Technological Addictions:

The New Frontier in Addiction Medicine

Petros Levounis, MD, MA
Professor and Chair, Department of Psychiatry, and Associate Dean,
Rutgers New Jersey Medical School
Chief of Service, University Hospital, Newark, New Jersey
Director, Northern New Jersey Medications for Addiction Treatment Center of Excellence
President, American Psychiatric Association

Clinical Updates Track

American Psychiatric Association 2024 Annual Meeting
New York City
Wednesday, March 8, 2024 (my last day as APA president…)
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 Disclosures

Dr. Petros Levounis has

no financial disclosures

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 Outline
1. The Lay of the Land
2. Internet Gaming
3. Cybersex
4. Assessment and Diagnosis
5. Treatments
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 1
THE LAY OF THE
LAND
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 Behavioral Addictions
Gambling
Sex
Technology
Food
Shopping
Tanning
Exercise
Love
Work
Ascher MS and Levounis P, The Behavioral Addictions,Copyright
2015.. © Presenters, 2024. All rights reserved. Do Not Copy or Distribute.
 Technological Addictions
Internet Gaming
Cybersex
Social Media
Internet Gambling
Infobesity
Emailing and Texting
Online Auctions & Shopping

Levounis P and Sherer J, The Technological Addictions, 2022.

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 Social Media
✔ The Self v. the Selfie

✔ FOMO v. JOMO
o Fear or Joy
o Of
o Missing
o Out

Andreassen CS, The relationship between addictive use of social media, narcissism, and self-esteem: findings from a large national survey,
Addictive Behaviors, 2017; Sherer J and Levounis P, Is social media
Copyright © Presenters, 2024.misuse a Dobad
All rights reserved. Not Copyhabit
or Distribute.or harmful addiction?, Psychiatric News, April 1, 2024.
 Sports Betting

GrandViewResearch.com, U.S. Sports Betting Market Size,

Copyright Share, and
© Presenters, 2024. Trends
All rights reserved. DoAnalysis, September 2021.
Not Copy or Distribute.
 Infobesity
✔ Internet Surfing:
Aimless web browsing for extended periods

✔ Information Overload:
Difficulty understanding a topic or making
decisions due to too much information

Janssen R, Information overload: why some people seem to suffer more than others, Nordic Conference on Human-Computer Interaction,
2006.
Levounis P and Sherer J, The Technological Addictions, 2022.
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Emailing and Texting

10

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 Auctions & Shopping

When I shop, the world gets better,

and the world is better,
but then it's not, and
I need to do it again.
- Rebecca Bloomwood

Film: Confessions of a Shopaholic, 2009. Copyright © Presenters, 2024. All rights reserved. Do Not Copy or Distribute.
 2
INTERNET GAMING

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 Careers, Friends, Popularity

Courtesy of James Sherer, MD. Copyright © Presenters, 2024. All rights reserved. Do Not Copy or Distribute.
 Kids and Video Games
✔ 61% play video games on a given day.
✔ Average Time: 2 hours 13 minutes
✔ Boys > Girls
✔ 14% boys, 5% girls play 4 to 10 hours/day.
✔ Do parents limit kids’ screen time?
o 94% parents say YES
o 48% report a “constant battle”
o 72% youth say NO
o Those with no rules play twice as much

Levounis P and Sherer J, The Technological Addictions, 2022.

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 Positives
✔ Eye-Hand Coordination
✔ Multi-tasking
✔ Vision
✔ Visual Attention
✔ Visual Tracking
✔ Mental Rotation

Mayer RE, Computer Games in Education, Annual Review

Copyright ©of Psychology,
Presenters, 2019.
2024. All rights reserved. Do Not Copy or Distribute.
 Negatives
✔ Academics
✔ Exercise
✔ Sleep
✔ Not Hanging Out with Friends
✔ Feeling Lonely
X Do they cause violence? No.
Suziedelyte A, Is it only a game? Video games and violence, Journal
Copyright © Presenters, ofreserved.
2024. All rights Economic Behavior and Organization, 2021.
Do Not Copy or Distribute.
 The Flow Zone

17

Deines J, “Flow wave” and instructional theory, johndeinesblog.wordpress.com/tag/game-design,

Copyright © Presenters, 2024. All rights reserved. Do Not Copy or Distribute. accessed on March 1, 2022.
 Arousal and Control

