What’s your addiction? Exploring the humanity and science behind a stigmatised topic
What’s the link between ‘Cheers’ and alcohol-related deaths?

Will technology scale addiction services, or create new addictions? Photo by Clayton Robbins on Unsplash

One of my favourite public health case studies is the ‘Designated Driver’ project by Harvard’s TH Chan School of Public Health. Whilst the idea of a designated driver seems commonplace now, this wasn’t always the case. A concerted effort between major television networks, Government agencies and advocate groups birthed a ‘new social norm’. With an estimated $100m in donated airtime, shows like ‘Cheers,’ ‘L.A. Law,’ and ‘The Cosby Show’ began to insert prevention messaging into storylines, with some shows going further to see characters lost to drunk drivers. Even major FMCG companies get in on the act today, with designated drivers receiving free Coke and other soft drinks for their efforts. So what does this have to do with addiction? As we’ll discuss in today’s article, addiction is a combination of biological processes and understanding individuals’ wider contexts (including social norms) and vulnerabilities across society.

Next week 👉 It’s not just you: community psychology and the social determinants of health

If you just landed here — this article is part of a ten-part series providing bite-sized expert insights on mental health topics (from world-class speakers via Zinc) and my thoughts on the role tech can play in addressing these themes (part of my day job at Kamet). All smart ideas come from the speakers and my peers — all poor phrasings and misunderstandings are my own.

What you’ll learn from this article 🧠

This week’s speaker was Robert West, Emeritus Professor of Health Psychology. The big ideas were around defining and understanding addiction, and public health measures to tackle addiction. Our discussion focused on the role of society in tackling addictions and the line between obsession and addiction. Technology thoughts include the role of digital support for addictions and whether we’re addicted to tech.

The big ideas 💡

Although addiction is a socially defined construct, in public health it is a disorder. Addiction happens because of the way in which behaviours and conditions act on our animal brains. It involves repeated strong motivation to engage in a given behaviour (i.e. not just a result of withdrawals), learned through experience, with actual or potential harmful consequences. Addiction-related processes are often rational: people risking their lives to inject opiates are not making an irrational decision if they feel this is more important than living, or those addicted to alcohol may feel the costs are worth the benefits of anxiety relief / mental escape. So it’s important to look at an individuals’ wider circumstances and life. Addictive substances also impact our brain-reward pathway in a number of ways (e.g. incentive sensitisation, reward-seeking, emotional attachment to addictive substances). It involves both classical conditioning (repeated pairing of cues + effects leading to anticipatory reactions) and operant conditioning (positive / negative reinforcement associated with cues, provoking a strong impulse to engage)

Tackling addiction traditionally requires both demand and supply side factors. On the supply side, there are options to restrict / prohibit supply (however this comes at a huge cost to those addicted, and there is a trend toward moving away from this approach), ways to increase the cost (e.g. taxes on alcohol and smoking), restricting or prohibiting marketing and controlling product features. On the demand side, options include changing social norms, providing treatment, creating media campaigns (especially for illicit substances) and finally, building societal resilience. Addiction doesn’t occur in a vacuum — it exists in a situation where people have vulnerabilities, and there is more we can do from an early age to boost resilience.

Discussion points 🗪

What is the link between addiction and societal structures? Addiction is closely linked to life circumstance: factors like poverty, poor parenting and abuse, adverse living conditions, addictive behaviours among a peer group and lack of opportunities for fulfilment. Social influence is big, and things can spiral when a drug itself impairs control — impacting how we make plans, evaluate things, our wants, needs and ability to exercise inhibitions. When working with the supporters of people who have addictions, it’s important to take a ‘systems thinking’ approach as you’re dealing with family dynamics, wider community networks and individual challenges. You can’t engage everyone, but you can work with some and try to strengthen support networks.

Is obsession the same as addiction? One question asked in our discussion was whether expertise and the ‘10,000 hours’ required for mastery is a pathology or puts you at risk for addiction? One difference is that compulsion is often about short-term immediate gratification whereas obsession is usually linked with a long-term goal. Biologically, these result in different types of dopamine release, where those working toward a long-term goal feel a sense of satisfaction whereas those with an addiction disorder are learning a stimulus impulse association.

Technology thoughts 💻

How successful are digital interventions for addiction? Apps such as Smoke Free, Drink Less and Quit Genius have been paving the way for scalable digital support for addiction, delivering strong results. The gold standard remains a combination of face-to-face therapy + medication, but this isn’t scalable. Engagement is key, and having a strong understanding of the science as well as design principles is important. An interesting insight from DrinkLess highlights the importance of social norms — whilst overall alcohol consumption is falling, there remain sub-populations where groups of people drink more. Therefore people define the ‘average’ amount to drink based on their peers and are likely to over-estimate how much others drink.

Are we addicted to tech? There are an increasing number of papers looking into issues related to internet / phone use. It’s not the ‘internet’ we’re addicted to but specific elements that harness and dive into our brain chemistry. For example, a browser extension found most people spent 80% of their time online on only two websites. This is especially true for online gambling which has had catastrophic impacts on individuals. Public health professionals are mixed on their response to online addictions: compared to other areas the health impact may seem lower, but there is still a mental health toll and opportunity cost associated with how we’re using our time.

Reading list 📚

Speaker bio 🔈
['Ushma Baros']
['Addiction', 'Technology', 'Recovery', 'Mental Health', 'Healthcare']