 All right, now it's my pleasure to introduce Dr. Paul Marcil. Dr. Marcil is a licensed psychologist with over 35 years experience working with adolescents in inpatient, outpatient, and academic settings. He's a former full professor and program director at Palo Alto University and the Pacific Graduate School of Psychology. He's the former Vice President and Dean of Students at the American University of Paris and the former director of psychology at Potomac Hospital in Woodbridge, Virginia. Dr. Marcil earned his BA in psychology from Ohio University and his PhD in clinical psychology with an emphasis in behavioral medicine from the Chicago Medical School. Dr. Marcil is the past president of the Santa Clara County Psychological Association and the California Psychological Association. He is now working full-time in private practice which is evolving into a new center for integrated psychological and educational services for young people in Saratoga. He specializes in working with adolescents and their families, all of whom struggle with issues around technology use. Dr. Marcil has a particular interest in the developing adolescent brain and helping his adolescent clients to develop more effective critical thinking and executive functioning skills in order to achieve their academic and personal goals. Please join me in welcoming Dr. Paul Marcil. Paul, good morning. And Cameron, thank you very much for having me. The one thing you neglected and I didn't provide that information in terms of an introduction is that I'm the successful father of two no longer teenage boys. Two boys have made it through, you know, teenage boys. Yeah, we're almost there. My youngest son is doing his last semester at Washington State University, so fingers crossed. And I'd like to thank Karen, Diane Bridgman, the board of the Calciana Symposium for inviting me to speak with you today. I recently retired from academia and teaching, which I loved, and so actually having a captive audience again is quite exciting to me, you know? So, let's get started today. So the goal of today's talk is, let me just set something up here, voila. And the goal of today's talk is to review the latest findings about teens and technology and addiction, and I'll explain what I mean by addiction, because that's gonna change, and I hope it'll change your conceptualization of addiction as I continue today. We'll talk about the use of social media, gaming, sexting, multitasking, the impact of technology on empathy and social skills and young people. Then I'd like to spend a little bit of time talking about how we conceptualize the neurology and the neurobiology of addiction nowadays, and addiction not just for substances, but for all of the behaviors that both teens and we do. We'll talk about the pleasure pathway in the brain, and rather, as I mentioned, a new conception of addiction. And then I'll introduce, because I understand a lot of you are caregivers, some new concept about the treatment of tech addiction. We'll talk about some residential and inpatient programs that are springing up around the country, intense invite patient programs, cognitive behavior therapy for internet addiction, which at the moment is the only evidence-based approach to treating tech addiction, and that'll include some information about motivational interviewing, cognitive behavior therapy, harm reduction, reality therapy, which I practice, behavioral design, which is a relatively new concept, and resources for professional, for you all, some suggestions and resources for things to read and visit. Can any of us remember a time when we didn't have a PC, a laptop, an iPad, an iPod? Anybody remember iPods? A watch. Anyone remember typewriters? Any of you do your work on typewriters? Yes, we have fond memories. And how about whiteout and correction tape and whatnot? All right. Mimeograph machines, anybody remember that? That odor getting high in the copy rooms? All right. So I typed my dissertation on one of the first Macintosh computers, which was a revolution at the time. Now let's just talk a little bit about benefits. Many of us would be unwilling to roll back the clock. I mean, we've seen incredible improvements in progress and communication and entertainment and education and literacy and healthcare and manufacturing, delivery services. I mean, can we live without Amazon delivering things to our front door? Improvements in safety and transportation. I mean, I used to be able to repair my own car. None of us can do that nowadays with all the safety techniques and the electronics. So the question to ask is, what about the pitfalls of technology? How might these things be altering the brains of our children and our brains and our behaviors? Are these things designed to benefit us or are they likely to cause problems or both? And are we, as Gene was saying earlier, do we necessarily need to pay close attention to the way that we're using these things? And I hope at the end of my talk today, you'll be a little bit more thoughtful about your own use of technology, as well as the use that we're giving our children. Any of you remember these things? I mean, rotary dial phones or the phone in the kitchen on the wall. Most of our children wouldn't remember it or that Game Boy, the Game Boy which we could play Tetris. Anybody remember Tetris and stuff? One of the first things that came out. I had one of those little cell phones and stuff when I lived in France and thought I was really hot shit and stuff. I was this thing with the antenna and whatnot. And answering machines, what are those? And how about this? How has the world changed in such a short period of time? So only 12 years ago, Steve Jobs introduced the first iPhone. Only 12 years ago. I mean, just think about the rate of technological change and the impact it's having on our lives and what's gonna come in the next 12 years? How quickly are things gonna come along? Now I'd like to challenge all of you today. If you haven't done so already to silence your phones or actually turn them off and put them in your bag or your pocket. I mean, this is extremely difficult for most of us to do and it can be painful at times. We're gonna talk about the effect of having these things just near us and our inability to resist the little buzzing kind of thing or to imagine. I mean, how many of us when we hear a phone ring around the room reach for our own to see if we've received a message or receiving a phone call? That's a programmed neurological response in most of our brains today. I'm embarrassed because I actually, last night, with the intention of having something to watch the time on my presentation to make sure I have a time, I went and looked for a watch. I haven't worn a watch in 10 years. I was able to find a collection of five of them in a box in my bedroom. None of them had a battery that worked. And I have actually no idea where I would go to get a battery in order to make one of these things function stuff. So I'm using my phone unfortunately to time my presentation today. So if you see me glancing down that's what I'm gonna be doing. So let's talk about the addictive nature of technology. And again, I wanna have you think differently about addiction. It's not, addiction is not just an addiction to chemicals and things. It's an addiction is an attraction to behaviors, to entertainment, to certain types of activities in our life that is actually modifying our brain today. How many of you use a navigation system today to get here? Think about that. The human brain has a facility to develop what we call cognitive maps. Cognitive maps are maps of physical locations. For example, when you get up in the middle of the night and the lights are turned off, you know where your bed and the dresser is and the path to the bathroom. If you lived in the same neighborhood for years you automatically know where to turn right and left in order to go get a coffee or a newspaper. We have maps in our heads for social networks in terms of our relationships with individuals. The scary thing about these devices we're using now is that we're not using that part of our brain. I mean, how many of us will become lost without being able to turn on that screen in our phone and program in an address? And how is that changing the brains of our young people who no longer develop those skills? Now we might assume that it's no big deal to not know how to get across town. You just ask Siri and you give an address. But what might that be doing to that part of the brain which is also responsible for organizing academic information, organizing relationships? I mean, do any of you remember telephone numbers? And memorized telephone numbers anymore? I mean, I don't, I mean, if my life depended on it could not tell you the telephone number, my wife's telephone number, which is embarrassing because I simply tell the phone, call Ann Marie, and it dials it for me. So how is that changing our minds and our brains? Now let's see if this works. How many of you have seen this video? It's a video entitled, It's Not an iPad. And this is a video about a young girl who's a year old who has been allowed like many young children to play with an electronic device and whatnot. And the video is about the impact on the way that she reacts with the world. So let's see if this functions. We need audio, somebody to turn things up. All right, we're gonna work on that. But watch what she does with the magazine, right? Watch what she does with her finger. This is a one-year-old, watch her. She knows how to swipe things on and push the icon and stuff in order to make things. So what is this teaching? What is this teaching of young people, and young people who from the moment that they're alive have access to these types of things? So during our discussion today, I'd like you to think about how these devices may be rewiring our brain, okay? And making us think differently, behave differently. Ah, okay, all right. All right, let's just, we're gonna pause just for a minute because I have a couple of other videos. All right, so hopefully that will work now. No? Well, we'll try. If it doesn't work, next time I'll try it again. The brains of children and adolescents go through tremendous changes. I mean, we're all cognizant of the fact that the body is growing, but the brain changes as well, okay? Children, all of us are born basically with our full complement of neurons in our brain. Our brains consist of anywhere from 80,000 to 100,000 neurons in birth. And unfortunately, they tend to disappear as we get older. So hold on to those neurons for as long as you can and avoid getting hit in the head. It's not a very, very healthy thing to do. During the critical stages of human development, and that is principally during childhood, from birth to very early on, the human brain is going through an explosive growth pattern. This is a