How Much Smartphone Use Is Too Much?

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Since the iPhone debuted in 2007, ushering in the age of the phone-as-computer, smartphone use has exploded worldwide, with an estimated 2.3 billion users last year. According to a 2016 Pew Research survey, 77 percent of Americans own a smartphone, and other recent stats have found that users are on their phones an average of more than five hours per day—almost double the rate in 2013. More people now use a mobile device to get online than they do a computer. This is especially true in regions where people may not be able to afford a personal computer but can buy a smartphone.

We love our smartphones perhaps a little too much, and the desire to unplug is growing among people who see 24/7 connectedness as damaging to their mental health. This week, Apple announced new iPhone features meant to curb our dependence on our devices, including a weekly "Report" app that shows your phone and app usage, as well as how many times you physically pick up your phone. (One small study by the consumer research firm Dscout found that we touch our phones more than 2600 times a day.) You can also set customized limits for overall phone usage with the "Screen Time" app.

Many of us feel anxiety at the very thought of being without their phone and the access it offers to the internet. Researchers have a term for it: nomophobia ("no mobile phone phobia"). So how much smartphone use is too much?

That turns out to be a surprisingly difficult question to answer. "Smartphone addiction" isn't an official medical diagnosis. Even the experts haven't decided how much is too much—or even whether smartphone addiction is real.

DEFINING ADDICTION

To understand what's going on, we have to first step back and define what addiction is. It's different from habits, which are subconsciously performed routines, and dependence, when repeated use of something causes withdrawals when you stop. You can be dependent on something without it ruining your life. Addiction is a mental disorder characterized by compulsive consumption despite serious adverse consequences.

Yet, our understanding of behavioral addictions—especially ones that don't involve ingesting mind-altering chemicals—is still evolving. Actions that result in psychological rewards, such as a crushing a castle in Clash Royale or getting a new ping from Instagram, can turn compulsive as our brains rewire to seek that payoff (just like our smartphones, our brains use electricity to operate, and circuits of neurons can restructure to skew toward rewards). For a minority of people, it seems those compulsions can turn to addictions.

Psychologists have been treating internet addiction for almost as long as the internet has been around: Kimberly Young, a clinical psychologist and program director at St. Bonaventure University, founded the Center for Internet Addiction back in 1995. By 2013, addictive behavior connected to personal technology was common enough that in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the bible for mental disorder diagnoses, the American Psychiatric Association included "internet gaming disorder" as a condition "warranting further study." These days, thanks to an abundance of horror stories involving people who were glued to the internet until they died—and living gamers who are so engrossed in their games that they ignore paramedics removing dead gamers—internet rehabs are popping up all over the world.

But in virtually all of the medical literature published so far about internet addiction—including the WHO's forthcoming 11th edition of International Classification of Diseases (ICD-11), whose "excessive use of the internet" is built around how much gaming interferes with daily life—there's no mention of smartphones.

According to Marc Potenza, a professor of psychiatry and neuroscience at the Yale School of Medicine, there's a reason for these omissions: Despite the official definitions included in the DSM-V and ICD-11, "there's debate regarding the use of those terms [internet addiction]. Both the ICD-11 group and the DSM-V group chose to focus on the behavior rather than the delivery device."

So while you may feel nomophobia when you can't find your internet "delivery device," the global psychiatric community thinks it's the internet itself that's the problem—not the phone in your hand.

THE REWARDS THAT COME FROM OUR PHONES

We are getting something from our phones, though, and it's not just access to the internet. Receiving a notification gives us a small dopamine burst, and we learn to associate that dose of pleasure with the smartphone. You may pull your phone from your pocket a dozen times an hour to check for notifications—even if you know they're not there because your phone would have, well, notified you.

