Food For Thought: Student Edition #1

As the neuroscience of addiction lab is also highly involved in teaching at the University of Amsterdam, we would like to share some of the great output from our recent bachelor course on addiction. In our ‘Food for thought: Student Edition’ series we will share some excellent essays on a variety of addiction related topics. This time you will have the opportunity to read Marisse Koolstra’s essay on a highly interesting and relevent question: “Excessive social media use: A modern addiction or coping mechanism?”

About the author: Marisse Koolstra is a 21 year-old from a city close to Utrecht and because she wanted to understand the biological background of human behavior and brain diseases, she decided to study Psychobiology at the University of Amsterdam. After she has finished her bachelor thesis, on which she is currently working, she hopes to combine a research master with a more clinical oriented one, because she would like to bring together both fields in her future working life.


Excessive social media use: A modern addiction or coping mechanism?

Could one have imagined at the time of the invention of one of the very first social media sites, GeoCities, which was founded in 1994, that nowadays one can be called ‘addicted to social media’? Studies on internet addiction reveal prevalence rates ranging from 2.6% to 10.9% differing per country (Cheng & Li, 2014), and studies specifically focusing on the prevalence of Social Network Site (SNS) addiction report rates varying from 1.6% to 8.6% in the case of Facebook, and 34% to Xiaonei, a Chinese social media site (Andreassen, 2015). Keeping in mind the fact that these prevalence rates are often based on small and non-representative samples, it does show that there are people who use SNSs excessively, and – not unimportantly – experience negative consequences of it, just like other addicts. Besides the problems, the other addiction stages (salience, tolerance, mood modification, withdrawal, relapse and conflict) are applicable to SNS addicts as well (Andreassen, 2015).

It can be debated, however, whether addiction is a proper term for the behavior observed. Since the introduction of gambling disorder in the DSM-5, it has been a topic of discussion for several possibly addictive behaviors whether these should be considered addictions as well (Kardefelt-Winther, 2017). This raises the question of whether excessive SNS use can be considered an addiction. In my opinion, it is too soon to draw conclusions yet because of sparse and inconclusive neuroscientific evidence and the suggestion of other underlying problems to be the core of the behavior observed, when taking into account the model proposed by Kardefelt-Winther et al. (2017). Therefore, I will from now on use ‘problematic SNS use’ instead of ‘SNS addiction’.  

Neurobiological substrates

First of all, research focusing on the neurobiological substrates of the excessive use of and dependence on SNSs is limited. He et al. (2017) studied the grey matter volume (GMV) of several brain areas associated with the presence of an addiction of people with varying degrees of problematic SNS use and conclude that SNS addicts have reduced GMV in the amygdala and increased GMV in the anterior cingulate cortex (ACC) and midcingulate cortex (MCC). No structural changes were found in the nucleus accumbens (NA). In my opinion, this conclusion should be nuanced, since there was no group of controls who did not experience problematic SNS use included in the experimental design, so they compared problematic-users of varying degrees with each other. The way the conclusion is formulated now suggests that they compared problematic users with non-problematic users. When the same research group did include a control group, however, the same structural changes in excessive SNS users regarding the amygdala were found, but excessive SNS users did not show significantly different grey matter volumes in the prefrontal regions including the ACC compared to the control group (He et al., 2017).

He et al. (2017) compared their findings with structural brain changes found in substance use disorder or food addiction, namely that the changes found in the amygdala are the same for people with a substance use disorder or other behavioral addictions such as gambling. The changes found in the ACC and MCC and the absence of structural changes in the NA are not consistent with changes seen in substance and food addiction. However, there are a lot of inconsistencies in the findings on brain changes in other addictions and it is still controversial whether food addiction should be considered an addiction as well (Fletcher & Kenny, 2018), so they might be jumping to conclusions a little too quickly.

