Ajitha Anilkumar describes her life as a series of tragedies. Her elder son died from a congenital heart condition. Her second son got addicted to drugs and gaming, became involved with a gang, and eventually took his own life. Her daughter, once a glimmer of hope, has cut ties. Though still legally married, Ajitha and her husband have been separated by wounds too deep to heal. “I had three children, but now I have no one,” she says, weeping. “It is because of my husband's addiction to alcohol and tobacco.”
Ajitha, 52, recalls Anilkumar being inebriated even on their wedding night. “When he was a temporary worker at a public sector undertaking, he did not have much money to drink more,” she says. “But once he became permanent and his salary increased, so did his drinking. Despite multiple warnings, nothing changed. I first admitted him to hospital in 2006. Around10 stints at de-addiction centres had no effect and he lost his job to alcoholism.”
Her second son, Anujith, would have been 23 now. She says he suffered the most in the chaotic environment created by his father's addiction and his brother's illness. “I could not give him the care he needed,” she says. “But, it was his father’s reckless decision that sealed his fate. Against my wishes, he enrolled Anujith in a ‘notorious’ government school in Ernakulam. That is where drugs found him.” Her voice trembles as she continues: “That is where I lost him. I did not know; it was only later that I began hearing about his links to drug dealers.”
During Covid-19, when Anujith was in class 12, he demanded a Rs33,000-phone for online classes. “His father never gave any money; I worked as an LIC agent to raise my kids,” says Ajitha. “I bought him a phone worth Rs10,000, but he refused to touch it. When he started showing suicidal tendencies, I gave in and bought him the phone he wanted, on EMI. I did not realise I was making a terrible mistake.”
Anujith became addicted to online gaming, especially a game called Free Fire. Soon, he started playing for money, spiralling deeper into the addiction. Though he enrolled in a college in Thiruvananthapuram, he had no interest in studies and maintained ties with drug users. Before the lockdowns were over, Anujith had taken his own life.
“On the day he died,” Ajitha recalls, “a man who is part of a gang came to see him.” Anujith stepped out and later stormed back into the house, demanding money from his mother. “When I asked why, he flew into a rage and tried to strangle me,” she says. Her daughter managed to calm him by recharging his data plan (Anujith had said during the quarrel that he did not have money to meet even such needs). He then locked himself in, saying he wanted to be alone. Within a few hours, he hanged himself.
The demons haunting Anujith may never be fully known, but one thing is clear―he was ensnared by addiction, to substances and to online gaming. These compulsions likely fed off the same destructive cycle: a relentless imbalance of dopamine in his brain.
Feel-good fuel
Dopamine is often called the “feel-good” neurotransmitter. When you are expecting something good, your brain releases dopamine, sending a message that boosts your sense of pleasure. It is the brain's way of saying, “This is worth it!” Interestingly, the same part of the brain that processes pleasure also handles pain. Neuroscience shows that pleasure and pain are counterbalancing forces. Dopamine fires up with every hit of reward―whether it is from a tasty meal, a thrilling game, social media likes, sex, shopping spree, liquor or a line of cocaine. But, when dopamine levels in the brain become abnormal, it becomes dangerous. “It can lead to neurological disorders,” says Shalini Menon, a UK-based Indian chemist who recently patented a first-of-its-kind portable device to detect dopamine levels to aid early diagnosis of such disorders. “A prime example is Parkinson's disease, caused by low dopamine levels. Schizophrenia is triggered by excessive dopamine. And, of course, addiction―it can contribute to these kinds of disorders as well.”
American psychiatrist Dr Anna Lembke is medical director of addiction medicine at the Stanford University School of Medicine. In her bestseller, Dopamine Nation, she explains that scientists use dopamine as a universal currency to measure the addictive potential of any experience. “The more dopamine in the brain’s reward pathway (the network responsible for pleasure, motivation and reinforcement learning), and the faster it releases the dopamine, the more addictive the drug,” she notes.
Researchers have quantified dopamine release during activities, finding that in rats, chocolate can increase dopamine levels by 55 per cent, sex by 100 per cent, nicotine by 150 per cent, and cocaine by 225 per cent. Methamphetamine can raise dopamine levels by around 1,250 per cent―far exceeding other stimulants. And, unsurprisingly, synthetic drug addiction is on the rise worldwide. However, with the advent of digital media, there is a growing number of addicts beyond traditional realms like substance abuse.
Good vibes... only?
Odysseus and his crew, blown off course during their return from Troy, land on the island of the lotophágoi or the lotus eaters. When scouts encounter the tribe, they are offered a plant that induces blissful apathy, causing them to forget home and lose the will to leave.
This metaphor of a pleasure island, conceived over 2,600 years ago by Homer, has never been more strikingly relevant. Today, scientific advancements have created a labyrinth of secretive pleasure avenues, luring individuals into seductive escapes. Just as Odysseus’s men were entranced, modern societies now face a myriad of digital and physical islands offering pleasures that create addiction and consume the mind.
