How do you treat addiction when abstinence isn’t an option?

Can’t put it down.
Can’t put it down.
Image: AP Photo/Altaf Qadri
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Treating addiction is never easy. Though some psychologists do question whether abstinence is the only option, conventional wisdom dictates that recovery is impossible without going cold turkey. Once they’re sober, recovered alcoholics aim to stay sober. Once they’re off drugs, former opioid addicts don’t casually use medicinal marijuana, but instead work to stay clean for life.

However, there are new forms of behavioral addictions in which abstinence is quite simply impossible.

This week, the World Health Organization declared that it would officially recognize “gaming disorder” as a distinct mental health condition in the upcoming 11th International Classification of Diseases. Those who develop an unhealthy relationship with games won’t be able to avoid them entirely if they do try to cut back, as games permeate the internet and crop up quite unexpectedly on various websites.

“It feels like everything bit by bit becomes gamified,” says Richard Graham, a psychiatrist at Nightingale Hospital in London who specializes in technology addiction. “You can’t even shop without it being like a roulette wheel where you’re trying to win your weekly shopping.” When the web devolves into one all-encompassing game you have to play to partake in society, how can you abstain?

Then there’s the related phenomenon of internet addiction, which is not yet formally classified as a distinct disorder, but is increasingly recognized as a behavioral compulsion that impedes the lives of many. Internet addiction is a broad condition that includes an unhealthy relationship with online porn, shopping, and social media. “It becomes absolutely ridiculous to ask people to live without the internet when you do your banking, shopping, communication on it. We have to look at a different model,” Graham says.

One of the key steps in treating any internet-based addiction, he says, is to figure out the impulses driving such behavior. Are patients distracting themselves with games as a soothing coping mechanism, or are they seeking the buzz of a reward from each new like on Twitter? Just as there are different emotional impulses behind the alcoholic who goes to a bar to be sociable and the one who drinks spirits at home alone, it’s important to understand the emotional desires behind the addiction.

John Suler, a cyber psychologist and professor of psychology at Rider University, frames behavioral internet addictions as “compulsions,” distinguishing them from “addictions,” which typically refer to chemical substances. “When psychologists use the word “compulsion,” they then consider the underlying needs that are driving the problematic behavior,” he writes in an email. “Is it a need for dependency, to feel important and powerful, to express anger, to release oneself from guilt? In compulsive behaviors, people are expressing such needs but rarely does the activity actually resolve those needs. People are simply acting out their underlying emotions without becoming more aware of what those emotions are or how to productively address them. They are on a merry-go-round and don’t know how to get off.”

Psychologists are still in the early stages of developing methods to treat internet addiction. Daria Kuss, chartered psychologist and member of the International Gaming Research Unit at Nottingham Trent University, has developed treatments methods based on cognitive behavioral therapy (CBT), which helps patients recognize their maladaptive behavior. She’s also working on a preventative approach that raises awareness about problematic behaviors and aims to deter people from developing such addictions, rather than treating them once they’re already a problem. In years to come, Kuss hopes to see such preventative conversations aimed at teenagers in schools across the UK.

Dealing with internet addiction

Both Suler and Graham note that there are ways to manage temptations, such as turning off notifications, installing grayscale screens to make internet browsing less appealing, and occasionally turning off your phone or leaving it in another room.

Graham also notes that in addition to limiting addictive behavior, it’s important to consider what you want to replace the hours you previously spent on the internet with. “You can focus so much on the restriction and trying to stop without thinking about the substitute—where you’re headed and what you want to achieve,” he says. Strong relationships, a healthy life with both good sleep and physical exercise, and a focus on building knowledge are all ways to build resilience to the unsatisfactory lure of addictive behavior.

In order to both limit your internet activity and replace it with something more satisfying, Graham suggests that rigorous scheduling can help to replace online behavior with more positive activities. “Make sure you don’t just slide into another evening of social media or blogging and suddenly, there’s another day gone,” he adds.

No addiction—whether it’s alcohol or the internet—is only about the substance of the addictive behavior. Addictions reflect a negative way of coping with emotional stresses, so when abstinence isn’t an option, those who suffer have to focus on what they want to do instead, rather than simply eliminating the focus of their attention. “What do you want to do with your life?” Graham says. “It’s about finding that purpose or meaning, grasping your goals, and clutching them close to you.”