This is an exclusive BHB+ story.
A bellwether lawsuit recently found tech giants like Meta and YouTube liable for platform and design features that perpetuated what has been described as “social media addiction.” While the term was used as a descriptor throughout the case, social media addiction still lacks a formal definition in the DSM, making it challenging to both diagnose and get reimbursed for treating as a provider.
Industry insiders told Behavioral Health Business they suspect this verdict could lead to formal recognition of the condition, creating easier reimbursement pathways and more straightforward diagnostic options.
There are only a handful of programs across the U.S. that formally advertise treating social media addiction. However, these programs are growing in number and are seeing more demand than ever before, providers told BHB. Other addictions in this vein — such as gambling and internet gaming disorder, which are known as process addictions — do have DSM codes.
While the DSM is not used to directly bill payers, having a diagnosis in the manual can be a catalyst for later reimbursement. Adding one for social media addiction would pave the way for standardized screening, research, treatment specifications and reimbursement.
“As the broader public and policy community increasingly treat this as a legitimate health issue, awareness and recognition grow, which can make people more likely to seek help,” Michelle Hatfield, president and chief operating officer at Kindbridge Behavioral Health, told BHB. “Because of that, we do expect demand for social media and digital addiction care to increase. On diagnostic frameworks, we are cautiously optimistic, but that process is usually much slower. … From a clinical and operational standpoint, more clarity would benefit clients by reducing stigma, standardizing care and opening reimbursement pathways.”
Kindbridge Behavioral Health is a provider of mental health and addiction care via both in-person and telehealth modalities with locations in Colorado, New Jersey, New York and Tennessee.
Year-over-year, Hatfield said patients presenting with social media or digital dependency concerns have increased by 40%.
“Because there is not yet a standalone DSM diagnosis for social media or general digital addiction, our clinicians use a behavioral addiction framework that draws on validated screening tools and comorbid diagnoses,” Hatfield said. “At intake, we use screening instruments such as the Bergen Social Media Addiction Scale, the Internet Gaming Disorder Scale–Short Form, Problem Gambling Severity Index, and Kindbridge’s internal assessment tools, alongside a full biopsychosocial evaluation.”
Kindbridge utilizes billing codes for typical diagnostic evaluation, individual therapy and family therapy. The organization also leans heavily on patients’ co-occurring mental health conditions like depression and anxiety to receive reimbursement for related treatment, Hatfield said.
“For problematic gaming, social media and pornography use, however, there is no universally adopted billing code,” Hatfield said. “As a result, care related to those issues typically has to be reimbursed through the covered behavioral health diagnosis that most accurately reflects the patient’s clinical presentation, making reimbursement heavily dependent on the payer, the state, and the clinical documentation.”
To make sure eligible services receive reimbursement, clinicians must document co-occurring diagnoses carefully. Even then, prior authorization can vary widely and several payers still don’t recognize process addictions like those listed above. As a result, often it “forces clients into self-pay arrangements and creates inequitable access,” Hatfield said.
While not standardized yet, the approaches above to identifying this type of addiction as an issue and billing for services are common. Other providers told BHB they use similar approaches.
Navigating a diagnosis that doesn’t exist
Dr. Nicholas Kardaras, CEO of New York Center for Living, a nonprofit outpatient treatment center specializing in mental health and addiction recovery, launched a technology addiction program in March. The impetus was driven by demand for these services and the success of his past work with Austin, Texas-based Omega Recovery, which has a similar program and specializes in social media addiction.
Kardaras founded Omega Recovery and launched its technology addiction services in 2018. It treats around 75-100 individuals annually for these addictions, Omega Recovery’s executive clinical director, Nicholas Hoenes, said.
“It’s especially impactful today, as we’ve seen by this court case that has laid out how these companies are doing big-time harm to people’s mental health,” Hoenes told BHB.
While the focus has typically been on younger individuals impacted by these digitally-driven addictive behaviors, Hoenes said there has also been an increase in older adults coming in identifying it as an issue in their own lives.
But getting to the point where patients recognize their technology usage as an issue is not easy because the addictive parts of these platforms reward the brain with dopamine, and the negative effects are not as visible as they are with drug addictions.