Dr Anna Lembke
Lembke tells THE WEEK that about 20 years ago, with the advent of smartphones, she began seeing more cases of what is now known as behavioural or process addictions―addictions to behaviours, not substances. “Almost universally, these individuals reported that the internet, particularly smartphones with their 24/7 access, tipped them from recreational use into maladaptive, addictive behaviours like online pornography, shopping, video games, and social media,” she says.
Lembke draws on her decades of experience to explain that progression of addiction to drugs and alcohol is comparable to addiction to digital media. “People typically start using for one of two reasons: to have fun or to solve a problem,” she says. “If it works, they return to that substance or behaviour, and over time, their brain changes. They need more of the drug or more intense versions of the behaviour to get the same effect. For pornography addiction, this could mean starting with generic images and gradually progressing to more deviant, violent, or even illegal content.”
Lembke reveals that while treating a patient with severe online pornography and sex addiction, she recognised similar addictive patterns in herself. “I realised that my own behaviour with romance novels had become addictive,” she says. “My addiction was triggered by technology―specifically [an e-reader], which allowed me to read books continuously, cheaply, anywhere, and in secret. Over about a year and a half, I went from tame romance novels for teenagers to hardcore erotica.”
She adds that while her compulsive behaviour was not life-threatening, she wants to be careful not to trivialise life-threatening addictions of patients, to drugs, alcohol or behaviours. “Addiction exists on a spectrum,” she says. “We all share the same basic brain reward pathways that seek out pleasure and try to avoid pain. In the context of unlimited access to our 'drug of choice,' whatever it may be, we are all vulnerable to compulsive overconsumption, also known as addiction.”
Recent studies have increasingly emphasised the link between sedentary lifestyles and various forms of addictions and other behavioural issues. Modifiable behavioural risk factors―such as physical inactivity, unhealthy diets, and tobacco and alcohol addiction―are major contributors to non-communicable diseases, which account for 74 per cent of global deaths each year.
Dopamine economy
The limbic system, a complex network of brain structures beneath the cerebral cortex and above the brainstem, is central to regulating emotions, behaviour, memory and smell. Among its key components, the amygdala is particularly important in processing pleasure. Just before the onset of global Covid-19 lockdowns, University of North Florida historian David Courtwright, an expert in drug history, introduced the term “limbic capitalism” in The Age of Addiction: How Bad Habits Became Big Business. Courtwright defined it as “a technologically advanced, but socially regressive business system in which global industries, often aided by complicit governments and criminal organisations, promote excessive consumption and addiction”.
With the pandemic deepening the roots of this technology-driven business model, access to addictive substances has surged dramatically. Experts like Lembke warn that this access, alongside the variety and potency of new-age drugs, may now be one of the greatest risk factors facing modern societies.
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Trauma, social upheaval, and poverty are all reasons contributing to addiction risk. However, according to Lembke, the most vulnerable people to limbic capitalism are the poor in well-resourced countries. “This includes India, as it is a country with a large population, many of whom live in relative poverty, yet still have access to the internet,” she says. “This gives them access to digital media, which can act like a drug, and it is largely free. Additionally, because of the global supply chain, drugs are now accessible almost anywhere, with no place fully insulated from them. Poor people in well-resourced countries are particularly vulnerable because they have less access to healthy dopamine sources, like clean air and water and meaningful work. Often, they have to work long hours in menial jobs, with little exposure to nature or access to healthy foods. As a result, they are more susceptible to seeking out cheap pleasures or drugs to cope with the stresses of poverty.”
Alarmingly, experts warn that the dopamine-driven economy has turned consumption itself into a drug. Sylvia, a techie from Bengaluru, tells THE WEEK that just scrolling through products online became addictive for her. “I do not go out shopping any more; I browse constantly, making purchases when I find good offers,” she says. “My cupboards are overflowing with items I never use. But when I see something nice, I feel the urge to shop.” The 33-year-old says that the pandemic shifted her shopping habits from in-store to online. “I think of uninstalling those apps, but it has not happened yet. The urge to keep them is strong every time I consider it.”
Kalyani Gopakumar
Notably, Lembke says that whenever someone experiences pleasure from an activity, a self-regulating mechanism of the brain counterbalances it with pain. This manifests in various forms, including guilt, anxiety or hangovers after indulgence.
When individuals are repeatedly exposed to the same stimuli, the brain's response to dopamine decreases, a process known as “dopamine downregulation”. This reduction in sensitivity necessitates that individuals seek larger amounts of pleasurable stimuli to achieve the same effect. Lembke, in her book, says: “Needing more of a substance to feel pleasure or experiencing less pleasure at a given dose is called ‘tolerance’.” It plays a significant role in the development ofaddiction.
Importantly, experts emphasise that dopamine downregulation and tolerance leading to addictive behaviours are not issues confined to adults. As children are introduced to digital devices at a very young age, the potential for developing these patterns is increasingly prevalent.
Home-made addicts
Kalyani Gopakumar, a young entrepreneur who conducts storytelling sessions called Oridathoridathu (Once Upon a Time), shares a striking observation. “I hold sessions for children from both privileged and underprivileged backgrounds,” she says. “The difference is stark. Children from privileged families, often exposed to digital devices from a young age, are harder to engage. Simple games, crafts or fairy tales no longer surprise or excite. But, children in government-run homes are far more enthusiastic and engaged.”
