A few weeks ago, a teenage boy and his mother presented to my office for an addiction evaluation. While the intake paperwork noted current nicotine and cannabis use, the substance of abuse listed by the pair on the intake paperwork said “other.” During the appointment, his mother told me, “I’m not worried about the cigarettes and pot. I’m worried about gaming. He doesn’t want to go to school. He doesn’t want to see friends. He doesn’t leave his room on the weekends. The video games are taking over his life.”
Unfortunately, these kinds of complaints from patients are becoming more and more common as the landscape of addiction evolves beyond substances. While opioids, alcohol, and stimulants continue to devastate communities, a quieter wave of screen addictions is emerging. From compulsive gaming to online gambling to the relentless pull of social media, these patterns of engagement are reshaping how we think about addiction treatment and prevention.
What’s new and different about these addictions? They start subtly. Legally integrated into our day-to-day environment, these algorithmic wolves hide behind the comforting interface of everyday life. They are the newest predators of the human brain’s ancient dopamine reward system, cloaked in convenience and entertainment. And like most predators, they prey on the youngest in our society.
Many folks are surprised to find out that behavioral addictions engage the exact same neural reward pathways as drugs. “Likes” on social media, “wins” in video games, or “views” on streaming services trigger micro dopamine surges in the brain that powerfully reinforce repetitive screen-seeking behaviors. Stanford psychiatrist and author of Dopamine Nation, Dr. Anna Lembke, explains that repeated exposure to these digital dopamine spikes eventually causes the brain to reduce overall dopamine output, leading to a chronic dopamine deficit state where we’re less able to experience pleasure.
The repetitive, screen-seeking behaviors often escalate into symptoms we see in traditional substance use disorders: loss of control, neglect of responsibilities, disengagement, emotional dysregulation, and even withdrawal. Just as drug formulations like fentanyl are engineered to maximize potency, platforms like Roblox, YouTube, Instagram, and TikTok are designed to maximize user engagement at all costs. The result is a population increasingly tethered to constant digital feedback loops, with adolescents and young adults particularly at risk because of their still-developing brains.
In 2013, the DSM-5 took a landmark step by recognizing gambling disorder as the first formal, codified behavioral addiction. Internet gaming disorder was included as a “condition warranting further study.” As evidence mounts, the forthcoming DSM-6 will likely broaden the category of behavioral addictions to include problematic social media use, compulsive shopping, and perhaps even excessive engagement with emerging technologies like virtual or augmented reality.
These inclusions will reflect not only evolving clinical realities but also mounting public health concerns — especially as digital behaviors become increasingly inextricable from daily life. Formally defining these conditions will be essential for research, insurance coverage, destigmatizing treatment, and providing much-needed practical guidance to clinicians, parents, and teachers.
Unlike substance use disorders, behavioral addictions rarely respond to medication. This presents both a challenge and an opportunity. Parents, educators, and clinicians like me will increasingly need to rely on nonpharmacologic strategies — especially early behavioral interventions, digital hygiene routines, and psychoeducation. We’ll need skills over pills.
Skills like CBT and mindfulness-based approaches have shown promise in helping individuals regain control and reestablish healthy reward systems. Family-based interventions, school programs that teach emotional regulation, and digital literacy curricula will become the next medication-assisted treatment (MAT). These will be critical tools in the fight against digital addiction.
With more and more of my daily addiction intakes circling “other” for screen addiction, I finally added an additional option to circle entitled “digital/screen addiction.” It’s clear we can no longer afford to view addiction solely through the simplistic, black-and-white lens of substances. We now know that the exact same neurobiological vulnerabilities that make some individuals prone to alcohol or opioids may also predispose them to compulsive gaming or endless scrolling. Our prevention frameworks, policy efforts, treatment algorithms, and parenting frameworks must adapt accordingly.
The rise in behavioral addictions represents not just a clinical challenge, but a cultural one. The goal isn’t to demonize technology, but to promote conscious engagement — helping individuals, especially our “digital native” youth, develop healthier, informed relationships with their screen environments. Helping kids understand how to use technology as a tool to enhance, rather than impair, their lives is key. Educating children and parents alike on the early warning signs of digital addiction is crucial.
The DSM-5 era was defined by formal recognition of gambling disorders, as well as refinement and renaming of substance use disorders. The DSM-6 era will likely mark the normalization of digital addictions as legitimate, treatable conditions. As we move toward this horizon, it will be the combined efforts of parents, educators, and clinicians — not merely medications — that will make all the difference.
If you are a parent seeking additional guidance and resources on implementing realistic, evidence-based digital guidelines in your household, consult this website. It’s one of my favorites!
How do you discuss behavioral addictions with patients? Share in the comments!
Dr. Lauren Grawert is an addiction psychiatrist in Arlington, VA. She enjoys walking, traveling, and spending time with her two young children. Dr. Grawert is a 2025–2026 Doximity Op-Med Fellow.
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