Dr. Anna Lembke
Appearances
Pivot
Trump's Big Speech, Trade War Roller Coaster, and Elon v. Jon Stewart
Drugs in all their forms are the great human replacement. Addiction is a disease of loneliness. even if we have a lot of great people in our lives, if we get addicted, we will isolate, and we will use our drug to replace that human connection.
Pivot
Trump's Big Speech, Trade War Roller Coaster, and Elon v. Jon Stewart
And I say that because we sometimes talk about loneliness as the cause of addiction, but more often than not, what I see is that the addiction causes the loneliness. Oh, I like that.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
They were excited. And from the moment we got into the car and started driving to Yosemite Valley, I felt excited. a distinct difference in the quality of the presence of all of us, even in the car. And it lasted through the whole three days. It's like we played board games. We had meals together. And the key thing there was like nobody was sort of
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
looking toward the end of the meal to go check their device. Because there was no device to check, we lingered, right? We extended these conversations. We moseyed along after dinner, you know, under the stars. It was so different. And I became even more convinced that we need internet-free communal spaces. We need places where we come together
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Not all of the time, but some part of the time we come together and nobody is connected to the Internet and they can't get connected. Because when the ability to choose is removed, it changes the state of craving.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, I think that's right. We are now turning to these devices and to the Internet to meet our physical, emotional, sexual, educational, every need we have. We don't really need other people anymore. We can get those needs met from the Internet. And I think that's a very scary prospect because I think it means that we will get more and more isolated.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
The Surgeon General issued an advisory on our loneliness epidemic. And the irony is that even though the Internet can connect people, you know, across oceans and borders in a way that's amazing, it also, I believe, engenders and creates more isolation because people aren't needing other people in the same way anymore. They're getting their needs met. through the internet.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And originally the concern was sort of like, oh, well, they're getting their needs met through other people in chat rooms or what have you for good and bad. But yeah, as you point out, now with AI and large language models, it's not even real people. It's like this amalgam of collected language creating a simulated person. I don't know. I just, it's really scary.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Right. So the data here is really preliminary, and we need a lot more research. But there is clearly a signal that the GLP-1 agonists can help with alcohol addiction. We have patients in our clinic who have failed all other treatments for whom we have prescribed GLP-1. Things like Ozempic and Munjara and seen benefit.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And these are people who literally have tried everything and struggled for years and years and now report sustained remission from alcohol in a way that's just so hopeful and wonderful. I think there are some studies showing its benefit in possible behavioral addictions like gambling disorder and sex addiction. So, yeah, I mean... I want to emphasize that they don't seem to work for everybody.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So it's not like some kind of miracle cure. I mean, we have patients for whom, as I just described, they seem like a miracle cure. And then we have other patients for whom they don't really seem to do much. And that's true across the board with our medication treatments for all kinds of addictions. They work for some people individually.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And not for others, which is why it's so important that every individual has access to all the different options so they can use what works best for them.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So I know that my work is often interpreted that I'm skeptical of medical interventions.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I guess I would nuance that a little bit and just say I have seen that our medical system overemphasizes prescribing pills and performing procedures because it's more lucrative and it's faster and because we have a system that's not well set up to deal with chronic relapsing and remitting disorders like addiction and and other mental health concerns.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
But I very much use all kinds of medical interventions. I prescribe psychotropics and other types of medications on every clinic day. So what I'm seeking is more balance here and the recognition that, first of all, that psychotropics are overprescribed and that many patients experience debilitating polypharmacy where they're on 13, 14, 15 different psychotropics
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
to the point where it becomes completely unclear what's working, what's not. Plus, you have drug interventions, which can be really dangerous. But getting back to GLP-1, I mean, you know, I don't have really a judgment one way or another about whether people should stay on them long term. I think it depends on the person.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
You know, it does appear that when people stop the GLP-1 agonists, they have, with food addiction, a resurgence in their appetite and they're at risk to gain the weight back. I've seen reports of individuals now kind of pulsing the GLP-1 agonists and
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I think the irony is that amazing research has been going on for a long time, but for whatever reason, the American public hasn't been particularly interested until very recently. And why that shift? I mean, I have my theories. I think that with the advent of smartphones and 24-7 access to the Internet online,
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So using them for a period of time and then going off of them and then going back on for brief periods in a kind of pulsing way if, you know, the weight starts to creep up again or the relationship with the food starts to get verklempt again.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I think those cultural shifts can have a huge impact. I think we are seeing that with alcohol. More people, especially in the last two to three years, seem to be interested in drinking less alcohol. This is, you know, outside of the temperance movement and prohibition, it's definitely a new trend. But I think like most things, it tends to be a pendulum swing.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
We typically go too far in one direction and then too far in another. I mean, in general, I think it's very good.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Obviously, given my profession and all the terrible harms I've seen associated with alcohol and drug use and other addictive substances and behaviors, you know, I'm glad that there's more awareness and that people are interested in finding out about how to have fun together without using substances.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I do have a fear, though, that progress in the arena of drugs and alcohol might be happening because people are turning to digital drugs. I don't know. I hope that's not the case, but I do have some concern in that regard.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, it's a really fair question, and I think on some level we really are, which then begs the question, what is it about human nature, or I would argue, what is it about modern life that makes us so vulnerable to these addiction problems? I have kind of a, you know, some theories on that, totally, you know, speculative. Hit me. All right. You know, I think that...
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
We're essentially struggling with endemic narcissism, where our culture is demanding that we focus on ourselves so much that what it's creating is this deep need to escape ourselves. And I think that is what is driving much of our pursuit of intoxicants as a way to just not have to think about ourselves for a blessed hour or two.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, that's right. And it's not like the whole explanation, because obviously the whole point of dopamine nation is that we also live in this world of abundance with constant access and access alone is a risk factor. So I've already kind of made that point.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
But although I think access is important and supply is more important than we have given credit for, we do have to focus on the demand part of this equation. What is it about our lives now that make us so desperate to essentially be intoxicated in one form or another? And I do think it is this sort of obsessive self-focus.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I think that we can, like most things, take it too far and end up doing harm with all the time that we spend thinking about ourselves. Now, having said that. I think that good therapy gets us to a place where we can mindfully observe ourselves without being self-absorbed. But ultimately, I think the goal is to tune out.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
All of a sudden, people who saw addiction as a problem that somebody else had began wondering about their own compulsive consumption of digital media. And then I think COVID just really, like, you know, we just went off a cliff with COVID. Sure did. Yeah. And it was, I think, along the lines of, like, life is really weird.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
That is not to tune out as in not listen to ourselves, but to get out of our own heads ultimately. Yeah.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, I mean, it's a really sad, sad thing when people die of their, you know, mental disorder, addiction or otherwise. You know, there are lots of risk factors for addiction. There are genetic risk factors.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
If you have a biological parent or grandparent with alcohol addiction in particular, where the evidence is strongest, you're at increased risk for alcohol addiction, even if raised outside of that alcohol-consuming home. So we know there are genetic vulnerabilities. People don't come into the world. with equal risk.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Having said that, given all of the different drugs, including drugs that didn't exist before and the increased access, I think even without a genetic risk, we're now all more at risk than we were before. You know, there are social determinants of health that make a big difference in terms of people's ability to
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
To get into recovery, we know that poverty is a risk factor, multigenerational trauma, unemployment. These are all enormous risk factors that if we could target, we would improve people's chances of pulling out of the spiral of addiction. Gosh, I mean— There's a whole element, too, I would say, of just unpredictability.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Like, I used to think that I could predict when a patient came in whether or not they would be able to get into recovery, and I've long given up that idea. I've seen people with decades of severe and life-threatening addiction miraculously late in life get into recovery. And I've seen people who I thought for sure were helpable who ended up dying of their disease. So...
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
You know, there is still a lot we don't know.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So my father's alcoholism was a major factor in my childhood. He was a surgeon, but he would go long periods without drinking, and then he would have long periods where he was drinking large amounts every day.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I remember coming home from elementary school with my best friend Laura and finding him not on the hammock but under the hammock passed out and just looking at her and saying, let's go to your house. So, you know, that was sort of a specter in my childhood.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Like, I am at home all day long in my pajamas consuming more alcohol, more cannabis, more YouTube shorts. And I think all of a sudden people were like, wow, this addiction thing is real. And I do think that that's been a big cultural shift. And so I think it's more that the spotlight has turned toward this problem.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
What I first did with that in medical school and residency was to not want to have anything to do with addicted patients, just because that's kind of what we call negative countertransference, but also hadn't really learned very much in medical school or even residency. So I didn't have the tools, didn't know what to do.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And then very early in my career, I was specializing in treating mood disorders. And I had a young woman in my clinic I was treating for depression. Her parents were paying for the care. And I saw her weekly and we had in-depth discussions about her childhood. I talked about every conversation she'd ever had with her mother. I was prescribing an antidepressant.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And I noted that she would often nod off in the sessions. And I thought, huh. That's funny. I wonder why she's so sleepy. Maybe she's a slow metabolizer. You know, I was like, I was trying to draw on, you know, what I had learned in medical school. And then one day her brother calls me out of the blue and he says, she's been in a rollover car accident. I said, oh my goodness, that's terrible.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
What happened? And he said, well, she's been using again. And I literally did not understand anything. the structure of that sentence. As using, I said, using what? He said, well, using heroin. Isn't that what you've been treating her for? Oh, wow. Yeah.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And that was the moment that I realized I'm a bad psychiatrist because the kind of don't ask, don't tell policy, because I never once did ask her about drugs and alcohol, and she never once volunteered the information, but that's not really her job, right? It's my job to get that information.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So I was really doing harm to patients out of my ignorance, and that was a huge turning point in my career. I realized, oh my goodness, I need to figure out something about addiction or I'm going to be a menace. And the irony is that... As soon as I started asking patients about drugs and alcohol, they were eager to talk about it.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And the majority of my patients had problems with drugs and alcohol. And when I started treating that problem alongside their other psychiatric disorders, they got better in ways I had never seen prior to that. And the work was fun. It was so enjoyable. People got into recovery. They were amazing people. Their recovery impacted their spouses and their children and their parents and their workers.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
It's like the most rewarding work. So a lot of times people say, well, how can you do this work? I say, are you kidding? It's the best work. It's the best population.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, there is something trivializing about doing that. And I don't mean to do that. You know, I don't mean to compare my relatively modest compulsive overconsumption of romance novels with people who are struggling with life-threatening addictions.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
On the other hand, by drawing a comparison between what they're struggling with and what I struggled with, I'm also attempting to humanize the behavior and to acknowledge the ways in which we're all vulnerable to compulsive overconsumption given enough access to our drug of choice. So, you know, again, just looking at my own life here,
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
As I mentioned, you know, father with severe alcoholism, alcohol does nothing for me. Absolutely. It's not reinforcing. And so therefore, I've never been vulnerable to alcohol addiction. And so thought I just wasn't vulnerable to addiction, period. But the truth was, I hadn't just hadn't yet met my drug of choice.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And my drug of choice turned out to be this behavior I've done as an escape behavior since childhood, which is read. But then once, you know, kind of discovered a certain type of romance, vampire novel at a certain critical period in my life, plus the applied technology of a Kindle, which meant I had immediate access 24-7, I was off and running.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And yeah, it never got to the point where it was life-threatening, but it did get to the point where I was staying up till three in the morning every night reading. I was bringing romance novels to work and reading in the 10 minutes between patients.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I was taking romance novels to neighborhood parties and going and finding a room during the party and reading romance novels rather than... You mean that's not normal?
