Technology and Substance Use Disorder (SUD)

We recently had the pleasure of hosting a webinar by Dr Jose Luis Vasquez about problematic internet use and its intersection with substance use disorder. Subsequently, at the recent ISSUP 2024 Conference in Thessaloniki, Dr Maria Veronica Brasesco presented a talk in a session I moderated, about the impact of social media on exposure to substance use advertising, the impact of influencer culture on substance use and possible progression to disorder.

Upon reflecting on the insightful presentation by Dr Brasesco, I was reminded of the closing plenary discussions at Lisbon Addictions 2024, during which some concern was raised that current strategies in Screening, Brief Intervention and Referral to Treatment (SBIRT) don’t sufficiently take into account the fervent efforts by industry to assure exposure of youth and the population in general to enticing imagery and incentives for engaging in substance use. This might well be reflected in findings from a systematic review by Barata and colleagues which showed the SBIRT delivered in the emergency room fails to translate to behaviour change for at-risk drinking (Barata et al., 2017). Necessarily there are other factors to consider, such as the quality of SBIRT training for practitioners, which remains inconsistent and poorly objectively measured (McAfee et al., 2022).

But, pivoting back to the omnipresence of social media in our reality: Bright and images of holidays on yachts and colourful social hangouts drenched with images of sunsets and bliss and that ever-so-subtle incorporation of alcohol (and/or tobacco) as the driver of this experience (Janiuk & Maleki, 2023). The Alcohol and Drug Foundation in Australia has published some guidance on how one might go about mitigating exposure to alcohol advertising for oneself or one’s child (link). The discussions in Lisbon centred on the idea that our focus on the individual in SBIRT, while warranted and valuable, falls short of considering, also, the wider milieu of factors which might drive motivation for change (Miller & Rollnick, 2012), such as targeted advertising and social media exposure. We focus strongly on what steps the individual needs to take to move them to a position of making decisions regarding their engagement in substances, that will bring them closer to achieving their desired outcome in behaviour change, but we perhaps don’t mitigate enough for the exposures which may in many ways be outside the control of these individuals, while the industry continues to maximise its reach with little regulation (Goodwin, 2022). 

Dr Brasesco’s presentation outlined some of the strategies that have been employed to exploit social media as a platform for reaching vulnerable populations through influencers who often, if not generally, have no investment in the type and value of the product they are being paid to promote. Folding this active effort into the algorithms built into social media creates a firestorm of a platform for forcing content driving engagement in substance use. The question is what is our place as a network of practitioners in the prevention and management of substance use disorders.  A first step is certainly always creating awareness. Perhaps that’s my hope though this piece is sensitizing all of us to keep this in mind and perhaps seek to open some dialogue with our clients regarding their own engagement with social media content that may appear to drive engagement in substance use. Perhaps we might choose to be mindful ourselves, how we contribute to the dissemination of such content by becoming more aware of what we choose to “like” and “share” onwards. 

If we take a step back and consider the webinar talk by Dr Vasquez Martinez, it is worth noting that there is some discourse still around how different entities of internet addiction disorders might be defined (Griffiths, 2021). It is possible to understand problematic internet use as inclusive of excessive engagement in online activities such as gaming, use of social media and e-commerce sites, streaming content on the web, etc (Pettorruso et al., 2020). Dr Vásquez-Martinez explores in his webinar what the current literature says about the engagement of youth in technological platforms, and reflects on how the availability of these as a social interface impacts on the exposure of youth to harmful content, including, but not limited to exposure to alcohol advertising. 

In this webinar, Dr Vásquez-Martinez also introduces us to the overlap of internet gaming disorder and how this impacts globally on mental health amongst youth. Gaming disorder and internet gaming disorder are defined din the ICD11 (World Health Organization, 2022) and DSM 5 (APA, 2022) respectively, and both speak to engagement in internet gaming that results in significant impairment to an individual’s functioning across multiple areas. Several questions arose from the hearty discussion that followed the webinar, one which was of specific interest to me was what then is the implication for those of us working in the field of drug demand reduction. Does this discussion infer that we are tasked as well with making enquiries around the engagement of clients in internet use, and even internet/gaming? Is our role to be more intentional about contextualising our clients within the broader impact of the internet and social media?  If so, when do we do this? Do we do this at every assessment, or at specific  assessments triggered by a suspicion that there may be a link. Indeed, when it comes to treatment planning, how do we manage the intersection where it exists, between problematic internet use and substance use disorder? Do we incorporate these considerations when we conduct SBIRT? If so, are we appropriately equipped to do so at this time? Does the SBIRT package need to evolve? A review of reviews is available for those keen on exploring the literature on the management of internet use disorders (Basenach et al., 2023).    

If you missed the webinar, watch the recording here, and maybe let us know your thoughts.

References

APA. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). In Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder.

Barata, I. A., Shandro, J. R., Montgomery, M., Polansky, R., Sachs, C. J., Duber, H. C., & Weaver, L. M. (2017). Effectiveness of SBIRT for alcohol use disorders in the emergency department: A systematic review. In Western Journal of Emergency Medicine (Vol. 18, Issue 6). https://doi.org/10.5811/westjem.2017.7.34373

Basenach, L., Renneberg, B., Salbach, H., Dreier, M., & Wölfling, K. (2023). Systematic reviews and meta-analyses of treatment interventions for Internet use disorders: Critical analysis of the methodical quality according to the PRISMA guidelines. In Journal of Behavioral Addictions. https://doi.org/10.1556/2006.2022.00087

Goodwin, I. (2022). Programmatic alcohol advertising, social media and public health: Algorithms, automated challenges to regulation, and the failure of public oversight. International Journal of Drug Policy, 109. https://doi.org/10.1016/j.drugpo.2022.103826

Griffiths, M. D. (2021). Internet use disorders: What’s new and what’s not? Journal of Behavioral Addictions, 9(4). https://doi.org/10.1556/2006.2020.00072

Janiuk, K., & Maleki, N. (2023). Exposure to Alcohol-Related Content on Social-Media. Psychiatric Research and Clinical Practice, 5(3). https://doi.org/10.1176/appi.prcp.20230009

McAfee, N. W., Schumacher, J. A., Madson, M. B., Villarosa-Hurlocker, M. C., & Williams, D. C. (2022). The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. In Academic Medicine (Vol. 97, Issue 8). https://doi.org/10.1097/ACM.0000000000004674

Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing, Third Edition: Helping People Change. The Effects of Brief Mindfulness Intervention on Acute Pain Experience: An Examination of Individual Difference.

Pettorruso, M., Valle, S., Cavic, E., Martinotti, G., di Giannantonio, M., & Grant, J. E. (2020). Problematic Internet use (PIU), personality profiles and emotion dysregulation in a cohort of young adults: trajectories from risky behaviors to addiction. Psychiatry Research, 289. https://doi.org/10.1016/j.psychres.2020.113036

World Health Organization. (2022). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO. World Health Organization.