00:00:00
There's a great experiment where rats
00:00:02
were given a lever to press for cocaine
00:00:04
and after learning that it releases a
00:00:05
lot of dopamine, the rats will [music]
00:00:07
press that lever till exhaustion or
00:00:09
death, which is essentially the model of
00:00:11
addiction that we see in humans. But if
00:00:13
the cocaine is then removed, eventually
00:00:15
they won't press [music] the lever
00:00:16
anymore. Now, if that same rat after a
00:00:18
period of time is then exposed to a very
00:00:20
painful foot shock, the first thing the
00:00:22
rat will do is run over and start
00:00:24
pressing that lever again. And that's
00:00:26
really powerful because it shows that
00:00:28
when individuals are under extreme
00:00:30
stress, they are more vulnerable to
00:00:32
going back to compulsive overconumption
00:00:34
of our drug of choice because their
00:00:36
brain has already encoded using these
00:00:38
high dopamine rewards as a way to get
00:00:40
out of that pain.
00:00:41
>> Okay, so what do I need to do to make
00:00:43
sure that I can knock the bad habits and
00:00:45
add some new ones?
00:00:46
>> Here's what we do.
00:00:47
>> Dr. Anna Lumpy is chief of the Stanford
00:00:49
Addiction Clinic and a [music]
00:00:50
worldleading expert on the subject of
00:00:51
dopamine. And now she's returned to warn
00:00:54
us that addiction is the modern plague
00:00:56
and how we can rewire our brains to take
00:00:58
back control.
00:00:59
>> On average, it takes 4 weeks for people
00:01:01
to get out of constant state [music] of
00:01:03
craving. But here's the problem. Our
00:01:04
survival depends on figuring out how to
00:01:07
live in a world of abundance. For
00:01:08
example, we're now seeing the
00:01:10
drugification of human connection
00:01:12
through social media, dating apps, and
00:01:15
now artificial intelligence designed to
00:01:18
flatter, to validate. There's no
00:01:20
friction there. And so it's pulling us
00:01:22
away from the hard things that we need
00:01:24
to be doing in real life to cultivate
00:01:26
real life relationships. Just we cannot
00:01:28
go in that direction because in a world
00:01:30
of abundance, we are entertaining
00:01:32
ourselves to death.
00:01:33
>> Sounds like a good way to go.
00:01:34
>> It's really not because the relentless
00:01:36
pursuit of pleasure leads to anhidonia.
00:01:38
[music]
00:01:38
>> What's that mean?
00:01:39
>> The inability to take joy in anything at
00:01:42
all.
00:01:43
>> Teach me everything.
00:01:46
I see messages all the time in the
00:01:47
comments section that some of you didn't
00:01:49
realize you didn't subscribe. So, if you
00:01:51
could do me a favor and double check if
00:01:52
you're a subscriber to this channel,
00:01:54
that would be tremendously appreciated.
00:01:55
It's the simple, it's the free thing
00:01:57
that anybody that watches this show
00:01:58
frequently can do to help us here to
00:02:00
keep everything going in this show in
00:02:02
the trajectory it's on. So, please do
00:02:04
double check if you've subscribed and uh
00:02:06
thank you so much because in a strange
00:02:07
way, you are you're part of our history
00:02:09
and you're on this journey with us and I
00:02:11
appreciate you for that. So, yeah, thank
00:02:13
you, [music]
00:02:17
>> Dr. Anna Lemi, for anyone that might not
00:02:21
know you and they didn't watch our
00:02:22
conversation last time, which was a
00:02:24
fantastic conversation, one of my
00:02:25
favorites of all time, and also I know
00:02:26
Jack has said to me as well that it was
00:02:28
one of his favorites of all time. Who
00:02:30
are you and what have you spent your
00:02:31
career doing if you had to summarize it?
00:02:33
What are the reference points that your
00:02:36
wisdom draws upon and the experiences
00:02:37
you've had and the people you've worked
00:02:39
with?
00:02:40
>> I'm a psychiatrist. I did a residency in
00:02:43
psychiatry at Stanford University and
00:02:45
then I stayed on joined the faculty. I
00:02:48
see patients. I do research and I teach.
00:02:52
>> You wrote this um iconic book about this
00:02:55
word dopamine. Why does it matter so
00:02:57
much? Why does this this idea of
00:02:59
dopamine matter so much?
