Hundreds of thousands of Swedes caught in the web of online casinos. Children who sit glued to screens, risking their future physical and mental health. New technologies have made the path to addiction more of a maze than ever before.
The map of addiction has undeniably been rewritten since the days when schnapps ravaged the Swedish landscape. The unregulated distilleries of the nineteenth century, when annual spirits consumption reached up to 20 litres per person, have today been replaced by a relatively strict alcohol policy that has halved consumption. Unfortunately, the sum of our burdens appears to be constant and, when traditional intoxicants lose their allure, new stimulants lurk in wait to take their place.
"This trend is most apparent among young people; for example, alcohol consumption among ninth graders has decreased by two thirds. Many state that they never drink because it impairs their computer gaming skills. Others are worried about social media exposure if they get drunk. As addiction researchers, we also see how schools that invite us to lecture to their pupils increasingly ask specifically for knowledge of screen time and gaming, rather than alcohol and tobacco," says Ingrid Nylander, professor in pharmacology.
Laying the foundations for an addiction
New technologies play a central role in these developments. At present, we Swedes spend almost half of our waking life on digital pursuits. We spend three hours a day on our smartphones. The benefits are clear; it makes it easier for us to keep in touch with friends and family, provides rapid access to information and simplifies many of our everyday tasks. On the other hand, more and more studies are confirming the fears that have long been voiced about our escalating screen use.
"Our brains are affected and changed by our mental state and new research demonstrates how our biological reward system reacts positively when the images we post on social media get many likes. Naturally, we want more; however, like any other drug, we must continually increase the dose to achieve the same kick and, just like that, we lay the foundations for an addiction," explains Fred Nyberg, professor emeritus of biological drug dependence.
A risky habit
A recent report from the Swedish Media Council states that the percentage of children between 9 and 12 years of age using social media for over three hours a day has doubled since 2012. According to the same study, in excess of every other child and young person in the age group 9-18 years see their internet use as a problem that, among other things, leads to them neglecting things they should be doing; for example, homework, physical activity and going to bed on time.
"In a survey of teenagers in Uppsala County, Sweden, one third of respondents stated that they suffered from sleep problems that, to a large extent, are the result of taking their telephones to bed with them. This is a risky habit given that irregular sleep patterns have a negative impact on our metabolism, inhibit the brain's ability to process impressions and, among young people, lead to deteriorating school performance," says Christian Benedict, associate Professor in neuroscience.
Sedentary behaviour also increases the risk of developing obesity and, in the long term, serious lifestyle diseases such as diabetes and high blood pressure. It is estimated that globally 41 million children under the age of five are currently overweight and, in the interests of laying the early groundwork for an active and healthy life, the World health Organization (WHO) recently recommended severely limiting children's screen time. In Sweden, similar guidelines remain notable by their absence, despite the fact that nowadays children and young people are less active than their peers in other Scandinavian countries. This particularly applies to Swedish teenage girls, generally among the most prolific users of social media, who are so sedentary that they are risking both their physical and mental health.
"Mental illness among the young has doubled over the past decade and we are convinced that social media plays a very large role in this. There is constant pressure to fit into the mould, while at the same time one is constantly measured against the entire world. And, given that there will always be someone with better clothes or a cooler car, it is easy to be overcome with a sense of inadequacy," reasons Ida Höckerstrand – creator of Ångestpodden, a podcast dealing with various types of anxiety – at a seminar arranged by U-FOLD, Uppsala University's forum for research on addiction to medical products and illegal drugs.
Positive parenting a protective factor
In a recently published study of 4,000 young people between the ages of 12 and 16, almost 25% of girls and 13% of boys responded that their self-esteem is adversely affected by social media. Over half of girls also responded that they experienced dissatisfaction with their bodies after comparing themselves with others on social media. These figures are in line with studies that suggest young people who spend over two hours a day on social media run an increased risk of suffering from depression.
"We must bear in mind that, despite everything, most people do switch off their gaming console or Instagram account when they need to get their homework done; however, we do have a group that can't manage that and, like many other problems, this is usually due to an unfortunate combination of genetic and social conditions. There is normally already some form of addiction in the immediate family and the wisest thing for us adults to do is to set clear rules for our children. The fact is, positive parenting is a strong protective factor, while a disruptive home environment also generates problems in other contexts," confirms Kent Nilsson, professor in psychiatric research.
Gambling addiction on the increase
Unfortunately, many adults have their plates full mastering their own digital habits. A study from the United States shows that parents who focus on their telephones at the dinner table are more likely to become irritated by their children. In Germany, a seven-year-old boy recently organised a protest march through Hamburg during which children protested against their parents' mobile phone use. Here in Sweden, almost half of the country's swimming baths are looking into banning mobile devices after accidents in which parents have neglected to keep an eye on their children. And we haven't even got to our era's other great challenge: gambling.
"Over 340,000 Swedes currently have some form of gambling problem. Over the past decade, the number with serious problems has in principle doubled. This increase has largely been among women and some 68,000 children now live in a home affected by problem gambling. Since 2018, gambling disorder has been recognised as a clinical addiction in Sweden, something that places a preventive and therapeutic responsibility on municipalities and regional health authorities. Almost three of four municipalities currently offer gambling-specific treatment," said Anne H Berman, associate professor of clinical psychology, summarising the situation at a seminar organised by U-FOLD.
On 1 January 2019, the Swedish gambling market was re-regulated. For many people, the most readily apparent consequence of this has been the aggressive marketing campaigns launched by gambling companies; something that, for the majority of those with a gambling problem, has already had tangible adverse effects. New research shows that the suicide rate among gambling addicts is currently fifteen times higher than in the general population, as well as that rapid online gambling is by far the most common problem among those seeking treatment. Representatives of the Swedish National Association for Gambling Addicts has called for even clearer regulations, among other things concerning duty of care towards customers, with severe consequences for those companies that break the law.
"We appreciate that during the summer the Swedish Gambling Authority revoked SafeEnt Limited's licenses, something that demonstrated to all what will happen in the event of excessive violations. I have previously stated that it is naïve of the Government to believe that the same companies that have run amok for the past decade will comply with the regulations they have signed. I am now really hoping to see a successive weeding out of the less serious companies on the market or, alternatively, that these companies will fall into line and begin following the rules," says Henrik Nygren, a consultant at the Swedish National Association for Gambling Addicts in Stockholm.
Research, policy and society must come together
One important aspect of gambling addiction from a future public health perspective is the significance afforded to the issue in the Swedish Government's alcohol, narcotics, doping and tobacco (ANDT) strategy, which until now has had the stated aim of "a society free from narcotic drugs and doping, with reduced alcohol-related medical and social harm and reduced tobacco use". On the other hand, the basis of health-promoting, preventative work is to protect children and young people from addiction, whether that be their own or other people's, and to close any avoidable health gaps.
"The current ANDT strategy expires in 2020; however, with only a year remaining, we are still lacking a clear line going forward, not least with regard to substanceless addiction. What is clear is that the road to addiction is more complex than ever and the challenges we encounter demand new knowledge and closing the gap between research, policy and society. Here at Uppsala University and U-FOLD, we will continue to gather experts and policy makers for discussions that will hopefully generate lasting effects; both gambling and social media are undoubtedly subjects to which we will need to return for the foreseeable future," states Mathias Hallberg, professor in molecular addiction research.
