by Adam Alter
The bottom line: a staggering 41 percent of the population has suffered from at least one behavioral addiction over the past twelve months. These aren’t trivial disorders; Griffiths and his colleagues were saying that almost half of the population had experienced the following symptoms:
[The] loss of ability to choose freely whether to stop or continue the behavior (loss of control) and [the] experience of behavior-related adverse consequences. In other words, the person becomes unable to reliably predict when the behavior will occur, how long it will go on, when it will stop, or what other behaviors may become associated with the addictive behavior. As a consequence, other activities are given up or, if continued, are no longer experienced as being as enjoyable as they once were. Further negative consequences of the addictive behavior may include interference with performance of life roles (e.g., job, social activities, or hobbies), impairment of social relationships, criminal activity and legal problems, involvement in dangerous situations, physical injury and impairment, financial loss, or emotional trauma.
Some of these addictions continue to grow with technological innovation and social change. One recent study suggested that up to 40 percent of the population suffers from some form of Internet-based addiction, whether to email, gaming, or porn. Another found that 48 percent of its sample of U.S. university students were “Internet addicts,” and another 40 percent were borderline or potential addicts. When asked to discuss their interactions with the Internet, most of the students gravitated toward negative consequences, explaining that their work, relationship, and family lives were poorer because they spent too much time online.
At this point, you may be wondering whether you or someone you love is technically “addicted to the Internet.” This is a sample of five questions from the twenty-item Internet Addiction Test, a widely used measure of Internet addiction. Take a moment to answer each question using the scale below, from 0 to 5:
If you scored 7 or below, you show no signs of Internet addiction. A score of 8–12 suggests mild Internet addiction—you may spend too long on the web sometimes, but you’re generally in control of your usage. A score of 13–20 indicates moderate Internet addiction, which implies that your relationship with the Internet is causing you “occasional or frequent problems.” A score between 21 and 25 suggests severe Internet addiction, and implies that the Internet is causing “significant problems in your life.” (I’ll return to the question of how to deal with a high score in the third section of this book.)
Beyond Internet addiction, 46 percent of people say they couldn’t bear to live without their smartphones (some would rather suffer physical injury than an injury to their phones), and 80 percent of teens check their phones at least once an hour. In 2008, adults spent an average of eighteen minutes on their phones per day; in 2015, they were spending two hours and forty-eight minutes per day. This shift to mobile devices is dangerous, because a device that travels with you is always a better vehicle for addiction. In one study, 60 percent of respondents reported binge-watching dozens of television episodes in a row despite planning to stop much sooner. Up to 59 percent of people say they’re dependent on social media sites and that their reliance on these sites ultimately makes them unhappy. Of that group, half say they need to check those sites at least once an hour. After an hour, they are anxious, agitated, and incapable of concentrating. Meanwhile, in 2015, there were 280 million smartphone addicts. If they banded together to form the “United States of Nomophobia,” it would be the fourth most populous country in the world, after China, India, and the United States.
In 2000, Microsoft Canada reported that the average human had an attention span of twelve seconds; by 2013 that number had fallen to eight seconds. (According to Microsoft, a goldfish, by comparison, has an average attention span of nine seconds.) “Human attention is dwindling,” the report declared. Seventy-seven percent of eighteen- to twenty-four-year-olds claimed that they reached for their phones before doing anything else when nothing is happening. Eighty-seven percent said they often zoned out, watching TV episodes back-to-back. More worrying, still, Microsoft asked two thousand young adults to focus their attention on a string of numbers and letters that appeared on a computer screen. Those who spent less time on social media were far better at the task.
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Addiction originally meant a different kind of strong connection: in ancient Rome, being addicted meant you had just been sentenced to slavery. If you owed someone money and couldn’t repay the debt, a judge would sentence you to addiction. You’d be forced to work as a slave until you’d repaid your debt. This was the first use of the word addiction, but it evolved to describe any bond that was difficult to break. If you liked to drink wine, you were a wine addict; if you liked to read books, you were a book addict. There was nothing fundamentally wrong with being an addict; many addicts were just people who really liked eating or drinking or playing cards or reading. To be an addict was to be passionate about something, and the word addiction became diluted over the centuries.
In the 1800s, the medical profession breathed new life into the word. In particular, doctors paid special attention in the late 1800s when chemists learned to synthesize cocaine, because it became more and more difficult to wean users off the drug. At first cocaine seemed like a miracle, allowing the elderly to walk for miles and the exhausted to think clearly again. In the end, though, most users became addicted, and many failed to survive.
I’ll return to behavioral addiction shortly, but to understand its rise I’ll need to focus on substance addiction first. The word “addiction” has only implied substance abuse for two centuries, but hominids have been addicted to substances for thousands of years. DNA evidence suggests that Neanderthals carried a gene known as DRD4-7R as long as forty thousand years ago. DRD4-7R is responsible for a constellation of behaviors that set Neanderthals apart from earlier hominids, including risk-taking, novelty-seeking, and sensation-seeking. Where pre-Neanderthal hominids were timid and risk-averse, Neanderthals were constantly exploring and rarely satisfied. A variant of DRD4-7R known as DRD4-4R is still present in about 10 percent of the population, who are far more likely than others to be daredevils and serial addicts.