00:03:01
>> Dopamine is a chemical we make in our
00:03:04
brain. But I use it in the book as
00:03:06
really an extended metaphor for the ways
00:03:08
in which overabundance itself is a human
00:03:13
stressor. We are living in a time and
00:03:16
place where we have more access to
00:03:18
luxury goods, more disposable income,
00:03:20
more leisure time even for the poorest
00:03:23
of the poor ever before in recorded
00:03:26
history. And it turns out that is
00:03:29
stressful for our brains. And it's
00:03:32
stressful in a brand new way that we
00:03:34
really haven't confronted before, making
00:03:37
us all more vulnerable to the problem of
00:03:40
compulsive overconumption
00:03:42
and addiction. And I do think that
00:03:44
addiction is the modern plague. I think
00:03:47
we're going to be struggling with the
00:03:48
problem of compulsive over consumption
00:03:50
in a world of abundance for the
00:03:54
foreseeable future, as in centuries. and
00:03:57
our survival will depend on figuring out
00:04:01
how to live in a world of abundance.
00:04:04
Even though we have brains that evolved
00:04:07
for a world of scarcity,
00:04:08
>> at this time of the year, people are
00:04:10
thinking a lot about making changes in
00:04:11
their life. They want to get in shape.
00:04:13
They want to lose a couple of pounds.
00:04:14
They want to save their money. They want
00:04:16
to knock the addiction. They want to
00:04:17
stop the smoking, the
00:04:22
drugs, and the alcohol. So, as it
00:04:26
relates to the subject of dopamine,
00:04:29
how do these two things link our habits
00:04:31
and dopamine? What is the the link or
00:04:34
the connection there? Because I think
00:04:35
most people listening right now have
00:04:36
probably made a New Year's resolution,
00:04:38
even if it's just in their mind. And I'm
00:04:40
wondering how everything you write about
00:04:41
in dopamine nation is related to and
00:04:44
critical to understand if I am going to
00:04:46
shake some of these bad habits that I
00:04:47
have or pick up some new ones. The place
00:04:49
to start is to have self-compassion
00:04:53
because we are living in a world of
00:04:55
abundance where we have easy access to
00:04:58
all kinds of reinforcing substances and
00:05:00
behaviors and access itself is one of
00:05:03
the biggest risk factors for addiction.
00:05:06
So if you grow up in a neighborhood
00:05:08
where drugs are easily and readily
00:05:10
accessible, you're more likely to try
00:05:11
them and more likely to get addicted to
00:05:13
them. And what do addictive substances
00:05:17
and behaviors do to our brains? They
00:05:18
release a lot of dopamine all at once in
00:05:21
a dedicated part of the brain called the
00:05:23
reward pathway.
00:05:25
And the fact that they release so much
00:05:28
dopamine at once means that they're
00:05:30
highly salient and memorable
00:05:32
experiences. Right? So our brain really
00:05:36
encodes that experience deeply, that
00:05:38
experience of intense pleasure that was
00:05:43
self-administered
00:05:44
that I could potentially do again.
00:05:48
>> Why?
00:05:49
>> Okay. In a world of scarcity and
00:05:52
everpresent danger, which is the world
00:05:53
that we evolve for, we will naturally
00:05:57
reflexively approach pleasure and avoid
00:06:00
pain. And we must do so for our
00:06:02
survival. Why? So, if I have a cigarette
00:06:04
now, [sighs]
00:06:07
it's going to be a really memorable
00:06:08
experience from a brain perspective.
00:06:12
Why does my brain make it memorable? And
00:06:14
why would I want to then go do that
00:06:16
again from a survival perspective?
00:06:18
>> Okay, great question. So, let's first
00:06:21
distinguish what we call na natural
00:06:23
rewards. So, natural rewards are food,
00:06:26
clothing, shelter, finding a mate.
00:06:28
>> Yeah,
00:06:29
>> these are things we must obtain in order
00:06:31
to survive.
00:06:33
What addictive drugs and behaviors do is
00:06:37
they mimic those natural rewards by
00:06:40
exploiting our internal brain chemistry
00:06:45
to release a lot of dopamine all at
00:06:47
once, much more than we would get from
00:06:49
natural rewards existing in nature.
00:06:52
Amplifying that experience, making it
00:06:54
even more memorable, even more salient,
00:06:57
and also making our brain think, "Ah,
00:07:00
this is important for my survival. Uh
00:07:02
okay. So there's certain natural rewards
00:07:05
like eating which of course my body
00:07:07
wants to reward me for. So I eat again.
00:07:09
And these chemicals in front of me like
00:07:11
the cigarettes, the whiskey, the drugs,
00:07:14
those have been designed to hijack that
00:07:17
particular part of the brain and really
00:07:19
amplify the feeling so that my brain
00:07:21
kind of is tricked into thinking that it
00:07:22
was potentially a natural reward, but
00:07:25
it's actually a synthetic sort of
00:07:27
man-made chemical.
