Internet Addiction

The subject of Internet addiction as a serious problem came to my attention earlier this month with the headline: “Lawmaker Aims To Curb Social Media Addiction With New Bill.” A US Senator from Missouri introduced a bill to ban addictive social media features. It would address such things as infinite scrolling, tracking of streaks, constant loading and auto-play on video sites, while requiring time limits on apps. He accuses the media companies of “using psychological tricks that make it difficult to look away.”

Many questions came to mind: What is the definition of Internet addiction?; Is it real?; and How big is the problem?

In another article NPR asks the question of whether it is real. One expert that they interviewed said, “Addiction begins with intermittent to recreational use, then progresses into daily use, and then progresses into consequential use, which in some cases will progress to life-threatening use," such as insomnia, dysfunctional relationships and absenteeism. It is the opinion of many experts that Internet addiction fits this pattern. NPR’s introductory story told how it led a young girl to experience depression, anxiety and suicidal thoughts. 

China and South Korea have recognized Internet addiction as a mental disorder, but that is not yet the case in the US. Despite many suggestions dating back to 1996, it has not been included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), therefore, it is not officially a mental health disorder and mental health professionals don’t have a standard way to assess and diagnose it.

This answers my first two questions. Some experts in the US consider it real and a major problem, but it has not yet qualified as an official diagnosis. That leaves the definition open to individual interpretation. As a result the question of the size of the problem is fuzzy, at best.

This can be seen by the fact that one website from 2012 cites a survey putting the problem at between 1.5 and 8.2% of the population. Another source from last May says that the rate of addiction is estimated at 1.5 to 8%. That’s not much of a change in the seven years that have elapsed.

Other studies continue slicing and dicing the problem in various ways. By gender, 27% of women and 25% of men report being near-constant internet users with many more college than high school graduates (34% to 20%). Constant use also varies by income and race. Still, some people must be on the internet more than others just to be able to do their jobs properly. There is more to addiction than time on the computer.

This site provides links to 32 studies between 2008 and 2014 showing “Facts, Figures, & Numbers” from several countries. It’s been a very popular research subject, but has still failed to make the grade as a recognized disorder in the US.

Ultimately, it seems to be just another case of the government stepping in to solve a behavior problem. Every time Americans can’t exercise a little discipline, we lose our freedom to a well-meaning politician intent on solving our problems for us with another law. In this case it seems to be happening even before there is a clear definition of the problem or an understanding of its size.

Fortunately in this case, it doesn’t appear to stand a chance of passing, but it’s an excellent indicator of the general mindset. Whenever we fail in personal responsibility or discipline, help or “protection” comes in the form of regulations, restrictions and less freedom. And it takes only a small minority (8% or less, in this case) to get the ball rolling.

How Are We Addicted?

Let me count the ways. In fact, in the spirit of perspective everyone is invited to give this addiction issue some thought.

With the media and politicians making so much fuss about the opioid epidemic, it’s easy to overlook the other ways we have become addicted.

Smartphones would be a good place to start. I read recently that eighty-seven per cent of smartphone users go to sleep and wake up with their phones, phones that they touch, swipe or tap on average over 2,600 times a day.

This USA Today article emphasizes the negative affect smartphone use can have on sleep patterns. That should be obvious, but the frightening statistics are at the beginning of the piece. “Nearly 7 in 10 children, or a slightly lesser percentage than their parents, kept their mobile device either in bed or within easy reach. And 29% of the younger group actually sleeps with the device, compared to 12% of parents.” In addition, “36% of teens wake up at least once during the night to check the device; about 1 in 4 parents do likewise.”

This is not new. The Business Insider had the same warning with similar statistics at the end of 2012, over six years ago, and the number of users has increased greatly since then. The same was reported at a site called constant contact three years later, and at uberguxmo at the end of the following year.

