Yesterday, as the 2024 Annual Meeting wound down, outgoing APA President Petros Levounis, M.D., M.A., capped his presidential theme of “confronting addiction” with a presentation titled “Technological Addictions: The New Frontier in Addiction Medicine.” During the session, he outlined some of the parallels between technological addictions and substance use disorder (SUD) in terms of assessment, diagnosis, and treatment.
Levounis said that technological addictions (such as video/internet gaming, cybersex, and online gambling addiction) have several characteristics in common with other addictions such as SUD, as follows:
- Tolerance, such as needing to use technology increasingly more often to get the same mood-enhancing effect, and withdrawal, such as feeling anxiety or irritability upon stopping use of the technology abruptly.
- Internal concerns, such as being preoccupied with the technology, being unable to cut down on using the technology when desired, and using the technology as a way of relieving negative moods.
- External consequences, such as giving up other activities, jeopardizing relationships, or losing a job.
Treatments for technological addictions are similar to those used for other addictions, namely cognitive behavioral therapy (CBT) and motivational interviewing, said Levounis, professor and chair of psychiatry and associate dean for professional development at Rutgers New Jersey Medical School.
Levounis said that cognitive behavioral therapy is better suited to patients who already recognize they have a problem and want to address it. “CBT does require some motivation. There’s a lot of structure and there’s homework.”
In contrast, motivational interviewing may work best early in the process, he said.
“Motivational interviewing does its best job with people in the precontemplation and contemplation stage of change,” Levounis said. “It can help people who are either highly ambivalent about their use or who think there is nothing wrong with what they’re doing.”
Levounis noted that there are currently no approved medications for any technological addictions, but there are a few potential options. He said that opioid antagonists such as naltrexone or nalmefene may help patients whose technological addiction is characterized by arousal and impulsivity. He added that these medications decrease dopamine function by blocking opioid receptors, which may reduce the “high” patients get from using the technology.
He added that serotonin enhancers like SSRIs may help patients whose technological addiction is characterized by problems with control or compulsivity because these medications may decrease obsessiveness.
Psychiatrists who treat patients with technological addictions should be sure to treat any co-occurring mental disorders aggressively, Levounis said.
“Do a very thorough diagnostic assessment. See if there are other psychiatric disorders for which we have robust pharmacological treatments and treat them in order to help the person both with the other psychiatric disorder and the technological addiction,” Levounis said.
For related info, see Dr. Levounis’ Psychiatric News special report: “Be Prepared to Address Technological Addictions in Psychiatric Practice.”
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