Hooked on Q-Tips

“A day doesn’t go by that I don’t see people come in with Q-tip-related injuries,” laments Jennifer Derebery, an inner-ear specialist in Los Angeles.

And yet there’s a scary warning on every box of Q-tips. It reads, “CAUTION: Do not enter ear canal. … Entering the ear canal could cause injury.” How is it that the one thing most people do with cotton swabs is also the thing manufacturers explicitly warn them not to do? It’s not just that people do damage to their ears, it’s that they keep doing damage.

Some even call it an addiction. On an online forum, Q-tip user associates ear swabbing with dependency: “How can I detox from my Q-tips addiction?” MADtv ran a classic sketch on a daughter having to hide Q-tip use from her parents like a junkie.

What if Q-tips really do share something in common with other, more prevalent addictions like gambling, heroin, and even Facebook use? When a perceived solution to a problem becomes the problem, the resulting behavior shares something in common with addiction. The phenomenon raises some important questions about everyday products, and the responsibilities their makers have in relation to the welfare of their users.

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Some clinicians define addiction as a harmful, persistent, and compulsive dependency on a behavior or substance. But unlike other vices, addiction also implies self-inflicted damage. Simply doing something a lot, like checking Facebook or watching television, wouldn’t qualify as addiction unless the user has difficulty stopping the activity even though it harms them.

According to Marc Lewis, a developmental neuroscientist at Radboud University, addiction is another form of learning. “It’s the brain taking the shortest route to get what it wants, repercussions be damned.” An addict turned academic, Lewis documented his experiences with psychotropics in his book Memoirs of an Addicted Brain.

Lewis doesn’t believe addiction is a disease, at least not in the way cancer or glaucoma is a disorder in the structure of an organism. Rather, he understands that addiction is the brain’s rewards system channeling attention to just one single, solitary stimulus.

Most people think of addictive substances having powerful chemical hooks to which anyone could succumb, but that’s not really true. “Not everyone responds the same way to a drug,” Lewis told me. “Some people don’t like heroin, for example. It just doesn’t feel good to them.” Millions of people are given high-potency opiates after surgery but only an unfortunate few form a dependency. Many people drink alcohol but a tiny fraction become alcoholics. Everyone  eats, works, and has sex without necessarily becoming compulsive eaters, workaholics, or sex addicts.

What accounts for the difference? “It could be that what feels good is what you’ve been missing,” Lewis explains. In other words, an addictive behavior has to scratch a specific itch, physical or psychological. Addiction (as opposed to moderated use) requires that lingering itch.

For Q-tip users, it starts with an unpleasant sensation, perhaps some excess wetness from the shower. Using soft white cotton on the end of an ear canal-sized stick seems like a reasonable solution to the problem, despite the manufacturer's warning.

Of course, the problem isn’t really a problem. “Ear wax is good. It is supposed to be there,” Derebery explains. You don’t need to clean your ears; just being patient will resolve the sensation of wetness. Addictive products always provide the brain with a temporary fix—but the solution creates more of the problem. Repeatedly rooting out the ear canal dries out the skin and can scratch the eardrum, causing inflammation. Inflammation feels a lot like the blockage that incited the ear prodding in the first place. The more you prod, the worse the itch becomes, and the more you scratch. The cycle continues until medical attention is needed.

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I call it the Q-tip Effect: when a perceived solution becomes the source of the problem. Problem gambling leads to financial stress, increasing the allure of escaping into a mindless zone state where the weight of the gambler’s troubles can’t be felt. The social isolation and guilt that comes with opiate abuse makes the warm, love-like embrace of a heroin high even more desirable.

This itch-scratch cycle isn’t exclusive to products. The same pattern can be found in habits like nail biting or skin picking, where irritation exacerbates the underlying problem and prompts more of the self-harming behavior. But there’s something unique and unsettling about addictions to manufactured goods and services. When it comes to addictive products, someone profits from the harm done.

There are two types of addictive products. The first is the kind where the manufacturer does not know the user. Alcohol, cigarettes, and even Q-tips fall into this category. These products are bought off store shelves, leaving the manufacturer with little information about who uses their wares, how, and how much.

In the second type of addictive product, the maker knows their users’ behaviors well. Casinos know their players through loyalty cards. Gaming and social media companies track every user’s click. And drug dealers know each of their clients.

Both manufacturers who know and who don’t know their addicts can help dampen the addictive effects of their products in different ways. Companies that don’t know their users have an obligation to warn potential buyers if there’s a high likelihood of harm. The more visible and ominous the warning, the more effective they are at preventing abuse.

