Ambivalence in Addiction

Smartphone addiction is no different from the hard-drug physical kind.

[Cross-posted at The Fallible Mind, my blog at Psychology Today]

Ambivalence is a defining feature of addiction, even with smartphone screens.

Ambivalence is a prominent feature in addictions whether of the physical or behavioral kind. Valence is the positive or negative weight one assigns to an event, object, person, or situation. Being ambi-valent (Latin, “both”) means that one is simultaneously of two minds. Importantly, the two minds are contradictory rather than merely different.

In practical terms, an addict wants to stop but can’t. This is what it means to be addicted and what non–addicted people often cannot grasp. They come at it from their own perspective of being able to moderate and stop drinking, smoking, or taking their pain pills without a struggle. But addicts continue despite severe experiences with negative consequences such as arrest or loss of job, family, home, and health. Because this behavior makes no sense to the non-addicted, they speak of moral failings or lack of willpower. Governments criminalize drug use even though it exacerbates the problem. Penal approaches don’t address the out-of-whack wanting system in the addict’s brain that produces the demand for the addictive substance whether it is crack cocaine or a smartphone screen. Incarceration isn’t a deterrent at all, and the same goes for most well–intended disincentives. What might this tell us about which countermeasures to ubiquitous screen distractions are most likely to succeed?

I have had a doctor addicted to narcotics tell me how he would jab a needle into his thigh while shouting, “Dear God, help me stop.” I’ve had alcoholic judges describe going to the liquor store determined to have “only two” drinks that evening and then ending up dismayed that they had yet again emptied the bottle. The struggles of smokers or dieters to limit their consumption are of course much more familiar. But the general principle is the same: the short term craving of the wanting network wins out over long-term considerations of future consequences.When it comes to excessive screen-checking, ambivalence is self-evident in laments about wasting time scrolling through Tumblr or Instagram, or spending more time than you meant to on Facebook, Reddit, or the feeds to which you subscribe. You feel the tug between promising yourself to cut down and willfully violating that resolution. This is the paradox of wanting-but-not-enjoying in action: we don’t say no despite knowing what the negative outcome is going to be.

The brain’s wanting and liking systems are distinct anatomically as well as psychologically. Circumstances easily push them in opposite directions. In a clever experiment from Stanford University titled “Lusting While Loathing” subjects were thwarted from winning a prize they had wanted. Rating it afterwards showed that those who didn’t win coveted it even more than they initially had. Yet, simultaneously, they also judged the prize less appealing than they previously had. Losers offered consolation gifts “merely similar” to the original demonstrated a high level of liking them, too. The disparity between wanting and liking was biggest in participants who weren’t strongly aware of their feelings as a rule, implying that emotion plays a role in the “relative harmonization of wanting and liking” [2]. In other words it is best if you can strike a balance.

Dr. Kent Berridge at the University of Michigan challenged prevailing wisdom years ago when he insisted that dopamine wasn’t the reward neurotransmitter at all but rather the one coupled to desire. Time proved him correct and also showed that dopamine was responsible for the reinforcement that makes us crave favorite goodies even more. What was initially hard to explain was why, after years of abstinence, addicts could still crave cocaine, alcoholics liquor, smokers nicotine, dieters carbohydrates, and so on. What he discovered is that addictive things that successfully commandeer the dopamine network can change it permanently. “The enduring change is the basis for ongoing addiction,” he told me [5].

Individuals become hypersensitive to the cues that trigger their particular craving—drinking scenes in film and television, cigarette displays or seeing someone smoking, the street corner where they used to score. The result is what Berridge calls heightened “incentive motivation,” or intense wanting. Yet—and this is the odd part—a Pavlovian conditioned response makes individuals (and animals) come to prefer the cue over the substance. The anticipation of scoring, downing the cocktail, or inserting the needle can become more rewarding than the substance that one was originally hooked on.

I knew a physician who after a successful rehab nonetheless injected sterile water into his veins; he’d become a “needle junkie” attracted to the ritual and sensation of injecting himself. “I have no idea why I still do it,” he said, “but I get antsy if I don’t,” an indication of how automatic, involuntary, and unconscious these motivations become. Electrode recordings from deep nuclei in the limbic brain of alcoholics confirms this because cues presented outside of the subject’s awareness still trigger conscious cravings [8].

Of course, “I get antsy if I don’t check it” is something one hears from people who can’t let go of their phones, which is why this discussion is pertinent to screen addiction. What we have learned from physical addictions should worry us when it comes to behavioral ones such as obsessive checking, video gaming, or Internet gambling. Here is why. Incentive sensitization has already been shown to be at work in eating disorders and food rewards, online pornography, and gambling [9]. It is entirely reasonable to ask whether the same might be the case with screens. I earlier discussed how it can take a long time to extinguish intermittent reinforcement, and how only one instance of giving in makes the situation worse. Given the permanent brain changes and renewed cravings that can be triggered after years of abstinence (which can lead to relapse), you can still crave your smartphone even if you have sworn off it for a while, and snatch it right back up the way that cigarette smokers suddenly resume their habit when exposed to a seemingly innocuous old cue. This is a disturbing thought.