From sleep we move on to exercise. In another piece USA Today reports that technology may be ruining our workouts. In one extreme example, a woman talks about walking out of the gym if she forgets her fitness tracker at home or if the battery dies. They also report, “Experts say that fitness trackers can motivate us to get moving, however, unfavorable readings can lead to low self-esteem and feelings of guilt. Studies show that smartphones encourage people to hit the gym, while also inhibiting their ability to do so safely and efficiently.” One fitness instructor reports, “when you use your cellphone while resistance training, you’re actually doing less…you’re more likely to spend more time overall engaging in exercise if you left the device at home.”

This need to have smartphones or some other device at hand keeps increasing. The developers come up with a new app or feature that encourages users to turn over control of their lives bit by bit. Ads about taking your entertainment with you are ubiquitous. Banks and credit cards encourage customers to check their balances on the go. There’s even an app to tell when to take a break and get up to move around when we have spent too much time on the computer getting that adrenalin rush from likes, shares or hateful comments from like-minded friends.

We have subcontracted our memories to technology, storing facts and information in the cloud instead of the brain – use it or lose it? Students will argue that all facts are like phone numbers, they don’t have to remember them because they can always look them up from anywhere in the world. But facts are not knowledge; facts are not wisdom.

Years ago, if you had seen someone at the grocery store holding the side of his head or talking to the air, you would have thought he was sick or crazy. Today you just know he left the house with an incomplete shopping list.

With dependence on GPS capabilities, fewer Americans can use a map to find their destination.

Congress is considering a law to control robocalls, knowing that the lure has become so great that people are unable to ignore calls from unknown or blocked numbers. They answer and then are irritated.

Cities are passing laws about texting and walking. Why was there no need for laws about reading a book while crossing the street?

What began as a convenience, has made us dependent. The pity is that instead of being appreciative, we take the new technology for granted, just as we have become so complacent about electricity, indoor plumbing, air travel, air conditioning, microwaves, dishwashers and all the other conveniences we inherited from the last century.

A Hairy Subject

Men, are you suffering from hair loss? That’s the way the ad copy reads – suffering. A reader sent me this link a few weeks ago. Neither of us knew whether to laugh or cry.

The subject is the age-old search for a baldness cure. After the usual silly introductory story, The New Yorker, to show the seriousness of the situation, states that in 2013, “German researchers published a study indicating that men experienced hair loss as an ‘enormous emotional burden’ that could lead to an ‘impaired quality of life’ and ‘psychological disorders’.” Also mentioned was that people are more likely to vote for a (male) political candidate who has a full head of hair.

So this is scary for two reasons.  First, so many men are frightened of losing their hair that they support the hair-growth industry to the tune of $3.6 billion a year. But the only thing they are buying is the promise of slower hair loss – not actual hair growth – along with a “small risk of serious side effects.” Imagine what will happen when someone actually comes up with a way to grow back hair!  Imagine the suffering it will prevent!

Second, it’s just another indication that, despite what we try to teach our children about not judging a book by its cover, voters are so superficial that appearance wins out over competence.

The real message here is not about the hair but about the suffering. In the article they write about how the problem has a history all the way back to early Rome and Biblical times. But I doubt that common men, who were struggling to stay alive every day, were very worried about their hairiness or lack thereof. For most of recorded history the standard of living was relatively stagnant for ordinary people.  From generation to generation they had to struggle just to stay alive, to keep their family fed, clothed, sheltered and safe from bandits and raiders. The few technological advances prior to the industrial revolution primarily affected the wealthy.  Today things have changed and the regular working stiff has the luxury of “suffering” from hair loss – facing the “enormous emotional burden.”

Additionally, today, in contrast to the near-stagnant pace of progress in earlier times, changes take place from generation to generation at an ever-accelerating rate. I recently stopped in to see an 81-year-old friend. When he was born, a few Americans could buy a bulky, 12-inch black and white television for the equivalent of nearly $8,000 in today’s money. It was another 20 years before half the families in America owned a single television. Today almost no one is without access to at least one TV, to do without is considered a sacrifice. Last month the World Health Organization suggested that “gaming addiction” should be classified as a mental health condition. From TVs being exceedingly rare to gaming addiction within one lifetime, and that’s just one example.

