On Thursday 28^th October 2021 Mark Zuckerberg, Founder & CEO of Facebook Inc, made an announcement that the social media communication juggernaut that houses the eponymous Facebook, Instagram, What’s App and Oculus was to change its name to Meta (Meta Platforms, Inc).^[1] The word meta is derived from the Greek “μετα” meaning “after or beyond”, aptly named, given the growth and mainstay of virtual interaction in our daily lives post the lockdowns and the COVID-19 pandemic in the “new normal”.^[2] Though the name “meta” serves as an apt choice again, given that the word meta is the prefix to the word “metaverse”- the next digital frontier currently in the 21^st Century. In this feature we will define the metaverse, the benefits and possibilities the metaverse offers, whilst touching upon the concerns and the perceived risks to health and the measures proposed to mitigate these perceived risks. 

The metaverse is defined as a virtual reality world where users can interact, game and experience things just as they would in the real world through the conduit of current immersive technology such as augmented reality (AR) and virtual reality (VR) headsets. ^[3] There is very much an allure, intrigue and excitement surrounding the possibilities that the metaverse offers. According to a survey conducted by Statista, in which they asked respondents “What is the leading benefit of the metaverse worldwide in 2021?” The leading answer was the ability to overcome obstacles such as disabilities that impede individuals in real life. ^[4] Other benefits include; travelling the world without moving, the creation of new job opportunities as well as providing more possibilities in education. ^[5] Given the potential the metaverse offers in further enhancing the human experience, it is currently estimated to be worth $22bn (approximately £17bn) as of 2021 and is expected to be valued at $800bn (£613bn) by 2024 alone. It is even predicted that the metaverse could be a $10-30 trillion opportunity. ^{[6] [7] [8]}

Leading Benefits of the metaverse worldwide in 2021

Despite the exuberance of an imminent new digital reality and the bullish valuation and forecast attached to the metaverse, there very much exists a cautious hesitance and concern with this vast technologically immersive world. The metaverse could negatively and significantly impact a user’s mental health and could trigger problems with addiction to greater magnitudes than its primitive predecessor the Internet. The aforementioned problems are very much present with the Internet and to an arguable extent, remain unresolved.

Addiction, as defined by the NHS, is considered as not having control over doing, taking or using something to the point where it could be harmful to the individual.^[9]. A more specific and encompassing definition, defines addiction as a chronic brain disorder molded by strong biosocial factors that has devastating consequences to individuals and to society.^[10] The pathophysiology of addiction is underpinned by the delineation of the neurocircuitry that mediate reward and motivation, executive control and emotional processing. There are three regions of the brain that are responsible for the cyclical process of addiction. They are the prefrontal cortex, the basal ganglia and the amygdala and we shall cover their roles very briefly.

The prefrontal cortex is the region that underlies executive functions essential in the process of supporting an individual in making rational and healthy decisions whilst regulating our emotions.^[11] The craving stage of addiction is associated with the prefrontal cortex as the conditional stimuli (drug/addictive artifact) elicit dopamine in the striatum, triggering the motivation to seek and consume the drug. ^[12] The neurocircuitry includes various regions of the brain, the hippocampus & amygdala, of which, glutameric projections from these regions modulate the sensitivity and reactivity to cues and adverse emotions that trigger the urgent motivation for, and preoccupation with drug taking.^[13]  The second region, the basal ganglia, is responsible for intoxication and the binge use of the stimuli. During this stage “the drug” stimulates large bursts of dopamine in the mesolimbic reward system that reinforces drug taking and establishes a strengthened conditioned associations, between that preceding drug consumption with expectation of reward.^[14] The final region of the brain involved in the role of addiction is the amygdala, specifically the extended amygdala. The amygdala is responsible for the withdrawal phase, the period in which the intoxicating effects of a drug wear off. This period is associated with the ubiquitous negative moods; ahedonia (inability/loss of feeling pleasure), increased sensitivity to stress, dysphoria (a state of unhappiness, restlessness and frustration). The dopamine reward/motivation system is hypofunctional contributing to ahedonia and the aversive state during withdrawal.^[15] The circuits underlying the withdrawal phase comprise of basal forebrain areas including the extended amygdala. Increased signaling in these circuits are responsible for continuing the cyclic process of addiction as they trigger aversive symptoms that reverts and renders an individual to succumb to their vulnerability of cravings and preoccupation with taking drugs.

The relevance and correlation between addiction and the metaverse resides in the immersive technology projecting a powerful illusion of reality, a testament to the sheer awesomeness and power of the metaverse and the components that contribute to sensory overload that poses a neurobiological risk to the user. The neurobiological risk can be observed and assessed in both youths and adults. 

In youth, the neurobiological risk arises from the detrimental impact the metaverse may have on neuroplasticity, given that the adolescent brain has not completed its development and as a result is more neuroplastic than an adult brain.^[16] In the human brain from early to mid-20s the rate of development differs across neuronal circuits with development growing faster and earlier for reward/motivation than for prefrontal top-down control circuitry (emotional control and decision-making) which develops last. Hence, early exposure to a stimulus of abuse, runs the risk of significantly impairing the development of the prefrontal cortex and subsequently increases long-term risk of addiction as a result of increased neuroplasticity in a youthful brain and explains why addiction develops faster in an adolescent than in an adult. ^[17]

In adults, the neurobiological risk, arises in the form of impaired decision-making and an imbalance in assessing long and short-term consequences against rewards, hence potentially engaging in irresponsible and reckless behaviour. In a brain unaffected by addition, the circuits controlling desire for a drug/stimuli are held in check by the prefrontal cortical region. However, when the prefrontal cortical circuits become hypofunctional as a result of repeated exposure to drug or stimuli, the addicted individual is incapable of resisting the strong motivation that desires the drug or stimuli. This explains the difficulty an addicted individual faces when trying to stop taking drugs even when they experience negative consequences and the drug’s pleasurable effects.^[18]

Just as addiction from over stimulation from the use of the metaverse can impact the neurobiology leaving an impact on the anatomical and physiological structure on the brain, overstimulation of the metaverse can impart a negative psychological impact upon the mind, compromising the user’s mental health. Given our knowledge to date of social media’s and online gaming effect on the brain, they serve as relatable templates to forecast and examine the potential effects the metaverse may have on mental health.