Oridathoridathu was born out of Kalyani and her husband's determination to avoid exposing their child to TV or digital devices till the age of three. They committed to engaging him by spending quality time together and reading stories. This mindful approach contrasts sharply with many millennial parents―alarming trends show an increasing overindulgence in the digital world among children and adolescents.
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“There is a noticeable rise in developmental issues among children, especially those under five or six years,” said Dr Tina Gupta, a Delhi-based consultant psychiatrist and specialist in developmental neurology. “Many children are experiencing developmental delays, speech and language issues, early learning difficulties, and ADHD. Children as young as two spend two to three hours or more daily on phones. In India, parents commonly use phones as distractions at mealtimes, despite paediatric guidelines against it.”
Gupta highlights a new condition called virtual autism, where children under three exhibit autism-like symptoms because of overexposure to digital devices. “This issue, worsened by the pandemic, has become more prevalent as screen time skyrocketed,” she says. Nuclear families where both parents work often introduce phones early to aid feeding or for entertainment. However, this can lead to indiscriminate phone use, especially when caregivers like maids or grandparents are left in charge.
“Social and language development relies heavily on interaction with parents,” says Gupta. “In virtual autism cases, two-year-olds may not speak, despite meeting other milestones. Their imitation skills are weak, gestures are minimal, and they avoid eye contact. While physically active, their social and speech development is significantly delayed.”
Treatment begins with educating parents and reducing screen time. “Many kids show rapid improvement once phones are replaced with interactions,” says Gupta.
In children aged 10 to 12, excessive phone use is linked to poor academic results, disorganisation, delayed executive skills and emotional issues like anger, meltdowns and anxiety. “For teenagers and young adults, the effects include addiction (especially gaming), early exposure to sexual content, anxiety, depression, disordered eating and a range of psychiatric issues, linked to excessive digital consumption,” says Gupta.
Menon notes that children whose pleasure-pain balance gets disrupted by excessive screen time may become more susceptible to synthetic drug addiction in the future, seeking an “instant high”.
Gupta says that gaming addiction can indeed be seen as a “gateway drug”. “Gaming, being a solitary activity, often leads to loneliness, reduced social interactions, increased anger, isolation, and even depression,” she says. “It also tends to result in a decline in academic performance―a crucial protective factor for young people. Together, these factors can set the stage for addiction to substances like drugs or alcohol in the future.”
Balance your boat
The Yoga Vasistha, an ancient Indian text attributed to Valmiki, suggests that pleasure inevitably leads to pain, implying their interdependence. Contemporary thinkers echo this, observing that hedonism can lead to anhedonia, the loss of the ability to feel joy. Lembke advocates a “modern form of asceticism” with practices like “self-binding” and “dopamine fasting” to combat dopamine overload.
She explains that dopamine fasting involves abstaining from one's “drug of choice” for four weeks to reset the brain’s reward pathways. While this can be effective for most people, Lembke cautions that those at risk of life-threatening withdrawals from substances like opioids or alcohol should seek medically managed detox. For others, dopamine fasting can restore balance, enabling them to make healthier choices. Though some may choose to abstain, others may return to moderate use, though this requires careful planning and discipline.
“But, I emphasise that it is a small minority, and it is difficult,” she says. “This is where self-binding comes in―strategies that do not rely on willpower alone. Once we are caught in the throes of desire, resisting the craving becomes hard. Self-binding helps by creating literal or mental barriers between ourselves and our drug of choice, allowing us to pause before giving in to the urge. For example, if you were addicted to video games and gave them up for a month, the craving would lessen over time. If you choose to return, self-binding might involve limiting play to two hours a day or only playing with friends, not strangers. For alcohol, it could mean not keeping it at home, avoiding events where it is served, or even taking a medication like Antabuse that deters from drinking alcohol.”
Psychiatrists say that some of the strategies applied in the case of substance abuse are being replicated in managing addictions to digital drugs, too. “About 20 years ago, we began using interventions for drug and alcohol addiction to treat behavioural addictions like sex, gambling, pornography, shopping, and video games,” says Lembke. “That intervention starts out with an early intervention of the dopamine fast, trying to abstain from the drug long enough to reset reward pathways. But, also we use similar things, like some of the medications that we are using to treat drug and alcohol addiction we are now using to treat the behavioural addictions with good effect.”
Lembke says that in the last two decades, peer recovery groups akin to Alcoholics Anonymous have emerged for those addicted to gambling, video games, sex and technology.
Psychiatrists not only treat addiction but also address the misconception that once someone is addicted, there is nothing that can be done and there is no role for physicians. “In reality, when we treat addiction as a chronic, relapsing medical condition with a behavioural component, the response rates are comparable to those for other chronic illnesses like obesity, heart disease, asthma, and depression,” says Lembke. “Millions of people worldwide are living in long-term recovery from severe addictions; decades or even a lifetime. People can enter recovery even after years of addiction. So there is plenty of reason for hope.”