Besides findings suggesting structural differences between controls and problematic SNS users, a study conducted by Turel et al., (2014) found abnormal functioning of the inhibitory-control brain system in problematic Facebook users when performing a go/no-go task. The activation of the impulsive (amygdala-striatal) brain system in this task was positively associated with the degree of addiction, which is also seen in other addictions. However, there was no hypoactive inhibitory system (prefrontal system), which is also seen in gambling and substance addictions (Turel et al., 2014).

Underlying problems as the core

Considering neurobiological substrates, it cannot be concluded that excessive social media use is comparable with substance use addictions based upon the existing literature. However, it has been suggested that behavioral addictions should not necessarily be compared to the diagnostic criteria of substance addictions since this possibly holds a risk for pathologizing common behaviors. To avoid this, Kardefelt-Winther et al. (2017) proposed a definition of behavioral addictions, which includes the following four exclusion criteria:  “1.) the behaviour is better explained by an underlying disorder (e.g. a depressive disorder of impulsive-control disorder); 2.) the functional impairment results from an activity that, although potentially harmful, is the consequence of a willful choice (e.g. high‐level sports); 3) The behaviour can be characterized as a period of prolonged intensive involvement that detracts time and focus from other aspects of life, but does not lead to significant functional impairment or distress for the individual; 4.) The behaviour is the result of a coping strategy.” (Kardefelt-Winther et al., 2017).

Of particular interest in the case of problematic SNS use is the last criterion, since several studies are pointing towards the interpretation of problematic SNS use as a coping strategy rather than an addiction (Kardefelt-Winther, 2016). For example, a study investigating internet addiction suggested that heavier internet users are using the internet as an escape and another one suggested that excessive online gaming may be a way to avoid real-life problems. These both fit better with a perspective of problematic internet use as coping strategy than addiction, although both studies approached it from an addiction perspective (Armstrong et al., 2000; Lemmens et al., 2011 resp., cited by Kardefelt-Winther, 2016).

Problematic SNS use may also be a coping strategy rather than an addiction. In her review on SNS addiction, Andreassen (2005) indicates that problematic use of SNS is associated with the need for belonging (Pelling & White, 2009), social contact (Lee et al., 2012), and reduction of loneliness (Teppers et al., 2014). Besides these needs, Facebook use for mood regulation explained people’s inadequate self-regulation of their use (Lee et al., 2012). In addition, it is also related to low self-esteem (Hong et al., 2014) and fear of missing out (Buglas et al., 2017).

It could be questioned on the other hand, whether these coping strategies also play a role in substance use disorder. Indeed, Kronenberg et al. (2015) found that patients with a substance use disorder made more use of palliative reaction (seeking distraction; trying to feel better by drinking or smoking), avoidance (waiting, avoiding the situation) and passive reaction (rumination, drawing back) coping styles than healthy controls when confronted with problems or unpleasant incidents, as measured with the Utrecht Coping List. This would then maybe advocate for problematic SNS use being an addiction, since substance use disorders are called addictions despite the presence of palliative coping strategies.

Conclusion

To summarize, from a neurobiological point of view, there are indications that some differences between problematic SNS users and controls possibly exist, but drawing comparisons with patients with SUD remains difficult and premature. On the other hand, there are also studies suggesting that problematic SNS use is the result of a coping strategy. Therefore, I would not recommend to draw conclusions about problematic SNS use yet, since the label assigned to it will determine how we view and treat problem users: as individuals who need medication and professional intervention? Or as individuals who have underlying problems and should be taught more effective coping strategies? Too hastily drawing conclusions about these questions without a proper evidence base can cause pathologizing and stigmatizing of normal behaviors. On the other hand, people with problematic SNS use may also feel as if their problem is not taken seriously and will not receive adequate treatments if it actually appears to be addiction but is not viewed accordingly. 