It’s impossible to pinpoint the first human addict, but records suggest he or she lived more than thirteen thousand years ago. The world was a very different place then. Neanderthals were long extinct, but the Earth was still covered in glaciers, the woolly mammoth would exist for another two thousand years, and humans were just beginning to domesticate sheep, pigs, goats, and cows. Farming and agriculture would only begin several millennia later, but on the Southeast Asian island of Timor, someone stumbled onto the betel nut.
The betel nut is the ancient, unrefined cousin of the modern cigarette. Betel nuts contain an odorless oily liquid known as arecoline, which acts much like nicotine. When you chew a betel nut, your blood vessels dilate, you breathe more easily, your blood pumps faster, and your mood lightens. People often claim to think more clearly after chewing a betel nut, and it’s still a popular drug of choice in parts of South and Southeast Asia.
Betel nuts, however, have a nasty side effect. If you chew them often enough, your teeth will become black and rotten and they may fall out. Despite the obvious cosmetic costs of chewing the nuts, plenty of users continue chewing even as they lose their teeth. When Chinese emperor Zhou Zhengwang visited Vietnam two thousand years ago, he asked his hosts why their teeth were black. They explained that “betel-chewing is for keeping good sanitary conditions in the mouth; therefore, teeth turn black.” This is shaky logic, at best. When parts of you turn pitch black, you need an open mind to conclude that the transformation is healthy.
South Asians weren’t the only ancient addicts. Other civilizations delved into whatever grew locally. For thousands of years, residents of the Arabian Peninsula and the Horn of Africa have been chewing the khat leaf, a stimulant that acts like the drug speed, or methamphetamine. Khat
users become talkative, euphoric, and hyperactive, and their heart rates rise as though they’ve had several cups of strong coffee. Around the same time, Aboriginal Australians stumbled upon the pituri plant, while their contemporaries in North America discovered the tobacco plant. Both plants can be smoked or chewed, and both contain heavy doses of nicotine. Meanwhile, seven thousand years ago, South Americans in the Andes began chewing the leaves of the coca plant at large communal gatherings. A hemisphere away, the Samarians were learning to prepare opium, which pleased them so much that they etched instructions on small clay tablets.
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Substance addiction, as we know it, is relatively new, because it relies on sophisticated chemistry and expensive equipment. In television’s Breaking Bad, chemistry-teacher-turned-meth-cook Walter White is obsessed with the purity of his product. He produces “Blue Sky,” which is 99.1 percent pure, and earns immense global respect (and millions of dollars in drug money). But, in reality, meth addicts will buy anything they can find, so meth dealers cut the raw product with fillers that dilute its purity. Regardless of the emphasis on purity, the process of manufacturing the drug is intricate and technical. The same is true of many other drugs, which are chemically quite different from the raw plants that contain their primary ingredients.
Before drugs were big business, doctors and chemists discovered their effects by trial and error, or by accident. In 1875 the British Medical Association elected seventy-eight-year-old Sir Robert Christison as its forty-fourth president. Christison was tall, severe, and eccentric. He had begun practicing medicine fifty years earlier, just as homicidal Englishmen were learning to poison each other with arsenic, strychnine, and cyanide. Christison wondered how these and other toxins affected the human body. Volunteers were hard to come by, so he spent decades swallowing and regurgitating dangerous poisons himself, documenting their effects in real time just before he lost consciousness.
One of those toxins was a small green leaf, which numbed Christison’s mouth, gave him a burst of long-lasting energy, and left him feeling decades younger than his eighty years. Christison was so invigorated that he decided to set out for a long walk. Nine hours and fifteen miles later he returned home and wrote that he was neither hungry nor thirsty. The next morning, he awoke feeling fit and ready to tackle the new day. Christison had been chewing on the coca leaf, the plant responsible for its famous stimulant cousin, cocaine.
In Vienna, one thousand miles to the southeast, a young neurologist was also experimenting with cocaine. Many people remember Sigmund Freud for his theories of human personality, sexuality, and dreaming, but he was also famous in his day for promoting cocaine. Chemists had first synthesized the drug three decades earlier, and Freud read of Christison’s miraculous fifteen-mile stroll with interest. Freud found that cocaine not only gave him energy, but also calmed his recurring bouts of depression and indigestion. In one of more than nine hundred letters to his fiancée, Martha Bernays, Freud wrote:
If it goes well I will write an essay on [cocaine] and I expect it will win its place in therapeutics by the side of morphium and superior to it . . . I take very small doses of it regularly against depression and against indigestion, and with the most brilliant success.
Freud’s life was filled with highs and lows, but the decade that followed this letter to Martha was particularly turbulent. It began with a high point: the publication of his essay titled “Über Coca” in 1884. In Freud’s words, “Über Coca” was “a song of praise to this magical substance.” Freud played every part in the “Über Coca” drama; he was experimenter, research subject, and animated writer.