simulation of the way our neurons look, both at birth, where again, 100,000 neurons, but none of them or very few of them are connected. And over the critical period of development, when children are being stimulated, talked to by their parents, exposed to all sorts of environmental stimuli, including technology, those neurons are growing and making connections, okay? And networking with one another. Everything that we do, everything that we walk, we talk, we play, we know, our memories and stuff are a result of these neural connections in the brain. So during those first few years of life, the brain's explosively connecting things, and then it slows down. This is why it's possible for children to learn multiple languages almost effortlessly during the early years of child development. In fact, it's actually a crime that we don't expose children to multiple languages during childhood and that we wait until they're in high school or later for them to learn languages, which is almost impossible. I mean, I moved to Paris and France with my family, where I lived for almost 20 years, learned a second language at the age of 28, and compared to getting a PhD, that was a nightmare. It's one of the most difficult things I've done, not because I'm not smart, but because the brain's not designed to do that. Now in adolescence, along with puberty and hormonal changes, comes another explosive period of neuronal growth and connections. That's where children are learning to think for themselves. Their limbic system, which I'm going to talk about a little bit later and stuff, is incredibly active and whatnot, and this is another reason that that period of life is extremely vulnerable to influences, influences for drugs, influences for all sorts of behaviors that are potentially problematic. So just some statistics, and Gene reviewed some of these things earlier. Let me get this, there we go. So some of these you may be familiar with already. Today, 67% of the world's population has a mobile device, and most of these are now smartphones. In the US, 53% of children now own a smartphone by the age of 11, and almost 90% of the teenagers have their own phones by the time they're 18. The American Association of Pediatrics and every child development and parental organization around the country recommends that smartphones be reserved for children 14 years or older. As Gene talked about this morning, she forbids her children for even having a, only a phone which they're not interested in doing. Common sense media, which is a wonderful organization based in San Francisco, provides tremendous useful information about entertainment, technology, and recommendations for families, and I recommend that all of you look at their site. They found in a national survey that tweens, ages eight to 12, spend an average of almost five hours a day on screens. Teens, ages 13 to 18, spend almost eight hours a day, and yet they all spend less than 4% of their screen time doing school-related and academic activities. 96% of their time is spent on videos, games, and social media. Note that kids from higher education, kids with higher income homes spent four hours a day on screens and kids from lower income spend almost six hours. Any idea why that might be? Well, it's because kids from lower incomes don't have other options, huh? I mean, they might have their parents don't have the resources to send them to after school programs or camps, enroll them in sports programs and things like that. Yet, they have the resources to sign up with Verizon or AT&T for a smartphone or a device for their kids. I mean, we used to, those of us who are a certain age, remember talking about the television as an electronic babysitter? Well, that no longer exists anymore as the smartphone. 24% of teens are online constantly. That means 24 hours a day, okay? And we have some high school students with us today who I'm not gonna ask it out you and stuff, whether you ever turn your phone off, but few rarely do and respond. We're gonna talk about a little bit later, a phenomenon called FOMO, fear of missing out stuff, which causes young people and adults to monitor their phone constantly for emails, Facebook posts, texts, Instagram, Facebook updates and whatnot. 50% of teens report feeling addicted to their phones, so they recognize that this is an issue. 32% of young people have posted personal information, their name, their address, their social security number and other personal details. And 90% of boys and girls have viewed pornography by the age of 18, most by the age of 11. In fact, porn sites have become the number one form of sex education for tweens and teens these days and is modifying young people's concepts and attitudes and beliefs about sex, and I would argue rewiring their sexuality. Children are learning about sex, not from their parents or from school. I mean, if they take a course in school, the school program is usually probably boring and unstimulating compared to porn hub and Dr. Tuber. And it's altering their attitudes, as I mentioned before, about love, about objectification of women, sensuality and pleasure. In my clinical practice where I work principally with young men, okay? I have to educate many of them that what they witness on porn sites is not love, okay? It's not sex. It's not what intimate partners do who care about one another. And this is a huge topic. It's actually, could be a course for another discussion or another talk. For those of your clinicians who work with young people, I would urge you to ask every young person you work with how often they watch pornographic sites. What do you think the typical response to that is? Zero, I don't do that. I mean, and I laugh and say, come on, I mean, be real stuff. And ask how often they masturbate to such sites. And again, the response is, well, I don't do that. I mean, that's, you're not supposed to do that. Well, come on. And once I break the ice in that type of conversation, then we can talk about the reality of these things, you know, how masturbation, stimulation regarding such things basically conditions their attitudes about what sex is. And you'd actually be surprised when you asked young people about what a sexual act is supposed to consist of and some of the things that they would tell you. Yeah, I think most of us would be horrified. Half of college students check their phone every 10 minutes. Jean mentioned that this is for those of us who teach in colleges and universities, this is a constant challenge. I lived and worked in France for almost 20 years and you should be aware that the French government has now banned cell phones in schools, in public schools and what not, because of the distractions that it causes. The human brain is not designed for multitasking. I mean, we know that working memory only allows us to focus on a few things at a time. We know how dangerous it is, or we're told how dangerous it is to drive and speak on the phone or even listen to music, let alone texting. And yet one out of five teenagers who drive admit that they use their phone. They keep it next to them in the car or they've got it on the dashboard and stuff. And when a text message comes across or a phone call comes along, they can't resist turning to look at that screen and taking the call. And we all know how dangerous that is. I mean, particularly for those of us who drive back and forth on Highway 17. Divided attention and focus leads to reduce cognitive resources. 75% of students report that they actually text while they're in class. And students who use laptops in class perform worse, as Jean mentioned, on tests than students who don't use them. The mere presence of having these devices next to us raises levels of cortisol and corticosteroid, which are stress hormones. Jean talked about the danger of having these things next to us at night. They disturb sleep, even if they're not on. The mere presence of them and stuff causes us to be alert and whatnot, and we're waiting to receive things or worse using them at night, having that blue light shine into our eyes. And in fact, the production of melatonin. So as she said, keeping them out of the bedroom is absolutely essential. And I'll talk about that more later on. But this is even more critical for young and developing brains and minds. All right, let's see if this is gonna work now. So this is a social psychology experiment. And I'm just gonna let you look at it. It's self-explanatory. Let's see if this works. No volume yet? Okay, let's try one more. This is too good to pass up. Oh, okay, that was probably my problem. There we go. Okay, here we go, thank you. There we go. Oh my God. Follow me on Snapchat, you know, Instagram at KC Blue, K-A-Y-C-I-B-L-U. I never knew it was so tempting. Like, usually it's on demand. You can do it whenever you want, but you just have to look at it. I feel relaxed, just, you know, ignoring everything. Just being like in the present, even though I'm not doing anything. Feels good. Who's he trying to convince? Calls, new Snapchat, text, text, text. So again, I mean, I'm sure any of you young people know what the experience is like trying to resist pick up your phone. We do the same thing as adults. As I talk later on about the phenomenon of the pleasure circuit in the brain and addiction, think back to this video. Think back to the smile on that boy's face as his phone buzzed that there was a text message coming in and the desire, the need to pick it up but to respond to it. And then think about the look of pleasure he had in his face when he opened it up and read that type of thing. This is what addiction does to our brains. Now just a couple on a review, a couple of types of social media that young people are using on a regular basis. YouTube is the most commonly used site for tweens and teens. It's a major source of distraction for all of us. But adolescents who have a very, very limited attention span are drawn in by more funny, fascinating and educational videos. YouTube used to show you one video at a time. Remember that and you had to click on the next one. And it's done as the remarkable service of making that extra effort unnecessary. So what happens with YouTube? You finish watching a video and another one appears on the screen. In the last year I've worked with half a dozen of college students who have had to drop their studies and return home because of their inability to control the use of YouTube. And I'm gonna, throughout my talk I'm gonna try and sprinkle in a couple of clinical examples of kids that I'm working with are problems. One college freshman that I'm working with now stopped attending classes just a few weeks into the fall semester. He got into one of the UCs, prestigious school, a good high school student and whatnot, that became overwhelmed with the work because high school was easy for him and he suddenly finds himself having to study and to read. YouTube's a distraction. And once you start doing it, it's, I mean, I don't want to create false connections to heroin and things like that, but once you start doing it, it's difficult to stop. He ended up stopped attending classes, was watching videos eight to 10 hours a day, stopped going to the cafeteria, stopped showering, changing, going out of his room. Parents couldn't connect him until they finally drove to his campus and found him in a disheveled state and ended up withdrawing him, taking a leave of absence and bringing him home. Social media, our applications that enable all of us to create and share content and participate in social networking. 