It's not unusual for people to become attached to an action (checking the phone) rather than its reward (getting a notification). Sometimes smokers trying to quit feel the urge to chew or bite and need to replace cigarettes with gum or sunflower seeds. According to Stephanie Borgland, a neuroscientist and associate professor at University of Calgary, this is called a Pavlovian-instrumental transfer—a reference to Ivan Pavlov's experiments, in which he reinforced behavior in dogs through signals and rewards. Borgland tells Mental Floss that we can become compulsively attached to the cues of phone use. We cling to the physical stimuli our brains have linked to the reward.

There may be an evolutionary basis to this behavior. Like other primates, humans are social mammals, but we have dramatically higher levels of dopamine than our cousins. This neurotransmitter is associated with reward-motivated behavior. So when we get a notification on an app that tells us someone has engaged us in social interaction—which we naturally crave—it triggers our natural inclinations.

HOW TO CURB YOUR ENTHUSIASM (FOR YOUR PHONE)

The global psychiatric community may not be convinced our smartphones are a problem, and no one has died from checking Snapchat too often—or at least it hasn't been reported. But most of us would say that spending five hours a day on our smartphones is too much. So are there any guidelines?

At this stage of research into smartphone use, there are no specific time-limit recommendations, though some researchers are working on a smartphone addiction scale; one was proposed in a 2013 study in the journal PLOS One. Based on what's said to be coming out in the ICD-11, here's one simple guideline: Problematic smartphone use negatively interferes with your life. Some research suggests Facebook, Instagram, and even online gaming make us feel more isolated and less connected. The more we try to fill that hole by tapping away at our phones, the more we crave social interaction. "There are a number of factors that have been associated with these behaviors or conditions," says Potenza, who is developing tools to screen for and assess problematic internet use and has consulted with the WHO on these issues. "And arguably one of the most consistent ones is depression."

One way to assess whether your smartphone is a problem is noting how you react when you're cut off from it, according to the PLOS One study. The study proposed a "smartphone addiction scale" based on negative responses to being without a smartphone, among other criteria. What happens on a day when you accidentally leave it at home? Are you irritable or anxious? Do you feel isolated from friends or unsafe? Do you have trouble concentrating on work, school, or other important responsibilities, whether or not you have your phone?

While smartphones may not be truly addictive in a medical sense, learning how to use them in a more mindful, healthy manner couldn't hurt. Test yourself for nomophobia [PDF]—knowing how much time you spend online is the first step to identifying how that can be problematic. Block distracting sites or track usage via a timer or an app (beware third-party apps' privacy settings, however). Delete the apps that keep the phone in your hand even when you're not online, like games. If you're still struggling, you could ditch smartphones altogether and downgrade to a "dumb" phone or get a Light Phone, a cellular device "designed to be used as little as possible."

A recent WIRED feature argued that using the internet five hours per day isn't a personal failing so much as a reflection of the way many apps are purposely designed to keep you salivating for more. So perhaps the best measure is to leave your phone behind once in a while. Schedule a screen-free Sunday. Go for a walk in the woods. Meditate. Socialize instead of binging The Office again. Don’t worry—you’ll be fine.

A Generic EpiPen Coming in Early 2019 Could Save You Money

Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Alex Wong/Getty Images

For an incredibly common, life-saving medication, EpiPens (epinephrine auto-injectors) are surprisingly difficult for many consumers to get ahold of. Their cost has skyrocketed in recent years from less than $100 for a pack of two to more than $600. They’ve gotten so expensive that some EMTs have resorted to using syringes to manually administer epinephrine rather than purchasing the standard auto-injectors, which are almost exclusively made by the pharmaceutical company Mylan. Generic options have been slow to come to market, but according to Business Insider, a recently approved EpiPen rival is coming in the first few months of 2019, and it could save consumers a significant chunk of change.

The drug’s developers have had an unusually hard time getting the new EpiPen alternative, called Symjepi, onto store shelves. The drug was approved in 2017, but the company, Adamis Pharmaceuticals, had trouble finding investors. Now, Novartis, the Swiss-based pharmaceutical giant that manufactures drugs like Ritalin, is releasing the drug through its Sandoz division (perhaps most famous for it role in discovering LSD in the 1930s).