Last week I stopped at Subway and took along the change container I keep in my car. When I paid, the woman behind the counter asked the young man she was working with if he recognized it. He hadn’t a clue. It was a plastic container used for 35mm (camera) film. Kids laugh at grandparents when they get confused using an iPhone; grandparents laugh at kids when they don’t comprehend terms like “dial the phone,” “roll down the car window” or even “floppy disk.”  That's the rate of change we have to keep up with in a single generation.

As a result of all this rapid change, the definition of suffering has been watered down to the point where losing one’s hair, not having air conditioning on a hot day, giving up TV for a week, back acne, sinus problems or not having therapy dogs and teddy bears at final exam time are considered suffering. It makes people weep, protest or spend billions of dollars – all for lack of perspective.

Opioid Lawsuits

Recently states and cities, large and small, have made threats or begun the process of suing drug companies that manufacture opioids, blaming them for the epidemic of addiction and over-dose deaths that is sweeping the nation.

Here is a summary of one attorney general’s stance.  “Historically, opioid pain medications were considered too addictive and debilitating for anything but short-term acute pain and end-of-life care.”  But using sophisticated marketing campaigns in the 1990s, they “changed the prescribing culture, convincing doctors that opioids were not very addictive,” encouraging them to prescribe these drugs for chronic pain, using every trick at their disposal to increase sales.  They must take responsibility!

But the form of that responsibility is not specified.  The lawsuits reported on from cities in suburban Chicago “do not specify the amount of damages sought.”  So apparently their idea of responsibility means paying fines to governments.  A class action suit in West Virginia seems to be more focused and specific, seeking “relief for the following damages:

•  Medical expenses, including money (often thousands of dollars) spent on the prescription drugs in question
•  Costs for drug treatment programs
•  Lost wages
•  Pain and suffering
•  Funeral expenses (if they lost a loved one to overdose)
•  Any other relief the Court deems fair and just”

You would hope that such threat of penalties would motivate the drug companies to stop enticing doctors to do their dirty work.  These accusations certainly don’t cast a favorable light on the medical profession as a whole, but it’s probably like politics where everyone thinks their representative (or in this case doctor) is good, but the rest are despicable.

  

It reminds me of the lawsuits against Big-Tobacco, the primary difference being that tobacco has no redeeming characteristics, whereas opioids help people cope with severe pain.  Shutting tobacco companies down or at least fining them and requiring them to widely advertise the evils of their product makes sense, especially if it drives up the cost of cigarettes.  Driving up the cost of drugs or making them less available for the people who need them, on the other hand, would not be optimal.

Another problem arises from the fact that some of the people who became addicted and overdosed, did so using drugs that they obtained illegally.  Do we reward people for breaking the law by reimbursing them for lost wages, pain and suffering or money spent on their drugs?  That is for the courts to decide. 

Something to consider is how such a precedent may play out, suing companies that make a legal, beneficial product that can also be used irresponsibly or to break the law.  Some have already raised the idea of suing gun manufacturers.  Will cities move on to sue paint companies because they can’t control the spread of graffiti?  Will ladder makers be held accountable for the actions of cat burglars?  Why not sue glove companies or towel companies when no fingerprints are left behind at the scene of the crime?  Why didn’t this come up years ago when drivers were buying radar detectors for the sole purpose of warning them to slow down before they're caught speeding?  That was a product that, only with a great deal of subterfuge, could be represented as a benefit to society.  Lawsuits of this kind have already driven companies to plaster packaging and inserts with a host of, often ridiculous, warnings.

Some of those examples are farfetched, but the point is that states, cities and individuals seem to be surrendering, admitting the problem is beyond their control, their resources and their abilities, while looking for a scapegoat.  But isn’t this search for someone else to blame typical behavior of the addict they are trying to help and one of the first things they must overcome before recovery is possible?  Does no one else see the irony?

Compassion and Tolerance

One of the purposes (or maybe just a side effect) of my writing is to inspire readers to investigate or to think about the world in a slightly different way.  The entry last week about mindfulness and focus seems to have done the trick in at least one case.

I received an email with several embedded links and the conclusion:  “It is interesting that longer and deeper thinking tends to lead people to more compassionate and tolerant approaches.”  I dug deeper and began to think that ideas like this that we take for granted are not so simple.

