Addictions and Recovery

From https://commons.wikimedia.org/wiki/File:Meta_Headquarters_Sign.jpg, Author is Nokia621

In a series of settlements at a federal court in August 2026, Meta platforms agreed to pay up to $18 billion over the next decade and strictly limit how teenagers use Facebook and Instagram. The settlements ended a federal trial over allegations that Meta’s products harmed children and that the company misled the public about their safety ( Meta agrees to pay $18 billion to settle US lawsuits over children’s social media addiction | Reuters ) .

There are, in fact, thousands of other lawsuits against social media companies, and governments around the world are responding to children’s access to harmful online content.

The terms of the agreement include the restriction of teenagers’ use of Facebook and Instagram to two hours a day and block all usage from midnight to 6 a.mm., absent parental consent.

Some states will deposit the funds they receive into general accounts, while some will designate portions to address children’s mental health.

Is “social media addiction” a recognized psychiatric condition. If so, is it treatable?

Meta used the argument that it could not have misled consumers because “social media addiction” was not a recognized psychiatric condition and they have a point. While gambling disorder is a recognized behavioral addiction in the DSM-5, the definitive book used by U.S. mental health providers, social media addiction is not. According to the Cleveland Clinic ( What Is Social Media Addiction? And How To Stop ), the use of social media stimulates the reward centers of the brain, much like addictions do. Furthermore, users show similar behaviors, such as the following:

• They feel anxious when offline;
• They choose social media over other activities;
• Their actual life concerns become secondary to their online participation;
• They experience problems at work or school.

The author of the article goes so far to state “It’s a type of behavioral addiction — an activity that stimulates your brain’s reward system. That compels you to keep taking a certain action (in this case, using social media apps) even though it’s causing problems in your life.”

The seriousness of the problem

Ursoniu, et. al. (2022) refer to findings mentioned in a number of research articles which show profound detrimental effects caused by the excessive use of social media:

1. It can lead to the lowering of previous individual academic levels, deficient social functioning or even criminal activities;
2. The current ingrained social media use is associated with elevated anxiety, depression, loneliness, and poor sleep;
3. Neurobiological evidence shows significant detrimental structural and functional changes in brain regions involved in emotional processing, attention, decision-making, and cognitive control.

It gets worse:

The problem is international

Doan et. al. (2021) studied the prevalence of social media addiction and the factors associated with social media addiction among Vietnamese youths. The sampling size included 173 individuals who were questioned via a SurveyMonkey (surveymonkey.com) questionnaire. This questionnaire included four other questionnaires:

• Social Characteristics;
• The Bergen Social Media Addiction Scale (BSMAS);
• Stress associated with neglect and negative reactions by online peers and fear of missing out (FOMO scale);
• Status of social media platform usage.

Most respondents were female (81.5%), about 85% of respondents were single, and 83.2% were living with family. Facebook, Zalo, and Youtube were the most popular social media platforms among these youths (97.1%, 80.9%, and 75.5&, respectively). The mean social media time per day was 5.9 hours.

Age distribution of participants (n=173), Adapted from Table 1.

Below 18 18-24 years Above 24 Total

	n	%	n	%	n	%	n	%
Total	36	20.8	109	63	28	16.2	173	100

The major findings include the following regarding the participants:

• Characteristics of social media addiction among participants
  • 16.8% reported that they had often/very often tried to stop using social media but failed;
  • About 16.2% often/very often spent time thinking/planning to use social media platforms;
  • 15% felt the need to use social media or used it to forget about personal problems; 11.5% of participants became anxious or agitated when they were banned;
  • Only 8.1% felt the negative impact of social media overuse.
• Status of social media addiction among Vietnamese youths
  • Males had higher scores on social media addiction than females;
  • Higher social media addiction scores were found in people living in rural or mountain areas or those who were single;
  • Participants who used social media to play games had higher addiction levels;
• Potential predictors of social media addiction were elucidated with statistical analysis of data. The score of social media addiction increased with both the scales for stress related to neglect by other users, and for FOMO.