00:07:29
>> Exactly. And what we see in the
00:07:32
evolution of drugs over you know human
00:07:36
lifetimes but especially in the last 200
00:07:39
years is the application of science and
00:07:42
technology to take like the cocoa leaf
00:07:46
for example right that's been around
00:07:49
forever and essentially make it even
00:07:53
more potent even more uh available to
00:07:56
make it a faster delivery mechanism. So
00:07:58
we have this history of increasing
00:08:01
potency and availability over time. Said
00:08:04
more simply, drugs are getting even more
00:08:07
potent over time. So this vulnerability
00:08:10
to the hijacked brain is even more
00:08:13
common, including taking things that we
00:08:16
didn't even really think of as drugs and
00:08:20
turning them into drugs. So remember the
00:08:22
natural rewards, one of them is finding
00:08:25
a mate. Mhm.
00:08:26
>> And one of the ways our brains gets us
00:08:28
to do that is by making falling in love
00:08:32
and making intimacy and human connection
00:08:34
rewarding on a neurobiological level,
00:08:37
including releasing dopamine in our
00:08:40
reward pathway when we make uh those
00:08:42
kinds of social connections. My
00:08:44
colleague at Stanford, Rob Balanka, and
00:08:47
uh and his colleagues did an interesting
00:08:49
experiment where they were able to show
00:08:51
that oxytocin, our love hormone, binds
00:08:55
to dopamine releasing neurons in the
00:08:57
reward pathway and releases dopamine,
00:09:00
which is just one more link in the chain
00:09:02
showing us that falling love, human
00:09:05
connection is rewarding. It feels good.
00:09:08
It it releases dopamine. What we see now
00:09:11
is the drugification of human
00:09:15
connection. For example, through social
00:09:18
media, dating apps, online pornography,
00:09:22
and now artificial intelligence and
00:09:24
other large language models, which
00:09:27
create this frictionless experience with
00:09:30
technology that feels like talking to a
00:09:33
human being and is incredibly
00:09:35
validating. Right? So the algorithms for
00:09:38
large language models are to make us
00:09:40
feel really good, to make us feel like
00:09:41
our point of view is the right point of
00:09:43
view, to bolster our self-esteem, to
00:09:46
validate our point of view. That's how
00:09:48
those algorithms are designed. And now
00:09:50
even more explicitly, we have AI models
00:09:52
that are explicitly pornographic,
00:09:55
explicitly erotic, right? So now you
00:09:57
have this interactive component that
00:09:59
learns what we like and then is able to
00:10:01
regurgitate it back to us. So you get
00:10:03
this really very powerful action
00:10:06
perception loop which is part of what
00:10:10
makes a drug potent. It's that I have
00:10:12
control over it. Right? I can decide
00:10:16
when I'm going to change the way I feel
00:10:18
by using this drug.
00:10:19
>> Are you concerned about AI and LGBT and
00:10:22
all those large language models that
00:10:24
have emerged that are now simulating
00:10:26
human connection?
00:10:27
>> Yes, I'm very concerned. I see the not
00:10:30
so good outcomes, meaning people who get
00:10:33
addicted to social media, to dating
00:10:35
apps, to online pornography,
00:10:38
um, and to AI, you know, and who end up
00:10:42
using those forms of media to simulate
00:10:47
human connection while they actually
00:10:50
become more and more disconnected. Have
00:10:53
you started to see anybody in your
00:10:54
practice or heard of anybody that's
00:10:56
developing an addiction to
00:10:59
AI or relationships with AI?
00:11:01
>> So we are starting to see that um you
00:11:04
know individuals who are spending more
00:11:06
and more time on AI looking for
00:11:10
companionship.
00:11:11
Often this is individuals who are
00:11:13
experiencing marital or interpersonal
00:11:16
conflict who turn to AI for advice on
00:11:20
how to handle interpersonal conflict and
00:11:23
often for emotional validation because
00:11:25
they're not getting it from their
00:11:26
partners. And what they experience with
00:11:28
AI is an enormous amount of emotional
00:11:31
validation, validating their point of
00:11:33
view, but also a a sense of
00:11:36
companionship.
00:11:38
um you know a repeated process of
00:11:41
feeling like they're understood, they're
00:11:43
they're validated such that then they're
00:11:45
spending more and more time on AI. And
00:11:49
of course that is the essence of
00:11:53
the addiction to digital media. It's the
00:11:57
time spent, right? Which then leads to
00:12:00
opportunity costs, other things that
00:12:02
we're not doing because we're spending
00:12:04
so much time online. Furthermore, it in
00:12:08
my experience often leads to a rift
00:12:11
between
00:12:13
those individuals and their real life
00:12:14
partners because instead of going to
00:12:17
their real life partners and talking and
00:12:19
we know that the most important thing
00:12:22
that you know two individuals in a
00:12:24
relationship can do is one four-letter
00:12:27
word that ends with K, which is talk.
00:12:30
Those individuals stop talking, right?
00:12:32
and instead they're getting their needs
00:12:34
met through AI
00:12:36
and that leads then to a further and
00:12:38
further rift between those individuals.