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
You know, what I argue for is a combination of trying to avoid using intoxicants in high volume too often. So it's not that I imagine that, you know, we're never going to use intoxicants. We wouldn't be human, and it's a deep part of our culture, and it can be neutral or even beneficial. But we have to really be careful about over-consuming intoxicants or consuming them too often.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And I do think given this world of abundance that we have to now intentionally seek out things that are hard. Because our lives have become so easy, so convenient, so sedentary, the default is a state of consumption that's ultimately not good for our bodies or our minds.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So I do think that we have to kind of simulate hardship and intentionally create inconvenience and create struggle for ourselves.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Well, I've never heard the amoeba analogy, which is kind of funny. Yeah. Yeah, I mean, right. There's the risk here that it all starts to sound too schoolmarm-y, right, or kind of scolding or judgy. And that's a real danger, and I wouldn't want—I'm sure I probably do come off that way, and that's not at all my intention. I sometimes feel like that. Yeah, right, right, exactly.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I mean, I've got kids, so you can imagine how they feel. I mean, you know, again, I can certainly appreciate a criticism of my including things like that, like, oh, that lady doesn't want us to do anything. We're just going to be bumps on a log and not just... But I think what I'm advocating for is something like a reframe. You know, when we decide not to indulge in these pleasures...
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
It's not like all of a sudden things shifted in 2020. I think what happened was COVID just accelerated the trends that were already happening. So to put it in perspective, just from my clinical front row seat, such as it is, in the early thousands, what we were seeing is a sudden increase in people addicted to the very same pills their doctors were prescribing to them.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
The culture has us telling ourselves that we are denying ourselves. And I think a potent reframe here is, no, I'm actually going towards something that's good for me and that in the long run makes my life better. So, you know, I mean, that's just what I see clinically. That's what I've experienced in my own life.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And I think people are unhappier than they'd like to be and kind of can't figure out why.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
foremost opioids for chronic and minor pain conditions leading to our current day opioid epidemic, but also a signal early on in the early 2000s, middle-aged men coming in with severe internet pornography addiction and compulsive masturbation, primarily men who had been able to consume pornography in reasonable moderation without a lot of harm to their lives until the advent of the internet.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And then especially, you know, in the first decade of the 2000s, the smartphone. And that was probably our earliest signal for behavioral addictions. And then around 2012, 2013, we were seeing a bunch of teenage boys brought in by their parents primarily for Internet gaming disorders.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And then sort of roughly 2015, 2016, we start to see the earliest signal of social media addiction, online shopping, a huge increase in online gambling addiction. And then what I would say I've seen primarily in the past five years is a sort of diffuse addiction to the Internet, right?
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So people will have their drug of choice, whether it's shopping or social media or video games or pornography or what have you. But if that's not available, they'll switch to something else.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others. Importantly, there is no brain scan or blood test to diagnose addiction, and there won't be for a very long time, if ever.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
We still base our diagnosis on what we call phenomenology, which is patterns of behavior that repeat themselves across individuals, temperaments, cultures, time periods, etc.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Oh, interesting.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Well, I mean, I think these issues are debatable, and the use of language is important. When I use the term addiction, I am talking about a form of psychopathology, which is a spectrum disorder. So there is mild, moderate, and severe addiction. When we see severe addiction, we all recognize it. Like, it's obvious, right?
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
They're struggling, they're suffering, there's incredible consequences as a result of their use, and yet they can't stop using without significant help. On the less severe end, you know, it's much harder to tell when we might cross over from healthy, recreational, and adaptive use of a substance or a behavior into unhealthy, maladaptive use.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And often that's a judgment call, and it's also culturally informed. So, for example, when we think about something like work addiction, right, we live in a culture that absolutely celebrates workaholism. So we're not really going to identify that as a problem, typically.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
It is both, right? So sometimes... an outside observer might say, hey, this is clearly a problem. But, you know, a part of the addiction process is that we ourselves don't necessarily recognize a problem, even when it's obvious to others. This is why people talk about denial as an important part of the addictive process. People end up with this kind of double life phenomenon where
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
They have this secret life where they're engaging in their addictive behaviors, and then they have this other life that other people see. And the lives are so separated and the addictive life is so covert that we can actually convince ourselves that it's not really happening or it's not happening to the extent that it is or that it's not causing problems, even if it is happening.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
I agree 100%. This is a collective problem. I see it as part of the Anthropocene, which is a term that's been coined to describe the age we live in now, when human action is changing the face of the planet for the first time in history. You know, climate change is often included in this idea of the Anthropocene.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
But I do think that this, the stressors of overabundance should also be included in that. In the richest countries in the world, we have more leisure time, more disposable income, more access to leisure goods than ever before. And I think that, you know, as a result, we are all struggling to know what to do with all that extra time and money.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And one would hope and think that we would be like engaging in deep philosophical discussions, helping each other, cleaning up the garbage. Sorry, I'm laughing, of course. Yeah. But instead, what we're doing is spending a whole lot of time masturbating, shopping and, you know, watching other people do things online.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And essentially what's happened is we're spending more and more time of our energy and creativity investing in this online world. which means that we are actually leeching our real-life existence of our energy and creativity. So when we try to get off out of the metaverse and reenter the real world, it actually is more boring, right? Because there's less going on because there's nobody there.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yes, exactly. And it seems to me we've kind of crossed over some kind of abundance set point where we went beyond meeting our basic survival needs and now have so much access to so many pleasure-inducing substances and behaviors. that we may actually be changing our brain chemistry such that we're in a dopamine deficit state.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Now we need to keep using these highly stimulating drugs and behaviors not to get high and feel good, but just to level the balance and feel normal. And, you know, interestingly, even more recently, I'm part of a state of the nation project.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And some of the findings that we're seeing for the United States are that despite the fact that a lot of parameters would suggest the nation is doing better, from a mental health perspective, we're doing worse. And that's true around the world. Rates of depression, anxiety and suicide are going up in countries all over the world. And they're going up fastest in the richest nations of the world.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So there's some kind of phenomenon where this overwhelming overabundance has reached a tipping point such that now we're actually dealing with the stress of overabundance, which our ancient reward pathways were not really evolved for.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
No, I don't. I mean, I think we all struggle with appetitive control in the modern world. But I do think it's important to use this term addiction, or as the DSM defines it, a use disorder, as when we've crossed that threshold into self and other harm that is on some level out of our control.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
So I don't want to just say like everybody's addicted, but I do think that the problem of compulsive overconsumption has become something that all of us are probably struggling with in one form or another.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
And, you know, although I've been treating addiction for, gosh, going on 30 years and thought that I personally was somewhat immune to the problem of addiction, it wasn't until I got addicted to romance novels that I was like, oh, wait a minute, like, even I can get addicted to something. Right.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
Yeah, I'm always a little reluctant to talk about sort of, you know, what we as a family did, because I don't want people to feel like, oh, you know, we should have done that or we should do that. I really think every family has to kind of find their own way. And I will say up front, I mean, my family struggles with this as much as the next family.
The Daily
'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
But one thing that we did as a family that I am very grateful for and my kids are grateful for is that We did not have any devices in the home environment until our eldest started high school. Now, when our daughter started high school, she came home and said, I actually can't function as a student in high school unless we get a connection to the internet.
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'The Interview': Digital Drugs Have Us Hooked. Dr. Anna Lembke Sees a Way Out.
You know, we're in the heart of Silicon Valley. So we realized that that was true. With the constantly changing high school schedules, all of the assignments in line, like there was no way to participate in high school life without without connecting to the internet. And this was already some eight years ago when she started high school.
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So we got internet connection, and really it was downhill from there. I just want to pause here.
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We did not have internet in our home, and I did not own a smartphone, if you can believe it, until about 2019 when I was forced through work to get one in order to be able to prescribe controlled substances using Duo Security. Again, I want to emphasize, like, I'm not judging other people because... I get it. Most people... I'm just at awe.
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Yeah, well, and, you know, I have the kind of work that allows me to do that. Most people do not have that.
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Exactly, exactly. But, you know... What can I tell you? My kids are now between ages 18 and 23. They have struggled to various degrees with their time online. But what I'm really grateful for is that they have at baseline this notion that too much time on the Internet is not a good thing. It's not a good thing for relationships. It's not a good thing for mental health.
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It's not a good thing for physical health. So even if they intermittently struggle with spending occasionally too much time online, they have this very strong idea rooted in, let's be present. Let's be present together. Let's not be distracted. To the point where this past winter holiday, we decided to go to Yosemite Valley together as a family.
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And we had done tons of vacations with the kids, always device-free, which, by the way, is like being a blind person now when you're traveling. It's literally like you cannot see because everything is—you need the QR code. But we've done it. And I said, are you guys still game for device-free? Because it had been a couple years since we'd gone on that kind of trip together. And they were.
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And that gap or synapse is bridged by what we call neurotransmitters. And dopamine is one of those neurotransmitters, okay? And when the presynaptic neuron pulses and releases dopamine, it crosses the synapse and binds to a receptor on the postsynaptic neuron, which either continues or aborts that electrical signal. Does that make sense?
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Now I need more of my drug in more potent forms to get the same effect, which then leads to addiction. And that's what happened to me when I got addicted to romance novels.
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Okay. So one of the ways that our brain can decrease the effects of dopamine, decrease dopamine transmission, is by involuting or taking inside the neuron the postsynaptic receptor. That way when dopamine is released, it has nowhere to bind.
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Exactly. Very good. It's removing the docusation. So essentially, getting back to our scale, we've ingested alcohol. We've increased dopamine firing in the reward pathway. But remember, our pleasure-pain balance wants to return to a level position, level with the ground, homeostasis. So it's going to decrease dopamine transmission by, for example, involuting those postsynaptic dopamine receptors.