The words compassion and tolerance have become very popular.  At least a couple research organizations are on a campaign to convince as many as possible that these two mental attitudes will combine to yield a more successful future for the world.  We need more, and mindfulness training for adults and children may be the key.

I am inclined to ask:  How do we measure compassion and tolerance, and more important, what are they?

Whenever I see words like more or better, I believe some measurement must be involved.  Finding metrics for mental activity can be deceptive.  Self-reporting is always suspect.  One way to identify compassion is to observe some behavior and label it compassionate, but such classification is impossible without a clear definition.  Someone must define what behaviors demonstrate compassion.  How do we know it when we see it?  As researchers report more positive brain scans on compassionate people, they still must have a definition that distinguishes compassion from other traits.  The same goes for tolerance.

The Center for Compassion and Altruism Research and Education operating at Stanford says, “Compassion unfolds in response to suffering,” recognizing it, feeling empathy and concern, which “motivates us to take action, and help relieve that suffering.”  They promote compassion by saying, “With compassion, our empathy for the suffering of others can give rise to altruism – bringing immediate and long-term happiness and tranquillity [sic] to our lives.”  (But technically, if we are motivated to do it by the good feelings it gives us, that’s hardly altruism.)  A simple dictionary definition of compassion is concern for the suffering of others.  But, since no one can go into people’s head and actually see it, they must infer this concern from observing behavior – she did or said this or that, therefore, she is compassionate.  Then they can observe and classify the brain scans.

But here’s where it gets tricky.  When others are suffering, is it always wise or proper to step in and “take action, and help relieve that suffering”?  Is that always the best solution?  Sometimes suffering is the result of bad luck or natural disaster or birth defect, but sometimes suffering is the direct result of the action or inaction of the individual.

Behavior has consequences.  The purpose of those consequences is to encourage or discourage similar behavior.  In bowling, the feedback comes from the number of pins knocked down.  If you get a strike, try to do the same thing again.  If you get a gutter ball, make a change.  A coach can work with the bowler on technique and equipment as long as the bowler is dedicated to improving.  If the bowler is not interested and expects the coach to do the bowling for him, the consequences have failed; any lesson is lost.  If the bowler decides on a course of action that results in him being unable to roll the ball, no coaching will help.

Likewise in life, immoderate compassion, the taking action to relieve the suffering when the suffering is self-inflicted, crosses the line from aiding to enabling.  Yet so many people are motivated by that “happiness and tranquility” that it brings to our lives and fail to see the long term damage it does to others and to society.

Parents who give in to a child’s every desire or step in to solve every problem are not being compassionate, even as they believe they are recognizing suffering and taking action to relieve it.  They are robbing the child of valuable lessons on how to survive as an unselfish, responsible grownup.  Likewise a society that steps in to assist all adults who appear to be suffering regardless of the source of the suffering are, in some cases, negating the consequences (lessons) of poor decisions, encouraging a continuation of that behavior and possibly contaminating others.

Bad things happen when we get carried away by our emotions and our caring but are still rewarded by those feelings of happiness and tranquility.  It’s called unintended consequences. Compassion requires care as well as caring.

And what of tolerance:  The willingness to tolerate opinions or behaviors one does not necessarily agree with?  This too is difficult and will be taken up next time.

One Crisis After Another

Nothing could make the point better, about behavior having consequences, than the short parade of crises in the news this last week.  According to the CDC, the US has a sleep crisis.  Meanwhile a health advocacy group blames Coke for the continued obesity problems in America.  We text while we drive because we are addicted to technology.

The watchdog group, Center for Science in the Public Interest, is circulating their own version of the famous Coca Cola commercial from 1970, the “Hill Top Ad,” to raise awareness about the dangers of drinking sugary soft drinks.  The parody is necessary, they say, to counter the promotion efforts by Coke, Pepsi and others.  "The industry is spending billions of dollars to encourage people to drink more, and the health side of the equation needs to get the message out to drink less.”

