By Elaine Park
Featured in a recent National Public Radio (NPR) article about smartphone usage and addiction, Stanford psychiatrist Anna Lembke M.D. sat down with The Daily to discuss her clinical work and how it relates to the increasing prevalence of technology addiction.
The Stanford Daily (TSD): Could you describe the type of work you do at Stanford?
Anna Lembke (AL): I went to Stanford Medical School and stayed to do my residency in psychiatry. Out of necessity, I became an expert in addiction, because I was seeing so many patients with a variety of addictions in my clinic. Now I’m the medical director of addiction medicine at Stanford. I run a dual diagnosis clinic. Dual diagnosis stands for having two or more addictions, meaning patients who have a psychiatric condition like depression, anxiety or schizophrenia and a co-occurring addiction problem, whether it’s to drugs and alcohol or to process addiction, like gambling, internet or sex. Most of my time is taken up teaching, treating patients with addiction and scholarly work on the side, including collaboration with colleagues, research and writing.
TSD: How did you get in touch with NPR?
AL: I get lots of calls from journalists, especially in the last year since the opioid epidemic exploded in the media and since my book, “Drug Dealer M.D.: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop,” came out. Now I’m on a lot of journalists’ shortlists whenever a topic in addiction comes up.
TSD: What’s your main method of treatment that you prescribe at the clinic?
AL: The main method is to first recommend four weeks of abstention from the addictive drug or behavior. Why four weeks? Four weeks is the minimum time people need to reset their brain pathways in order to be able to re-engage in recovery work and reassess their goals. After four weeks of abstinence, some patients decide they want to continue abstinence and other patients decide they’d like to return to using that substance in moderation. People are variably successful at abstaining and some people with severe addiction are unable to do that on their own, living in their usual environment. Sometimes they have to go to the hospital, a residential treatment setting or sober living environment in order to help them abstain. Also, some forms of withdrawal, especially with drugs and alcohol, are life-threatening so you need medical monitoring for that.
Then, if the goal is continued abstention, there’s a combination of different therapies–group and individual psychotherapy–as well as medications that can help people. Finally, in the recovery phase, we try to help people rebuild their lives and create new habits without using. It’s a three-pronged approach. It’s first abstaining to reset the physiology. Then it’s setting goals and using medication and psychotherapy to maintain those goals, whether it’s moderate re-engagement with or continued abstention from the substance or behavior. Finally, the long-term approach to recovery is creating a life worth living. It’s not a simple solution. it’s a chronic care model. We view addiction as a chronic relapse and remitting problem. It’s not something that gets fixed by medicine. Many people need continued intervention and monitoring.
TSD: Between behavior and substance addiction, is one harder to treat?
AL: The natural history or evolution associated with both are very similar. Often times, people start off using to have fun or to solve a problem like insomnia, attention or anxiety. Over time, the drug stops working as well as it used to. They escalate their use until they build up tolerance and dependence and experience withdrawal. This narrative is about the same so the treatments can be equally challenging and effective. The big difference is that with drug and alcohol addiction, initial withdrawal can be more difficult, because of the way they change the brain. With behavioral addiction, there is a physiological withdrawal but it’s much more subtle. Often, people think addiction is hopeless, but really, there’s about a 50% percent response rate for all types of treatment, which is on par with the response rates toward other chronic relapse and remitting illnesses like Type II diabetes or depression.
TSD: Have you done research on the usage of smartphones?
AL: I would say it’s naturalistic research by observing the types of problems that my patients have. Problems that are related to behavioral addictions like pornography and gambling are mostly consumed through the Internet. There’s also addiction to the Internet itself, including social media. Very often, the ways people access the Internet is through their smartphone. Also, the smartphone has exacerbated the problems of drug and alcohol addiction, causing heightened access and social contagion. Now you can order drugs like you’re ordering a pizza. Social contagion is a phenomenon in which people go online and learn about other drugs by reading on the Internet or watching Youtube videos of others consuming drugs in certain ways.
TSD: In the article, you mentioned smartphone usage disrupts the creativity flow. Could you elaborate?
AL: This is hypothetical on my part, but I do believe when we’re constantly having our train of thought interrupted by checking a message or checking a text, we deprive ourselves of having a sustained flow of thought, which is crucial to creating something. Yet by constantly checking and responding on the smartphone, we have the sensation of doing or making something. But it’s an illusion, because at the end of the day, we haven’t created anything. We’ve only been in response mode.
TSD: As a busy clinical doctor yourself, how do you manage your smartphone usage?
AL: I don’t own a smartphone. Smartphones are about ten years old, right? At the time, our eldest was six and we had four kids the age of six and under. My husband and I decided that we didn’t want smartphones because it would distract us from our primary task, which was paying attention to these little people. We had already observed the way it affected people. When they use smartphones, they cease to exist in that place and moment. We wanted to be as present as possible in our family life and be good parents.
We both have excellent fast IT-supported systems at work, so we tried to create boundaries between work and home life. At home we lived off the grid–no TV, computer, Internet, phones–until our oldest daughter started high school. When we came home from work, it was an oasis, and it was very nice.
My husband has much more self-discipline that I do. I’m much more compulsive. If I had a smartphone, it’d be hard not to check it. It’s easier for me not to have it than to resist the temptation. Every once in a while, it’s a handicap, especially when I travel for work. It’s increasingly difficult in some circumstances and eccentric.
But it’s a decision I’m still happy about. I personally feel the benefits of not having one outweigh the inconveniences. Now I am worried that we won’t have the close communication with our kids when they go off to college, whereas other parents may have that. Again there are pros and cons. I’d love to be in close communication with them, but if they can’t turn to me, it’ll force them to figure out for themselves. Maybe that’s a good thing.