In my Clinical Mental Health Counseling Masters program, I am diving deep into my own addictive behaviors as part of my Addictions Counseling coursework. My professor, a therapist and substance user in recovery, has asked us to journal our experience of letting go of an addiction.
Culturally in the U.S., when we say addiction, it is common to first think of a drug: alcohol, cocaine, heroin. This is in part due to the social influence of the DSM-5. Written by the American Psychiatric Association, it focuses on substance use disorders as the main expressions of addiction. The small section on behavioral addictions only includes gambling addiction, and lists a few more that are undergoing further study:
- Internet Gaming Disorder
- Caffeine Use Disorder
- Sexual Addiction (Hypersexual Disorder)
- Compulsive Shopping (Oniomania)
- Work Addiction (Workaholism)
- Skin Picking Disorder (Excoriation Disorder)
As the DSM-5 was published in 2013 and hasn't been updated since, it's clear we are missing well, a lot. And even still, I notice a few on this list I have struggled with throughout my life. This is to say, humans have a tendency for addiction.
Let's travel to 2013. The internet has already been well established. We moved from dial-up to wifi, which is now available in most households in the U.S. and creeping into public establishments. In 2010, I traded in my brick-resembling, sliding, T9 word phone for my first smartphone. My first handheld screen. I was into photography and started posting heavily filtered photos on Instagram to zero followers. I used my phone to call and text my friends, and would guess my screen time otherwise was insignificant, simply due to the fact that there was nothing vying for my attention. The internet's addictive features had not yet reached the world's fingertips.
Fast forward to the present day. My smartphone is a TV, library, gaming console, and social space. Now, I can nearly live out my whole life online. Now, it takes every ounce of willpower to keep my social media use under one hour a day and I know many people who average 6-7 hours a day.
It makes sense the DSM-5 published in 2013 doesn't mention social media addiction. What doesn't make sense is that this 10 year old model still dictates what insurance will approve for treatment. Can you imagine a world in which we can get insurance coverage for treatment of social media addiction? Instead, a therapist must give you a diagnosis like "Generalized Anxiety Disorder", arguably the least pathologizing path to coverage we currently have. Therapists have an ethical obligation to tell you they are diagnosing you, that it will be on your medical record, and can impact your experiences with future medical professionals. And yet, many don't.
While the DSM still dictates how our insurance operates, more mental health counselors are moving away from this narrow medical lens. I am grateful to attend school in 2024, where we openly criticize the DSM and it's application. It was written by psychiatrists after all, and my clients won't be coming to me to get a psychiatrist's point of view.
In sharing my journey, I hope to offer a non-pathologizing view of addiction—one that sees it not as a shameful condition or a simple matter of choice, but as a natural response based on biological, psychological and social factors. I intend to offer a lot of care and understanding to myself and the nature of addiction as I explore my motivations and influences behind my addiction.
You can read my first journal here.