00:12:41
>> Do do you actually think that it it is
00:12:43
these chat bots that we're increasingly
00:12:45
speaking to about our problems are
00:12:47
actually taking the place of humans in
00:12:50
our life. I do you know in my book I my
00:12:54
first chapter in the book is about a
00:12:57
patient of mine a scientist and an
00:12:59
engineer who got addicted to pornography
00:13:02
and eventually made his own masturbation
00:13:05
machine.
00:13:07
And he did that with a record player and
00:13:09
a metal device attached to his organs
00:13:12
that he could then uh fine-tune control.
00:13:15
And then ultimately that got more and
00:13:17
more sophisticated over time and he had
00:13:19
electrical wires from his body to the to
00:13:23
a through a stereo system and the
00:13:24
internet. And when I first heard um from
00:13:28
Jacob about his trajectory and the
00:13:31
severity of his sex addiction which
00:13:35
ultimately led to the dissolution of his
00:13:36
relationship, the near loss of his
00:13:39
employment and ultimately severe
00:13:41
depression and suicidal ideiation.
00:13:43
Thankfully, he did not end his life.
00:13:47
When I first heard about that, I had
00:13:49
this distinct sense of like otherness,
00:13:52
like, "Oh my gosh, I can't even imagine
00:13:55
doing that." And that's just kind of
00:13:59
horrific. But that that response really
00:14:03
lasted all of five seconds before I
00:14:05
realized, oh, wait a minute. I do that,
00:14:08
you know, I do that with romance novels.
00:14:11
And in a way, we're all doing that with
00:14:13
our devices, right? We're turning to
00:14:16
these devices to meet our
00:14:19
emotional, sexual, intellectual, you
00:14:23
name it, needs. And these devices are so
00:14:26
good at meeting those needs that we are
00:14:30
getting further and further away from
00:14:32
investing in our relationships with the
00:14:35
people who are, you know, in our lives.
00:14:36
And you can see this especially with
00:14:38
younger generations like the the
00:14:40
epidemic of loneliness now you know Gen
00:14:43
Z weaned on this technology many of whom
00:14:46
endorse significant loneliness isolation
00:14:50
depression spending more and more time
00:14:52
online um report preferring to interact
00:14:56
socially online than to do it in person.
00:14:59
So this is definitely a dark
00:15:01
undercurrent um that we're seeing in the
00:15:03
world today. I was reading about a story
00:15:05
which was published in People magazine
00:15:07
of a 28-year-old woman who admitted that
00:15:09
she's fallen in love with her AI
00:15:11
boyfriend that she created using chat
00:15:13
GPT. She's got a husband, a real life
00:15:16
husband, yet she found more comfort in
00:15:19
her Chat GPT boyfriend. Um, and she said
00:15:22
that it started as a fun experiment. Um,
00:15:25
but eventually they ended up getting
00:15:26
attached and now she's paying a $200 a
00:15:28
month subscription so she can interact
00:15:30
with her AI boyfriend without
00:15:32
restrictions.
00:15:34
The AI has helped her throughout her
00:15:36
life and has given her incredible
00:15:39
emotional support
00:15:41
and now there's actually AI companion
00:15:43
apps like replica where which have
00:15:44
millions of users and the whole sort of
00:15:47
premise of those apps is that they will
00:15:48
be your companion. The other really
00:15:50
interesting thing that I um I don't
00:15:52
think people realize about the AIs that
00:15:54
they're using is that they are
00:15:55
personalizing their answers and their
00:15:57
responses to you.
00:15:58
>> Right?
00:15:58
>> And I didn't I didn't believe this fully
00:16:00
until one of my friends in our
00:16:01
Manchester United chat recently. We were
00:16:03
debating who was the best football
00:16:04
player of all time, Ronaldo or Messi.
00:16:06
And I went on my chat GBT and I asked
00:16:08
the question and it said Messi. So I was
00:16:10
like, here you go. [laughter] And then
00:16:12
he went on his and asked the exact same
00:16:15
question word for word and it said
00:16:16
Ronaldo. And I thought, oh, it's telling
00:16:18
me what I wanted to hear based on what
00:16:19
it knows about me,
00:16:20
>> right?
00:16:20
>> It knows that I think Ronaldo's the
00:16:22
Messi is the best. So, it's telling me
00:16:23
that. And then I thought, okay, so what
00:16:25
else is is it telling me that's
00:16:27
personalized to me to make me feel a
00:16:29
certain way or to think a certain way?