So here is one more group who believes that Americans are so gullible or stupid or impressionable that billions in advertising can talk them into doing something that, if they were just a little better informed, they would not.  Is that even credible?  Are commercial ads really so powerful that we are helpless to resist?  Get a grip!  The industry’s response was that they “put clear calorie information on all of our cans, bottles and packs” to allow consumers to make the choices that are best for them.

Obesity does continue to be a problem in America, and The LA Times reports a new study finding a constant increase.  “Two-thirds of U.S. women and three-quarters of U.S. men are overweight or obese.”  This is not good, but can we blame that on beverage advertising?  This is a discipline issue compounded by a responsibility issue as another advocate enhances their own income and job security by trying to protect victims by shifting the blame. 

Just two days earlier came the reports of a “sleep crisis.”  The CDC is working on new sleep guidelines as research shows that adults get less sleep than recommended, a minimum of at least 7 hours each night. “Anything from 6 hours and below can raise your risk for a heart attack, stroke, diabetes and obesity.”

On the same subject Reader’s Digest announced in March:  “Sleep deprivation now rivals obesity and smoking as our greatest public health crisis.”  They say lack of sleep is making us “fat, sick and stupid.”  Later in the article the blame is placed on technology and the responsibility to solve it has fallen on employers as they try to combat workplace fatigue by offering “sleep-hygiene courses, taught by an increasing legion of sleep experts who come at the problem from various disciplines: medicine, psychology, business. Recognizing that getting their employees to sleep more at home will help them perform better at work, top corporations are bringing these experts in to preach the gospel of sleep to their employees.”

Once upon a time employees were expected not to fall asleep at work.  Once there was a simple concept called bedtime – when we were children, parents enforced it; by the time we became adults, we had developed the habit.  Today it’s technology’s fault and the employer’s problem to fix.  The only surprise was that they didn’t try to also blame it on the caffeine in the cola.

A few days later CBS informed us that use of smart phones behind the wheel is on the increase and “distracted driving caused 3,100 deaths in 2013.”  Their expert explained how this is an addiction, like gambling.  Technology is being developed in Australia to track drivers’ eye movements and sound an alarm, at the same time as states propose new laws.  You see, we have shown we cannot control or be responsible for our own behavior.

So the lack of sleep is making Americans fat, sick and stupid; the soft drinks are making Americans fat and sick; and it takes a watchdog group and employers to solve that problem because we are apparently incapable of saying no to the cola, no to the smartphone and yes to a reasonable bedtime.  We cannot resist using the phone while driving, a practice that began only a few years ago.  Am I the only one that finds this trend really, really scary?

Healthcare and Behavior

The topic of healthcare costs is so large that it takes many short essays to even scratch the surface.  On Monday, April 16, 2012, I listed 8 categories – reasons for higher healthcare costs that should be addressed to solve the problem.  These were explained further on that date and at other times including on the following Friday, April 20.  I did, however, leave out one very important point, that a major influence on healthcare costs is how well we take care of ourselves – yes, individual behavior.

This was reinforced as I read in the past few days articles about:  13,000 newborns needing additional hospitalization because they are born addicted to painkillers; more teens requiring drugs for obesity-related diabetes; and almost half the people treated in emergency rooms being under the influence of drugs or alcohol.

Remember, I have argued on several other occasions that the solutions to our problems, our ability to overcome the so-called crises challenging our society, come not from big government programs or from punishing the big, evil corporations, but from adopting more positive behavior in one or more of the five key dimensions.  Applying this same approach to the problem of rising healthcare costs we see that improved behavior in responsibility and discipline goes a long way toward solving it.  Take responsibility for our health and then do something about it. 

Remember back on August 5, 2011, I pointed out that all legitimate health advice we receive from the media can be reduced to a few basic habits, but we see them over and over presented as “news.”  Likewise reports about preventing or lessening the impact of many diseases include the same advice:  eat right, stay active, get enough rest, quit smoking, drink alcohol in moderation, avoid soft drinks and snack food, etc.  It’s not rocket science.  By taking individual responsibility, we improve our own health, reducing overall healthcare spending.  And reducing the demand for anything usually has a favorable effect on price.