Ursoni, et. al. (2022) state that specific social media platforms are detrimental to the mental health of young people, as they tend to generate feelings of inadequacy and worsen body image issues for approximately a third of teenage girls, and 14% of boys. These same social media platforms were related to suicidal thinking amongst 13% of British and 6% of American users.

Mohsenpour, et. al. (2023) conducted a study of 12-22 years old adolescents and young adults to determine the extend to which social media can exert effects on health-related behaviors such as eating behaviors. In this study of 970 subjects, 55.8% of which were boys, a higher social media addiction is related to disordered body image. Furthermore, multi-group analysis of the data revealed that increments in social media addiction were associated with higher scores for emotional eating. They conclude that social media addiction is associated with eating behaviors both directly and indirectly through deteriorating body image in adolescents and young adults.

One of the concerns which medical school administrators and professors have is the impact of social media on health sciences students. Of all people in our society, these are the individuals upon whom we depend to have a sense of empathy with their patients. Osman (2025) examined the extent of social media use and its correlation with mental health indicators among health sciences students at Mogadishu University, Mogadishu, Somalia.

He found that 84.7% of the students spent more than 3 hours daily on social media. This extent of social media use was significantly associated with sleep disturbance, mental exhaustion, social isolation, and anxiety.

What assessment tools are used?

The two most commonly used assessment tools are The Bergen Social Media Addiction Scale (BSMAS) and Sahin’s Social Media Addiction Scale-Student Form (SMAS-SF)(Sahin, 2018).

Bergen Social Media Addiction Scale (BSMAS)

The Bergen Social Media Addiction Scale is designed to ask the question, “Does this person’s social-media use show the characteristic signs of an addiction?” The BSMAS is essentially a behavioral-addiction checklist consisting of 6 questions to address each component of Griffiths’ component model of addiction:

All six questions refer to the preceding 12 months and are answered on a 5-point frequency scale from very rarely to very often. Each represents one component of Griffiths’ addiction model.

#	Addiction component	Question — paraphrased
1	Salience	How often have you spent a great deal of time thinking about social media or planning how you will use it?
2	Tolerance	How often have you felt an increasing need or urge to use social media more and more?
3	Mood modification	How often have you used social media as a way of escaping from or forgetting personal problems?
4	Relapse	How often have you tried unsuccessfully to reduce or stop your social-media use?
5	Withdrawal	How often have you become restless or distressed when you were unable to use social media?
6	Conflict	How often has your social-media use become so extensive that it negatively affected your work or studies?

These correspond directly to salience, tolerance, mood modification, relapse, withdrawal, and conflict, respectively.

The scoring is particularly simple: 6–30 points, with higher scores indicating more addictive/problematic use. There are various proposed cutoffs in the literature, but there are none no single cutoff used as a clinical diagnosis.

This scale is used for assessment individuals of all ages. In contrast, the SMAS-SF was developed by Cengiz Şahin in 2018 specifically for students.

Sahin’s Social Media Addiction Scale-Student Form (SMAS-SF)

Sahin’s Social media Addiction Scale Student Form is designed to ask the question, “How extensively and problematically is a student involved with social media?”

The SMAS-SF contains 29 items divided into four subscales: virtual tolerance (5 items), virtual communication (9), virtual problems (9), and virtual information (6). Higher scores indicate greater perceived social-media dependence. Some SMAS-SF items concern things that aren’t inherently pathological. Wanting to stay informed, communicating with others, and checking social media for information can all be perfectly normal activities. The scale is therefore capturing a broader construct of social-media dependence/addiction-like involvement.

Here is what each item is asking, in paraphrased form:

A. Virtual tolerance — Items 1–5

1. Increasing use: I find myself spending progressively more time on social media.
2. Preoccupation: I think about social media frequently.
3. Morning priority: Using social media is among the first things I do after waking.
4. Escape: I regard social media as a means of escaping from the real world.
5. Meaning: Life without social media would seem meaningless to me.