71% of teams report being regular occasional Facebook users, that's changing. Facebook's kind of de-passé for most young people, but almost 60% of teams now say that they use Instagram, 41% report using Snapchat, and opening the Snapchat at least 30 or 40 times a day to look at posts and to respond to them. There are relatively few differences between how girls and boys are using these applications. They're very similar in terms of frequency. However, we do know that there are some differences between African American and minority teens who still tend to be users of Facebook and Twitter. These are wonderful tools for connecting us with friends and family, but they consume a tremendous amount of young people's time, and they can be sources of online bullying, which I'll talk about in a short period of time, trolling, slut-shaming, and a phenomenon called catfishing, which is creating false profiles and stuff to try to entice people to connect to you and then do some unpleasant things, which I'll talk about shortly. So social media is so interesting and stimulating to young people because during adolescence, during the teen years, the part of the brain that's the most active, that's developing the most quickly is the limbic system. That limbic system which houses our emotions, memory, and other social interests and social attractions and whatnot. I'm gonna explain that the limbic system functions very heavily with dopamine, which is like the cocaine of the brain, and all of these stimulations and stuff stimulate the production of dopamine, which teenagers are very susceptible to and vulnerable to. This is just a little bit, look at the social media landscape. Now these are not just for teens, this is for all of us. I mean, Facebook is still the most widely used application followed by WhatsApp, Messenger, WeChat, Instagram, and TikTok, which is a new and growing popular social media site. 59% of teens have been bullied online. Social media provides a powerful tool for kids to be very cruel to one another. It allows rude comments, harassing images to go viral within minutes. So within minutes of any kind of posts on a social media site, rude comments, positive comments, harassing images can go viral. It's easy for anyone to set up anonymous accounts. Most of these, some of these social media sites require an age limit, but they have no way of verifying the age of young people who are signing up for them. Most importantly for those of us who are parents is that the use of these things, most of us are, I mean, I don't know how Ocaron, most of you are about Snapchat, for example, okay? But most parents don't have a clue what their children are posting, what they're receiving, or what they're doing on these sites. I'm working with a family right now, with a 12-year-old daughter who created a fake profile on Instagram. And she created a fake profile indicating that she was a boy, uploaded a picture of a boy in order to connect with another boy at school who she thought was gay, enticed him to respond to her, making some comments that he was attracted to him. And when that boy did, she outed him publicly on Instagram. He attempted suicide as a result of it, and she, after she was suspended from school, received all sorts of punishments for this, began cutting herself and attempted suicide as well. So these are, I mean, it's hard not to think that these devices can be deadly weapons, okay, in the hands of people who don't know how to use them appropriately. Snapchat, okay? It's a mobile messaging application we use to share photos, videos, and text. You guys, you high school students, do you all have Snapchat accounts? No, some of you do, yes or no? All right, those of you who are honest are admitting that you do. Snapchat, supposedly, okay, the posts disappear, you know, was it 10 seconds after it's been put, or is it supposed to, okay, unless somebody takes a screenshot, okay, of what you posted and stuff, and then forwards it to friends or posts someplace else, huh? Within minutes, you know, of someone posting a Snapchat photo and stuff, it can go viral as well, okay, and be distributed across the internet, okay? Some of you may have heard the expression sexting, okay? Sexting is the posting of sexually content. They may be photos, they may be texts, they may be videos and stuff on a social media site. Sexting is a phenomena that occurred, it's rampant, you know? I've just recently had to do a CPS report or a 15-year-old boy who I've been seeing. His parents discovered, because he left his phone unlocked one day, that he had been sending naked images of himself, in videos of himself masturbating, okay, to other young people, or whom he believed were other young people. I had to do a CPS report because this is actually distribution of child pornography, okay? Anyone under the age of 18, I mean, if you're two consulting adults and you wanna send naked pictures of yourself back and forth, that's not a problem, but a young person below the age of 18 who takes sexually explicit images and transmits those is producing child pornography and anyone who has those images on their phone actually has child pornography, which could lead to even minors being put on the sexual offenders list, okay? Now when I confronted this young man about this, now he reported to me that what's the problem? Everybody does this. And I pointed out to him that then everybody else might be smarter than he is in terms of locking his phone and keeping it away from his parents, but I told him that just because people do things, people jump off cliffs and stuff is not a reason to do it. Now CPS in this case didn't do anything. They told me that there was no harm being done that we know of and he wasn't being abused on, it wasn't the parents who were doing these things, but this is dangerous. And it's dangerous because he actually had no idea that the people he was texting were children his age. Cat fishing is this phenomenon where people troll other individuals by creating fake profiles. And those may be on dating sites and whatnot, but they are also on these social media sites and are used by pedophiles to try to encourage children to connect to them, to share images of themselves and then can use those images and stuff to harass or blackmail children into sending more explicit images of themselves. And this has led to suicide attempts and actually completed suicides by some young people who've fallen victim to this process. So another reason why giving these devices to young people is potentially problematic, but most importantly, not knowing what they're doing on them is even more problematic. You all know this thumbs up signal like, the Facebook like. There are now like buttons on most social media sites. Most of us have emojis on our phones for indicating likes, send hearts back or a thumbs up back to individuals and whatnot. The like function for most of us is addictive. I mean, getting a like on a social media site is like getting a jolt of getting paid money or getting a burst of dopamine in your brain. The fellow at Facebook who created the like function actually has deleted the app from his phone and his children's phone and has reported that he regrets ever creating it because it's made these sites even more enticing and addictive. FOMO, okay? FOMO stands for fear of missing out. The fear that a friend might post something and you miss it and that you don't respond to a message right away. And if you don't, your friend's gonna think you don't like them or that you're just a nerd, okay? It can lead to feeling left out if everybody else is being included or that you weren't actually invited to do something. 72% of teams report that they oftentimes feel that they're being excluded or missing out on things but so do 48% of adults as well. And that's what creates this need to check our phones on a constant basis for messages. It also leads to, as Jean was saying, the lack of sleep, okay? I'll reiterate with her that the best thing that we can do for young people is to ensure that they're getting eight or nine hours of sleep. And without some type of restriction on internet access, getting those phones and other electronic devices out of bedrooms and stuff, we have no way of knowing that they're actually getting those things or not. I dealt with just last week an 18-year-old that I've been working with for quite some time whose parents are concerned that he might have sleep paralysis or some other sleep disorder because he just can't get up in the morning. And we've tried, any of you have that sonic boom alarm clock? It's an alarm clock that actually has a vibrating pad that you put under the sheets and it makes an unbelievable, I mean the next door neighbors will hear it when it goes off and he'll sleep right through it. And prior to prescribing a sleep study for him or medication, I had the parents actually monitor what time he was up at night using the internet. They simply looked at his search history and he was getting three or four hours of sleep at night because of that. Since they've limited the internet access, shut it off as of 11 o'clock and whatnot and he has to give up his electronic devices, he doesn't have sleep paralysis anymore. The developers of tech, the very people who are producing these products, the hardware, the software, the social media sites and whatnot, fear for their own children. I'm sure some of you have heard that Steve Jobs did not let his children use his devices until they were much older. Bill Gates banned mobile phones till his kids were 14 and Mark Zuckerberg, the Facebook developer, has publicly said, not when he's testifying to Congress, but publicly said that he hopes that his children don't become addicted to technology. Some of you may be familiar with a school up in Mountain View called the Waldorf School of the Peninsula. Anybody know about that? It's a very exclusive private school that many of the giants, the tech industry, send their children to. It's near the Google Mountain View campus. The school administrators believe they're the exposing children to technology before the seventh grade, so that's when kids are 12 or 13 years old, can quote, hamper