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But one thing about the brain in its process of trying to get back to homeostasis, and again, I like to think of this neuroadaptation process as these gremlins hopping on the pain side of the balance to bring it level again. You don't have gremlins here. You have these little rocks. But let's go ahead and put a rock on the pain side of the balance. And these rocks are our friends, right?
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Their job is to level the balance because, remember, we've got to go back to homeostasis. So I'm going to put a rock on, and you're going to see, oh, my gosh, it overshot. Right? Right? Now I've got it pressed down on the pain side of the balance. But that's exactly what happens in our brains.
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In this process of neuroadaptation, those gremlins hopping on the pain side of the balance don't get off as soon as the balance is level. They stay on until we're tilted an equal and opposite amount.
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I was out of control, and I needed to restore a level balance and take advice I give my patients.
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Exactly. That's exactly what it is. That's the hangover, the comedown, the blue Monday, or on a much smaller scale, just that moment of craving, right? That moment of wanting to have one more shot, right?
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Such a great question.
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Yeah. Why did Mother Nature do that to us? So cruel, right?
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Okay. I'm going to tell you an evolutionary just-so story. What we mean by that is we don't really know why, you know, this mechanism exists. But from an evolutionary perspective, if you're living in a world of scarcity and ever-present danger, this is the perfect mechanism to make sure that we're never satisfied with what we have, that we're always wanting more. It's made us the ultimate seekers.
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Perfect.
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Yeah.
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Right. So now that's – so why is that, right? It's because alcohol is a product of human engineering. that releases so much dopamine all at once in the reward pathway that our brains are reeling to compensate, right? We really weren't evolved for this much pleasure with this much easy access. As you said yourself, we were really evolved to have to do quite a lot of work upfront in
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and to be hungry and to be lonely and to be tired, and then get a little bit of reward that would then bring us back up to homeostasis. So really, we were evolved to be pressing on the pain side of the balance in our effort to find pleasure. And then when we find it, that little bit of food or clothing or shelter or a mate would bring us back to the level position. Does that make sense?
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Right. Coming to a website near you. Yes. I guess I would qualify that a little bit by saying we're wired for survival in a world of scarcity. That's not the world we live in now. We live in a world of overwhelming overabundance. And so there is a mismatch between this ancient wiring that has us relentlessly pursuing pleasure in order to survive and
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And a world that's so infused with pleasure and so many rewarding stimuli that now we're overwhelming our reward system and our brains are reeling in response to try to compensate.
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Okay, great. So let me get there. Let me first say, though, that remember, after we do something that's highly pleasurable, our brain compensates with neuroadaptation, tilting an equal and opposite amount to the side of pain, and then restoring our balance back to the level position, right, or what we call homeostasis. So this doesn't last forever, right?
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It's to pleasure, then it's to pain, then it's back to the level position. But if we continue to consume our drug of choice over days to weeks to months to years, and we add in a whole bunch of other drugs, and now we're consuming, you know, pornography and smoking pot and eating—
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donuts and, you know, you name it, all at the same time, then essentially what happens is those gremlins on the pain side of the balance end up camped out there.
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Right. And now we've entered addicted brain, by which I mean that we've changed our hedonic or joy set point to the side of pain. Now we need more and more of our drug in more potent forms, not to get high and feel good, but just... to level the balance and feel normal. And this is not going to be enough.
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To level the balance, I would have to like keep filling this much more than this container can hold. And that would be in pursuit really of just trying to level that balance so that we can feel normal. And when we're not using...
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We're walking around with a balance tilted toward the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving.
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More rocks.
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Oh, gosh. I'm so glad you said that because I think that is the key to empathy for the disease of addiction, as well as for people with the disease. Having empathy for themselves is recognizing that on some level, it it's out of their control, right?
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Because when we are tilted to the side of pain, the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use, right? It's just like, get back to the level position because if I do that, I'll at least feel temporarily better.
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Absolutely. I agree with you. And I think, you know, this metaphor, it makes an assumption that we all start with a pleasure-pain balance that's level with the ground, but actually that's probably not true, right? Some people at baseline may actually be more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction. And
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And we know that people with co-occurring psychiatric disorders, for example, are at increased risk of developing addiction probably because they're reaching for that substance to self-medicate their psychiatric problem. The issue with that is that it's not medicinal, right? It's not healing.
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Although in the short term, substances can help with those kinds of feelings of psychological and physical pain. Over time, because of the way the brain adapts, as we've discussed, substances and other addictive behaviors just make psychiatric problems worse, right? As we drive ourselves further into the kind of, you know, the pain side of the balance.
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Yeah, to numb ourselves, to not be present in our reality and have to deal with what's going on there.
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It's all the same. Dopamine originally was to help us find those things that we need to survive. Food, clothing, shelter, a mate. We call those natural rewards. But today... That same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our brain confuses as necessary for survival, which is why people with severe addiction will –
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be willing to lose, you know, not consciously but unconsciously, their loved ones, their homes, their jobs, everything they have in pursuit of their drug of choice. It's because their brain has been hijacked and they now confuse the drug as necessary for survival. The other thing about drugs is that they're incredibly potent.
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They release a lot of dopamine all at once, which again is confusing for our brain. Natural rewards require upfront effort where we do a lot of work and then we get a little bit of dopamine. And that's what our brains evolved for.
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Can I get back to your question about trauma and stress? So there's a very interesting series of experiments in rodents, mice and rats, where they – first of all, rodents very easily get addicted to cocaine. They will press a lever for cocaine until exhaustion or death. Right.
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But if that cocaine is then taken away, that behavior will extinguish, which means that the mice will eventually just stop pressing the lever, right, because they're not getting any cocaine. Totally makes sense. And then they'll go off and do something else in the cage.
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But if they're then exposed to a very painful foot shock, right, so a very extreme physical pain, which you could equate to a serious life stressor, the first thing the rat will do is run over to the lever and start pressing for cocaine.
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which tells us that once our brain has discovered a drug that releases a lot of dopamine in our reward pathway, even after we stop using that drug, if we are exposed to an extreme stressor, Our brain will tell us immediately, go and do that thing that gives us a lot of dopamine because you are under stress and I need to be relieved of stress. Does that make sense? It makes perfect sense.
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Right, and we see that again and again in people in sustained recovery from addiction, that when they are under stress, that is a trigger potentially for them to relapse. So they have to be really thoughtful in their lives for, number one, trying to avoid stressful situations. And by the way, stress can come in many different forms.
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There's a great acronym in Alcoholics Anonymous called HALT—hungry, angry, lonely, tired— Those kinds of stressors, everyday stressors, which we all experience, hungry, angry, lonely, tired, can trigger us to want to use. So people in recovery have to be really thoughtful about not getting too hungry, not getting too angry, not getting too lonely, and not getting too tired.
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Oh my gosh, yeah. So that's the bulk of my career, is working with people with all different kinds of addictions.
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I had a patient who was addicted to water. I know, hard to imagine. You have to, though, understand her narrative. So she had a very severe alcohol addiction. She got into recovery from that addiction and gave up alcohol. But she discovered that by drinking copious amounts of water, she could become hyponatremic, meaning that she could –
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lower the sodium levels in her bloodstream, which would then lead her to become delirious. And so in her desire to just be checked out, she would do that. She would drink large amounts of water.
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No, sadly, she's not. She ended up taking her own life. So that was very sad.
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Yeah, you know, I'm just speaking broadly. For some patients with severe addiction, trauma is a huge factor, especially severe early childhood trauma. But there are also many folks we see who have kind of great parents and have had happy childhoods and have great social networks and work that they enjoy, and yet they still become addicted.
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And that's because we, again, we are wired to consume as much as possible of whatever releases dopamine in our brains to have survived evolution to this date, and yet we're living in this world where we have access to so many different drugified substances and behaviors that we've all become vulnerable to this problem.
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And the reason I highlight this is because one of the things that I think has happened in the field of addiction medicine that maybe isn't the best is that oftentimes patients themselves, as well as their providers, are digging really deep to find the trauma or the reason behind that someone has become addicted. And I think that that's important to do in some cases.
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But in other cases, it can lead to kind of manufacturing trauma where there really isn't any. Furthermore, I would say that when a person is in the throes of their addiction, they're not going to be able to really do the complex emotional processing of their trauma while they're still using their drug of choice.
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that they really need to get out of that vortex of addiction and get into some degree of recovery before you would even want to go tackle some of those early traumatic experiences.
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Well, if you think of addiction as a spectrum disorder, right, there's mild, moderate, and severe. And there's, I would even say, a kind of a pre-addiction state where we're all sort of dabbling in compulsive overconsumption. I would say the vast majority of us, like 90, probably 95%, have some degree of compulsive overconsumption.
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And, you know, if and when it tips over into what we would call addiction, there's not a brain scan or a blood test to assess that. It's not like, you know, switching a light switch and it's like, oh, yeah, now you have addiction. It's not like that. It's, you know, it's a gradual, often a gradual and insidious thing. And we don't, in fact, have a biological measurement of addiction.
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We base it on what we call risk. phenomenology, which is patterns of behavior that repeat themselves across time. And broadly speaking, the definition of addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others. And so, you know, that harm can be very subtle or not, right? And it can be a judgment call.
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Yes, that's right. And to also recognize that we're not very good judges of that when we're chasing dopamine.
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Exactly. And we're not very good at seeing true cause and effect, honestly, when it comes to these behaviors, which is why oftentimes people won't really see the harm until they've stopped using for a period of time.
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Yes.
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So I was in my early 40s. My kids were no longer little. I got a lot of my self-worth and identity from being a mom. And my kids were sort of entering adolescence. They were doing fine, but they didn't need me as much. So I had kind of a grief reaction, you know, in response to that was trying to figure out, you know, how to navigate this next phase of my life.
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I'd always been a reader and in particular a reader of novels. In my own way, that was how as a child I self-soothed was to escape into the fantasy life of novels. But I never had what I would call a problem with it. And then one day I heard another mother at school said that she was reading this great book. It was called Twilight. It was about these vampires. And she was going on and on about it.
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And I read it. And I can't tell you what it was, but it was just like the key in my particular lock. It was completely transporting. It just released a lot of dopamine is all I can imagine in my brain's reward pathway. And so I read the whole series and then I read the series again and I read it again. And of course, by the third or fourth time, it wasn't as, you know, reinforcing.
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And I thought to myself, I wonder if there are any more vampire romance novels. And then for me, the real tipping point was I got an e-reader. I got a Kindle. Because what happened was, even before I got the Kindle, I started reading, you know, novels that I would say I would be slightly embarrassed to admit that I was reading, like kind of bodice ripper novels.