These items are quite interesting because they aren’t all measuring “tolerance” in the strict addiction-theory sense.

B. Virtual communication — Items 6–14

6. Preference despite company: I would rather use social media even when other people are physically present.
7. Online friendships: I prefer friendships formed through social media to friendships in the real world.
8. Self-expression: I can express myself better to people I interact with through social media.
9. Online identity: I can present myself on social media as I want to appear.
10. Communication preference: I generally prefer communicating with people through social media.
11. Difficulty stopping: I continue using social media despite objections from my family.
12. Social interaction: Social media is an important way for me to maintain contact with other people.
13. Online interaction: I prefer communicating through social media rather than through other forms of communication.
14. Everyday-life intrusion: Social-media activities have taken hold of my everyday life.

C. Virtual problems — Items 15–23

15. Academic/work interference: I neglect or skip my homework/other responsibilities because I spend too much time on social media.
16. Loss of control: I find it difficult to control how much I use social media.
17. Excessive time: I spend more time on social media than I originally intend.
18. Neglect of activities: Social media causes me to neglect other activities.
19. Sleep interference: My social-media use interferes with my sleep.
20. Social consequences: My social-media use causes problems in my relationships or daily life.
21. Preoccupation/interference: Social media interferes with things I need to accomplish.
22. Reduced productivity: I have noticed that my productivity has declined because of social media.
23. Physical problems: I experience physical problems as a consequence of social-media use.

D. Virtual information — Items 24–29

24. Immediate information: I use social media even while walking because I want to know immediately what is happening.
25. Keeping informed: I enjoy using social media to stay informed about events.
26. Group information: I browse social media to find out what groups I’m interested in are sharing.
27. Announcements: I spend additional time on social media to see special announcements, such as birthdays.
28. Course information: Information about my courses, homework, or activities keeps me continually engaged with social media.
29. Friends and relatives: I remain active on social media so that I can immediately know what my family and friends are sharing.

The published validation article gives the actual item content for this portion of the scale and identifies items 25–28 as particularly associated with the virtual-information factor.

Finally, the FOMO scale is used to measure the anxiety or uneasiness that other people maybe having rewarding experiences without you, together with a desire to remain continually connected to what others are doing.

FOMO scale

The most widely used measure is the Fear of Missing Out Scale developed by Przybylski and colleagues (2013). It was designed primarily as a 10-item self-report measure, which focuses on a fairly specific psychological experience:

“Other people are having rewarding experiences, and I am worried that I’m missing them.”

Its items cover two closely related aspects:

• Fear of missing rewarding experiences — concern that others are doing interesting or enjoyable things without you.
• Desire for social connectedness — wanting to remain continually connected with what one’s friends and social group are doing.

For example, the scale asks about experiences such as:

• worrying that friends are having rewarding experiences without you;
• becoming anxious when you don’t know what friends are doing;
• feeling bothered when you miss a planned gathering;
• feeling it is important to keep up with what friends are doing;
• wanting to know what others are doing even when you are busy.

Responses are generally made on a 5-point scale, from not at all true of me to extremely true of me. Higher scores indicate greater FOMO.

Why is FOMO relevant to social-media addiction?

FOMO is not itself a measure of social-media addiction. Rather, it is a psychological characteristic that may contribute to problematic social-media use.

A possible cycle is:

FOMO → checking social media → temporary reassurance/information → continued monitoring → greater dependence on social media → more opportunities to experience FOMO

Social media is particularly well suited to generating FOMO because it provides a continuous stream of information about other people’s activities. Seeing friends at a party, traveling, eating somewhere interesting, or simply interacting with one another can create the perception that everyone else is participating in rewarding experiences while one is absent.