their ability to fully develop strong bodies, healthy habits of discipline and self-control, fluency with creative and artistic expression, and flexible and agile minds. So if the very creators of technology are shielding their children from its effects, what does that say about the rest of us that they're selling this stuff to? Apple, Microsoft, and Google, I mean those of us who work in education, know that the products of these organizations are ubiquitous in our classrooms. They provide school districts with MacBooks, with iPads, with Chromebooks, Google Sheets, Google Docs, learning management systems, and I would ask you all, whose interests are these serving? Has technology in the classroom improved learning outcomes, grades, graduation rates, employable skills among high school and college graduates? Perhaps in some area, if a student wants to become a computer programmer, which is not the majority of our students. But speaking as a university professor with 35 years of higher education experience, I can tell you that trying to teach students who are distracted by their phones, who use laptops in class or tablets, and not just them, but the other students who are witnessing what they're doing and stuff that degrades the attention, focus, and concentration, and I believe it actually hinders the learning for the average individual. Technology has all sorts of potential for helping us with education, but we have to learn how to use it in a constructive way. I used to joke with my students that I thought our classes would be much more constructive if we simply went out onto the quad, sat on the grass, and talked to one another. So Dr. Twenge is, she mentioned it early, founded a national survey of one million high school teens that those who spend more time seeing their friends in person, exercising, playing sports, attending religious services, reading or even doing homework are happier and more emotionally stable. Teens who spend more than five hours a day online were twice as likely as she demonstrated to be unhappy or depressed. Now again, it doesn't mean that an absence of technology is gonna improve mental health. I mean, any child who's been deprived of a smartphone, a gaming console, and the ability to participate like his or her peers in social media feels left out, angry, frustrated, oftentimes depressed as well. But as Gene said, there's a balance to be met. That general idea of two hours a day is probably a good benchmark, and we're far from that. As she said, most teens are spending at least eight hours a day online. Teens who have voluntarily given up their phones. Now as Gene said, all of her work is correlational. And we all know that, but what's that expression? Correlation doesn't need to, this isn't causation and stuff, and she's right. And we really can't do controlled studies. Randomly assign groups of teens to never have a phone, others to have a phone, and then I guess put dummy phones in their pockets as a placebo control. I mean, that's not very practical. The genie's already been let out of the bottle. But we do know that teens who've voluntarily given up their phones and stuff for a week report feeling more alive, having more contact with their families, they're happier. Does anyone remember things like playing capture the flag or kickballed in the neighborhood dealing with the neighborhood kids? We don't see that stuff happening nowadays, because kids are inside playing on their consoles, playing multiplayer games from a distance and whatnot. And again, I don't want to sound like this is the devil. We've let the devil out into the world and stuff, but we need to learn to teach children and ourselves to control our use of these things. So the name of the game is moderation and we'll keep coming back to that. I mentioned before that kids from minority groups and lower socioeconomic categories are particularly vulnerable to the impact of social media. A quarter of teens in that category feel completely useless and empty and feel like they're nothing if they don't have access to their cell phones and most would not be able to do without them for a single day or they believe that they wouldn't be able to do without them. So it's important to note, however, that many of the behaviors exhibited by teenagers on their phones are an expression of normal developmental needs. During childhood and teen years, one of the most important things that happens is the development of social contacts, social networks and social skills, the ability to integrate. I mean, we are a tribe. I mean, human beings don't live in isolation. We live in families, communities, professional groups and whatnot, because we need one another to support one another. None of us are, I mean, I don't know about you, but I'm not capable of living on my own without being able to go to Safeway or get gas from my car or build a fire. I mean, I'd be clueless for doing something like that. Maybe if my phone had an app to focus this on, I'd be able to do it. So needing to reach out and network, make contact and stuff is absolutely something that children and teenagers need to do. What tech has done is provided a means for them to do so. So they're taking advantage of that. They're doing what they're supposed to do. And the question for us is, is this method of connecting and stuff healthy and useful for their development? The importance of peer relations, as I mentioned before, or I should say it's important because it provides feedback about themselves, their abilities, allows them to make mistakes and learn from those mistakes, as Gene was saying before. And the reliance on technology and social media to do those things may be producing some shortcomings and handicaps as they move into their adult years. The statistics Gene showed about teens since the inception of smartphones, driving later, dating later, working later. I mean, the number of 18-year-olds that I see in my practice who do not have their driver's license and see no problem with that at all, who actually think it's great that their parents drive them around. Can any of you, I mean, how would you react to that? I mean, I think most people from our generation were salivating at the idea of getting your driver's license and being independent and whatnot. And to not have that as a developmental milestone is a phenomenal change. Upside is perhaps there's less teen accidents, okay? Gene talked about the decrease in teenage pregnancies, which who can be critical of that. But it's not necessarily because children are voluntarily deciding not to have sex, they're just doing it in their room online and on their phone. Video games. On average, children play video games for two, two and a half hours a day. And 92% of parents allow their children to play at least one hour of games a day. Some 8% of parents actually admit, almost 10%, allowing their children to play unfettered. Five, eight, 10 hours a day. Mobile gaming platforms, and many of you may do that as well. Sounding common for us, we're sitting for a doctor's appointment or whatnot to play a crossword game or something else. Those are becoming even more ubiquitous and present in our lives. Most people play games on a daily basis. We're doing more and more mobile gaming because it's cheaper. These games come on our phones. We don't have to buy a dedicated console or have a PC or an internet connection. The difference between boys and girls is irrelevant. 97%, 99% of boys play games compared to 94% of girls. And most teenagers admit to having played some type of game just yesterday. What makes games so addictive? I mean, have any of you heard the concept gamification? Gamification is actually a science today. It allows for the development of these games, but it's also used in marketing. It's used in business practices to get our attention and get us hooked. It involves providing a tool or a device that's fun and easily learned and mastered. So if you remember ever playing games like Super Mario's Brothers or Tetris, now when you started playing Tetris, the blocks fell nice and slowly. It was easy to make adjustments and stuff and then it got progressively difficult as you achieved each level. Reaching each level provides progressive rewards and points and reinforcement, okay? And the most addictive are games that involve a social nature, okay? Multiplayer games or playing with your friends and whatnot because it's fun. It's fun to interact and chat and talk and whatnot. So if you walk into a teenager's room and they've got a headset and a microphone on and stuff and they're talking, they're typically playing a game. And at the same time talking about other things with their friends, okay? So gamification, again, it's an application of typical game-playing elements, points, competition, rules to play, rewards, prizes, levels and things like that that are typically used for games. But if any of you participate in frequent flyer programs for airlines, okay? That's gamification, okay? You rack up points and stuff because you've traveled with that particular airline. You get awards or rewards and whatnot. And if you're a real high reward, you get to go to special lounges and stuff and get special treatments and stuff, huh? These companies like this, how about credit cards that give you back money? What credit card gives you money? What they're doing is sucking you in to use their products and stuff by making a game out of it and providing rewards. So think about this. As you participate in these types of activities, some of them are fantastic to get points and be able to travel for free. The company's not giving away free travel and stuff. They've sucked you in and stuff with this marketing technique. Gamification is used in almost every major industry today, consumer product industry. And it's not all bad. I mean, I'm gonna suggest a little bit later that we can actually use gamification to teach healthy behaviors as well. Geometry Dash. Just as an example, Geometry Dash is what I find a very mindless game, very similar to Super Mario's Brothers where you push the up arrow to have a little character jump around on the screen. I have a 15-year-old client who I'll call Jerry, who spends five to eight hours a day playing Geometry Dash, watching YouTube videos and Twitch. Anybody know what Twitch is? Twitch is a streaming video platform that allows you to watch other players playing video games, huh? And learning techniques from them as well. And in a sense, becoming just as addicted to the game, more addicted to the game, just playing it yourself. So Jerry keeps track of the number of times he's played Geometry Dash, which now numbers over 10,000 times. He recently broke his keyboard from hitting the arrow to make his little character jump. When he's denied, when he's not allowed to play Geometry Dash because his parents insist he does his homework and