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As time went on, I needed more and more, like,
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graphic kinds of descriptions in order to find it pleasurable and and by the way that's classic for the addiction narrative right where you start out with a little bit and it goes a long way and then over time you build up tolerance that's neuroadaptation the gremlins pressing down on the pain side of balance now i need more of my drug in more potent forms to get the same effect and
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Gradually over time, I started reading more and more graphic, erotic, sexualized versions of this novel. And I was embarrassed, so I would hide that I was reading them. And that gets into the whole double life of addiction, where now we're lying about our use, we're using our drug over here, but pretending like we're not. So my kids or my husband would walk in the room and I would be
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you know, hiding behind another book, one book behind another book. So it looked like I was reading something, you know, I don't know, more sophisticated. And then the tipping point for me came really when I got a Kindle or an e-reader. And then my reading was totally anonymous. I could read these books anywhere, anytime. No one knew what I was reading.
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And as soon as I finished one, I could read another one. And I almost overnight became a chain reader, like literally. When I wasn't doing something else that I had to do, I was reading romance novels one after another after another, which meant I was, you know, less present for my kids, less present for my husband.
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I would often stay up till 2, 3, 4 in the morning on a weeknight reading romance novels. have to get up two hours later, go to work exhausted, not able to be present for my patients, not enjoying my work, gradually getting more depressed, more irritable, more anxious, more insomnia.
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We went on a family vacation with a family friends of ours, everybody together at this beach house, all the kids playing. I was like hiding in a room reading romance novels. So it And this is exactly what happens with addiction is that our focus narrows and the things that we used to enjoy are no longer pleasurable. Only this one thing has salience for us.
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We plan our whole day around getting it, using it, hiding our use. And that's what happened to me.
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You know what? It's really hard. These digital devices are powerful tools, but also very potent drugs. There's no doubt that digital media lights up the same reward pathway as drugs and alcohol. These devices and platforms were designed to be addictive. That is to keep us scrolling and tapping long beyond what we plan for or what we want or even what's pleasurable.
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I think we can all relate to using this medium to a point where we don't even like it anymore and yet have difficulty getting ourselves off of it. That really speaks to the inherently reinforcing and cognitively adherent nature of this medium. It is a drug. And so if and when and how we're crossing into addictive use, I think we need to be very vigilant about whether that's happened in our lives.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
And one of the ways to do that is actually to try cutting out that particular digital medium, that website or that behavior for a period of time long enough that to experience withdrawal, potentially reset reward pathways, and then reevaluate. Because when we're in the behavior, as you yourself noted, it's very easy to rationalize. Oh, I need to do this for work.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Oh, I need to do this to stay in touch with my friends. Oh, I'm learning so much from this, right? And All of that may have been true initially, but may not be that true anymore. And what I often point to is the subtler signs of addiction, which are things like depression, anxiety, inattention, insomnia, restlessness.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Ah, good question. Good place to start. I mean, dopamine matters because it's fundamental to our survival, right? So it's the chemical that we make in our brain that tells us this is something we should approach, explore, investigate. So it's really almost the survival chemical.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
These can be early signals for our consumption entering into that addiction range, but us not realizing it because, again, we don't see cause and effect.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
which is why doing an experiment like I did with my romance novels, you know, following in the footsteps of my patients and taking the advice I give them, and I gave my romance novels up for 30 days, right, just to see, like, okay, I think this is a problematic behavior. Can I give it up? How will I feel? And the very first day that I –
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
the very first 24 hours that I did not read any romance novel, any novel at all, I was astounded at my level of anxiety, restlessness, and utter insomnia. I had completely unlearned the art of putting myself to sleep without this digital narrative. And that lasted a good 10 to 14 days, completely mapping on with the amount of time it takes typically to get out of acute withdrawal.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
That is to say for those neuroadaptation gremlins to hop off the pain side of the balance and for homeostasis to begin to be restored. But by the time I got to weeks three and four, I felt not just better than I had in the first two weeks, but actually better than I had felt in a really long time. I enjoyed my kids more. I was more present for them. I enjoyed my husband more.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
My work seemed salient again. I had started to think, oh, maybe I should do something else. You know, maybe I, you know, this work I've been doing in a long time, I don't, it's not that interesting anymore, all of a sudden it was interesting again, right?
The Diary Of A CEO with Steven Bartlett
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So you see the relativity of that hedonic pathway and how when we're doing that behavior or substance that's so reinforcing that everything else loses its salience, we can really misidentify what is causing our irritability, anxiety, insomnia until we stop that substance for long enough to see its impact on our lives.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
I mean, I think that romance novels are essentially socially sanctioned pornography for women.
The Diary Of A CEO with Steven Bartlett
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And the medium is narrative. And if you're a person for whom narrative is a powerful drug, as it is for me, a story, a narrative, a fiction, very potent since I was a child. then, you know, it was a natural that that would be the thing that I would get addicted to.
The Diary Of A CEO with Steven Bartlett
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And basically, just like we've hacked and bioengineered everything to make it more potent, I mean, people, there's a formula for writing romance novels. Like, if you take a physical copy, if you go to a store and you pick up a romance novel and you literally physically open it to two-thirds of the way through, you will get to the climactic scene, pun intended, right? It's like it's engineered.
The Diary Of A CEO with Steven Bartlett
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I mean, I got to a point where I wouldn't even read it, read after. I wouldn't finish the book. I would go on to the next book.
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Yeah. And I wouldn't even read the denouement or like what happens to the characters. I didn't care.
The Diary Of A CEO with Steven Bartlett
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And also, I got to a point where I didn't care about the quality of the writing or the depth of the care. It didn't matter. It was the drug. It was that moment I was looking for. And there are a lot of free books on Amazon, some of which are high quality and some of which are not. But like any good drug dealer knows, free samples, that's the way you hook people.
The Diary Of A CEO with Steven Bartlett
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I would search for these free samples. And that's part of it, too, like the searching for the drug. So the working, the upfront work you do for the drug is part of the drug, right? Yeah. It's all that, you know, the machinations and the hiding and the this and the that that gets to be part of like all of the rituals surrounding it.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
So dopamine is a chemical that we make in our brain. It has many different functions, but one of its most important functions is that it helps us experience pleasure, reward, and motivation. It may be even more important for the motivation to do things than it is for the pleasure itself.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
I feel for you.
The Diary Of A CEO with Steven Bartlett
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That's right.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
People can get addicted to work, and part of the reason is that we've drugified work, right? When I say drugified, what do I mean? We've made it more potent, and this is true for all these drugs. We've made them more potent, more novel, more bountiful, meaning there's more of it, and more accessible. So if we break that down with work, how is work more potent?
The Diary Of A CEO with Steven Bartlett
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Well, certain types of work are more reinforcing, not all types of work. So, for example, works – white collar work is often now associated with stock options and bonuses, right? There's often like a social media aspect to it or maybe even a fame aspect. Or as you pointed out, those are our cultural heroes, right? So you get all this, you know, adulation for being a workaholic. Right.
The Diary Of A CEO with Steven Bartlett
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There's a very famous experiment in which rats were engineered to have no dopamine. And the scientists discovered that if they put food in the rat's mouth, the rat would eat. But if you put the food even a body length away, the rat will starve to death. Which tells us that dopamine is fundamental to get the things that we need for our basic survival.
The Diary Of A CEO with Steven Bartlett
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And that also, because we're such social creatures, right, and human connection stimulates dopamine, that also makes work more of a potent drug.
The Diary Of A CEO with Steven Bartlett
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As you said, the awards, the trophies. And then you've got the fact of novelty. So once we've exposed our brains enough times to a certain drug, as I said, we develop tolerance, right? And then we need more potent forms or novel forms. One of the ways we overcome tolerance is by taking our drug and then changing it slightly, like adding a little new molecule on this chemical, right?
The Diary Of A CEO with Steven Bartlett
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Or on the internet, you know, when we're searching videos, we want something similar to what we liked before but just a little bit different. And that's what the algorithm does automatically, right? It offers, oh, you should check this out. Oh, how about this? Oh, check that out, right? And that engages our treasure-seeking function. We're looking for that algorithm.
The Diary Of A CEO with Steven Bartlett
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that novel thing, but that's not too novel, right? It has to be in our category of things we like. And I think for work, we have that too. Like there are so many ways now that people can engage in their work. And it's not all bad that it's novel, but, you know, certain types of work, it makes it very enticing. Then you have quantity, right? I mean, work never ends.
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There's like no natural stopping point for work. You know, you do a line of cocaine, you run out of money, you run out of cocaine, you're done, right? But that's not true for work. Everywhere, anytime, and then that gets to accessibility. One of the biggest risk factors for addiction to any drug or behavior is simple access.
The Diary Of A CEO with Steven Bartlett
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We know that if you grow up in a neighborhood where drugs are sold on a street corner, you're more likely to try them, more likely to get addicted. If you live in a world where you have access to work 24-7, you're more likely to expose your brain to more work and more likely to get addicted to work. Again, especially if it's got all those other reinforcing qualities.
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You mean if they just get overwhelmed or it's partially why people can never quit. But I think it's important to make a distinction between work that's reinforcing in those ways and then work that's completely not reinforcing.
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So, for example, there's a very famous experiment in which rats were engineered to have no dopamine in the brain's reward pathway. And the scientists discovered that if they put food in the rat's mouth, the rat would eat the food, would seem to get some pleasure from the food, if you can determine that from watching a rat eat, which I think they felt like they could.
The Diary Of A CEO with Steven Bartlett
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Alienating, mind-numbing, work in which the actual task is separated from the meaning of the task.
The Diary Of A CEO with Steven Bartlett
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Right.
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Yeah. And that's true. Many people change jobs every two to three years. I recently read that the average life of a business now is like 15 years, whereas, you know, 50 years ago, it was 50 years. And there's all this turnover, all this churn, chasing novelty.
The Diary Of A CEO with Steven Bartlett
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Also, you know, I do want to emphasize that people who are in work that's not like intrinsically rewarding but is the opposite, kind of soul-sucking, that's also a risk factor for addiction because people just wait till the end of the day till they can go home and then use a drug to numb themselves from the stress of work.
The Diary Of A CEO with Steven Bartlett
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Yeah, or simply opt out of the workforce as many young men are doing now in the United States. And what we know from data that's been collected is many of them are playing video games, right? They've just completely opted out of the workforce.
The Diary Of A CEO with Steven Bartlett
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You know, maybe that's partially true, but even people doing like doctors and lawyers, there are equal rates of alcoholism among those groups. I think what's happening there, though, is that the nature of the work is just so stressful, whether it's white collar or blue collar, that there's this kind of work hard, play hard, right?