A few minutes after taking cocaine, one experiences a sudden exhilaration and feeling of lightness. One feels a certain furriness on the lips and palate, followed by a feeling of warmth in the same areas . . . The psychic effect of [cocaine] . . . consists of exhilaration and lasting euphoria, which does not differ in any way from the normal euphoria of a healthy person.
“Über Coca” also hints at cocaine’s darker side, though Freud seemed more fascinated than concerned:
During this first trial I experienced a short period of toxic effects . . . Breathing became slower and deeper and I felt tired and sleepy; I yawned frequently and felt somewhat dull . . . If one works intensively while under the influence of coca, after from three to five hours there is a decline in the feeling of well-being, and a further dose of coca is necessary in order to ward off fatigue.
Many psychologists have criticized Freud because his most famous theories are impossible to test (are men who dream of caves really preoccupied with the womb?), but he championed careful experimentation with cocaine. As his letters show, Freud discovered that cocaine, like any addictive stimulus, wore off and its effects weakened over time. The only way to recreate the original high was with repeated, escalating doses. He took at least a dozen large doses, and ultimately became addicted. He struggled to think and work without the drug, and became convinced his best ideas flowered under its influence. In 1895, his nose became infected and he endured operations to repair his collapsed nostrils. In one letter to his friend and ear, nose, and throat specialist, Wilhelm Fliess, Freud described in graphic detail the effects of cocaine. Ironically, the only thing that soothed his nose was another dose of cocaine. When the pain was particularly bad, he painted his nostrils with a solution of water and cocaine. A year later, dejected, he concluded that cocaine was more harmful than helpful. In 1896, twelve years after first encountering cocaine, Freud was forced to stop using the drug completely.
How could Freud see cocaine’s upside but not its staggering downside? Early in his infatuation with the drug, he decided it was the answer to morphine addiction. He described the case of a patient who quit morphine cold turkey and went into “sudden withdrawal,” wracked by chills and bouts of depression. But when the man began ingesting cocaine, he recovered completely, functioning normally with the help of a heavy daily dose of cocaine. Freud’s biggest mistake was to believe that this effect was permanent:
After ten days he was able to dispense with the coca treatment altogether. The treatment of morphine addiction with coca does not, therefore, result merely in the exchange of one kind of addiction for another . . . the use of coca is only temporary.
Freud was seduced by cocaine in part because he lived during a time when addiction was presumed to affect people who were weak of mind and body. Genius and addiction were incompatible, and he (like Robert Christison) discovered cocaine at the height of his intellectual powers. Freud so deeply misunderstood the drug that he believed it could replace and eliminate morphine addiction. He wasn’t the only person to hold this belief. Two decades before Freud wrote “Über Coca,” a Confederate Army colonel became addicted to morphine after he was injured during the final battle of the American Civil War. He, too, believed he could overcome his morphine addiction with a cocaine-laced tincture. He was wrong, but his medicine ultimately became one of the most widely consumed substances on Earth.
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The Civil War ended with a brief but bloody battle on the evening of Easter, April 16, 1865. The Union and Confederate armies converged on the Chattahoochee River, near Columbus, Georgia, and fought on horseback near two bridges that spanned the river. One unfortunate Confederate soldier, John Pemberton, encountered a wall of Union cavalrymen when he tried to block a bridge that led into the heart of Columbus. Pemberton brandished a saber, but before he could use it he was shot. As he reared back in agony, a Union soldier inflicted a deep slash across Pemberton’s chest and stomach. He slumped down, near death, but was dragged to safety by a friend.
Pemberton survived, but his saber wound burned for months. Like thousands of other injured soldiers, he treated his pain with morphine. At first, army doctors administered small doses spread many hours apart, but Pemberton began to tolerate the drug. He demanded bigger doses more and more often, and eventually developed a full-blown addiction. The doctors did th
eir best to wean him off the drug, but they were undermined at every step—Pemberton had been a chemist before the war, so his old suppliers stepped in when the army’s contribution dwindled. His friends became concerned, and Pemberton was ultimately forced to acknowledge that morphine was doing his body more harm than good.
Like any good scientist—and like Freud after him—Pemberton experimented. His goal was a non-addictive replacement for morphine to relieve chronic pain. By the 1880s, after several false starts, Pemberton found a winner in Pemberton’s French Wine Coca: a combination of wine, coca leaves, kola nuts, and an aromatic shrub called damiana. There was no Food and Drug Administration in the 1880s, so Pemberton was free to wax lyrical (and ungrammatical) about the tonic’s medical properties, even if he wasn’t quite sure how it worked. He paid for one newspaper ad in 1885, which read:
French Wine Coca is indorsed by over 20,000 of the most learned and scientific medical men in the world . . .
. . . Americans are the most nervous people in the world . . . All who are suffering from any nervous complaints we commend to use the wonderful and delightful remedy, French Wine Coca, infallible in curing all who are afflicted with any nerve trouble, dyspepsia, mental and physical exhaustion, all chronic wasting diseases, gastric irritability, constipation, sick headache, neuralgia, etc. is quickly cured by the Coca Wine . . .