TCPR: How did you get interested in digital addictions?
Dr. Sherer: I wear many hats. I lead a large psychiatric hospital and a recovery center. I also have a small psychodynamic therapy practice, which balances out the medication focus of my other work. In 2024, I helped found Nostos, an online group-based therapy program for technology addictions. I also coauthored the APA textbook on internet gaming disorder and serve on their task force for tech addictions.

TCPR: How do you screen for social media addiction?
Dr. Sherer: Ask how much time they spend on social media, whether they’ve tried to cut back, and whether it negatively affects their life. The Bergen Social Media Addiction Scale has six questions like that, scored from 6 to 30, where a cutoff of 24 suggests problematic use. Patients find these questions enlightening. They usually spark a conversation. That said, we don’t have an agreed-upon definition for social media addiction. There are only two behavioral addictions in the DSM, which are gambling disorder and—in the appendix for further study—internet gaming disorder. If you’re treating social media addiction, you can use the ICD-10 code F63.8 (other impulse disorders).

TCPR: How does social media addiction affect people’s lives?
Dr. Sherer: Behavioral addictions cause distress and impair functioning. Someone might say, “I’m not the best parent, spouse, or employee I could be because of my obsession with TikTok, Facebook, or X.” It may cause depression, anxiety, or insomnia. They may have baseline anxiety and feel some relief when drawn into Facebook, but then they get into an online argument and become despondent about life or politics, making their anxiety worse. They see perfect-world narratives on Instagram or TikTok and feel inadequate, left out, or depressed.

TCPR: Are they aware of the problem?
Dr. Sherer: Most people I see are. They may have tried to change by installing a blocker or deleting the app, but it’s not that easy. “Why can’t I just cut it back?” they ask. I tell them that the apps are designed to be addictive, to reward frequent use and punish sparing use. They hijack the same brain pathways involved in addictions to alcohol, cocaine, and opioids. I’ll say, “You’ve spent years adapting to it, and it’s not going to be easy to cut back overnight.”

TCPR: Do you recommend total abstinence?
Dr. Sherer: I use a harm reduction approach for technology addictions, especially in young people. They need these technologies. For example, in med school I relied on Facebook to find study partners, old tests, and preceptors. An exception is pornography and gambling. When people have those addictions, their lives are usually unmanageable, so I suggest a trial period of abstinence.

TCPR: Do you involve the family?
Dr. Sherer: Yes. Family and friends are crucial for recovery, especially for children and adolescents where we need the family to reinforce what we’re doing in session. Some people may feel infantilized if I ask a spouse to take “parental control” over their phone, but involving a patient’s social network greatly increases their commitment to recovery.

TCPR: Are there apps that help with digital addiction?
Dr. Sherer: Yes. I don’t recommend specific apps, but most people begin with the built-in parental controls on Apple and Android devices, which can block categories of apps or restrict them to certain times. The tricky part is when the urge to use them outweighs the guardrails. While we start with guardrails, we quickly learn when the patient has bypassed them.

TCPR: Some patients do not have an addiction, but have ADHD and are distracted by apps. Are these blockers useful there?
Dr. Sherer: I think so. I have ADHD myself, and I would have benefited from having guardrails with video games growing up. Today, I don’t have any social media apps on my phone, and it’s been one of the best decisions I’ve made for my mental health.

TCPR: Can adults use parental controls on themselves?
Dr. Sherer: They can, and while I’ve seen that work in rare cases, most patients need a broader mindset shift. As with other addictions, that shift often happens when they hit rock bottom, when they are sick and tired of being sick and tired. At that point, they’re ready for bigger changes—not just deleting the app, but deleting their profile. If it’s online gambling, they can put themselves on a self-exclusion list (eg, through tools such as Gamban or Jamf) so they can’t use gambling apps in the future.

TCPR: What specific apps do people get addicted to?
Dr. Sherer: For gambling, it’s casino apps, sports betting like DraftKings, or just day trading stocks. We see addiction to social media, doom scrolling, pornography, and shopping apps. There are apps like Twitch where people stream themselves playing video games or watch others playing, possibly developing parasocial relationships with famous gamers. They feel that they know these gamers and donate money to show their devotion, but they’ve never communicated with them. Others get into dating or hookup apps like Tinder and Grindr. Some spend days going down internet rabbit holes, chasing obscure research questions. We’re starting to see people get sucked into AI chatbots, including virtual AI romantic partners.

TCPR: What about streaming services and binge-watching?
Dr. Sherer: I haven’t seen that rise to the level of clinical addiction, but it can worsen depression, anxiety, and insomnia. Maybe that will change as the streaming services start incorporating games.

TCPR: Are they doing that?
Dr. Sherer: Yes. There is a trend toward the gamification of all apps. They are taking what we’ve learned from behavioral science and decades of video game development. Gambling and gaming apps imitate social media, letting you tell your friends about your wins. They keep you in a loop where you feel constantly compelled to continue betting because you are in a state of flow. We find flow in tasks that are challenging enough to hold our attention, but not so challenging as to be overwhelming.

TCPR: When I do behavioral activation for depression, I look for activities that create flow. How do you distinguish good flow from harmful flow?
Dr. Sherer: Negative flow is not productive and steals time from important things like work and relationships. With positive flow, there’s generally a sense that time with the activity has been well spent. It may broaden their social horizons, build mastery, or bring joy, as people find in playing an instrument, walking in nature, or making art. I never hear patients say, “I’m really glad I spent that six hours on TikTok.”

TCPR: Once the patient is motivated, how do you help them change?
Dr. Sherer: CBT techniques focus on monitoring substance use, identifying the triggers and dysfunctional thought patterns that lead to it, and building self-awareness through motivational interviewing, while also developing alternative behaviors to replace use (Stinson L and Dallery J, J Appl Behav Anal 2023;56(2):323–335; Lu P et al, J Med Internet Res 2025;27:e59656; Nagata JM et al, Curr Psychiatry Rep 2025;27(9):491–499).

TCPR: How is all this changing sexual behavior?
Dr. Sherer: The latest survey shows a decline in all sexual behaviors, including masturbation, among young adults since the 2000s (Herbenick D et al, Arch Sex Behav 2022;51(3):1419–1433). Porn may be a factor. Paradoxically, porn can reduce not just sexual contact, but also masturbation and erectile function. As people become addicted to pornography, they watch it longer, have difficulty getting aroused, and require more extreme content to get the same satisfaction. Soon the content is ego-dystonic and causes negative emotions. We see the same thing with chemical addictions. These are not lives of pleasure.

“Paradoxically, porn can reduce not just sexual contact, but also masturbation and erectile function.” James Sherer, MD

TCPR: Are companies using gamification to promote healthier lives?
Dr. Sherer: Yes. There are video games that have a beginning, a middle, and an end, so they don’t go on into perpetuity. I see patients who are LGBTQ+ who find a safe space to explore their identity in video games. Organizations like Common Sense Media (commonsense.org) review apps and media for how addictive or problematic they are. Another resource is HowLongToBeat.com, which shows how much time specific video games can take to complete. Some games can be finished in 15 minutes, while others could demand thousands of hours.

TCPR: Can people become addicted to podcasts?
Dr. Sherer: Absolutely not.

TCPR: That’s good to hear. I do have a conflict of interest there.
Dr. Sherer: Well, I was joking. They can. People become afraid of being alone with their thoughts. They neglect quiet time with their mind, always playing a podcast or having a YouTube video on. It’s not as bad as the apps we’ve talked about, but sometimes it goes along with those other addictions.

TCPR: Thank you for your time, Dr. Sherer.