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Where I'm going to work all day, and at the end of the day, I'm going to reward myself. So now you've got a pleasure-pain balance that's going pleasure-pain, pleasure-pain. And remember, the biological definition of stress is any deviation from neutrality.
The Diary Of A CEO with Steven Bartlett
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So that every time our brain has to work to restore a level balance, we're actually triggering our stress response, triggering our own adrenaline. It's stressful to have to restore the balance from those extremes of pleasure and pain.
The Diary Of A CEO with Steven Bartlett
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Yes.
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You know, I really think that it depends on the person. And we've got to look at drug of choice, right? I mean, potent drugs like methamphetamine, like opioids, like alcohol, like nicotine, like cannabis are going to be very reinforcing for many people, but not for all people. And most people do have their one drug that they sort of prefer above all others.
The Diary Of A CEO with Steven Bartlett
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But if you put the food even a body length away, the rat will starve to death. The idea being that without dopamine, we're not motivated to seek out the things that we need for our basic survival.
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So although generally speaking intoxicants release a lot of dopamine in the reward pathway, I think every person is going to be different. And also we don't really have good ways of measuring absolute values of dopamine in human beings, right? We can do that in rats, but we can't really do that in humans. It's relative values.
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So the red in this image represents dopamine transmission. So how much dopamine is being released from the presynaptic neuron, crossing that synapse, binding to receptors on the postsynaptic neuron, how much dopamine is kind of swirling around in the reward pathway part of the brain. And what this image shows is that on the left-hand side, in healthy control subjects who do not have addiction—
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There's plenty of red, right? So there's plenty of dopamine transmission in the reward pathway, specifically here in the nucleus accumbens. But if you look at the right-hand column, you'll see that in these individuals who have been using cocaine, methamphetamine, alcohol, and heroin in addictive ways, there's almost no red, which means there's
The Diary Of A CEO with Steven Bartlett
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decreased or below normal levels of dopamine transmission. They are in a chronic dopamine deficit state. This is evidence of the brain trying to compensate for for too much dopamine being triggered by down-regulating its own dopamine production and transmission, not just to baseline but below baseline.
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And importantly, these individuals who are addicted to these substances, these brain scans were done two weeks after they stopped using.
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Yeah, which tells us that this dopamine deficit state persists for some period of time. For how long? Well, it depends on the person, but we know at least from this experiment that the first two weeks are this persistent dopamine deficit state, which is consistent with acute withdrawal, right? People feel when they first stop their drug of choice, they feel terrible, right?
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They experience all of the symptoms of physical withdrawal that correspond with that particular drug they were using, usually the opposite of what the drug did, plus the universal symptoms of withdrawal from any addictive substance or behavior, anxiety, irritability, insomnia, depression, and craving. Now, if they can get through the first 10 to 14 days...
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What we see clinically is those acute withdrawal symptoms slowly start to get better. And we think that that is mapping on to regenerating dopamine transmission in the reward pathway. And if they can make it to a month, that's usually the point for, on average, based on clinical experience, when people really can start to get out of that
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constant state of craving for their drug of choice and begin to see some light at the end of the tunnel for what their lives might look like if they can maintain abstinence from their drug.
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Yeah, it's a great question because we have some natural experiments that suggest what might happen if we do that. So as I mentioned before, people with Parkinson's have depletion of dopamine in the substantia nigra. That's what causes that motor disease. The treatment for it is to give L-DOPA, which is a dopamine precursor.
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Yeah, essentially. Maybe it's not an inch. Maybe it's a little more than an inch. But the idea being that dopamine is necessary to be motivated to do the work to get the thing that we need.
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If I were to give you a spoonful of dopamine, it would do absolutely nothing because it doesn't cross into the brain. It doesn't cross the blood-brain barrier.
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But I could give you L-DOPA, which is a precursor chemical that would cross your blood-brain barrier and get turned into dopamine and then diffusely bind dopamine receptors in your brain in the reward pathway, but also in the movement pathways. When we give patients with Parkinson's dopamine in this form, that can temporarily improve their movements.
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But in about one in four Parkinson's patients, they will develop a de novo addictive disorder. Shopping addiction, sex addiction, other types of addiction. Because we have the same problem. We are stimulating... the reward pathway with dopamine that is ingested exogenously from the outside.
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And our brain reads that as, oh boy, got to compensate by down-regulating dopamine transmission to below baseline, which then puts us in that addiction vortex. Does that make sense?
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Right. Even more than having to try to live within this sort of narrow range of homeostasis, in the world we live in today, we probably have to intentionally do things that are painful, right? do things that are hard. Pleasure-pain balance, right?
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We learned that when we press on the pleasure side of the balance, like with alcohol or pornography or romance novels or cannabis or whatever it is, right? No sooner does that happen that our brain adapts by those neuroadaptation gremlins hopping on the pain side of the balance to bring it level again, but they like it on the balance, so they don't get off right when it's level.
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They stay on until we're tilted. An equal and opposite amount to the side of pain, that's the come down, the hangover, et cetera. But it turns out the opposite is also true. If we intentionally press on the pain side of the balance,
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for example, with exercise or an ice-cold water bath or intermittent fasting, those gremlins will hop on the pleasure side of the balance, and we will get our dopamine indirectly by paying for it up front. And there are studies in humans showing that when humans expose themselves to exercise, for example, Dopamine levels gradually rise over the latter half of the exercise.
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And then when the exercise stops, dopamine levels will remain elevated for hours afterwards before going back down to the baseline level position without ever going into that dopamine deficit state. So it's a great way to get our dopamine indirectly because it's much less vulnerable to that compulsive craving phenomenon of overuse.
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having a basic understanding of how dopamine works, how we process pleasure and pain, and also what happens with dopamine as we go from adaptive recreational use to maladaptive addictive use is something that is really useful, especially for those of us living in the modern world, where now we're exposed to so many reinforcing substances and behaviors that we've all become vulnerable to the problem of addiction.
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You can, but – and people can get addicted to exercise, right? But typically it's very unusual because the upfront cost to do the work and endure the pain of exercise in the first place – mitigates our vulnerability to an exercise addiction.
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Yeah, those are amazing. I didn't know that. Those are amazing numbers. You know, in general, there's a part of me that wants to say, well, that's a good thing. But there's another part of me that's wary also because we're so good at drugifying everything that we do that there's a way in which these types of behaviors can also be drugified, right?
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Made more potent with all of the technology, the way that we count ourselves, the leaderboards, the social comparisons. All of that takes this thing, which is, really in its natural state, kind of impervious to addiction. Like, you just typically wouldn't get addicted to these types of painful physical activities. You would do what you needed to do for survival.
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But we've managed to make them addictive in all these different ways. I still think it's a better way to get your dopamine. Like I really encourage exercise. We always talk about movement as medicine. And in general, our life is so convenient, so easy, so passive, so sedentary that I'm telling patients all the time, you know, get up off the couch, move your body, walk around the block.
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I think that's the bigger obstacle right now is just getting people to move. But I do think we need to be wary of not going too far in the direction of like the ultra, ultra, ultra, whatever it is.
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I think that part of the problem is that we've organized our lives now around rewards. Almost everything that we do is predicated on the feel-good moment we'll have at the end of it. And because of that, we are missing out on the process. We're projecting our psyche forward into the future toward the reward and not able to really be here in the moment. Okay, this is going to sound weird.
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I'm going to give you a weird example. So driving over here today, I found I was nervous for this interview and in a way looking forward to it, but in a way wanting it to be over. Right? And in seeing that in myself, I thought that's so sad.
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Like that's so sad that we live our lives that way, myself included, always this weird blend of wanting whatever we're doing to be over so that in a way we can just go hide and do whatever that self-stim thing is that we do where we're safe and we're like, you know, stimulating ourselves in some way. And then I thought, well, what if I knew that I was going to die right after this?
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I've been off really weird now. But what if I knew that I was actually going to die right after our conversation today? That totally changes my perspective, doesn't it? Because this time you and I have it. That's all I got. It's over for me. So this conversation is it. I really better be right here right now and really taking joy in whatever you and I can find together.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
And I think the more we can do that, the better.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
It's a great question. And I've actually given this quite a lot of thought because I remember when I was in college and I, you know, met some like Zen people and they were like, be here now, be here now. And I thought, well, whenever I'm here now, I'm miserable. Like I don't like me and I don't like being in the world. I don't want to be here now. I want to be somewhere else.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
So I didn't really understand what they were getting at. It really took me until I had lived quite a lot of life and had some significant experiences and given it some thought that I realized, oh, be here now means be here now and be uncomfortable. And be okay with being uncomfortable. And being okay with not being able to control my pleasure or my pain or my comfort level.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
But just being open to whatever comes. And I think that's really a key shift. That... I'm not trying to control my experience in the moment and that it's okay to be unhappy or restless or uncomfortable and not trying to run away from that but just really turn and face it and embrace the discomfort, which I also think is quite universal. I don't think I'm alone in that.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
And then the key piece about not anticipating the reward is – Helps me be in the moment, right, because I'm not just waiting for the good thing to come after. I'm saying to myself, imagine there's nothing good coming after, nothing at all, right? There's just, there aren't rewards. This is it. And then also being able to say, and it's okay if in the moment, like, it's not great.
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Like, I can embrace that. You know, I can be unhappy, right? or restless or anxious or whatever it is. And then when I do that, you know, I feel like there's a funny, funny thing that happens and all of a sudden I'm not as anxious, right? And I am present and there is some joy there.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
the main misconception is that somehow we can get addicted to dopamine. We're not getting addicted to dopamine itself. Dopamine is neither good nor bad. It's a signal to tell us whether or not something that we're doing is potentially useful for our survival. And also, it's related to what we predicted about how rewarding or pleasurable something would be.
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Yeah. I think we have this, and it's fed by modern culture, this kind of expectancy that really we should be happy all the time. And that if we've arranged things appropriately for our lives and we've done our work and aimed true, then we should just be like, life is great. And I don't believe that anymore. Yeah. I think that, you know, I mean, like Buddha said, life is suffering.
The Diary Of A CEO with Steven Bartlett
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But I really think that fundamentally, like, it's uncomfortable to be alive and that it's a kind of a constant state of restlessness and discomfort. If we're being really honest and tuning in, when I really let myself see that and feel that, all of a sudden I'm freed from some of that.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Yeah, you're good. You could have been a psychiatrist.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
There's still time.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
You get a new profession. Yay. I think, you know, for me, the big turning point was that we lost a child. And in the immediate aftermath of our child's death, I was just determined to, like, sort of undo the experience and, you know— get enough psychotherapy and enough whatever, whatever it took to sort of not feel that pain.
