Dr. Sussman teaches an approach to healthy screen use that divides up activities according to their effect on the reward system of the brain, instead of whether they are “productive” or not. Dr. Sussman offers an introduction to this approach in his article for Attention Magazine, Limiting Screen Time During a Pandemic: A Guide for Parents. If you prefer to learn from videos, he did two videos on Parenting during the COVID-19 Pandemic you can link to from this website. One is a 1-hour presentation done for OperationParent.org and is more comprehensive, and the other is a roughly 20-minute overview done on YouTube. If you view the YouTube video on the YouTube page, there are comments at the bottom which contain a growing user-generated list of low-dopamine activities. You can go there and browse them or add your own.
Dr. Sussman is the first psychiatrist to have a room in his office designed to double as a screen-free activity room for the younger children he works with and a model for a low-dopamine room for parents to learn how to create a more balanced home environment. You can contact him for a consultation and see it for yourself.
Not everyone who uses screens uses them excessively, but some people find that they cannot stop when they need to. This can lead to devastating consequences, such as losing interest in all other activities and losing the ability to function in the real world. There is a growing amount of evidence that from a neurological, behavioral, and clinical perspective, screen addictions, also known as digital use disorders, should be taken seriously.
Scientific research has showed remarkably similar results in metabolic imaging studies of the brain in those who use drugs like cocaine heavily and those who are heavy gamers. Both activities activate the "reward center" of the brain much more than a typical activity. This is in part because both activities provide instant and continuous stimulation. Other screen activities such as binge-watching TV series or using social media on a cell phone are also know to provide instant and continuous stimulation.
The behaviors that are typically observed in screen addictions are also remarkably similar to the behaviors seen in those who abuse substances or gambling, such as inability to control use despite negative consequences, preoccupation with use over other activities, and lying about use.
The World Health Organization has announced that the ICD 11, the upcoming edition of the official clinical guideline which lists medical conditions, will contain the diagnosis of "Gaming Disorder", making it an official medical diagnosis. You can view the criteria on their website here.
Despite the growing evidence and improved understanding of screen addictions, some continue to argue that excessive screen use is harmless, or at worse a "bad habit" not requiring medical intervention. Unfortunately this denial may create a barrier to recovery for many. In 2018 I explored this issue in an editorial which you can view here.
Children, teens, and young adults are more vulnerable to screen addictions, due in part to less cortical ability to delay gratification. People with psychiatric disorders such as Autism, ADHD, Anxiety, Depression are also at higher risk. People with a history of other addictions or a family history of addiction are as well. Some data suggests men are at a higher risk of video game addictions while women are at a higher risk for addiction to social media platforms. However, as screen use becomes more ubiquitous throughout society, screen addictions are appearing more in a wider range of patient ages and presentations. For more information contact Dr. Sussman.
Excessive screen use becomes a problem when your devices start to control you instead of you controlling the devices. The definition of a use disorder, also referred to as addiction, is that the substance or activity cannot be successfully self-regulated despite negative consequences to your everyday functioning, such as work problems, academic problems, relationship problems, or health problems. Typical symptoms are preoccupation with screen use over other activities, lying about screen use. missing school or work due to screen use or related sleep problems, failure to launch due to screen use, or stealing money for screen use.
If you think you may have a problem with screen use, please know that healthy screen use is possible and help is available.
Dopamine is the reward neurotransmitter- it flows in the brain in response to rewards and stimulation. The release of dopamine increases significantly when the brain does not have to wait as long for the reward. Activities such as video games, streaming media, and social media, which produce instant and continuous stimulation, can therefore be considered “high dopamine activities” (HDA). In fact, metabolic imaging studies confirm that these activities produce a large amount of dopamine flow. If this flow lasts for many hours daily due to regular screen "bingeing," the residual effect on the brain is significant. Over time the brain will develop a higher tolerance to dopamine, due in part to a process called receptor downregulation, and therefore will require even more stimulation. This end state is described in peer-reviewed literature as “reward deficiency syndrome,” which is marked by even more loss of interest in activities that are less stimulating, like schoolwork. Children may be more vulnerable to this effect the younger they are, because the region of the brain that regulates delaying gratification, the prefrontal cortex, takes more time to develop than the reward system. This may explain to parents why their children, when allowed unlimited access to the stimulation they seek, seem to just get more bored and irritable during most off-screen activities.
This process seems to be reversible if someone is able to reduce their exposure to HDA for an extended period of time. For more information on dopamine receptor downregulation, you can view this video here.
The topic of long-term, irreversible effects on the brain from excessive screen use needs a lot more research, but one thing that seems to last indefinitely is the conditioning of the brain to respond to "cues". For example, the brain associates certain environmental changes, such as the sights, sounds, and smells of a bar, with the activity typically done in that environment. Therefore someone with alcoholism may experience increased release of dopamine in the brain even before they have had their first drink. Similarly, one who is addicted to gaming may start to experience dopamine release upon seeing their device or screen on their desk. This makes it harder to resist turning the screen on instead of doing homework. And it is possible that this effect may remain long after receiving treatment and successfully regulating screen use. This is why being aware of cues is important for someone with a history of addiction.