18

Based on the work of Mihaly Csikszentmihalyi. Copyright © Presenters, 2024. All rights reserved. Do Not Copy or Distribute.
 3
CYBERSEX

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An All-Inclusive Term
Online Pornography
Online Dating
Sex Chats
Sex Webcams
Teledildonics

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Online Pornography

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The Triple A Model

Accessibility
Affordability
Anonymity
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Online Dating

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 Dating on Sites & Apps

Vogels EA, 10 Facts About Americans and Online Dating,

CopyrightPew Research
© Presenters, Center,
2024. All rights reserved. Do Not Copy2020.
or Distribute.
 Dating in Today’s World

► Love and sex, both virtual and real, is

only a click or a swipe away.

► Variable-ratio reinforcement

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 4
ASSESSMENT AND
DIAGNOSIS
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 HOW DO I KNOW
MY PATIENT IS ADDICTED
TO TECHNOLOGY?

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 Same as All Addiction

✔ Tolerance and Withdrawal

✔ Internal Concerns
✔ External Consequences

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 Physiology

✔ Tolerance
o Requiring more use to get the same satisfaction

✔ Withdrawal
o Anger and irritability
o Depression and despair
o Tantrums in children

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 Internal Concerns
✔ Preoccupation
o Beyond what is acceptable for a patient’s age,
social circle, and profession

✔ Inability to cut down despite desire

and efforts
✔ Attempt to relieve negative moods

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External Consequences

✔ Giving up activities
✔ Jeopardizing relationships
✔ Losing a job
✔ Deceiving loved ones

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Reprinted from: Sherer J and Levounis P, Is social media misuse
Copyright a2024.
© Presenters, bad habit
All rights orNotharmful
reserved. Do Copy or Distribute.addiction?, Psychiatric News, April 1, 2024.
 5
TREATMENTS

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WHAT CAN I DO
ABOUT IT?

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 Psychotherapy

✔ Cognitive Behavioral Therapy

✔ Motivational Interviewing

Levounis P, Arnaout B, and Marienfeld C, Motivational Interviewing for Clinical Practice, 2017.
Levounis P and Sherer J, The Technological Addictions, 2022.
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 Medications

✔ We have no approved medications

for any Technological Addiction.

✔ Treat co-occurring psychiatric

disorders.

Levounis P and Sherer J, The Technological Addictions, 2022.

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 Arousal and Control

37

Based on the work of Mihaly Csikszentmihalyi. Copyright © Presenters, 2024. All rights reserved. Do Not Copy or Distribute.
 A Tech Addiction as an
Arousal/Impulsivity Problem

Opioid Antagonists
▪ Consider naltrexone (or nalmefene).
▪ Decrease dopamine function by blocking
opioid receptors.
▪ Reduce the “high.”

Please note: No medication has been approved by the Food

Copyright and
© Presenters, 2024.Drug Administration
All rights reserved. Do Not Copy or Distribute. for the treatment of any technological addiction.
 A Tech Addiction as a
Control/Compulsivity Problem

Serotonin Enhancers
▪ Consider Selective Serotonin Reuptake Inhibitors
▪ Increase serotonin function by blocking
serotonin reuptake receptors.
▪ Decrease obsessiveness.

Please note: No medication has been approved by the Food

Copyright and
© Presenters, 2024.Drug Administration
All rights reserved. Do Not Copy or Distribute. for the treatment of any technological addiction.
 And Back to Neurobiology

Koob GF, Addiction as a coping response, American Journal of Psychiatry, 2020.

Mason BJ and Heyser CJ, Alcohol use disorder: the role of medication
Copyright © Presenters, 2024. All rightsin recovery,
reserved. Alcohol Research 2021.
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 Our Team
Aitzaz Munir, MD
Ana Claudia Zacarkim Pinheiro dos Santos, MD
Diego Garces Grosse, MD
Donya Nazery, MD
Faisal Kagadkar, MD
Heather Wurtz, MD
James Sherer, MD
Lancer Naghdechi, DO
Lukmanafis (Lukmon) Babajude, MD
Muhammad Aadil, MD
Rafael Coira, MD, JD
Robert Rymowicz, DO
Seyed Parham Khalili, MD, MAPP
Yonatan Kaplan, MD
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 THANK YOU
NJMS.Rutgers.edu/Psychiatry

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