Symjepi will cost $250 out-of-pocket for a pack of two doses. That’s 16.6 percent less than the Mylan-authorized generic EpiPen or Teva’s generic EpiPen, which both sell for $300. It differs a bit from its rivals, though, in that it’s a pre-filled, single-dose syringe rather than a spring-loaded auto-injector. Auto-injectors are plastic, pen-like devices that keep the needle shielded until the moment of injection, and are specifically designed to help make it easier for untrained (even squeamish) people to use in an emergency. With this version, patients will need to remove a needle cap and inject the needle. Just like the EpiPen, though, it’s designed to be injected in the upper thigh, through clothing if necessary.

If you have health insurance, the difference in cost may not matter as much for you as a consumer, depending on your plan. (I personally picked up a two-pack of Mylan-authorized generic Epipens at CVS recently for $0, using a manufacturer’s Epipen coupon to knock down what would have been a $10 copay.) But it will matter considerably for those with high-deductible plans and to insurers, which, when faced with high costs, eventually pass those costs on to the consumer either through higher co-pays or higher premiums. It also affects agencies that buy EpiPens for emergency use, like local fire departments. And since EpiPens expire after just a year, the costs add up.

However, there’s currently a shortage of EpiPens on the market, according to the FDA, making it more important than ever to have other epinephrine drugs available to those at risk for serious allergic reactions.

[h/t Business Insider]

Brain-Eating Amoeba Kills Seattle Woman Who Used Tap Water in Her Neti Pot

CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain
CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain

If you use a neti pot to clear out your sinuses, there's one important rule you should always follow: Don't fill it with tap water. Doing so could land you a sinus infection, or worse, a potentially fatal disease caused by a brain-eating amoeba. Although the latter scenario is exceptionally rare, a 69-year-old woman in Seattle died from doing just that, The Seattle Times reports. Experts are also warning that these infections could become more common as temperatures in the northern hemisphere continue to rise.

Physicians at Seattle's Swedish Medical Center initially thought the woman had a brain tumor. She was brought into the emergency room following a seizure, and a CT scan of her brain seemed to reveal a tumor-like mass. The only other known symptom she had was a red sore on her nose, which was previously misdiagnosed as rosacea. When surgeons operated on her the following day, they noticed that "a section of her brain about the size of a golf ball was bloody mush," neurosurgeon Dr. Charles Cobbs told The Seattle Times. "There were these amoeba[e] all over the place just eating brain cells. We didn't have any clue what was going on, but when we got the actual tissue we could see it was the amoeba."

She died a month later of an infection called granulomatous amoebic encephalitis (GAE), according to a recent case report published in the International Journal of Infectious Diseases. The disease is caused by a single-celled amoeba called Balamuthia mandrillaris, and it's extremely deadly. Of the 109 cases between 1974 and 2016, 90 percent were fatal.

According to the FDA, some bacteria and amoebae in tap water are safe to swallow because acid in the stomach kills them. However, when they enter the nasal cavity, they can stay alive for long periods of time and travel up to the brain, where they start eating their way through tissue and cells. Another brain-eating amoeba called Naegleria fowleri can cause a similar disease, except it acts faster and can cause death in just a few days. Although it's also rare, it's usually found in warm freshwater, and infections start by getting contaminated water up one's nose while swimming or by using a nose irrigation device filled with tap water.

Dr. Cynthia Maree, an infectious disease doctor at the Swedish Medical Center, said the changing environment could facilitate the spread of these infections. "I think we are going to see a lot more infections that we see south (move) north, as we have a warming of our environment," Maree says. Researchers say these amoebae are still little-understood. Future studies would need to be conducted to learn more about the risk factors involved.

[h/t The Seattle Times]

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