The potential damage to mental health begins from the activation of the dopamine system that provides temporary pleasure and a form of escapism sought by the user of the metaverse. The negative impacts begin to arise post the binge and intoxication phase, fully manifesting itself through the vicious circle of tolerance and dependence (T&D). Tolerance, in so far as incremental prolonged use for the same level of stimulation and dependence (psychological dependence - emotional and motivational withdrawal), would be the byproducts of an individual’s immersion into a digital world that increases the likelihood of being divorced from reality.^[19] This risk is greater if the users has a genetic disposition to T&D. It is the discrepancies between perceived reality and actual reality that leads to symptoms of anxiety and major depression, predominant symptoms that impact mental health and well-being when reviewing the effects of long-term use of social media and online gaming. Having illuminated the challenges and concerns surrounding the metaverse, with regards to addiction and mental health, our attention shall now turn to suggestions and possible solutions to safeguarding an individual’s experience in the immersive world of the metaverse. 

Dangers of the metaverse according to Internet users worldwide in 2021

With the impending mainstream adoption of the metaverse and the admission of Meta Platforms Inc’s vice president of augmented reality, that moderating user behaviour at “any meaningful scale is practically impossible”, there indeed exists a race to provide safety measures to protect and improve the users experience, particular if it poses any risk or harm to wellbeing mental or physical. ^[20] One organisation leading the efforts to combat harm to users of online services, such as the metaverse, whilst preserving the safety and wellbeing of society is the Carnegie United Kingdom Trust (CUKT). The CUKT aims to do this through the development of the Online Safety Bill (OSB). The OSB is a proposed Act of Parliament with the intention to improve Internet safety. The responsibility of creating the skeleton and model underpinning the OSB has been tasked to Professor Lorna Woods (Professor of Internet law at University of Essex) and William Perrin (Carnegie UK Trustee).^[21] Through the work of the aforementioned academics, they seek to eventually create an encompassing piece of legislation with the proposed OSB as a means to increase the scope of liability to ensure technology companies can not use the metaverse to escape regulation.^[22] The regulation would tackle issues surrounding body dysmorphia and false advertising, which both contribute to mental health disorders as well as the ingredients that lead to addiction as mentioned by a previous Meta Platforms Inc whistleblower Frances Haugen.^{[23] [24] [25]}  Nevertheless, it is immensely difficult to say with any certainty to what extent the metaverse would impact addiction and mental health from its current form today. However, proposed bills, like that of the OSB, and with the oversight of the Carnegie UK Trust, are meaningful attempts to safeguard the wellbeing of the society and its members from the potential effects of metaverse.



To reiterate, this article is not a hit piece or criticism of Meta Platforms Inc. for they are not the only companies exploring the capabilities of the metaverse. Google, Disney, JP Morgan and Microsoft. The metaverse can indeed be a force for good. This has been demonstrated in the therapeutic applications of clinical mental issues such as; anxiety (social), phobias, PSTD, delusions and hallucinations.^[26] . Aside from the clinical benefits, the metaverse has the capacity to provide us with opportunities and experiences that either compliment or enhance our daily experiences ranging from work possibilities, to live entertainment to education.^[27]

Main Reasons for Joining the Metaverse, according to Internet users in 2021

Through, this article we seek not to be alarmists or prophets of doom. We seek not to accelerate the fears of the arrival of a dystopian future here on Earth, depicting isolated and drooling addicts seeking ruinous, though pleasurable escapism, akin to those that frequented the opium dens in the 19^th Century. Nor do we wish to be the luddites that obstruct the pioneering and logical pathway towards technological evolution. Rather, we seek to scrutinise and objectively critique caveats in the adoption of the metaverse and the negative impact to societal health and wellbeing. We have an obligation to do so as a means to probe and evaluate our defences in order to establish our level of preparedness, not just in providing a safe user experience of the metaverse, but in supporting a user’s clinical needs and wellbeing should it be required. 

To conclude, the metaverse is the next inevitable frontier for the Internet and how we connect with it. The metaverse at this nascent stage, is a source of much hype and conjecture and it is the latter that gives rise to skeptical caution, which can be misconstrued as pessimistic and regressive. Rather, it seeks to highlight genuine concerns of addiction and their effects upon neurobiological development and neuroplasticity, along with the impact upon an individuals perception of fantasy (escapism) and reality and thus on the mental health and wellbeing of users. Nevertheless, there exists much curiosity, excitement and optimism as the metaverse presents a host of opportunities and enhancements, all of which is intended to be delivered within proposed UK regulatory parameters of the OSB to reduce online harm whilst using the metaverse. It is indeed too early to say and near nigh impossible to confidently forecast the impact of the metaverse on addiction and mental health. However, what must remain at the forefront as we head towards the adoption of the metaverse is the collaborative cooperation of healthcare institutions, regulatory institution and technology companies that create and provide the online experience and service of the metaverse to devise a framework that allows for the full capability of the metaverse to be enjoyed whilst safeguarding the health and wellbeing of users. Nnadi’s Healthcare & Pharmaceuticals stand ready to contribute and support these efforts when the opportunity to do so arises.

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