictive and is linked to problems with emotion regulation, impulse control, and substance abuse, new research suggests.

Results from a survey of university undergraduates showed that almost 10% met criteria for what investigators describe as "disordered social networking use."

"Respondents who met criteria for the proposed diagnosis of disordered online social networking were significantly more likely to also meet criteria for problem drinking compared to those without problems related to Facebook use," first author Julia Hormes, PhD, assistant professor of psychology at the the University at Albany in New York, told Medscape Medical News.

Respondents who met criteria for "Facebook addiction" also reported "significant" symptoms commonly linked to addiction, such as tolerance (increased Facebook use over time), withdrawal (irritability when unable to access Facebook), and cravings to access the site, she added.

"Our findings suggest that there may be shared mechanisms underlying both substance and behavioral addictions," Dr Hormes added.

The study was published in the December issue of Addiction.

Powerful Influence

Awareness of the addictive potential of certain behaviors, such as gambling or tanning bed use, has been increasing, said Dr Hormes. Currently, though, pathologic gambling is the only behavioral addiction included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

About 800 million people use Facebook daily, according to background information in the article.

"We can think about new Facebook notifications as a type of reward that keeps people coming back for more," said Dr Hormes. "This reward is delivered on a variable interval schedule of reinforcement ― you never know when a new post will be available, so you keep checking ― a schedule that is known to be very powerful in establishing habits."

Researchers conducted a cross-sectional survey of 253 undergraduates (62.8% women; 60.9% white; mean age, 19.68 years; standard deviation = 2.85). The students received course credit for completing a 1-hour online questionnaire. The response rate was 100%.

Researchers assessed disordered social media use using criteria validated in a previous pilot study and taken from sources widely used for assessments of alcohol addiction. These included the DSM-IV-TR; the Penn Alcohol Craving Scale; the Cut-down, Annoyed, Guilt, Eye-Opener (CAGE) screen; the Young Internet Addiction Test; the Alcohol Use Disorders Identification Test (AUDIT); the Acceptance and Action Questionnaire-II; the White Bear Suppression Inventory; and the Difficulties in Emotion Regulation Scale. Questions focused on tolerance, withdrawal, and cravings to access the Facebook site.

Respondents reported having spent a mean of 148.83 minutes on the Internet in the previous day, with about one third of that time (46.05 minutes) on Facebook. Of those surveyed, 9.7% (n = 23; 95% CI, 5.9-13.4) met criteria for disordered online social networking use. The most commonly reported symptoms were "spending substantial time" and "more time than intended" on Facebook (36.3%, n = 91, and 62.9%, n = 158, respectively).

Results suggested significant associations between disordered Facebook use and Internet addiction (P < .001), difficulties with emotion regulation (P = .003), and problem drinking (P = .03). Those who met criteria for disordered Facebook use were significantly more likely to have AUDIT scores above the upper limit for risky drinking (P = .03).

The study's focus on college students with regular Internet access could limit generalizability of the results, the investigators note. Use of online questionnaires could have introduced self- selection bias by a group of frequent Internet users already at risk for Facebook addiction.

Finally, the cross-sectional study design did not allow for determination of cause and effect and the possibility that problems with emotion regulation could result from disordered Facebook use.

Brain Changes

Commenting on the findings for Medscape Medical News, Nina Urban, MD, assistant professor in clinical psychiatry and research scientist in the Division of Substance Abuse at Columbia University in New York City, said, "A distinction has to be made between addiction, substance abuse, and impulse control disorder."

An addiction is mediated largely by the dopamine system, Dr Urban explained, whereas impulse control disorders are predominantly mediated by the serotonin system in the brain.

Online disordered social networking is hard to frame in terms of addiction, because it engages normal behaviors and drive for interaction, though it contains elements known to contribute to addiction formation, Dr Urban added.

Preliminary evidence from positron emission tomography imaging studies suggests that a general "Internet addiction" can lead to brain changes that are similar to those associated with substance use disorders, including changes in glucose metabolism and dopamine levels in brain areas that are associated with substance abuse, Dr Urban added.

Nevertheless, she advised care when comparing the two.

"Needing an alcoholic drink first thing in the morning is more detrimental to health and overall functioning and more indicative of the severity of alcohol dependence than the urge to check Facebook first thing in the morning," Dr Urban noted.

Dr Hormes and Dr Urban agree that more research is needed to establish online social networking disorder as a diagnostic category.

"This study provides additional evidence for the well-known comorbidity between substance abuse, impulse control deficiencies, and some personality traits hinting at underlying mood or anxiety disorders," said Dr Urban.

"[These disorders] have clinical pictures with a clear biological basis that warrant addressing."

The authors and Dr Urban report no relevant financial relationships.

Addiction. Published online November 10, 2014. Abstract

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