“This is where people are finding their validation, or they’re finding their community,” Hoenes said. “If you think about other addictions, you don’t get someone with substance use disorder who is addicted to heroin coming in and going, ‘I can’t quit this. I am the world’s best heroin addict!’”
But that is often what he sees with social media and gaming, specifically, he said.
That also requires a different approach to treatment, which Kardaras has been working on for years at both Omega Recovery and now will inform the new program at the New York Center for Living.
“We created a new protocol that combined a lot of evidence-based modalities, cognitive behavioral therapy, dialectical behavioral therapy, with a lot of the ‘cool stuff’ like hiking and kayaking with therapists and doing things in community with other people to break the shackles of their screen addiction,” Kardaras said. “But that had a promise as part of a digital detox.”
Omega Recovery itself is a partial hospitalization program that offers five service hours all seven days of the week. Depending on what clients need, they will typically stay in treatment between four and six weeks. A majority of the program was acquired by a private equity fund three years ago, and demand has grown since then.
“I had the opportunity to also launch this program in New York, which I thought was pretty ideal, because a lot of our clients in Austin were coming from the New York area because there wasn’t any treatment for it in this whole region,” Kardaras said. “So that evolved to us doing what we’re doing now.”
The New York Center for Living will provide intensive outpatient treatment for teens and young adults who are experiencing technology addictions ranging from video games and social media to AI.
These issues are becoming more pervasive, and he said that at some point, payers will have to recognize these addictions more formally within the industry, but that will likely require education.
“It’s getting validated by these lawsuits, it’s getting validated by the clinical reality, by the mental health crisis, by the adolescent suicide rates,” Kardaras said. “You can’t now deny all the research that’s going on that’s showing the causal relationship between technology and some of these mental health effects. At the end of the day, they’re responsive to not only their stakeholders, but to their consumers. … I think they can only keep their heads in the sand for so long before the reality has to be attended to.”
The way forward
Dr. Tan Ngo, a psychiatrist at Hazelden Betty Ford’s Center for Teens, Young Adults and Families, said he believes the recent court case will help the industry strengthen the criteria to formalize a diagnosis soon, which will in turn boost protective legislation, regulatory action and thereby payer support.
“I’m hoping that through that, that can also provide more teeth for the next iteration of the DSM to really spell clearly that yes, this should be a category that is officially there,” Ngo said. “That might be a little tricky, because it has to tie in with the ICD… and that’s been, I think, one of the biggest barriers… to be able to actually connect and bill for that.”
The ICD-11 is viewed as the sister to the DSM and having overlap between the two is critical for the field because they are treated as companion systems and ICD codes make diagnosis legible for reimbursement and health records. If a condition appears in one, but not the other, it is challenging to document, reimburse for and standardize care around.
The Hazelden Betty Ford Foundation is one of the largest nonprofit providers of addiction and mental health treatment across the U.S. Ngo said the organization is also seeing a growing share of patients present with these conditions.
“There’s real damage about this right now, because that damage and the real impacts that have been validated now through a court,” Ngo said. “I think it’s going to have more teeth with this ruling to be able to go further. But I’m hoping that the legislation will come through.”
If reimbursement and diagnostic pathways evolve around social media and other technology and process addictions, Hatfield said the industry will also need to prepare for changes to workflows, documentations and partnerships too — something that Kindbridge has been quietly preparing for in the background.
“We are already preparing for that. If a formal diagnostic code for social media or digital use disorder emerges, whether through the DSM, ICD, or payer-specific policy, providers will need updated screening and intake processes, clearer documentation templates, clinician training on the new criteria, electronic medical record updates, and more standardized tracking of symptoms, progress and outcomes,” Hatfield said. “We would also expect closer coordination with primary care, pediatrics, employee assistance programs, schools and employers, all of whom are on the front line of identifying these issues.”
But it’s worth acknowledging that “reimbursement pathways do not open in a vacuum. They follow the evidence,” Hatfield added. Before the industry can expect broader coverage and reimbursement, there needs to be more concrete research validating what providers are seeing in the field.