whatnot, he gets angry and agitated, okay? If any of you have dealt with the young people who are addicted to their phones or games and parents take them away, and I'll have an example of that shortly, can oftentimes lead to violent reactions, punching holes in the wall, breaking things and whatnot, no different from a drug addict going through withdrawal. So he's come to see me because his grades have plummeted, very, very smart boy and whatnot, but he's not turning in assignments. His grades are dropping precipitously because of the amount of time he spends playing the game and not doing other things. And I'm not gonna say that playing games is bad. We just need to use them in a constructive way, and I'll talk about that shortly. Fortnite. Today's video games are unbelievably immersive, stimulating from a visual point of view, from an auditory point of view. For kids who are socially awkward, the idea of having an avatar, a powerful figure in stuff that has weapons, that's attractive, that's strong and powerful, is almost something difficult to resist. So let's just look just for a few minutes at this, and I'm not advertising Fortnite and stuff, just for any of you who haven't seen it, just take a look at this promotional video. Okay, so who wouldn't wanna play in a world like that? It beats playing kickball on the street and stuff. So these games are unbelievably interactive, very stimulating and whatnot, as I said, and this is primitive compared to what's coming down the pipeline, okay? Virtual reality, okay? The ability to put on a headset and not just manipulate a character, but be that character stuff, huh? The possibility of wearing VR suits, okay? Where we feel things and we're stimulating stuff. This is coming, okay? Right now it's very expensive, and that's why most people don't, most kids don't have these things or parents and stuff, but once it's accessible, okay? Once you can actually be these characters, who's gonna wanna go to school and study calculus or algebra? So do you see the attraction and the possibility? And investors and companies are putting in tons of money. I forget, who was it that bought Oculus Rift? Was it Facebook or Microsoft? I mean, somebody acquired that company for billions of dollars and stuff because they realize what a potential, huge market and stuff, this is gonna be in the future. But just think about what this might do to our children's lives and their brains and stuff, huh? Okay, let me get out of this. All right, now, yeah, you've seen this, okay? So this is from a, there's a series of YouTube videos called the world's greatest freak outs, okay? And this is a video of a young man whose mother canceled his World of Warcraft account. World of Warcraft is an immersive video game. It's a multiplayer role-playing game where you create an avatar, a character, you play in the mystical world of Azeroth, and you play with a guild with friends online, which makes it particularly addictive. I mean, this is like the crack cocaine of video games. His parents have deleted his account. So let's watch this reaction and be thinking about addictions as soon as you watch this. Ah, okay, hold on, hold on, hold on. I anticipated that this might be a problem. Let's see if we can get it here. Video unavailable, all right, well, I'm sorry about that. So you just wanna look at world's greatest freak outs, right, isn't that the site and stuff? Yeah, I think it's just the internet connection here is problematic. So I wanna go here. So what this is, if we were able to see this, we'd see this young man burst into his room after his parents have deleted his World of Warcraft account. And that's a big deal because it eliminates your connection to your friends and whatnot, your history, points, weapons, things that you've accumulated over the months or years of playing and stuff. I mean, he basically goes hysterical, pulling at his hair, ripping off his clothes, banging his head, jumping up and down in his room and screaming and stuff. Now, I've had the pleasure of experiencing this myself. Some of the families I work with have done me the enormous privilege of waiting until they're in my office to tell their son or daughter that they're taking away their phone. Okay, this is not funny, I mean the reaction literally is like pulling a heroin needle out of the hand of an addict who's about ready to inject himself or herself. I mean, I've had children attack their parents, children who've called Child Protective Services to report their parents for doing this, even called the police to report that they're being abused and stuff that their parents have taken away their phone. So, I mean, funny only if you don't have to experience it yourself. Let's talk about social skills and empathy. As I said before, during the childhood and the teen years and stuff, young people are developing the skills they need to connect with their friends, to develop intimate romantic relationships and stuff, to develop social skills that are gonna be necessary in professional situations. I mean, Gene mentioned this, I mean, I've worked for 30 some years with college graduates and watched a slow decline in students' abilities to interact with employers, to interview, ask intelligent questions. I, for years now, with my seniors, right in the beginning of the senior year, I encouraged them all to get out and do informational interviews, talk with potential employers, people who work in industry, to actually learn. I mean, any of you have young people who think that becoming a forensic psychologist involves flying around on an FBI Learjet, tracking down serial killers. Most of my students think that that's real. I mean, if it was, I wouldn't be talking to you today. I'd be doing it myself. It's only by going out and talking to people that you learn what these professions and careers consist of and develop the skill to be able to talk to adults in an intelligent way. Social media and technology, I believe, is creating difficulties and challenges. From over a 40-year period, American college students' scores on two measures of empathy dropped sharply. The steepest decline occurred after 2000, and again, the inception of technology and social media. Most teams report that they share everything online, and there may be some positive aspects of that, feeling free to communicate and talk about things, but the constant barbarmint of information from social media, news sites, blogs, tweets, et cetera, makes, we believe, makes young people less empathetic and more emotionally disconnected from things. Some of the horrible things that we can witness and stuff, online and stuff, not only has a potential to traumatize us, but to desensitize us, to shootings, to wars, to misogyny and whatnot, and again, we need to be aware that as parents, as educators, as mental health practitioners, we should be gatekeepers for that kind of information. Teams who connect only on social media miss out a tremendous amount of visual cues, making eye contact. I mean, how many of us who are therapists are taught the importance of reading body language, being aware of our own body language and how much we communicate? Most of us are aware that we communicate more information non-verbally than we do verbally, and how much information can you communicate in a text, in a text message? If any of you had the unpleasant experience of writing an email and hitting that send button and regretting two minutes afterwards or two seconds afterwards that you sent it and stuff, because the text message or the email lacks the cues, the information or stuff that might soften a particular message and whatnot, and many of us have had personal problems and professional problems as a result of such communications. So let's not forget, yeah, let's not forget and stuff that it's parents and adults who buy these devices, allow their children to play video games, download apps and technology, and it's us that models the behaviors that we use. Watch your own behavior, the way you interact with technology. Now let's talk about internet and tech addiction. This is a potentially serious condition which needs additional study, because we're just beginning to understand it, and impacts, we believe young people's physical, cognitive, social, and emotional development. Internet addiction refers, internet or tech addiction, which I'll use interchangeably, refers to a pattern of excessive tech-related behaviors resulting in negative consequences in multiple areas of life. It's also referred to as internet addiction disorder, tech addiction, compulsive internet use, problematic internet use, and eye disorder or problematic media use. And again, it's not the use that's problematic, it's the lack of other behaviors and the impact on other behaviors, like school, social life, physical exercise that produces problems. Used in moderation, like anything else and stuff, there's nothing inherently wrong with these things. 26% of American adolescents report excessive internet and tech use. We're not aware, we still don't know today whether the success of use is similar to addictions in the same way we use substance abuse, or if it's a behavioral disorder, including pathologically seeking out rewarding stimuli despite negative outcomes. Internet addiction does not exist in the DSM-5. In fact, there are no behavioral addictions that are listed in the DSM-5, though it does include a category called internet gaming disorder, which is open for study at the moment, okay? And we need to be aware that technology moves quickly. Just as you all who are mental health providers and therapists realize that there are all these, in essence, obsolete rules about tele-mental health and doing therapy across state lines, that's simply because state laws and regulations haven't kept up to date with the technology that's available. And when it does, we'll be free, hopefully, to practice our profession wherever our patients are, wherever our clients are. And the challenge with technology, as Gene was saying earlier, is it's ubiquitous. It's all around us. It's ever present in our life, and it's not gonna go away. So treating tech addiction like we would, alcoholism or substance abuse, where you just have to abstain from it and stay away from it, that's not possible. What we need to do is teach teens to use these things in responsible ways. Other problematic uses of online services by teens consists of adult dating sites and sexting, adult dating sites, things like match.com, Tinder, which is a hookup site, in principle are reserved for adults, but anyone can create a profile. They have no way of verifying the age of participants, and it's not unusual for young people to create fake personas on such sites in order to elicit and solicit likes and offers to hook up. And as I mentioned before, there are child predators that live on these sites and looking