When A 23-year-old engineering student recently walked in through the doors of the newly-opened behavioural addictions clinic at the All India Institute of Medical Sciences (AIIMS) in New Delhi, it was the first time in a long period that he had left his home to go somewhere. Owing to anxiety issues, he would avoid meeting people or venturing out. Instead, he would remain at home and play games online to kill time. But soon, this leisure activity turned into an obsession, with him spending around 18-20 hours everyday on gaming. “The saddest bit is that the parents knew this was happening, but had no clue what the problem was,” says Yatan Pal Singh Balhara, associate professor, department of psychiatry, and consultant-in-charge of the behavioural addictions clinic at AIIMS.
What’s frightening is that this gloomy story is not an isolated incident. There are scores of people around us today who find themselves unable to disconnect from the digital world.
Take into account the fact that India’s current Internet user base of approximately 330 million is expected to reach more than 700 million by 2020, as per reports, and the problem gets doubly serious. Also, there are currently close to 250 million smartphone users in India and counting. “In the past two months, I have seen more than 15 cases,” says Balhara when we meet him at the behavioural addictions clinic at AIIMS, even as a swarm of patients wait outside in the general psychiatry department. Explaining why they decided to start this specialised OPD, he says, “These patients were there earlier as well, but they weren’t aware of the problem, and we weren’t aware of them… Our main focus now is on Internet-related addictions, which could be gaming, excessive use of smartphone, social media, etc.”
Twenty-nine-year-old Isha Sharma believed it was her hectic work schedule and long-distance commutes that kept her from what she loved most: reading. But she soon realised that it was none of these. The thing that was slowly chipping away at her reading time was addiction to her smartphone. “I was too distracted all the time and noticed that my sleep was getting disturbed too. More importantly, it was my reading time that was getting killed,” says Sharma, who works as an editor with a book publishing company in New Delhi.
Sharma has been on a digital detox since February this year. She switched to an old Nokia phone and prefers calling people to stay in touch. The only other medium of communication she uses is email or the traditional SMS. Whenever she is out with family, Sharma leaves even this basic phone at home. She is not present on any social media platform either. “With this basic phone, I feel liberated,” she says.
The National Institute of Mental Health and Neurosciences (NIMHANS) started its SHUT (Service for Healthy Use of Technology) Clinic two years ago in Bengaluru, with the aim to build awareness about addiction to technology. “In the past two years, the clinic (open on Saturdays from
2 pm-4.30 pm) has handled around 300 cases, with a frequency of around two-three cases per week,” says Manoj Kumar Sharma, additional professor, psychology, and coordinator, SHUT Clinic at NIMHANS, Bengaluru.
He recalls a recent case of a young boy from Pune. “He was in class XI and would game for around 10-14 hours a day, skipping classes. He would wake up at odd hours to play with international players from around the globe. When the family tried to interfere, he started getting violent,” he says, adding that most cases at the clinic involve people in the age group of 16-21 years.
Interestingly, he says, most cases they get at SHUT Clinic are from single-child families, where parents don’t have time to spend with their child. “That is when the child resorts to gadgets to escape loneliness, boredom and stress,” he says.
Just like drugs
Tech addiction, medical experts say, isn’t too different from other kinds of addiction. The difference just lies in the ‘agent’. While addiction to alcohol, tobacco or drugs involves a ‘substance’ that a user’s body gets addicted to, in behavourial addiction, no such ‘agent’ enters the body. It’s just the mind’s craving to turn to the smartphone or Internet for gaming, social networking, etc.
Depression and substance abuse are common in tech addicts, say experts. Balhara says most cases they get are in the age group of 16-24 years. This is that age group for which exposure to technology has come at a time when devices are blazing fast and the Internet relatively cheaper to access.
The most challenging aspect of tech addiction is the method of treatment. After all, one can’t really do away with Internet because it offers a lot of good and is here to stay. At SHUT Clinic, says Sharma of NIMHANS, most patients are advised not to use their phones or social media an hour before sleeping.
Similarly, at the AIIMS clinic, says Balhara, their approach is ‘healthy use’ rather than ‘no use’. “You need the Internet… So it has to be a life with Internet, minus the problem, which can be substituted with alternate healthy behaviour,” Balhara says.
Once a patient is enrolled, the doctor does a detailed evaluation, which lasts for around three-four hours. The detailed history of the addiction, as well as other comorbidities, is noted down. Once the detailed history is recorded, it’s followed by a thorough examination. Questionnaires are used too, which give doctors an idea of the severity of the problem. Using diagnostic systems like ICD (International Classification of Diseases) and DSM (Diagnostic and Statistical Manual of Mental Disorders), the doctors reach a diagnosis, which is discussed amongst consultants, who then reach a final diagnosis. The therapy involves psychological intervention, including counselling, cognitive behaviour therapy, activity scheduling, stress management and time management. Patients are called for weekly follow-ups and the therapy usually lasts anywhere between seven and 10 weeks.
Since its inception in October, the behavioural addictions clinic at AIIMS, which is open on Saturdays, has so far handled around 17 cases. One of these patients was a 27-year-old professional game developer. As part of his job, the developer had to spend time playing games. Soon, he was gaming even when he wasn’t working. His family believed he was bringing assignments home. “Such cases become really tricky. You can’t ask him to change his profession because he is trained and qualified to be a developer,” says Balhara.
Such cases also beg the question: just how much is too much? “How much is okay depends on who you are and what you do. If you use the Internet for emails, watching videos or playing games, it’s perfectly fine, but you should know when to switch off and be able to do that. The problem starts when you either don’t know when to turn it off or are unable to,” Balhara says.
For those looking to keep a tab on their use of technology, Sharma of NIMHANS suggests the ‘5C’ approach, which means asking yourself certain questions: do you ‘crave’ to access gadgets? Do you lose ‘control’ over yourself when using these? Do you feel ‘compelled’ to use technology? Are you using technology to ‘cope’ with distress? And finally, think about the ‘consequences’—are you experiencing any problems due to all this? “If you answer yes to four out of these five questions, there’s a problem,” explains Sharma.
To tackle this, he suggests following the ‘3A’ approach: ‘acknowledge’ the problem, ‘ask’ for help and find an ‘alternative’ pleasurable activity.
Not everyone has the willpower to stay away from technology for long, especially when many of us use phones and apps to organise our lives. But there’s help at hand in the form of analog tools like the simple bullet journal, which just requires a pen and a notebook to organise your life. The concept was launched by New York-based digital product designer Ryder Carroll almost three years ago.
Bullet journals can double up as calendars, to-do lists, planners and organisers. In short, it’s the latest fad for people who are tired of looking at screens to organise things big and small. A recent Wall Street Journal report said that Carroll’s how-to videos on YouTube have been watched by almost four million people. “I use it almost everyday. I was finding it hard to remember things to do… So I started writing it all down in a bullet journal. People rarely make journals these days because of technology. The bullet journal is really productive for people who want to stay off apps and smartphones,” says 25-year-old Gourav Talwar, a New Delhi-based businessman.
As American author and blogger Gretchen Rubin put it: “Technology is a good servant but a bad master.”