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And it wasn't until I really just said, oh, I'm going to feel this pain for the rest of my life, it's never going away, that suddenly I felt some relief from that pain. And that was a real window for me.
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Yeah. And I think one of the reasons I love treating patients with addiction is because I really relate to that hitting bottom moment, that moment when it's like you just have the feeling that Like everything I try to do to manage this behavior or to make my life better only makes it worse.
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I felt like I had a very similar experience and that it was only when I kind of realized, oh, yeah, I can't run from this. I cannot run this pain that I began to have some, the beginnings of relief from that experience.
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The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Mm-hmm.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
That's the irony, right? We're really wired to outrun the pain. We are. Like we reflexively seek out pleasure and avoid pain, and yet that's the very thing that doesn't get us to where we want to go.
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The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Yes.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Yeah, that's exactly right. There are so many ways that we can now distract ourselves from our own suffering or our own awareness.
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Yeah, I mean, I feel like in many ways it's been a real gift in my life. You know, it's really informed my life in ways that... I mean, I've learned things from that experience that I think it would have been almost impossible for me to learn otherwise.
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And so it's really, you know, I sort of sometimes I joke it's like the reward theory of relativity, dopamine is, in the sense that pleasure and pain really are truly relative to one another. And so dopamine gives us information about where we are in that relativity scale between pleasure and pain.
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couple things. First of all, a lot of people get better. And when people with addiction get better, it's so much better that it's incredibly rewarding to see. And they're amazing people. Absolutely. Like some of the most tenacious, talented people you'll ever meet. And when they get better, it impacts so many other people, right? Their friends, their family, the people they work with.
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So it's very rewarding work and not at all burdensome. Of course, you know, for patients who don't get better or patients who die, it's a terrible feeling. And there is a sense of responsibility and guilt. Even when I feel like there was nothing that I could have done otherwise, you know, I carry those losses with me. So it's hard.
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I mean, every patient I've had who's died while under my care, those are incredibly painful. And I will never, you know, those people will be with me as a part of me for all of my life.
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Yeah, young and old. Yeah, it's especially tragic to lose young people. And it always feels like they're second guessing. Like, oh, if only I had done that or if only we had intervened here. But I just think that's the nature of death. We can't get away from the feelings of guilt around it, no matter who we are and no matter the circumstances.
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Oh, yeah. I mean, it's, you know, some kids use with their parents or their caregivers. They're exposed very early. If we... seriously conceptualize digital media as a drug. I mean, then we've got, you know, even younger cohorts starting with that. And we do know that kids can get addicted to digital media and, as a result, die from that.
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I mean, there was just this tragic case of a young man who essentially got addicted to a chat box. I think he was 14. Not my patient. It was written up in The New York Times and The Wall Street Journal.
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And he fell in love with this chat box, started to isolate, wasn't spending time with his family or friends, and then eventually took his own life purportedly so he could join this imaginary person.
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The youngest I've seen is probably around 15, 14, 15. And they had an addiction? Yeah, usually cannabis, alcohol, nicotine.
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Oh yeah. Oh my gosh. Cannabis is very addictive.
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Oh yeah. Yeah.
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Very harmful. The target organ that it damages the most is the brain. It's harmful in many ways. I mean, number one, it demotivates people often, and so they can have the feeling that they're getting stuff done or that they're creative when, in fact, they're not doing anything. Most people smoke it, and so it can be damaging to the lungs and other organs.
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A lot of people say that, well, cannabis isn't addictive because I don't have this standard withdrawal phenomenon when I stop, like I don't have the shakes or anything like that. But keep in mind the universal symptoms of addiction are psychological symptoms, anxiety, irritability, depression, insomnia, craving. And people have that in spades when they try to stop using cannabis regularly.
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Plus, we often see something called the hyperemesis syndrome. So cannabis can help with nausea and vomiting. It can help decrease the feeling of wanting to vomit. But again, as the brain continues to be exposed to it, There's this process of neuroadaptation. It stops working. And it can even turn on them and do the opposite.
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So eventually people can actually have a cyclical vomiting syndrome as a result of cannabis. So they'll show up in the emergency room and say, I can't stop vomiting. And the reason is because of the cannabis that they maybe initially started to stop feelings of nausea.
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Now, every time we're doing something that's pleasurable, from sugar to video games, work, pornography, social media, that will affect dopamine. And the more dopamine that's released, the more likely that drug or behavior is to be addictive. But also, the genetic risk of addiction is about 50 to 60 percent.
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I would say succinctly, yes, I do believe we have gone a bit soft, but I don't think it's a moral problem or a character problem. I actually think it's a physiological problem based on the fact that we're insulated from pain and we're exposed to all kinds of pleasures.
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So I really think that we have individually and collectively reset our reward pathways to the side of pain, meaning that the gremlins have now accumulated on the pain side. We've tipped ourselves to the side of pain.
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Because we've had so much pleasure. Yes. Thanks for having me clarify. So that now we need more and more pleasure to feel any pleasure at all. And the slightest little pain and we're experiencing excruciating pain.
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Yes, that's what I'm describing. Yes.
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You add to that the fact that we have a culture that tells us we should never be in pain and that if we are, something's wrong with our life or something's wrong with our wife or something's wrong with our job. And so now you've got a whole generation of folks who feels like They're experiencing more pain because they literally do not have the mental calluses to tolerate pain.
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And now they're being told, and if you have any pain at all, you must have something wrong with your brain. Go see a doctor. Go take a pill. And I think this is really – this is not a direction we want to keep going in.
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Let me answer this by talking a little bit about the role of language and narrative, because I think this is very fascinating. And as a psychiatrist and a therapist, that is my bread and butter, right, is narrative, how people tell their stories. By giving language to our experience, we gain awareness of our conceptual models of the world. And what I have learned over time is
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Well, probably almost everything in some ways. I mean, every time we are doing something that's pleasurable, reinforcing, rewarding, that will affect dopamine. It's really the primary signal that lets us know that this thing is potentially important for our survival, as I mentioned. But even aversive stimuli can trigger dopamine. What's aversive? Something that's painful or not pleasurable.
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is that the way people tell their stories is a window into their model of the world and that there are healthy narratives and not so healthy narratives. And in general, in my clinical experience, when people come into the room, And they tell their life story in such a way that they're always the victim of other people and circumstance in the world.
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Those are people who are, number one, not doing well. And number two, not going to do well going forward unless they change that narrative to acknowledge what they've contributed to the problem. And the reason for that is because the way that we narrate our lives is not just a way to understand our past. It actually is our roadmap for the future. So if I see myself as a victim,
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and that's my narrative, I will literally create victimhood for myself going forward. I will literally change my sensed experience so that whatever happens, I'll make sure I end up as a victim. When people with severe addiction get into recovery, one of the most palpable changes that I see is is the way that they narrate their lives.
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They go from, in addiction, talking about their lives as if it's always everybody else's fault, to in recovery, talking about their lives in a way that says, oh, you know what? I could have done better here. Or, you know what? That's something that I keep doing that really messes with my life that I want to change, and I'm going to figure out how to change that.
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Great question. We just hate to do it. Because when we do it, we feel shame. And shame is an incredibly painful emotion. It's like a gut punch of an emotion that is associated with fear of abandonment, fear of being shunned by our tribe. We'd much rather paper that shame over with anger and resentment toward others.
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Great question. And I have to say what I know about this, I learned from Alcoholics Anonymous and what they do because they do something that's really incredible. First of all, it's necessary to validate somebody's victimhood. So this is to say you have been wronged. If they really have been wronged, to validate that. Or you experienced this trauma.
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Or you were born into this crappy situation and you were just a kid and you had no choice about that. And to really acknowledge that. But then the fourth step of the 12 steps of Alcoholics Anonymous talks about looking at each of those situations and after writing down, like, this person wronged me and exactly what they did. So, you know, taking time to focus on the resentment, right?
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Then only after that to say, okay, but is there anything that I did? that contributed to that problem? Is there anything at all that I could have done differently? And for a little kid, you know, born into a horrific situation, there's not much, right, that a kid could have, you know, we don't expect a child to take responsibility. But
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Dopamine gets involved in that equation. Anything that's novel or new is something that triggers our dopamine in our reward pathway more. Dopamine is fundamental for movement, so not just pleasure and reward, but also movement.
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The adult who was that child who continues to perpetuate some of the harms they experienced on other people, now we're talking. Now you can begin to take responsibility for your actions in the world. So I think starting with validating. you know, the trauma or the victimhood or the way in which we were wronged, processing it. So giving it airtime, right?
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But not stopping there, which is, by the way, often, you know, in therapy, certain types of therapy, that's often where we stop. We don't then take it that very important next step and say, but, you know, let's go and look at that again. And like... is there anything at all that you're contributing to this problem? Maybe it's just that you continue to ruminate about it, right?
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That like you're ruminating on your resentments is in a way your happy place. And maybe that's what you need to stop doing.
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Yeah, great, great question. It brings to mind a patient of mine who said to me that... And he had very, very low self-esteem. And he said, essentially, Dr. Lemke, I'm the piece of crap around which the universe revolves. Meaning that he had his own brand of narcissism in which he wasn't the most successful person. He was the most successful at being the least successful person.
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And that became his identity, right? That was sort of how he saw himself and also how he saw the world. And it became very entrenched. And it was a kind of a narcissism because he created then situations in order to perpetuate like I'm the worst of the worst, right?
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So I think the ways in which we get these sort of entrenched ideas about ourselves and the world can really hold us back from seeing clearly who we are, who other people are, and what the possibilities are.
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So for example, Parkinson's disease, which is a disease related to stiffness and tremor, is caused by a depletion of dopamine in a part of the brain called the substantia nigra. And as dopamine gets depleted in that part of the brain, people lose the ability to move their bodies.
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I mean, I guess, well, what do you mean by positive?
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Yeah, I mean, as I said before, how we narrate our lives depends is important, right? It's not trivial. And there are healthier narratives and there are not healthy narratives. And I would argue that the victim narrative, where it perpetuates victimhood, you could make the same argument that the hero's journey narrative perpetuates herohood.
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Having said that, if we get too stuck in any fixed identity or any narrative, I think that can become its own trap, right? And then we wall ourselves off, feeling like we have to show up in a certain way or be a certain person. And I wonder if you have that experience. Like, I know you have this hero's journey and now you've got to be this hero.
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And I mean, I can imagine that that would be burdensome at times.
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When you say you don't understand, you mean when they praise you?