00:16:31
Um, but you don't realize when you're
00:16:32
speaking to it that it's giving
00:16:33
everybody different answers based on the
00:16:35
memory that it stores on you. And
00:16:37
that's, you know, if you play this
00:16:39
forward, actually the AI that is most
00:16:41
personalized, that caters to your needs
00:16:42
the most, that is most retentive, is
00:16:45
probably the one that you're going to
00:16:46
end up using the most. So that company's
00:16:48
going to be the most successful. So
00:16:49
we're in a probably a bit of an arms
00:16:50
race with these models to create one
00:16:53
that meets your needs the most.
00:16:56
>> Yes. Exactly. And it is that comfort
00:16:58
loop that is so incredibly dangerous and
00:17:01
also so insidious because we can't
00:17:03
observe it in the moment, right? We're
00:17:05
engaging with AI. It's telling us
00:17:08
exactly what we want to hear, but it
00:17:10
does it in such a seamless way with that
00:17:13
silky syntax that we don't even notice
00:17:16
that, you know, it's basically an
00:17:17
algorithm that's seducing us because
00:17:19
that's really what it's doing. We feel
00:17:21
vindicated and validated and it releases
00:17:25
dopamine in the reward pathway. That
00:17:27
feels good. But over time, essentially
00:17:31
what's happening is we are ingesting a
00:17:33
drug. Our brain will adapt to that over
00:17:36
time such that we'll need more and more
00:17:38
potent forms to get the same effect.
00:17:40
We'll need more validation. We'll need
00:17:42
more sexually explicit responses. You
00:17:44
name it, there will be tolerance. But
00:17:46
also there will be this pulling away
00:17:49
from the things the hard things that we
00:17:52
need to be doing in real life to
00:17:54
cultivate in real life relationships.
00:17:57
>> Give me some more color on what you mean
00:17:58
there.
00:17:59
>> Okay. If you think about what it takes
00:18:01
to make a to create a healthy
00:18:04
relationship with another human being in
00:18:06
in real life. Well, first of all, you
00:18:09
got to get up off the couch and you got
00:18:10
to go find them, right? And they're not
00:18:13
all beautiful and interesting and
00:18:15
neither are we, right? So there's got to
00:18:17
be, you know, some compromise on maybe
00:18:19
some idealized version that we have for
00:18:22
ourselves or other people. And then
00:18:23
you're in conversation and it's not
00:18:26
always interesting and sometimes you
00:18:27
have to listen to your partner even when
00:18:29
it's dull and then there are conflicts
00:18:31
and you disagree and you know my way or
00:18:33
the highway you have to give in, you
00:18:36
know, give and take. All relationships
00:18:37
are about compromise. All successful
00:18:40
relationships are about acknowledging,
00:18:43
you know, the other person's point of
00:18:45
view and incorporating that. And yet,
00:18:48
we're not doing any of that when we're
00:18:50
interacting with digital media, right?
00:18:51
It's all it's all validation of our
00:18:55
worldview, what we want to hear. And of
00:18:57
course, that feels great. It's it's
00:19:00
reinforcing. It's rewarding. But over
00:19:02
the long haul when we get really sick
00:19:05
and need somebody to come and you know
00:19:07
bring us some chicken soup or take us to
00:19:09
the doctor or you know take us to the
00:19:11
hospital like AI is not going to not
00:19:13
going to be able to do that.
00:19:15
>> Yeah. I mean this kind of dubtales to
00:19:16
another point which is you talked about
00:19:18
the word abundance earlier. One of the
00:19:21
really striking things that a lot of the
00:19:23
big AI entrepreneurs and founders and
00:19:25
CEOs are talking about is the age of
00:19:27
abundance that's around the corner. Elon
00:19:29
Musk tweeted saying, "This really will
00:19:32
be a world of abundance, specifically
00:19:34
advances in AI and robotics um will
00:19:38
create the age of abundance." And he
00:19:40
said, "Humanity is not constrained in
00:19:42
any real fashion. I thought your first
00:19:45
book when he was talking to a guy called
00:19:46
Peter Diamonds was pretty accurate. It
00:19:48
was called abundance. And there will be
00:19:52
universal high income and not universal
00:19:54
basic income. There will be no shortage
00:19:56
of goods or services." And really what
00:19:59
he's speaking to here is a world of
00:20:00
robotics and AI where I think his
00:20:02
shareholder remuneration package that
00:20:04
he's going to be paid in 2030 or
00:20:06
whatever um is linked to creating a
00:20:09
million humanoid robots that can work in
00:20:12
these physical spaces that could
00:20:14
theoretically bring me chicken soup um
00:20:17
that won't get sick, won't complain,
00:20:19
will reinforce me, will live in the
00:20:20
physical environment with me here at
00:20:22
home, will be in my office etc etc will
00:20:25
be in factories and there was a headline
00:20:26
I think last week saying that a um
00:20:28
Amazon were cutting back about half a
00:20:31
million jobs that they were intending to
00:20:32
hire previously because they now believe
00:20:35
that humanoid robots and robots
00:20:36
generally will be able to do those jobs.