Another recent article about more people walking shows that we are off to a good start. We can do it and don’t have to wait for any new programs or laws.  

Disney Backs Down

Walt Disney World is rethinking an exhibit on childhood obesity that was criticized for being insensitive.  They used superheroes to demonstrate good habits with villains to show poor habits such as eating junk food and not exercising.

The primary objection came from an organization called the National Association to Advance Fat Acceptance (NAAFA).  I went to their website to research their philosophy.  

Their home page has a banner that reads: “Discrimination is Wrong.”  That statement is totally incorrect.  Illegal or irrational discrimination is wrong, but otherwise we discriminate every day, about the food we eat, the people we associate with, the television shows we choose to watch or skip, the kind of car we buy.  The list goes on and on.  Rational discrimination (or even sometimes emotional discrimination), choosing one thing or one brand over another, is a natural and important human activity.  It’s the way we narrow options for decision making.  I like chocolate and will sometimes make decisions to satisfy my preference, discriminating against other sweets or desserts.  It’s not illegal and it’s not wrong – but so much for nit picking.  There are more troubling things about this organization.

First, I agree with their basic premise that everyone should be treated with respect and dignity.  Those who are otherwise fully qualified for a job should never be turned down on the basis of any non-job-related characteristic.  That’s bad business and just plain stupid.  Bullying in school for any reason is unacceptable.  This ideal of respect for all is a noble mission.

But they go on to say: “This discrimination [against fat people] occurs despite evidence that 95 to 98 percent of diets fail over five years…” Assuming that diets fail at that rate, is it time to give up?  It’s not constructive or responsible for people to declare themselves victims.  Diets fail precisely because they are diets.  They entail following a certain course until the problem is fixed, and then folks go back to old habits.  What if we treated oral hygiene the same way?  We would wait until we got a toothache and then brush and floss like crazy and start keeping dentist appointments.  When the toothache went away we would go back to neglecting our teeth and then scratch our heads wondering why problems recurred.  Diets fail because they are short-term solutions.  The NAAFA solution would be to have government regulate “and closely monitor and control all aspects of the $58 billion+ diet industry” and to ban them from advertising on TV, apparently because they don't work or give false hope.  I say, don't blame the diet; take responsibility.

From the statistics on the failure of dieting they conclude, “Our thin-obsessed society firmly believes that fat people are at fault for their size.”  Well, with the exception of valid medical problems, they probably are.  And the valid medical problems are likely no more common than they were 60 years ago when obesity in the US was far lower than it is today.  So the question is, do we let people off the hook for a preventable problem?  Do we call it an addiction, call for “acceptance” and become enablers, or do we try to support them in their effort to lose weight?  As a comparison, how do we treat smokers?  People addicted to tobacco and have tried and failed over years to quit seem to be treated the opposite.  Since the behavior is bad for their health and general welfare, society takes every opportunity to warn them of the dangers and urge, sometimes nag, them to quit.  They are charged higher health insurance premiums and laws limit the places where smoking is permitted.  Yet you don’t hear an uproar over smoker discrimination.  You don’t hear calls for “acceptance.”

Let’s try this approach with children graduating from high school who cannot read.  These young people have behaved in a way that will negatively affect their overall welfare for the rest of their lives.  It is preventable in most cases.  Do we decide that it could be a medical issue, dyslexia, and excuse it, or do we support and encourage them to change?  Is having high school graduates who can't read acceptable because it adds to diversity in our society?  Ridiculous!

The change model, presented last time, shows that change does not occur unless there is some discomfort or dissatisfaction with the status quo.  The more we try to make people comfortable, even proud of any behavior or lifestyle, the less likely they will be to change to a healthier, more positive one.

Bottom line, I have a problem with the NAAFA, not because they are caring people, but because they promote excuse, apology and rationalization over responsibility, an approach that guarantees no solution, but rather a continuation of people putting themselves in danger of a myriad of physical and medical complications related to obesity.  Presented as a service, it is actually a disservice to both the individuals it claims to support and to society as a whole.