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Okay, yeah, yeah, yeah.
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And it's probably no coincidence that the same neurotransmitter that is so important for pleasure, reward, motivation is also really important for movement because most organisms have to locomote toward the object of their desire. We want that thing. We have to exert effort, right? We have to put in the work to go get it. But in the world today, we really don't have to do that, right?
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Yes. Yeah. So when I think about, you know, your experience of feeling like people must be lying to you. I mean, sometimes we call this something like the imposter syndrome.
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You know, a projected personal persona that is, you know, true in a way, but also doesn't capture the fullness of who you are, or maybe is so extreme in terms of looking good, that it's inevitable that you'll feel some dissonance with that kind of heroic figure.
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And I think the way to think about that and also, you know, not become like cynically suspicious of people who praise you when they meet you is just to recognize that, you have become a kind of cipher or a vehicle for their projections. So they've listened to you.
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They've had a very positive experience or maybe they learned something and it meant a lot in their lives and you were the vehicle for that. And so you're a symbol for them and they're projecting positive feelings onto you because you're now integrated in their mental tapestry and As kind of a, you know, a totemic figure or a token, something important and symbolic.
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Well, you're wrong about that. So you're obviously really smart. And you also have, you know, a really high emotion quotient, right, which is its own kind of underappreciated smarts where you read people really well and you have intuitive reasoning, right? And, I mean, I don't know you, but you also seem very humble and real.
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And so all of these things that people have a craving for, you know, authenticity, someone they can relate to, someone familiar. I mean, keep in mind, too, that more and more people live alone and have maybe fewer close contacts. So a person like you with a regular show that they tune into regularly, you become – you're in their living room. You're not just some distant celebrity.
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Your voice is there. Your face is there. They feel they know you because they've seen you in all these different situations. And I think that's really natural and normal and not a bad thing. So you just have to realize when you go out into the world. you know, you become a symbol for people. They're projecting onto you.
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You don't have to necessarily identify with that, but it's okay to let them have, you know, their experience through you, if that makes any sense.
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We can swipe right, we can swipe left, and all of a sudden it magically appears at the touch of a finger. And that's very confusing for our brains because that's not how we evolved. We really evolved for having to do quite a bit of upfront work for a tiny little bit of reward.
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Yeah.
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That's amazing.
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Oh, no, they feel that they're there. And again, you know, the guests are totally secondary because they're watching because they're identifying with you. And the questions that you ask, as you yourself said, are questions that you anticipate they would want to ask, right? You said that. So you are also channeling them.
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Well, you know, there's this whole sort of area of the addiction field called codependency. And codependency refers to the ways in which a loved one of the addicted person can actually enable or make their addiction worse without realizing it and without intending to. And the way that essentially happens is that we can – well, number one, addiction is very often a family systems problem.
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So the person who gets addicted, their addiction affects everybody in the family. And in order to cope and compensate, families can end up in these very strange, maladaptive places.
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But they often have difficulty seeing how to get out of those situations or how their behavior is harming their addicted loved one because in a sense, they themselves get addicted to the addicted person and then use that addicted person to regulate the way that they feel. So for example, I treat a lot of families where like the adult child is deep in their addiction and
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The parents know that the money they're giving the child is mostly going to drugs and yet cannot bring themselves to stop giving the money.
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And often they're manipulated by the child, the child saying, well, the adult child saying something like, well, if you don't give me money for drugs, I'm going to go get it off the streets and it's going to be laced with fentanyl and then I'm going to die and it's going to be on your hands. So this kind of like emotional hostage taking.
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But even when it's not that blatant, what can happen is just this very fascinating, very twisted and meshed relationship between the addicted person and the codependent person. where, again, having the person engage in their addiction in a way is a predictable scenario for the codependent person.
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So even though they may say on the face of it they want this person to stop their addiction, on another level they really don't. They get to be the martyr. They get to be the savior. Or they even just get to predict what that person is doing based on their use.
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Yep. Yeah. It's really – so Kai Erickson wrote this book on deviance where he studied Puritan societies and found that no matter what group of humans you looked at, there was always – there were always going to be people who were on the margins of the society. He used the word deviance. His point being that
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Groups of humans, we just have these roles and we have these hierarchies and there's always somebody on top and always somebody below. And when we're occupying a certain niche or when we stop occupying it, we make room for somebody else. So when you stop being the hero and the savior, that person had room to stop being the sick victim.
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Yeah.
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I think we can always try to find our empathy for them without necessarily doing things that would perpetuate or enable that behavior. And we need to recognize that for many people with severe addiction, the only thing that will get them into recovery is real-life consequences. real-life negative consequences, and that our trying to protect them from that is not protecting them at all.
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So if you have a biological parent or grandparent with addiction, you are more likely to develop that addiction. We have to keep it in balance in order to stay healthy.
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I mean, this is a hard one because you have a lot of families now dealing with children who are severely addicted to opioids for whom, you know, being out on the streets might really result in their death. So this is not for every situation, but I can tell you in my clinical experience after 25-plus years...
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Sure.
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Oh, okay. So one of the most exciting findings in neuroscience in the past 75 years is that pleasure and pain are co-located in the brain. So the same parts of the brain that process pleasure also process pain. And in a very simple reductionist kind of way, they work like opposite sides of a balance.
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The majority of people with severe addiction who get into recovery get into recovery as the result of a real life negative consequences. Lost their job, lost their partner, ended up in jail, whatever it was. Until there are those significant consequences, for some people, they just won't be able to have the motivation to make a change.
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There you go. That's a good one.
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Oh my gosh.
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Yes. Yeah. So I do think that pornography addiction is one of the biggest addictions and the most silent and the most shameful addictions that we have now in the modern world. We will not infrequently have a patient come in to the clinic who claims to have other problems, and it's not until visit three or four that they finally fess up, I'm really here for a pornography addiction.
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There's so much shame around it. It's so incredibly shameful for people to admit that they are spending their time looking at these images often associated with compulsive masturbation. Some people, their addiction manifests by actually pursuing partners. So dating apps are highly addictive and meetups. All of this is related to sex and orgasm, which releases dopamine in the reward pathway.
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But it's not just the moment of orgasm. It's all of the rituals and the buildup and the searching that's related to it. Women can get addicted to pornography as well as men, although I would say that men outnumber women probably, you know, in my clinical experience, I don't know, 10 to 1. Women, however, are much more vulnerable to love addiction, which is also real, right?
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The pathological compulsive falling in love with partners, right? And then getting into these relationships that are really dramatic and not healthy and then falling out of love and then pursuing another love partner. So these addictions are real. They are very harmful for people who get addicted. Ultimately, they're not even about sex.
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They're about human attachment and the desire for human attachment and also just as a way to self-soothe and escape our own everyday suffering. And I'm particularly concerned about girls and boys who now have access to all kinds of sexual images that – Would not have been possible for them to get access to a generation or two ago.
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So imagine that deep in your brain's reward pathway, which is another exciting discovery, right, that there's this dedicated reward pathway of the brain that consists, broadly speaking, of the prefrontal cortex, which is this large gray matter area right behind our foreheads that's so important for future planning, for delayed gratification, for appreciating future consequences.
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And now, you know, a child of five with an iPad can accidentally end up on a site that has very graphic sexual images and videos.
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Well, there's a lot of potential harms. One of the harms, especially if combined with, you know, compulsive masturbation, is that it's just simply addictive, which means that the more people do it, the more they want to do it, then they have the comedown where they don't feel good.
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And then pretty soon it becomes like a compulsive, repetitive loop where they're spending large amounts of their day engaging in this activity. And that in itself is highly debilitating. But other harms I think that are significant are it really does change a person's conceptualization of what sex is and what sex is for.
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And I don't want to get into the whole thing of like, you know, sex is exercise or sex is recreational fun compared with sex, you know, as something that's maybe more sacred because I'm not here to judge any of that.
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Except to say that if a main pathway for a young person to learn about sex is through watching pornography, that's going to give them a very distorted view of what, you know, real sex is like. Not to mention what relationships are like, right, and how sex becomes a part of an intimate relationship.
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I absolutely agree, which is why I've talked about the smartphone as a masturbation machine. Essentially, these devices have become the way that we meet our physical, emotional, sexual, intellectual needs. And taken to the extreme, that would mean that We're no longer relying on other people to meet those needs. We're meeting the needs ourselves with this technology and with the devices.
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And I don't think that's a future that anybody wants taken to the extreme, right? Because we are social creatures. We need to connect with each other. Human connection is vital to a thriving life and survival in general. So, yes, I have a lot of concerns that pornography is now replacing intimacy with people in real life or disrupting our expectations of intimacy with people in real life.
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You might think of it as like the brakes on the car if we're going to analogize to an engine. And then deep, you know, in the brain, we've got what we call the limbic areas or the emotion brain. And there you have the nucleus accumbens and the ventral tegmental area that are rich in dopamine-releasing neurons, right? And they act like the accelerator on the car.
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That too and also just expectations around sex. So a lot of folks that I work with with sex addiction as they try to give up pornography, compulsive masturbation or whatever they define as their sexually addictive behaviors –
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What they find is that they almost go in the opposite direction and they kind of have zero interest in sex or they just don't have interest in sex with their real-life partner or they can't enjoy sex with their real-life partner, you know, which all kind of makes sense, right?
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When you've hijacked the reward pathway with this incredibly potent version of sex, you come back down to earth with your actual partner who's got his or her own needs and, you aging bodies or whatever it is, it's hard to experience pleasure in that realm.
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Step one is really just acknowledging the behavior, that it's problematic and that it might require some changing in our lives. The next step is being honest with ourselves and maybe another person about why we do the behavior, what we get out of it, what's positive. Step three would be honestly making a list of all of the problems with the behavior.
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How is it interfering with my goals and, as we talked about, my values? What do other people say to me about how it's problematic? Is one of the problems potentially that it's just not working anymore the way that it used to, right? I'm developing tolerance. I need more to get the same effect. It's doing the opposite of what I want it to do.
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And after we've done all that, really done a really honest self-assessment about the behavior, I recommend a 30-day dopamine fast. Now, we're not really fasting from dopamine, right? Because we're not really ingesting dopamine. What we're doing a fast from is whatever that substance or behavior is that is causing these kinds of problems potentially.
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Maybe we aren't even really sure, but we think it might be. Give it up for 30 days. Why 30 days? Well, we know that two weeks is not enough, right? We know that from this imaging study, right, that people are still in that dopamine deficit state two weeks after stopping. But 30 days based on clinical experience, not just mine, but that of many other people who do this work, right?
