While Often Helpful, Beware of Technology’s Potential for Misuse in Recovery

Behind closed doors in addiction treatment, we frequently use the term “whack-a-mole” to describe our clients’ tendency to replace one addiction with another in treatment. When you take away a person’s habitual coping mechanisms and defenses, it’s natural that they find another way to regulate and self-medicate. Treatment centers make it their business to limit access to unhealthy cross-addictions, but certain behaviors are more difficult to restrict.

One emerging area of concern is technology. Computers, smartphones, and the vast array of new technologies and modalities offer individuals a wide variety of options to self-regulate and meet emotional and interpersonal needs. These emerging technologies can be tremendously useful in many ways but can also run the risk of misuse and abuse.

Assessing a Client’s Use of Technology

It's critical for mental health professionals to do a thorough assessment of a client’s use of technology. The standard questions on addiction are often sufficient to determine if there is a problem. What sort of time commitment is there? Has their use resulted in problems at home, work, or school? Are they “using” more than intended? Do they try to change but struggle to do so? How do they react when they are unable to utilize their preferred technology?

Starting with the basics, it’s important to ask about a person’s television and streaming media habits. It may be widely accepted to binge-watch the latest season of “Ozark” or “Stranger Things”—and it may not be a terrible thing every once in a while. But it is important to get a sense of a person’s viewing habits. Asking how many hours per day they watch, if their viewing habits correlate with stress or anxiety, and whether they’re able to relax and unwind without these forms of entertainment is critical.

Smartphones are so easily accessible and can do so many things these days, including providing endless distraction and connecting us squarely to other people, for better or worse. Understanding which apps a client uses and how they spend their time is critical. There’s a very different profile for someone who spends hours a day playing a game of Candy Crush versus someone who endlessly scrolls on a news app or someone who compulsively checks social media. Consider asking your clients about their use patterns and even think about asking them for data from monitoring apps like Screen Time, which tracks time spent on various apps.

Evaluating Online Gaming in the Virtual World

Gaming is another major area for assessment. It’s crucial to understand what types of games your clients play, what their role is in the game, and how they interact with others and the environment within the context of the game. Games can range from multiplayer to single player, competitive to cooperative, and high-stress and challenge to relaxing and mellow. A person might choose to serve a role as a leader, take on a supportive role, or strike out on their own and be a lone wolf. Within the game itself, a player may choose to follow the “rules” of the game and be a perfectionist, or find ways to exploit or undermine the game. Someone who spends hours trying to perfect a difficult maneuver has a very different profile from the gamer who thinks it is enjoyable to kill all the neutral characters in a game. Asking about a person’s way of interacting in a virtual world is essential to gaining an understanding of the function of their gameplay.

Social media is another area for investigation. For clients who spend a lot of time on social media, their use of the platform can paint a vivid clinical picture. Someone who posts endless pictures of themselves in exciting situations may need something very different from the person who lurks and enviously watches celebrity accounts. Bullying and trolling are further phenomena that drastically inform your client conceptualization—you want to know if you’re working with someone who takes out their anger on others when given the option of anonymity.

Technology Behavior as Markers for Clients

We seldom ask our clients about their technology use in depth aside from perhaps a checkbox on an intake form asking the client about whether they’re struggling with technology. However, these are key markers that need to be explored in order to fully understand clients. Increasingly, people are able to live another virtual life and be distinctly different than they are in a therapist’s office; it is fascinating to know who they choose to be and how they choose to spend their time when the options are unlimited. For clients with addictive personalities, we expect that they will try to use these methods to serve the same function as their primary addiction. Even in those areas where a client’s use is healthy, an examination of their use patterns can be fascinating. A deep dive into a person’s virtual and technological world can inform a clinical picture as deep as any clinical interview and paint a thorough picture of who the client is, what their needs are, what they struggle with, and how they try to cope and compensate.

Ryan Drzewiecki, PsyD, LP, is chief clinical officer for Sierra Tucson.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Addiction Professional, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.