There is no evidence that playing a video game for a reasonable length of time is bad for children, and some to suggest there may be some positive cognitive benefits, depending on the game. Unfortunately, there are characteristics of video games that make it difficult for some to regulate their use. Video games are only clearly unhealthy when they are used excessively and at the expense of other important functions or activities, and therefore video games should be enjoyed responsibly just like alcohol, gambling, or other habit-forming activities.
There is some concern that violence in video games or other objectionable content may negatively influence behaviors, but this is a difficult theory to study scientifically. The data on this is limited and the results are inconclusive, in part because it is difficult to prove causality. There is some evidence that there may be an increase in aggressive behaviors immediately following play of violent video games, but the debate of whether this is a dangerous or lasting effect remains unsettled.
It is practically impossible to function in modern society without some regular access to screens. In most cases, the end goal of treatment for those who use screens excessively is not to eliminate screen use, but to balance screen activities with off-screen activities.
For children, how much screen time is OK depends on 3 factors:
- How old are the children? There is some evidence to suggest that younger children should have shorter blocks of screen time than older children.
- Is the screen time instantly and continuously stimulating, such as videos and video games, or does it require more effort and patience to receive rewards, such as coding and online homework? Different types of screen use have different effects on the reward system of the brain. This concept is explained in more detail in a video you can access here.
- How long is each session of screen time? Setting a limit on “hours per day” may be inadequate. For example, sitting for 5 hours straight playing a video game may be worse for a child’s brain than breaking up the time into 5 separate hours over the course of the day with at least an hour of break between each one.
If you are not sure your children have a healthy balance, or even what that looks like, Dr. Sussman may be able to assist you by not only customizing some guidelines for your family, but helping you to optimize the home environment and set limits so that the guidelines will be followed more consistently.
In addition to the many other hardships during a pandemic, there is less structure, more social isolation, online classes, and an increase in maladaptive coping behaviors and addictive behaviors. All of these factors can cause a rise in screen use and a proportional increase in screen addictions. It will also make it difficult for many students to transition back to in-person classes when they resume. Dr. Sussman has strategies for having as much healthy balance and structure as possible during this difficult time. Dr. Sussman offers two free videos on Parenting during the COVID-19 Pandemic you can link to from this website. One is a 1-hour presentation done for OperationParent.org and is more comprehensive, and the other is a roughly 20-minute overview done on YouTube. If you view the YouTube video on the YouTube page, there are comments at the bottom which contain a growing user-generated list of low-dopamine activities one can do at home or in the backyard in the pandemic. You can go there and browse them or add your own. For more information you can contact Dr. Sussman for a consultation.
If you contact Dr. Sussman for a free 15 minute phone consultation, you can explain your situation. Dr. Sussman can explain whether the services he can offer can fit your needs, and if not, he can present you with other options. He will also provide information on fees, parking, and the answers to other questions you may have. If you agree to an initial intake appointment, it will usually be a 90 minute meeting which can be divided into 2 sessions when treating teens over 14, one for the parents and one for the patient. At the end of the intake appointment, Dr. Sussman usually has enough information to present you with his assessment and a treatment plan.
Note: During the COVID-19 state of emergency, all appointments will continue to be on video. Click here for updates.
Some family members may be resistant to treatment. This is commonly seen with any form of use disorder. In some cases, Dr. Sussman is able to meet patients where they are. Dr. Sussman uses an approach developed for drug and alcohol treatment called Motivational Interviewing (MI), in which Dr. Sussman does not take on the role of another authority figure telling the patient they need to change. Instead, he becomes a reflective listener who is able to help patients become their own authority and tell Dr. Sussman how they need to change, in the process improving their insight on the consequences of their behaviors.
In other cases, in which the patient refuses to even meet with Dr. Sussman, he is able to meet with parents or other family members alone instead and help them to create an environment with more structure and limit setting interventions, and more motivation for change. He can also present other placement options if needed.
For more information, please contact Dr. Sussman for a free 15 minute phone consultation.
Psychotherapy, psychoeducation, and parent training are among the most effective interventions Dr. Sussman is able to use to treat digital use disorders. Dr. Sussman is a psychiatrist who prescribes medications, but they are often for treating secondary psychiatric issues, such as ADHD or depression, rather than a direct treatment of excessive screen use. There is not enough evidence to strongly support the outpatient use of any particular medication for screen addiction, although there is growing evidence of mild benefit from non-stimulant ADHD medications such as Wellbutrin and Strattera. Contact Dr. Sussman for more information.
There are a small number of inpatient or residential rehabilitation programs that exclusively treat digital use disorders. Dr. Sussman is the expert consultant who helped develop the digital use disorder track at Caron Renaissance in Boca Raton, Florida, a young adult dual diagnosis program (meaning they can handle cases with co-occurring psychiatric conditions, such as autism and ADHD). Ask him for more information about this program.
Dr. Sussman has reached thousands all over the country and the world with his many live talks and webinars, which have received much critical acclaim. He has presented to students, parents, teachers, and various organizations throughout the greater DC community and others. For more information on how to arrange to have him do a live or online talk for your community, school, or organization, please visit this page.