In Australia, for example, where cigarette cartons come plastered with a grisly image of a swollen cancerous mouth or a young man on his deathbed accompanied by large text reading “SMOKING KILLS,” smoking among adolescents has hit an all-time low. A manufacturer of cotton swabs could make the warning label more prominent, include an image of potential ear damage, or even print “DON’T STICK THIS IN YOUR EAR!” on the side of every swab.

But makers of these kinds of products can only do so much. People potentially abuse all sorts of things. Watching an episode of the television show My Strange Addiction spotlights people suffering from addictions to eating paint, smelling pine cleaner, and even “balloon loving.” It’s hard to justify asking the makers of every product to warn every possible user against every conceivable misuse.

However, there’s a difference between accepting the unavoidable edge cases among unknown users and knowingly promoting the Q-tip Effect. When it comes to companies that know exactly who’s using, how, and how much, much more can be done. Companies have an obligation to help when they know someone wants to stop, but can’t.

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Silicon Valley technology companies are particularly negligent by this ethical measure. Two years ago, I published a book on how to make products more habit-forming. The book became a bestseller and I’m frequently asked to consult with companies—particularly tech companies—looking to make their goods and services stickier and harder to stop using.

Unfortunately, making things more engaging also makes them more potentially addictive. The techniques I describe in the book, intended to help product designers build healthy habits in their users (like using a wellness app, keeping better track of personal finances, or staying in touch with family and friends) are the same tactics used by some to keep people un-healthfully hooked.

The solution is not stripping out what makes these products engaging; rather, it’s helping the addicts. Luckily, the two-way nature of Internet-connected services means companies could—if only they chose to—identify, message, and assist people who want to moderate use.

For example, instead of auto-starting the next episode on Netflix or Amazon Video, the binge-inducing video streaming services could ask users if they’d like to limit the number of hours they watch in a given weekend. Online games could offer players who cancel their accounts the option of blacklisting their credit cards to prevent future relapses. Facebook could let users turn off their newsfeeds during certain times of the day. Apple and Android could proactively ask certain users if they’d like to turn off or limit the triggers associated with notifications.

These services know the usage patterns of each and every user. They don’t need to bother everyone, just those people showing patterns of behavior indicative of a problem. For example, setting a trigger based on the number of hours spent using an online service could prompt the company to reach out to suggest ways to cut back or deprecate certain features.

Indeed, the benefit of all the data being collected these days is that companies could use this information to help people who may be harmed by their products’ overuse. Clearly, there are many things tech companies could do to help users break the cycle of addiction. Whether they actually do anything is another matter.

There are some industries and companies that can’t and won’t help addicts. It’s not just dealers of illegal drugs who benefit from harmful addictions. Legitimate industries depend on addicts as well. For example, those ubiquitous ads for online games like Clash of Clans and Candy Crush are fishing for what the industry calls “whales”—the 0.15 percent of players who bring in 50 percent of revenue. In an industry where the cost of acquiring players is barely less than the revenue generated per user, whales tip the scales to profitability. Without these extreme customers, their businesses aren’t viable.

Similarly, the casino industry depends on a disproportionate share of revenue coming from a small group of likely addicted gamblers, some of whom wear adult diapers to avoid having to stop playing. While most American casinos are required by law to have “self-exclusion” programs for gamblers who wish to stop their addiction, casinos have been known to welcome problem gamblers back with open arms.

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Thankfully, not all companies are as dependent on addicted users as the casino and online gaming industries. Helping addicts wouldn’t much hurt Facebook or Reddit, for example.

In fact, some tech companies are already limiting overuse, albeit in rudimentary ways. Stack Overflow, a technical question-and-answer site used by 6 million coders, was designed with breakers built-in. “The current system is designed to reward continued participation, but not to the point that it creates obsession,” according to a post on the site by co-founder Jeff Atwood. “Programmers should be out there in the world creating things too,” Atwood noted, stressing that Stack Overflow should be a utility, not an addiction.

Unlike Q-tips and cigarettes—potentially addictive products where the manufacture does not know the user—online services intimately aware of their users’ online behaviors have an opportunity to intervene. Of course, tech companies won’t be able to “cure” addictions, nor should they attempt to do so. Nor should they act paternalistically, turning off access after arbitrarily determining that a user has had enough. Rather, tech companies owe it to their users simply to reach out and ask if they can be helpful, just as a concerned friend might do. If the user indicates they need assistance cutting back, the company should offer a helping hand. With the data these companies collect, identifying and reaching out to potential addicts is a relatively easy step. A harder one, it seems, is caring enough to do the right thing.