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For most people, no matter the drug and no matter sort of the severity and chronicity, once they get to about 30 days, they begin to feel better. They begin to come out of that tunnel of constant craving. They begin to be able to imagine a life in which they would not necessarily have to rely on this substance or on this behavior.
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What I always tell folks when they're preparing for the dopamine fast is just remember you will feel worse before you feel better. But that is withdrawal-mediated suffering. Once you get through those first 14 days, you'll begin to feel better. And potentially, by 30 days, you'll feel much better than you have in a really long time.
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So when you've got a healthy functioning brain, you've got enough accelerator but not too much, right? So enough dopamine being released but not too much. And you've got a healthy prefrontal cortex putting the brakes on that dopamine release.
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Now, this is not to say that 30 days of fasting is going to cure your addiction. Not at all. But it's the beginning. It's the beginning of being able to see causality, getting some insight. It's an experiment, right? Our lives are one big experiment. What better way to understand the variables in our lives than to change one thing, one variable, and see what happens?
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Yes.
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Self-binding is a way of acknowledging that if we rely on willpower alone, we will not be successful, especially living in this drugified world. And what we need to do is anticipate desire before we're in the throes of desire. by creating both literal and metacognitive or thought, you know, good Duncan experiment, like barriers between ourselves and our drug of choice.
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So these barriers can be actual physical barriers like putting our device into a kitchen safe and locking it up over the night or leaving it outside of our bedroom or getting the potato chips, the alcohol, the cannabis out of the house, deleting our contact drug dealer's information and telling our drug dealer, don't call me and I won't call you.
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These are all cues. That's right.
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When people become addicted, there's either a problem with the brakes, the prefrontal cortex, or the accelerator, the nucleus accumbens and ventral tegmental area, or both, right? What we're finding is that there's actually a disconnect.
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Yeah, it's so fascinating. And I think this is sort of a universal experience. So first of all, sugar is addictive. It lights up the same reward pathway as drugs and alcohol. Clear dopamine release in the nucleus, accumbens, part of the reward pathway in response to sugar. And when we quit sugar, we have a come down, right?
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We go into withdrawal and it's manifested in all the different ways that we've talked about. And it lasts for about two weeks. And one of the most salient symptoms is intense craving for sugar. And it's so amazing how intense it is. But if we can get through that period and get out of that vortex of addictive craving, the craving gradually gets better.
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And then eventually goes away, which is, by the way, very paradoxical because whatever our drug is, when we first stop it, we have intense cravings and we have the feeling that the cravings will only get worse with time. Even though we logically may have experienced otherwise by giving it up before, we have the feeling this is going to last forever. It never does, right?
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With time, the craving goes away. And once we are in that arena where we're not constantly craving, we might have something that triggers the craving, right? but like stress, but generally we're not dealing with a craving. If we were then to re-expose our brains to a little bit of sugar, immediately back in the vortex of craving. And there's an experiment I love that illustrates this.
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It's an experiment in rats. where rats were injected with cocaine, the same amount of cocaine, every day for seven days. And over the course of those seven days, the rats went from kind of hiding in the shadows of the cage to progressively running a little bit more and a little bit more.
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And by day seven, they were in a running frenzy, right, as measured by these beams of light that they were crossing. Then there was no more cocaine injected after seven days, and no cocaine or any addictive substance administered to the rats for a year, which is a rat lifetime, a really long time that would make you think, oh, you know, that there's no more cocaine in the system, none of that.
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And then the rats were injected with a single dose of cocaine, and immediately they were plunged back into that running frenzy that you saw on day seven.
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So there are large neuronal circuits and pathways between those deep limbic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted. As we think about pleasure and pain being co-located in the same parts of the brain, working like opposite sides of the balance,
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really important information because it tells us that there's some kind of permanent latent echo in our brains once we've been exposed to, and especially if we become addicted to, a particular substance, such that even with sustained abstinence on the order of years and decades, if we are re-exposed to that drug, we can immediately be plunged into the depths of our addiction.
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There's no ramp-up period that happens. And, of course, we see this all the time, you know, people with alcohol addiction who are then exposed to alcohol and right back to their max use or even exposed to something like opioids. And alcohol also works on our endogenous opioid system, so there's some homology or similarity between alcohol and opioids.
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And then immediately being plunged into opioid addiction, which then leads them back to their alcohol addiction system.
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Yeah, it's all true, which is why a big focus of the addiction medicine field is prevention and trying to make sure that we protect kids' brains from the harms of these addictive substances and behaviors.
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From sugar to digital media, video games, pornography, social media, or any other drug, you know, nicotine. So many kids are vaping now, you know, taking 50 plus puffs a day on their nicotine vape, cannabis, alcohol.
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So essentially at age five, we have more neurons and neuronal connections than we have in the rest of our adult lives, about 50% more neuronal connections than we'll have as adults, which is what makes us such good learners when we're kids. Kids can just absorb anything because they're sort of like these totipotent sponges with all these neurons and all these neuronal connections.
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But as we age through adolescence to about age 25, we cut back or what's called prune the neural circuits that we don't use and we myelinate or make more efficient the neural circuits that we use most often, such that by age 25, we are left with the neurological scaffolding that will serve us for the rest of our adult lives.
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That means that if we're engaging in addictive maladaptive coping at a young age, we're elaborating a neural circuitry based on that maladaptive coping, which is going to set us up for addiction in adulthood. I always like to emphasize, though, that because the child and adolescent brain is so plastic or totipotent or so changeable, that's also a very hopeful message.
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It means that even a young person exposed at a young age to an addictive substance, if we can get in there early enough while their brain is still plastic enough, we can rewire them. Whereas when I treat people in their 70s and 80s who have been smoking pot their whole lives or drinking alcohol... Mainly it was manageable. Now all of a sudden they retire. They're in their 60s all this time.
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In order to understand what happens in the addicted brain is to appreciate that there are fundamental rules governing this balance. And one of the most important rules is that the balance wants to remain level. It does not want to be tilted very long to the side of either pleasure or pain.
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The pot's a lot more potent. They can develop these full-blown addictive disorders late in life and it's very hard to treat them because they've lost a lot of that plasticity that would allow them to regenerate new neural pathways once they abstain.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Oh my God, we talked about so much. I don't even know. It seems like it was a lot of stuff.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Talk about. Yeah. Well, I mean, I guess I would emphasize that when I talk about the dopamine fasting, it's an early intervention. It's not an intervention that I would recommend for someone who had repeatedly tried to quit on their own and been unable to. Clearly, that would be an exercise in futility. That person should go and get professional help.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Maybe they need to go to a residential treatment center. I also wouldn't recommend dopamine fasting or just quitting your drug of choice if you're at risk for a life-threatening withdrawal. So we could have a life-threatening withdrawal from alcohol and benzodiazepines like Klonopin, Xanax, Ativan. Again, in those cases, go see a professional.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Get help with a medical detoxification before you try to, you know, sustain abstinence for a period of time. So, you know, I would blanket the whole thing with like the caveat, go see your addiction, go see the addiction medicine specialist near you.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
And in fact, what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is. So I'm going to try to illustrate that here. So let's say our initial stimulus is alcohol. Now, alcohol works through its own chemical pathway. It works on our endogenous opioid system, the opioids that we make. We have receptors for opioids in our brains.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
I think the most recent piece of information that was very impactful for me was the realization that we are probably going to be cybernetically enhanced in the future and interfacing with technology in a way that's completely seamless and that this is inevitable.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Or at least we're going to be surrounded by the technology in a way that's invisible. And it's going to be just completely integrated into our lives. Whether it'll actually be under the skin, I think it will be. But... I can see in that so much potential good and promise and so much that's really terrifying, especially when I think about the way it's going to change us as humans.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
And my big fear about it is that we will become more and more isolated and that we'll end up sort of in these little cubicles of our own making forever. scattered alone all across planet Earth. I hope it doesn't lead to that, but that's my worry.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Yeah, thanks for the opportunity to, you know, teach people about this information. I hope it's helpful for people.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Thank you so much.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
It works on our endogenous GABA system, which is our calming neurotransmitter. And at the end of the day, it releases dopamine in the reward pathway. So any potentially addictive substance will release dopamine in the reward pathway. The more that's released and the faster that's released in a given individual, the more likely that substance is to be addictive.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Now, another important concept here is what we call drug of choice, which is to say what releases a lot of dopamine in your brain may not release a lot of dopamine in my brain and vice versa, right? Which is this idea that people have predilections to different kinds of drugs. And by the way, people can get addicted to behaviors too. I should emphasize that.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
One of the most important findings in neuroscience in the past 75 years is that the same parts of the brain that process pleasure also process pain, and the balance wants to remain level. The problem is that we automatically seek out pleasure and avoid pain, and we're exposed to all kinds of pleasures that we have in the modern world. And our brains are reeling in response to try to compensate.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Yes. The more dopamine that's released, the faster that it's released, the more likely that drug is to be addictive for a given individual.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
I'm holding some whiskey.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Exactly. And for many of my patients who become addicted to alcohol, they will tell you that from the first moment they had alcohol, they knew they were either in trouble or had met their best friend or some combination. It was a very potent experience for them. All right. So let's go ahead and put this on the pleasure side of the balance.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Dopamine is being released, but no sooner has that happened than my brain will work very hard to restore a level balance. And by the way, a level balance is what neuroscientists call homeostasis, okay? And one of the overarching physiologic drives for all living organisms is to return to homeostasis. Homeostasis is that parameter of...
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
what's often called affordances or states of being that are adaptive and healthy for the organism. For example, like we have a certain homeostasis of body temperature. And if we go much beyond that, either too high or too low, we will disintegrate and die, right? So homeostasis is that states of being that are compatible with existence and potentially advantageous too.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
That's right. Yeah, baseline level. And by the way, we're always releasing dopamine at a kind of tonic baseline level in our brains. I sometimes think of it as the heartbeat of the brain.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Exactly. So now we've released dopamine in the reward pathway.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Well, I think, you know, again, this is a metaphor. It's an oversimplification. The idea here is just when we press on the pleasure side, we're releasing dopamine in the reward pathway and experiencing pleasure.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Okay. But no sooner has that happened than our brain will try to compensate or adapt to increased dopamine firing by downregulating dopamine transmission, for example, by involuting postsynaptic dopamine receptors.
The Diary Of A CEO with Steven Bartlett
The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Really Doing To Your Brain! Your Childhood Shapes Future Addictions!
Okay. Okay. So our brain is a bunch of wires, you know, that conduct these electrical signals. And these long spindly cells are called neurons. And the thing about neurons is that they don't actually touch end-to-end. There's a little gap or space between them, and that gap is called the synapse.