The original Przybylski study found that people with higher FOMO tended to engage more frequently with social media and were more likely to use it in situations such as during meals, while driving, and immediately after waking. Importantly, the authors conceptualized FOMO as a motivational factor underlying social-media engagement, rather than equating FOMO with addiction.

Treatment and intervention options

Nagata, et. al. (2025) describe a number of interventions targeting Problematic Social Media Use (PSMU):

• Therapy-based interventions, including cognitive behavioral therapy (CBT) mindfulness-based interventions (MBIs), and self-compassion-based strategies;
• Media literacy, which refers to skills to evaluate and analyze information gleaned from the media. Media literacy training aims to help the individual to critically maneuver through negative content;
• Social Media Limits and Rules: Simply limiting screen time on social media has been linked to an increase in life satisfaction. In family-based interventions, adolescents collaborate with family members to set screen limits. However, simply restricting access without providing alternative coping strategies may not yield the desired long-term success.

At this point, allow me to quote the first paragraph of their conclusion:

This narrative review highlights PSMu (Problematic Social Media Use) intervention strategies and associated delivery considerations from the recent literature. Overall, interventions that equip adolescents with concrete strategies for healthier engagement with social media have shown greater potential in improving long-term well-being. Media literacy programs, while effective in raising awareness and potentially useful for prevention efforts, may lack the depth and individually tailored approach necessary to treat the mental health outcomes of PSMU. Similarly, social media limits and restrictions, despite their short-term benefits, fail to offer alternatives to generate sustainable results. Alternatively, therapy-based approaches may be more effective by using practical exercises and activities that promote the development of health behaviors with social media. These interventions also reinforce positive thought patterns and well-being beyond social media usage to address mental health outcomes arising from PSMU, such as body image. For long-lasting change, interventions should go beyond raising awareness of PSMU’s detrimental effects by actively equipping adolescents with alternatives and practical tools that will help them build sustainable habits, attitudes, and relationships with social media.

Doan, L.P.; Le, L.K.; Nguyen, T.T.; Nguyen, T.T.P.; Le, M.N.V.; Vu, G.T.; Latkin, C.A.; Ho, C.S.H.; Ho, R.C.M.; Zhang, M.W.B. (2022). Social Media Addiction among Vietnam Youths: Patterns and Correlated Factors. International Journal of Environmental Research and Public Health, 19, 14416. httpss://doi.org/10.3390/ijerph192114416.

Mohsenpour, M.A.; Karamizadeh, M.; Barati-Boldaji, R.; Ferns, G.A.; Akbarzadeh, M. (2023). Structural equation modeling of direct and indirect associations of social media addiction with eating behavior in adolescents and young adults. Sci. Rep. 13(1):3044. doi: 10.1038/s41598-023-29961-7.

Nagata, J.M.; Hur, J.O.; Talebloo, J.; Lee, S.; Choi, W.W.; Kim, S.J.; Lavender, J.M., Moreno, M.A. (2025). Problematic Social Media Use Interventions for Mental Health Outcomes in Adolescents. Current Psychiatry Reports 27:491-499. https://doi.org/10.1007/s11920-025-01619-3.

Osman, W.A. (2025). Social media use and associated mental health indicators among University students: a cross-sectional study. Scientific Reports 15:9534. https://doi.org/10.1038/s41598-025-94355-w.

Przybylski, Murayama, DeHaan & Gladwell (2013), “Motivational, emotional, and behavioral correlates of fear of missing out,” Computers in Human Behavior, 29(4), 1841–1848.

Sahin, C. (2018). Social media addiction scale – student form: the Reliability and Validity Study. Turkish Online J. Educ Technol. 17(1):169-182.

Ursoniu, S.; Serban, C.L.; Giurgi-Oncu, C.; Rivis, I-A.; Bucur, A.; Papava, I.; Brdicean, A-C. (2022). Validation of the Romanian Version of the Social Media Addiction Scale-Student Form (SMAS-SF) Among Undergraduate Medical Students. Neuropsychiatric Disease and Treatment 18:1195-1205.