A recovering addict can repeatedly resist cues in and of themselves only to relapse at a later time during an encounter with the same cue when stressed or excited. We can flood the wanting system’s nucleus accumbens in a rat with dopamine and be unable to tell any difference so long as the reward cue isn’t present. But as soon as the cue does appear the dopamine–flooded rat frantically tries to obtain the associated reward much more intensely than when it encounters the same cue in an undrugged state. It is the cue multiplied by the level of dopamine interaction that determines the degree of wanting [4].

In humans, vivid imagery about either a reward or a cue can substitute for its actual presence. As for screens, they are not merely novel bright lights and whooshes. If they were “just tools” as apologists argue, then the dopamine effect would wear off in tandem with the novelty factor as it does in the case of your refrigerator light that no longer surprises you.

It is true that novelty reliably activates dopamine. Drop your keys once, and your dopamine neurons will fire. Drop them a few more times and the neurons habituate and no longer take notice. Digital distractions fail to habituate and remain endlessly attractive because screen flashes and the sound of push notifications have become salient and familiar cues for associated email, texts, web sites, videos, and social connections. These sight–sound–vibrational alerts act as social information nuggets, functioning like rewards that keep the dopamine system firing in response to all their associated cues.

There is a growing polarity between those who favor tech-free time and question the unintended effects of ubiquitous screens, and those who advocate for yet more technology, especially giving kids iPads from birth. “Everything we know about child development tells us that tablet computers should not be banned for babies and toddlers,” says Professor Annette Karmiloff-Smith at the University of London [10]. I find her confidence glib. Believers like her say that we shouldn’t overreact, and that time will tell. Even organizations such as the American Academy of Pediatrics, which for 15 years advised no screens of any kind before age 2, end their new 2015 guidelines by calling for “more research” [11, 12]. But the participation of tech purveyors in the Academy’s report appears like a massive conflict of interest. And if we patiently wait for “more research,” then relentless screen exposure may have already altered millions of developing brains permanently. “So what?” you say. “Maybe it’s for the best.” But to what evidence can such cheerleaders point to suggest that early screen exposure if always and ever for the good? What if it isn’t? What do we do then? This is why I call the uncritical adoption of mobile technology the largest social science experiment ever conducted, and the largest undertaken without the participants’ consent.

Why is it so hard to put the screen down and stop? For one, pleasure is fundamental to survival and well-being. It is integral to homeostasis, the propensity of all living creatures to maintain a stable internal milieu. Homeostasis functions like a thermostat to keep our physiology—which includes how we think, feel, and act—at a balanced set point, so that without having to think about it we act out pain and pleasure routines written into the fabric of our DNA [13].

“Human brains notice, remember, think about, anticipate, and plan for pleasure,” says Professor Berridge. “It kept us alive for eons.” It is why today we always have room for dessert when we say we’re stuffed. It is why, “One more for the road” sounds agreeable [14]. Beridge painstakingly discovered “hedonic and motivational hotspots” within the brain’s liking and wanting networks. He described how natural opioid-like transmitters such as endorphins and enkephalins amplify pleasant sensations to make them “more likable.” The brain releases orexin when we are hungry, for example. It acts on hedonic hotspots to make food taste better. Likewise, stimulating a hotspot with anandamine, a natural brain version of the substance found in marijuana, enhances pleasure [15].

“Pleasure is never merely a sensation, but something the brain adds to sensations and experiences,” Berridge told me. One could theoretically mix wanting and liking in different proportions to arrive at different degrees of motivation. Liking without wanting might represent the plain vanilla version of happiness: Not being disturbed by desires by a wanting system set to zero would make this the state of contentment that the Oxford English Dictionary defined. But how motivated would such individuals be to do more than enjoy what they already had? If the degree of wanting were turned up so it equaled that of liking, we can imagine a person engaged in the world and apt to find meaning in it through his own efforts. But too much wanting? That can lead to sustained maladaptive behavior [14]. Both physical addiction and compulsive phone checking are the cause of much anxiety and unhappiness.

Some brains of course are more prone to addiction than others. And because pleasure and wanting are separable and distinct, screens can easily tantalize us without giving pleasure. The myth of Tantalus describes exactly how wanting on its own can be quite unpleasant. According to legend, Tantalus had stolen ambrosia from the gods and revealed to mortals secrets he had learned on Olympus. In the underworld he was forced to stand in water that receded every time he tried to take a drink, and beneath fruit trees whose branches lifted beyond his grasp whenever he tried to reach them.

The constant availability of screens is a tantalizing cue that makes us pick screens up when standing in line, waiting at the light, and during all those other moments when we used to pause—as if silence or a few seconds of inactivity were intolerable. Does screen checking deliver that much enjoyment? Does it make you content or give life meaning? Do you feel like a hamster running in a wheel, never able to catch up, or is it more like sitting in front of a slot machine waiting for a payoff? No wonder you feel ambivalent.

E-mail neuroman@gwu.edu to receive a copy Dr. Cytowic’s American Interest article, “Digital Distractions: Your Brain on Screens,” or to subscribe to his low-frequency newsletter. Follow him @Cytowic or at Cytowic.net.


 

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