Michael Smith, MD (Host): Welcome to Wellness Waves, your essential podcast source for in-demand healthcare information. I'm Dr. Mike. And joining me is Gianna Carrino, a manager of Adolescent Services at Bergen New Bridge Medical Center. Today, we're going to be discussing the impact of addictive behavior on mental health, specifically youth mental health. Thanks for coming on the show today.

Gianna Carrino, MA: Of course. Thank you for having me.

Host: So, let's start off. So, what are some of the common forms of addictive behavior observed in youth today? And how is that impacting their mental health?

Gianna Carrino, MA: Yeah, I'm really happy you asked that question. This is something we see a lot with the youth today. So, one of the most addictive behaviors we obviously see is the use of social media, right? So, this is their Instagram, their TikTok, their Snapchat. We talk a lot with the youth about the excessive use of video gaming. So, a lot of them, they enjoy video gaming. It disrupts their sleep patterns. Of course, there's the smartphone usage. A lot of people have smartphones now, especially the youth. They start using those at a young age. We talk to them a lot about the streaming and binge watching TV as well. And a lot of times too, they get into some problematic internet use going to sites maybe they shouldn't be. We even hear about online gambling for the youth population as well.

Obviously, these behaviors, they can have some serious mental health consequences. There's actually a study in 2023 published in the Journal of the American Medical Association that talked about when the youth have addictive patterns of social media use, they're more likely to experience mental health symptoms such as anxiety, depression, increased risk of suicidal thoughts. This also does tend to impact their self-esteem as well.

Host: Yeah. So, just being online, right? All those social channels. Everybody's "Like me," you know, click, all this kind of stuff. It's doing some damage, right?

Gianna Carrino, MA: Yes. A lot of times on social media, it gives them a false sense of reality, a false sense of expectations. And a lot of times, they can internalize that, and it can impact their mental health.

Host: Besides the tablets, the social media, the smart phones, are there other particular risk factors that make youth more susceptible to addictive behavior?

Gianna Carrino, MA: There are. There are a lot of risk factors that can make them more susceptible to this. So, there's a genetic component. So typically, family history, if anyone in their family has suffered an addiction in the past. There's also other things to take into consideration, like other underlying mental health conditions, low self-esteem or having poor social skills, any history of trauma that the youth has experienced in their past, or we call them ACEs, adverse childhood experiences. There could be a lack of parental monitoring or inconsistent boundaries. That's another risk factor we take a look at as well. Any history of family discord if they live in an environment with high family conflict or poor attachment styles. And like I talked about, one of the main things we look at is genetic predisposition and their environmental factors as well.

Host: How important is it for parents to lay down some boundaries for their kids as far as online, the smartphone, all that kind of technology?

Gianna Carrino, MA: Boundaries are so important, especially for parents. You want to think of it first and foremost, you want to model the behavior for the child, right? So if the parent can model the behavior and show the child or the adolescent how to put in those boundaries, they will be able to implement that better.

A lot of times, at a young age, these kids are exposed to smartphones, right? as a child, they get iPads or they get different type of stimuli to be able to distract them. It becomes something that that's all they know or that's all they have to cope with these thoughts, feelings, and emotions. So if parents are able to put in boundaries, they can monitor screen time, right? And it gives the child a chance to be able to explore other ways of coping. Otherwise, they may use that obsessively, and then that may be the only means they have to cope with their mental health or addictive personalities.

Host: If you're dealing with a child who maybe already is diagnosed with, say, depression or anxiety, or what is it? You know they're going to go online. They're kids, right? They're going to want to do that. How do we deal with that as parents with these other conditions?

Gianna Carrino, MA: Yeah. We call this co-occurring conditions, right? And often, they can complicate treatment. We can't just treat one without the other. We need to treat both together. So, we have to take a look at the whole person. Sometimes the addictive tendencies can make the co-occurring mental health condition worse. They can exacerbate the symptoms of anxiety. They can exacerbate the symptoms of depression. So, it's something we have to take a look at and treat the entire person for. Really, one goes with the other. Sometimes it's a chicken or the egg situation. Which came first? All we know is they're both there. Let's treat the whole person to be able to progress them towards recovery.

Host: When you look at online time, the smartphone, all that kind of stuff, do you see those as true addictions, just like alcohol, smoking, whatever?

Gianna Carrino, MA: Addiction, it does not have to just mean drugs and/or alcohol. There are different levels and different forms of addiction. It can be gambling. It can be some individuals have an addiction to shopping. It can be video gaming. It can be social media usage. What we're taking a look at is are they now giving up things that they used to like to do? Is this now their only means of coping? Are they not fulfilling other responsibilities due to this behavior that they're now engaging in? So, addiction is known as a progressive disease. So, it can start with maybe they're just not going to basketball practice anymore. But later on down the line, if it gets untreated, things can progress and it can develop further. It could look like maybe not going to family functions, not engaging in school and submitting academic assignments. So, this is something that we really want to take a look at because we know the evidence shows that addiction does progress over time.