To obtain more clarity about problematic SNS use, future studies should in my opinion determine to what extent problematic SNS use is related to a coping strategy. It could be argued namely, that problematic SNS use is the coping strategy, whereas coping could be just one contributive factor in substance use disorder. Another question which follows from this is whether everyone who experiences problems with excessive SNS use, uses SNSs as a coping strategy, or whether subgroups of people with problematic SNS use are distinguishable. Besides that, more studies that investigate the relation between problematic SNS use and brain structure and function are needed, but they should not necessarily be aimed at comparing problematic SNS use with other addictions a priori, since this does not leave enough room for an objective look for other explanations of problematic SNS besides being an addiction.

References

Andreassen, C.S. (2015). Online Social Network Site Addiction: A Comprehensive Review. Current Addiction Reports, 2, 175–184.

Buglas, S.L., Binder, J.F., Betts, L.R. & Underwood, J.D.M. (2017). Motivators of online vulnerability: The impact of social network site use and FOMO. Computers in Human Behavior, 66, 248-255. doi:10.1016/j.chb.2016.09.055

Cheng, C. & Li, A. Y. L. (2014). Internet Addiction Prevalence and Quality of (Real) Life: A Meta-Analysis of 31 Nations Across Seven World Regions. Cyberpsychology Behavior and Social Networking, 17, 755–760. doi:10.1089/cyber.2014.0317.

Fletcher, P.C. & Kenny, P.J. (2018). Food addiction: a valid concept?. Neuropsychopharmacol, 43, 2506–2513. doi:10.1038/s41386-018-0203-9

He, Q., Turel, O., Bechara, A. (March 2017). Brain anatomy alterations associated with Social Network Site (SNS) addiction. Scientific reports, 7. doi: 10.1038/srep45064

He, Q., Turel, O., Brevers, D. & Bechara, A. (November 2017). Excess social media use in normal populations is associated with amygdala-striatal but not with prefrontal morphology. Psychiatry Research: Neuroimaging, 269, 31-35.

Hong, F., Huang., D. Lin, H. & Chiu, S. (2014). Analysis of the psychological traits, Facebook usage, and Facebook addiction model of Taiwanese university students. Telematics and Informatics, 31, 597-606. doi:10.1016/j.tele.2014.01.001

Kardefelt-Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., Maurage, P., Carras., M., Edman., J., Blaszcynski, A., Khazaal, Y. & Billieux, J. (2017). How can we conceptualize behavioural addiction without pathologizing common behaviors? Addiction, 112(10), 1709-1715. doi:10.1111/add.13763

Kardefelt-Winther, D. (2017). Conceptualizing internet use disorders: Addiction or coping process? Psychiatry and Clinical Neurosciences, 71, 459-466. doi:10.1111/pcn.12413

Kronenberg, L.M., Goossens, P.J.J., van Busschbach, J., van Achterberg, T. & van den Brink, W. (2015). Coping styles in substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). BMC Psychiatry, 15. doi:10.1186/s12888-015-0530-x

Lee, Z.W.Y., Cheung, C.M.K. & Thadani, D.R. (2012). An investigation into the problematic use of Facebook. Proceedings of the 45th Hawaii International conference on System Sciences., 1768–1776. doi:10.1109/HICSS.2012.106.

van Oeveren, R. (2019) Should we acknowledge behavioral addictions? Mini-essay for subject Addiction.

Pelling E.L. & White K.M. (2009). The theory of planned behavior applied to young people’s use of social networking web sites. CyberPsychology & Behavior, 12, 755–759. doi: 10.1089=cpb.2009.0109

Teppers, E., Luyckx, K., Klimstra, T.A. & Goossens, L. (2014). Loneliness and Facebook motives in adolescence: A longitudinal inquiry into directionality of effect. Journal of Adolescence, 37(5), 691-699. doi:10.1016/j.adolescence.2013.11.003

Turel, O., He, Q., Xue, G., Xiao, L. & Bechara, A. (2014). Examination of neural systems sub-serving Facebook ‘addiction’. Psychological Reports: Disability & Trauma, 115(3), 675-695. doi:10.2466/18.PR0.115c31z8

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