for vulnerable children and stuff to make a connection, possibly end up meeting with one another, or, as I mentioned before, blackmailing them, into sending more explicit messages and pictures and what, to the titillation of these predators. You should be aware that in California, distribution of any types of images, videos, even texts about minors of a sexual content is against the law, even if it's minor to minors. I mean, we know that those of us who are mandated reporters know that children having sexual interactions with one another when the age difference isn't too much, we all know we have that chart memorized in our head and stuff. It was not a reportable offense, but any sharing of pornographic or sexual images by anyone under the age of 18 is against the law in California. There are several states that have created, have made a distinction between minors doing this and adults, but in California, we haven't done that. And there's always the risk that a 15, 16 year old could end up on the sexual predators list simply for sharing images of himself or herself. I had a clinical example, which I think I already showed, I told you about that young man's sexting images of himself. So some of the criteria for internet addiction are preoccupation with online activities, thinking about it all the time, think about alcoholism and substance abuse as I run through these. They need to be online for increased amounts of time, needing more like tolerance, making unsuccessful efforts to cut back and stop and just not being able to do it, being restless, moody, depressed, or irritable when attempting to reduce online activities, regularly staying online longer than intended, jeopardizing the loss of educational opportunities and relationships because of the internet tech disorder. Literally half of my adolescent clients are suffering academically, have had to withdraw from school, take leave of absences and stuff because of their inability to balance their use of tech with their academic responsibilities. Lies about the extent of the use of technology and using the internet in ways of escaping from other problems. Psychological symptoms include depression, dishonesty, guilt, anxiety, euphoria when using the computer or phone. You saw the images of those kids' faces when they were finally able to pick up their telephone, inability to manage time and prioritize things, being defensive, agitated and angry when people try to suggest that maybe they're using these things too much, mood swings and boredom without technology. Behavioral symptoms are things like social isolation, inability to manage time, avoiding work, schoolwork, chores, poor academic performance, poor social skills and excessive procrastination. And there are even physical symptoms, back aches. I mean, you can imagine that somebody who's hunched over a keyboard for eight hours a day hitting the thing is gonna, the button, the up arrow is gonna have carpal tunnel syndrome, headaches and somnia, poor nutrition. It's not unusual for people to play these multiplayer role games and stay on for five, six, seven, eight hours at a time to keep a bucket by their chair in order to urinate and stuff. Or just not going and getting food to eat or taking showers for days on end. Conflict in families. So in an international survey, almost 7,000 eight to 13 year olds and their parents report that they felt their parents check their devices too often. And, you know, more than a third felt that their parents felt that they were unimportant. They felt unimportant when their parents were distracted by the use of technology. And again, how many of us have seen images of this? I mean, how many parents and families and stuff don't treat the dinner tables as a tech-free zone where you turn off phones, put them away and you actually talk and have interactions with one another. My children were born in France and we moved here when they were 11 and eight. As you may be aware, eating for the French is like a religion and family meals. Getting together for two, three hours and talking about things and stuff is something that every family does. It was a shock when we arrived here to realize that many families don't have meals together. I ask every one of the teenagers I work with how often, how many times a week do they have meals with their family? Do you know what the average number is? Zero, okay? Zero because people are, parents work late. I mean, we oftentimes hear because of the cost of living, you've got both parents who work. They come home late because of traffic, because of work. They come home and check work emails and whatnot. Kids are in their rooms doing their thing. They come to the kitchen, get something back to the room and stuff and just think about how much valuable sharing of information, learning social skills, learning how to communicate, learning how to model behaviors, let alone talk about politics or talk about issues other than what's going on on social media. So this is an extremely thing to recognize. And everybody does it. I just found the shot of the Obamas and stuff with all of them on their phone. So what is addiction? According to the DSM-5, addiction is a brain disease that's manifested by compulsive substance use despite harmful consequences. People with addiction have an intense focus on using a certain substance such as alcohol and drugs to the point that it takes over their life and they keep using these substances despite the negative effect that it has on their life. The DSM-5 lists nine types of substance abuse. Alcohol, caffeine, cannabis, hallucinogens and halins, opioids, sedatives and hypnotics and zeolitic stimulants and tobacco. And you'll notice that anything unrelated to chemicals is missing, things like food, things like sex, things like shopping, things like internet use. What's the most abused substance in the United States? It's not caffeine, it's sugar. I mean, you're cognizant of the amount of sugar that's in everything that we eat, okay? More than half of the American population is overweight and I think I forget what the latest figure was, maybe 15% are morbidly obese. Not because we have a lack of self-control, it's because the people who manufacture these products are basically, and again, I don't mean to sound dramatic and stuff, but they're drug dealers, okay? They're basically feeding us products that give us a substance, sugar, which has no nutritional value at all, but which stimulates the pleasure, system of the brain and stuff and makes us crave it and want more. Addiction's not, I'd like you to think today of addiction not as a disease, but rather as a behavior that's a natural part of how the brain functions and I'm gonna talk about that right now. And that behaviors become addictions or problematic when we lose control of them. Some 20 million Americans have a substance use disorder making it more common than cancer, more than a billion people smoke which is implicated in the top five causes of death. What we find exciting, frightening, pleasurable, annoying, et cetera are all products of biochemical activity in our brain. So as I mentioned before, our ability to think, to walk, to talk, everything we do is a product of neuronal activity, connections between neurons in the brain, a result of neurotransmitters, hormones, the genes and the proteins on the genes, et cetera. And as I tell my students, we really don't know what goes on up there. I mean, what we know about the brain can be composed like that. What we don't know is like this. It's still the unknown frontier in a sense. And yet we're introducing number one, chemicals into our bodies and our brains, unaware of what the effects might be. I mean, those of us who deal with patients who we prescribe psychotropic medications know that they don't work on everybody. Now, and in many people they produce uncomfortable and unpleasant side effects because we don't know in any individual case how somebody or patient is gonna respond to those things. All of these behaviors we're talking about have an impact on the brain as well. We do know that there are hundreds of areas of the brains that are responsible for particular things. The parietal lobes for touch, the occipital lobe for vision, hippocampus for memory, frontal lobe for muscle movement, and temporal lobe for healing, hearing. But what we're now learning is that there's a particular area in the brain called the reward pathway that is the site of pleasure, what we enjoy, and also the site of addiction. The reward pathway is where our most basic survival instincts occur, such as eating and mating. If these things, if we didn't have a drive and a need and a desire, our species would have gone extinct a long time ago. But virtually all pleasurable activities, and that can be sex, drugs, alcohol, food, gambling, shopping, the internet, games, chocolate. I'll share with you one of my unhealthy addictions and stuff in a little bit. And so if they all affect us through the pleasure pathway. I captured this image from, I believe it was last year or the year before. National Geographic came out with a fantastic issue and stuff, talking about addiction with a great explanation that's accessible to anybody about the effects that substances and behaviors have in the pleasure pathway of the brain. So this is the reward system in the brain. It's located in the limbic system and involves a complicated pathway of neurons called the ventral tegmental area, or the VTA. The VTA produces dopamine. And anything that we experience that's exciting, potentially pleasurable will stimulate the ventral tegmental area, producing dopamine. And in teenagers, it focuses, well, for all of us, it focuses our attention and behaviors and motivates us to do the very behavior that will bring fun and pleasure in the brain. In adolescents, adolescents are particularly susceptible to dopamine because during that period of life, the limbic system is growing and developing. Those neurons I mentioned before are expanding, making connections. This is why teenagers are so moody and emotional and get so agitated when things are taken away or so excited about things. The VTA then releases dopamine into an area called the nucleus accumbens, or the NA, where we feel reward and pleasure. Now the nucleus accumbens produces and releases what we call endogenous opioid peptides. These have the same effect on the brain as morphine and heroin and generates the feelings of pleasure and bliss. So if you think about the act of sex, if you think about foreplay, anticipating being with someone that you like, that's the stimulus and the trigger that produces dopamine. It gets our focus, it arouses us, makes us excited. When the act is consumed, when someone has an orgasm, that's the bliss and the feeling of pleasure and release and relaxation comes from those endogenous opioids being released in the