Host: What are some of those long-term mental health consequences? And when I say long term, like not just now, but when they're young adults and in middle age, do you see that kind of stuff, those connections?

Gianna Carrino, MA: Of course. As this continues over time, there's some trends that we see, especially with the overuse of the social media. So, that can lead to social isolation down the road. That could lead to impaired relationships with family members, significant others. A lot of times, when we talk about the children and the youth, we see that take a trend towards academic failure. Or even school dropout, maybe they're no longer submitting their homework assignments or they're not as engaged in class because they're distracted by the use of social media or the cell phone. This can also lead to chronic anxiety and depression down the line. Like we talked about, it can impact someone's self-esteem and how they view themselves. So, these are all long-term effects that really can manifest in a person if this continues to go untreated.

Host: What are those common signs that parents or guardians should be aware of?

Gianna Carrino, MA: That's a great question. So, I always like to lead with, "You know your child best," right? So, you can see when they start to withdraw from themselves, when they withdraw from the family. Maybe they're spending more time alone, isolated in their room. So, some of the red flags we say to look out for is this lost of interest in activities that they used to once like to do. There can be increased irritability or agitation when you try to engage with them. Of course, there's the common, you know, vying and deflection about what's going on. Maybe they don't want to engage in a conversation about their screen usage or social media usage or even their addictive behaviors or mental health.

A lot of times, another common red flag is what we call a sleep disturbance. Maybe their sleep patterns have been interrupted. Again, that decline in academic performance we're looking for. So, sometimes they're not fulfilling their obligations that they have. And another sign is neglecting hygiene and responsibilities as well.

Host: You got to hate to see when sleep is being affected, right? Because that just causes everything else to be worse during the daytime, right? I mean sleep is a big one. If your child's not getting a lot of sleep, there's something there. And that's important to look at, right?

Gianna Carrino, MA: Sleep is huge. You know, it's hard for them to even function the next day or maybe it bleeds into them being able to fulfill their obligations in school, because they're not well rested. Maybe they were up all night playing video games. That's something we hear a lot from at least the individuals we treat here, the adolescents, right?

They come to group or they come to the school that we do the next day and they say, "I'm really not able to do this today because I was up all night playing video games." And it's hard to break that pattern. It becomes a pattern, right? And now, their sleep schedule is all messed up, right? They're up all night, and they're sleeping during the day when they're supposed to be doing other activities or going to school.

Host: Let's move into treatment options. What's out there for parents and youth to consider? And how effective are they?

Gianna Carrino, MA: There are different types of treatment options. So, one can seek individual therapy with a licensed counselor or a social worker. There are different programs and groups that run that can support children and adolescents with being able to cope and relate to peers in similar situations.

Now, when we talk about treatment, we also talk about what's called evidence-based practices. So, one is cognitive behavioral therapy. That is evidence-based. It helps the youth identify and replace any harmful thought patterns and behaviors. That's very common with working with adolescents and children with these type of issues as well as what we call motivational interviewing. So, that kind of helps them explore their own motivations and engage in treatment to make those changes.

Host: What about prevention? Like what are some of the things that families can do, parents, guardians can do to initiate maybe some preventive things to kind of keep those risky addictive behaviors away?

Gianna Carrino, MA: Early intervention is critical. It's really important for parents to have these conversations with their children and be proactive about them. We know the evidence shows that the earlier a problem is addressed and it's identified, the better the outcome is for the child. So, this will also prevent escalation into more progressed addictive behaviors or other co-occurring mental health conditions later down the line. The outcomes will be better. It increases the adolescent safety and them being able to feel like they can speak to their parents and family members and have these conversations openly and still be accepted by them.

Host: Any last words you'd like for the listening audience on youth addictive behavior?

Gianna Carrino, MA: Yeah. Just for the parents, I would tell them set clear boundaries with your children. Give them the expectations that you want them to follow through on. Have conversations, approach it with curiosity. Let them know that you want to engage in a dialogue with them, and that it is a safe space for them to share with you for anything that they're struggling with. If you need help with those conversations, don't be afraid to reach out to a professional to get some help with that.

Host: That was fantastic. What a great show. Wonderful information. Thanks for coming on today.

Gianna Carrino, MA: Of course. Thanks for having me. We really appreciate it.

Host: That was Gianna Carrino from Bergen New Bridge Medical Center. For more information, please visit newbridgehealth.org if you liked this podcast, go ahead and share it on your social channels and explore the entire podcast library for more topics. This is Wellness Waves. Thanks for listenIng.