00:20:39
People think, okay, well, I'm going to
00:20:40
be out of work. But what Elon is saying
00:20:42
is the price of everything comes down
00:20:44
when we're not paying humans to do it
00:20:46
and when we're paying a robot to do it,
00:20:48
which means that we're going to live in
00:20:49
this world of abundance where everything
00:20:51
is much cheaper. the world of abundance
00:20:54
that many of us are already experiencing
00:20:57
and more will experience in the future.
00:20:59
I agree with that. We are we already
00:21:01
have more leisure time than we had a
00:21:03
generation ago. By 2050, we're projected
00:21:05
to have 7 hours of leisure time per day
00:21:08
compared with 3 hours of work per day.
00:21:10
So, we're definitely moving toward that.
00:21:13
That is going to be our number one
00:21:16
social problem that we have time, we
00:21:20
have access to these highly entertaining
00:21:24
media
00:21:26
and hypothetically we would all be going
00:21:29
around and helping each other and
00:21:31
cleaning up the planet and reading
00:21:33
philosophy. But that is not what is
00:21:36
happening so far. What is happening so
00:21:38
far is we're spending an enormous amount
00:21:40
of our time online masturbating,
00:21:43
watching pornography, playing video
00:21:45
games, and talking to AI chatbots.
00:21:49
That is essentially the problem. And you
00:21:52
know, Elon Musk, he's very interesting
00:21:54
to me because he has talked before about
00:21:57
his tremendous fear that the machines
00:22:00
will take over, that there will be a
00:22:02
hostile takeover. It's not going to be a
00:22:04
hostile takeover. We will seed our
00:22:06
agency to these machines and we're
00:22:09
already doing it.
00:22:10
>> We will give them our power.
00:22:12
>> Yeah. Well, yeah. We will we will we
00:22:14
will entertain ourselves to death,
00:22:16
right? I mean, and this is what Neil
00:22:18
Postman warned about in his book,
00:22:20
Amusing Ourselves to Death, a theme that
00:22:23
was picked up by David Foster Wallace in
00:22:25
Infinite Jest. You know, beginning with
00:22:28
television and now the internet and
00:22:31
digital media and all its various forms,
00:22:33
we are entertaining ourselves to death.
00:22:37
>> Entertaining ourselves to death
00:22:43
sounds like a good way to go. [laughter]
00:22:46
Do you know what I mean?
00:22:48
>> You know, it's really not. It's really
00:22:50
not. And I'll tell you why. Because the
00:22:52
relentless pursuit of pleasure for its
00:22:54
own sake leads to anhidonia which is the
00:22:58
inability to take joy in anything at
00:23:00
all. Because of this process of neuro
00:23:03
adaptation and the way that our brain
00:23:06
recalibrates pleasure and pain such that
00:23:09
with the more pleasure we pursue, the
00:23:12
more pleasure we need and the more we
00:23:15
feel pain. No matter what we have,
00:23:18
eventually it won't be enjoyable
00:23:20
anymore. And that is the problem.
00:23:22
>> So explain that to me using uh
00:23:25
these scales that I have here.
00:23:27
>> Okay. So imagine that in our brain's
00:23:29
reward pathway there's a balance like
00:23:31
this that represents how we process
00:23:32
pleasure and pain. When we experience
00:23:35
pleasure it tips one way, pain, it tips
00:23:37
the other.
00:23:38
>> And what do you mean by pain?
00:23:39
>> Pain I mean all forms of pain. Physical
00:23:41
pain, emotional pain.
00:23:43
>> A hangover.
00:23:44
>> A hangover. That's a great example,
00:23:46
right?
00:23:46
>> Not just me being pinched.
00:23:48
>> It could be that too. So all different
00:23:49
forms of pain. Now granted this is a
00:23:51
vast oversimplification.
00:23:53
You know pleasure and pain can be
00:23:55
experienced simultaneously like when
00:23:57
we're eating spicy food or during sex.
00:24:00
So this is very simplified but this gets
00:24:03
at the core concept of homeostasis and
00:24:06
neuro adaptation which I will define. So
00:24:09
when the when the balance when the
00:24:11
pleasure and pain balance is level
00:24:13
that's what neuroscientists call
00:24:14
homeostasis. That is the baseline level
00:24:18
that we kind of live in. That's our sort
00:24:20
of the heartbeat of our pleasure system,
00:24:24
right? When we do something that's
00:24:26
reinforcing or pleasurable, right? Or
00:24:28
rewarding in some way right here. All
00:24:31
right. Or digital media, this little AI
00:24:35
robot.