brain. So it's a purely biochemical process. That being attracted to these things has nothing to do with voluntary control or willpower. It's dopamine that controls us and not vice versa. And once we understand this, we can then possibly develop treatments that will hopefully interrupt this process. Another area in the midbrain, the dorsal raffae nucleus, contains neurons that produce serotonin. Once the pleasure circuit is stimulated, it releases serotonin that floats throughout the brain and gives us a sense of satisfaction, pleasure, and reward. It also teaches us where to go to get a reward, where to go to get a fix, where to go to do pleasurable things. It's the feel good drug, so to say, serotonin. So dopamine and serotonin, two different brain areas in the VTA and the dorsal raffae nuclei and endogenous opioid peptides influence each other. This is our brain working to determine what we find pleasurable in stimulating. Sugar acts on the same part of the brain. So in any exposure to stimuli and cues that indicate the pleasurable activity is gonna come, will trigger the VTA to produce dopamine, even outside our conscious awareness. This is why we caution alcoholics to don't go into bars, to avoid friends who are associated with drinking because those are all stimuli and cues which trigger that release of dopamine, focus our attention, make them sweat and they think about having that drink or picking up and smoking that cigarette. It's also why programs like Alcoholics Anonymous are successful. It keeps people away from those cues, but also replaces, and this is something that, in part, remember, it replaces the use of alcohol with fellowship, with contact with people who are dealing with the same things and stuff and makes you feel another type of pleasure. So the addictive brain becomes tolerant to the opioid peptides or cocaine or heroin or sex or shopping and it causes us to need more and more to get the same effect. This is why these behaviors ramp up, is that we need more and more to get the same sense that release of dopamine, the endogenous opioids and whatnot to feel good. It also has the opposite effect of reducing the pleasure that we experience doing other activities. So if you become addicted to a particular behavior activity, you become less interested in other things which could or should produce pleasure. Being with your friends, playing kickball in the street and stuff. I don't know, I joined the sunset, or I was gonna say a cup of coffee, but that is addictive qualities as well. So I said I would share a little, an embarrassing thing about my addiction. So some of you may be familiar with this. Hagen-Dazs Cherry Vanilla Ice Cream. It's like heroin for me. The sight of those containers, I mean I keep telling myself don't walk down the freezer section in the grocery store because it just calls my name, just draws me like a magnet. And the worst thing is when I've got one of those in the freezer and I hide mine. I hide mine in the freezer in the garage so my wife won't find them behind things. Another sign of addiction. And then when I actually consume one of these things which I will do in the middle of the night when nobody else is around and eat the whole damn thing, then I'll hide the empty container in the garbage so my wife won't feel it or find it and stuff and guilt me out. But yet I feel guilty because I've just done something that's not healthy and good for me. Puts on weight, causes me to have to buy new clothes and whatnot and do you see? It's the same process. So what I'd like you to do is think about technology as maybe not Hagen-Dazs Cherry Vanilla Ice Cream and stuff but as being problematic. So what's the solution to addictive behaviors? Particularly those that are affecting teens today and how do we treat these? Absidence is recommended by AA and NA and for most addictions but is that a possibility with technology and the internet? I mean the cat's out of the bag. I mean we all recognize the positive things that these devices, these services produce in our life and what we need to do is learn to use them in moderation. So approaches to treating tech addiction include inpatient programs which are rare, few and far between mostly because such addiction is not recognized as a disorder in the DSM and what does that mean? That means we can't get reimbursed for providing services for those things unfortunately. I mean it's the insurance industry that often times drives what services that we're able to provide. There are intensive outpatient programs that focus on this, most not specifically devoted to it. There is an evidence-based cognitive behavior for internet addiction approach which I'm gonna explain and then there's a new concept that I wanna share with you today called behavioral design. How are we on time, Karen, are we good? Okay, good, thank you. So residential and inpatient programs. There's a program up in Falls Church, Washington that came integration around 2006, I believe. They're the first program in the country to treat internet or tech addiction. They use an evidence-based approach and work with teams who've developed unhealthy behaviors and tries to teach healthy behaviors and replace them. Now what's unique about Restart is that they call themselves a center for digital technology sustainability. They don't use the word addiction and I'm using it today because it's just something that we all understand but when I'm using it, please don't assume I'm talking about a disease. I'm talking about a behavior. Restart's a retreat rather than a treatment center. Its goal is to teach, as I said, healthy and sustainable use of technology. Teenagers learn problem solving and critical thinking skills around the use of their technology. They use a 12-week to 18-month, believe it or not, seven-step approach to treating tech and internet addiction and as you can imagine, an 18-week program is not accessible to the majority of the population so you can imagine the kids or parents that can afford to go to such programs. They spend three weeks doing detox, being in a home where there's no technology at all which for most teenagers is extremely painful for a week or so. But they replace the use of the technology with outdoor activities, with social activities that don't involve the use of technology. They work on family issues to identify family dynamics that may be contributing to the use of technology, such as parents being disengaged and not spending social time with their teenagers. They gradually move, kids gradually move to a tech-limited halfway house in Falls Church where they're taught the skills, they're given chores, many of them are encouraged to get jobs. I mean, one of the sad things and one of those slides that Gene showed us was the lack of young people getting jobs when they're 16 and able to work. One of the recommendations that those of us who work with young people is that make your kids work, make them earn money and stuff, whether it's doing chores around the house or going out and getting a job where they can't be on their phone all the time, where they need to learn to interact with customers and fellow employees and they're making money and learning the value of work. And the restart program also involves helping to prevent relapse just as a substance of use programs. Is problem solving, anticipating being around technology, anticipating getting sucked in. Now, restart is very successful but they'll gladly share that they've had setbacks. I mean, kids who leave too early go back home and end up plunging right back into an addiction with the worlds of Warcraft or YouTube or other things. And it's not unusual for the young people who are there and finish the program to stay there because they've become part of a healthy community and whatnot and are afraid of going back to their home environment where they might fall back into these things. Now, there are several, but a very small number of intensive inpatient programs. One of them is located in Pennsylvania. It's the Bradford Regional Medical Center which has a digital device treatment program. It was founded and run by Dr. Kimberly Young who actually created the term internet addiction stuff back in the 1990s and stuff when she noticed that more and more of her patients, adult patients were reporting problems with these kind of behaviors. The program consists of three days of digital detox followed by seven days of cognitive behavior therapy and then referral to outpatient therapists who specialize in this type of thing and who again work with families. I mean, tech addiction, I'm afraid to say is a family systems issue. And if we simply try to work with young people in isolation, as we do with many problems, aside from their family and not work on the family dynamics and the family systems, this is likely to, there'll be relapses and this problem will continue. There are some intensive outpatient addiction treatment programs that focus on technology. Most of them are parts of substance abuse programs. And unfortunately, in order to get reimbursed, clinicians and parents have to treat it as a substance use disorder with the internet part as a co-occurring type of thing, whereas that may be the actual problem. IOP programs are designed to teach skills in an outpatient basis. There are locally, I'm not familiar over here, but over in Santa Clara County, there are several IOP programs, including the Aspire program at El Camino Hospital, the Bay Area Clinical Associates Program, Evolve has an IOP program and the Los Gatos Therapy Center where they say they deal with technology, but it's generally part of a broader range of problems. So none of them are specialized in dealing with this particular issue. So cognitive behavior therapy for internet addiction, CPTIA, and you can look this up if you want more information about it, is an evidence-based form of treatment for technology internet addiction that was developed by Dr. Young, Dr. Kimberly Lung. And what I'll do is I'll describe the components of that, which consists of motivational interviewing, cognitive behavior therapy, positive psychology, and a twist that I do, a reality therapy. Motivational interviewing, and most of you who are therapists know about this. It's a goal-directed style of counseling that elicits behavior change by helping teens explore and resolve their ambivalence about technology. And what we do is we ask open-ended questions and stuff about how are you using technology? What impact is it having on your life? Motivational interviewing is non-judgmental, it's designed to create agency among young people, to teach them that they're responsible for their behavior, not doctors, not parents and whatnot, and to motivate them basically to take responsible for their problems, to understand why these things are creating difficulties in their life and understand how the use