00:24:36
>> So, you're putting a cigarette into the
00:24:38
one side of the scale at the moment and
00:24:40
then a little AI robot. Yeah, let's
00:24:42
combine them because we're, let's say,
00:24:43
we're we're we're watching a video and
00:24:45
smoking at the same time on our phone,
00:24:47
which by the way, you see more and more
00:24:48
of, right? People used to go out for
00:24:49
smoke breaks. Now it's the smoke and
00:24:51
squirrel break, right?
00:24:53
>> And why do they have to combine them?
00:24:54
Because of tolerance, which we're going
00:24:55
to get to in a second. So whe when we
00:24:58
ingest substances that are potentially
00:25:00
addictive um and highly reinforcing or
00:25:03
we engage in activities that are highly
00:25:04
reinforcing that releases dopamine in
00:25:07
the nucleus ccumbent that's typically
00:25:09
associated with pleasure and then our
00:25:13
pleasure pain balance tilts to the side
00:25:14
of pleasure. But no sooner has that
00:25:17
happened then our brain responds by
00:25:21
neuro adaptation. Okay. And that's where
00:25:24
we then downregulate dopamine
00:25:26
transmission.
00:25:27
>> When you say downregulate, do you mean
00:25:29
reduce?
00:25:30
>> Yes. So in in the brain's reward
00:25:32
pathway, we then reduce dopamine
00:25:33
transmission. And I like to represent
00:25:35
that as rocks in this case or I talk
00:25:38
about in my book gremlins going on the
00:25:40
pain side of the balance to bring it
00:25:42
level again. So this is the process.
00:25:44
These are neuro adaptation uh rocks.
00:25:46
Okay, they're going here because one of
00:25:48
the overarching rules governing this
00:25:51
balance is that it must return to
00:25:53
homeostasis.
00:25:54
>> It must return to balanced.
00:25:56
>> It must return to the level position.
00:25:58
Yeah. Okay. So then we we put in So this
00:26:00
is our brain working to return to the
00:26:02
level position by reducing dopamine
00:26:04
levels. Again, an oversimplification,
00:26:06
but just a way to get at this concept.
00:26:08
>> Has it released something in order to
00:26:10
counteract the balance there? In this
00:26:12
simplified metaphor, you know, at the
00:26:14
simplest level, what's happening here is
00:26:16
that it's, for example, taking away
00:26:20
dopamine receptors so that there's fewer
00:26:23
places for dopamine to land, thereby
00:26:26
decreasing dopamine transmission
00:26:28
>> because it has been flooded.
00:26:29
>> Because it has been flooded. That's
00:26:31
right. It's trying to compensate for the
00:26:33
too much dopamine.
00:26:34
>> Okay. And is this what I experience when
00:26:36
I have like a hangover or a come down?
00:26:38
>> Right. So, that's coming. So what
00:26:40
happens is once once we've gone with
00:26:41
this neur process of neuro adaptation it
00:26:44
would be nice if that pleasure pain
00:26:45
balance just went back to the level
00:26:47
position and then there would be no
00:26:49
hangover but it doesn't. It continues to
00:26:51
go down an equal and opposite amount to
00:26:54
the side of pain. This is this opponent
00:26:56
process mechanism.
00:26:57
>> Oh now my brain is dopamine
00:26:59
starved. It's
00:27:00
>> that's it. Okay that doesn't feel good.
00:27:02
>> Yes. And that doesn't feel good. And you
00:27:04
have basically two options here. more
00:27:07
dopamine.
00:27:08
>> You can get more dopamine, right, to get
00:27:11
bring yourself back. So, I'm now putting
00:27:13
the cigarettes back under the pleasure
00:27:14
thing
00:27:15
>> and some whiskey.
00:27:16
>> So, let's add some whiskey because
00:27:17
that's what you got to do because this
00:27:18
is tolerance, right? You need more and
00:27:20
more of your drug over time to get the
00:27:22
same effect or you need to combine drugs
00:27:24
to overcome tolerance. And by the way,
00:27:26
this is of course the fastest way to to
00:27:28
get back to level position is to use
00:27:30
more of your drug, right? Because that
00:27:32
then you're right there. You're back
00:27:33
again. the the problem with this method
00:27:35
is that the the brain will respond by
00:27:38
more neuro adaptation. So now we're
00:27:40
putting more rocks in on the in the
00:27:43
pains and then you're now you're now
00:27:45
you're doing this right
00:27:46
>> now I need even more to
00:27:48
>> now you need even more right. So, and
00:27:50
eventually over time,
00:27:54
you know, you're you're putting you're
00:27:56
doing this and this is simply a
00:28:00
metaphorical representation of
00:28:03
the addicted brain right now. Now, our
00:28:07
brain has downregulated dopamine
00:28:10
transmission in the reward pathway to a
00:28:13
kind of chronic dopamine deficit state.