of these things may interfere with their goals, the goals of getting good grades, goals of having friendships, goals of getting into college. Motivational interviewing involves empathy through reflective listening. It involves identifying discrepancies between kids' behaviors and their goals. The goal is to get into a good school and stop spending 10 hours a day watching YouTube videos and not doing your homework. It's not gonna help you achieve that. We avoid arguments and confrontation, and oftentimes that's what's been happening at home. It's parents being angry and frustrating, yelling and screaming about failing grades and spending all the time in your room on your phone. It adjusts to resistance rather than opposing it and supports self-efficacy and optimism. And we ask questions, as I said before, how many hours per week do you currently spend online? What applications are you doing? Explain to me what you do and stuff. Do you watch pornography and stuff? Do you like it? Are you interested in it? What problems or consequences might stem from it? Any relational problems, which they almost always are as a result of the use of technology. Then we use behavior therapy. Behavior therapy is used to examine the computer behavior, but also non-computer behavior as well. Computer behavior deals with online use and replacing problematic use with constructive controlled ones. And again, helping young people re-establish control over their life. I mean, most of you are familiar with basic behavioral modification techniques. Though a big part of my practice involves teaching, teaching those skills, using them to your advantage and stuff. We all know, I mean, we were taught this in school, that any behavior that's followed by a positive consequence is gonna do what? It's gonna increase itself. It's gonna be repeated itself. And any kind of behavior that's followed by unpleasant consequences likely to not be repeated. I mean, what's it like doing trigonometry homework? Now, is that pleasant? Does that make you feel good? Probably not. Whereas procrastinating and playing video games, watching YouTube videos, that's a lot more fun and stuff, huh? I mean, I have to explain to the kids I work with that procrastination isn't some kind of personality problem. It's a problem of doing nothing and rewarding yourself for doing nothing. So changing that contingency, okay? Finding something that's positive, like turning your phone on and checking your text messages after you finish your trigonometry homework, is likely to bring about a change. Behavior therapy also involves monitoring and measuring behaviors, keeping track of behaviors, okay? We all know that the mere act of counting calories, okay? Counting cigarettes and stuff, keeping track of hours that you're on your phone, maybe using one of those apps like moments and stuff, will actually reduce those problematic behaviors just because you're keeping track of how often you're doing it. Absonance and willpower, therefore, are not enough to deal with tech habits, okay? Most of us make new years revolutions and we all know how successful those are. And it takes months, if not longer, to change habits and change behaviors. One simple exercise I do with the kids I work with is I ask them to tell me how they tie their shoes. And I ask them, do you put the right lace over the left or the left over the right? Now, I don't expect most of you know the answer to that question either. But if you were to tie your shoes, you'd realize you do it the same way every single day and have been for years or decades. And I'll give them an exercise to go home over the next week and do it the other way, okay? And when they come back that week, they tell me it is effin' impossible. Now, it doesn't work and stuff. And that's simply because we do the behavior before we even think about it and whatnot. And if we do that with our shoes, just imagine how we do that with all the other complicated behaviors that we have. Cognitive behavior therapy, which is the second phase of CBT-IA, involves addressing rationalizations that justify excessive online use. We identify the cognitions that are irrational, like I'll never have a friend if I don't respond to Instagram posts immediately. And then we replace those irrational, problematic cognitions with positive ones. Many kids have negative self attitudes about themselves and they feel that they need to create these personas online. Kids who post Instagram photos will oftentimes take dozens and dozens of photos just to get the right one in order to post, which involves spending hours in front of the mirror. And what that basically says is, they don't feel that they're acceptable as they are themselves. And we address those cognitions. So it's a psycho-education approach that teaches young people how their brain functions, how to correct rational thoughts and replace them with rational ones. Positive psychology, which I'm sure most of you practice as well, doesn't attack or aggress teenagers. It tells them that they're valued and stuff, that all of us make mistakes. Doing some self-disclosure where we actually share some of the mistakes that we've made in the past, okay? And that you only learn by making mistakes, not being perfect. I mean, one of the most distressing things about where I live over in Saratoga, down the Silicon Valley, is this belief that everybody's gotta be perfect, that every high school senior is supposed to go to Stanford University and whatnot and never make mistakes. And the amount of stress that that produces and the need and the drive to be perfect, which is impossible, is ridiculous. I use a form of therapy called Reality Therapy and developed by Dr. William Glaser years and years ago. Reality Therapy, it's a problem-solving therapy to help people to make better choices in order to achieve specific goals. The focus is on the here and now. It's based on realism, responsibility, and right and wrong rather than symptoms of a disorder. And what it basically does is it teaches young people that they are responsible for their behavior, that every second of every day they're making choices about what to do or not, to reach for that phone and check a message or not do it. With the boys I work with, most of whom, they're teenage boys, so you can imagine most of them haven't volunteered to go see the psychologist. I mean, they're usually dragged into my office by their parents and whatnot. When I ask the parents to leave, so I can talk to the teen himself. When I ask what's up, he said, I don't want to be here, this is a waste of my damn time and stuff. And so I'll invite him to leave. I said, please, feel free to leave. I mean, that'll give me 50 minutes to read a magazine and stuff, and by the way, I'll be charging your parents anyway, so no sweat off my back. And the response to that is, well, I can't do that. I can't leave. And I said, why not? He said, well, because I'll get in trouble. And that's when I point out, well, welcome to the real world. There are consequences for all types of behaviors. Whether you do something or do nothing, there are consequences. So getting them to slow down and recognize that each of their behaviors leads to different paths and different consequences and stuff, and getting them to take responsibility, which also involves working with parents and getting parents to back off and not be helicopter parents and trying to control everything. That's the problem with those tracking apps and stuff on keeping track of everything is that it disenfranchises, it reduces agency in young people. Harm reduction, the third phase of CBT-IA focuses on continued recovery and relapse prevention. It addresses coexisting issues, so it doesn't mean that, as Gene said, technology isn't necessarily polluting our young people's minds. Oftentimes, teens turn to technology because they're anxious, because they're depressed, because they have other issues, family problems and whatnot, and we will address those things in harm reduction. And I'm just gonna wrap up in just two more minutes. Behavioral design, and I'd encourage you to all look this up, okay? Behavioral design is a concept used by architects as they design furniture, design homes and whatnot. I think we need to become experts in behavioral design as well. And what behavioral design means is trying to identify what are the cues and the triggers and the stimuli that cause people to do unhealthy behaviors or healthy ones. It involves redesigning our environments. So as Gene mentioned, we need to look at our homes, and how we're using technology. If there are screens in every room, how is a young person supposed to avoid spending eight hours a day on those things? The bedroom should be used for sleeping for young people, not entertainment centers. I think it's a sin to have a television and a bedroom where you're supposed to sleep, to bring in technology and stuff, cell phones. What she mentioned, turning a phone off, putting it downstairs, putting it someplace else, is absolutely essential for people to get healthy sleep. Not just because of the blue light, but because of the stimulation that I mentioned that it produces. So we need to design our environments, and I would encourage you to look up some information about behavioral design. I mean, none of us are taught these kind of things in our graduate programs. We're just taught to talk to individuals and identify their feelings and their thoughts and whatnot. But going into people's homes sometimes to find that there's, what is it, Alexa or Google Voice everywhere and whatnot, that's frightening. There are tools for parents to monitor and control tech use. Now, this is probably not gonna come as a surprise. Again, these agencies that deal with children recommend that kids not have unfettered access to these things until their brains have developed and they've learned some self-control. In order to manage this, if you're gonna give children phones, these are the kind of services and stuff that are available. All routers and internet service providers now have parental controls or devices have parental controls and social media sites have social controls as well. So setting up broadband or parental controls, search controls on kids' search engines, install them on the devices, limit time, have things shut off at a certain time, having apps that block inappropriate pop-ups. And so I understand we'll be providing slides to people afterwards. So I have some links to some websites that might be interesting to talk about parental controls. And then I have a list of books and things that I've read over the years that I found incredibly helpful to understand this phenomenon. There's lots of good research about this and I would encourage all of you to look up some of these things. Okay, thank you very much and I'll be here all day to answer questions. Thank you.