00:28:16
So to feel good when I've really abused
00:28:19
my drugs of choice, I'm going to have to
00:28:21
do so much probably so frequently to
00:28:24
feel good again.
00:28:25
>> That's exactly right. You're going to
00:28:26
need more of your drug in more potent
00:28:28
forms more often. Just not even to feel
00:28:32
like high and go to the pleasure side,
00:28:35
but just to level the balance and feel
00:28:37
normal. So, in the context of people
00:28:39
with bad habits, if I I'm having a
00:28:42
cookie every day, the more and more
00:28:44
cookies that I eat, the more and more
00:28:46
cookies I'm going to want tomorrow and
00:28:47
need tomorrow just to feel good again.
00:28:49
>> Essentially, yes.
00:28:50
>> And the same applies for things
00:28:51
[clears throat] like pornography and
00:28:53
maybe, you know, interacting with an an
00:28:56
AI and social media and whiskey and
00:28:57
alcohol. So the more of it I consume,
00:29:01
this is why, you know, I think everybody
00:29:03
listening can probably relate to having
00:29:05
moments in their life where they feel
00:29:06
like they're they're kind of losing
00:29:08
control of a particular habit and
00:29:10
they're doing it every day. They know
00:29:11
they don't really want to, but they're
00:29:13
doing it. They're getting cravings to do
00:29:15
it. I I reflect on my own life and I go
00:29:17
there there will be periods every year
00:29:19
where I just like I call it like falling
00:29:22
off the horse and I just can't seem to
00:29:23
get control of like not eating that bad
00:29:25
thing again the next day. and then
00:29:27
something happens. Maybe there's less
00:29:29
stress in my life for a week and I'm and
00:29:31
maybe there's more routine and I'm back
00:29:32
home in Los Angeles or the UK
00:29:35
>> and I'm not traveling around and then
00:29:36
suddenly I can get back on the horse.
00:29:38
>> What's going on there?
00:29:39
>> Yeah, great question. So um first of all
00:29:42
let me just say that many people also
00:29:45
report that in periods of high stress
00:29:49
they are more vulnerable to going back
00:29:52
to falling off the wagon or going back
00:29:54
to some problem with related to
00:29:56
compulsive overconumption or addiction.
00:29:59
But the opposite is also true. So some
00:30:01
people say that they actually do better
00:30:04
when there's stress in their lives and
00:30:06
it's when that stress is removed and
00:30:08
they feel like oh I can relax my
00:30:10
boundaries or my guard rails and those
00:30:13
individuals are more more vulnerable to
00:30:15
compulsive overconumption in times when
00:30:17
things are going well. So so things
00:30:19
going badly can be a trigger and things
00:30:21
going well can be a trigger depending
00:30:23
upon your unique like life history and
00:30:26
unique wiring. There's a wonderful
00:30:28
animal experiment where if you put a rat
00:30:31
in a cage with a lever to press for
00:30:34
cocaine, that rat will press that lever
00:30:36
till exhaustion or death, which is
00:30:38
essentially the animal model of
00:30:40
addiction. But if before the rat becomes
00:30:44
addicted, if the cocaine is then removed
00:30:47
such that pressing that lever no longer
00:30:49
yields the reward, that rat will
00:30:52
eventually extinguish that lever
00:30:55
pressing behavior. So they'll they'll
00:30:57
stop pressing the lever, right? They'll
00:30:58
stop doing the work. It can take a
00:31:00
while, but eventually they won't press
00:31:02
the lever anymore. Now, if that same rat
00:31:05
after a period of time is then exposed
00:31:08
to a very painful foot shock, the first
00:31:11
thing the rat will do in response to
00:31:13
that painful foot shock is run over and
00:31:15
start pressing that lever again. And to
00:31:18
me that's just a wonderful model of what
00:31:20
we see in humans that when individuals
00:31:23
are under extreme stress they are
00:31:27
typically more vulnerable to relapse um
00:31:30
because their brain has already encoded
00:31:33
using these high dopamine rewards um in
00:31:36
response to any kind of pain as a way to
00:31:39
get out of that state.
00:31:40
>> So we talked about the pleasure pain
00:31:42
balance here. But if in my life I
00:31:44
experience some form of pain, I'm likely
00:31:45
to go and seek out pleasure. And stress
00:31:48
could theoretically be considered a form
00:31:49
of pain.
00:31:50
>> Yeah. Which is why people um with severe
00:31:53
childhood trauma are at higher risk for
00:31:55
addiction. Um there are probably
00:31:58
epigenetic changes that are happening at
00:32:01
the level of DNA expression in their
00:32:03
brains making them more vulnerable to
00:32:04
addiction. Um we know that people who
00:32:07
are living in poverty are more
00:32:09
vulnerable to addiction. uh people who
00:32:12
are struggling with uh multigenerational
00:32:14
trauma uh unemployment major social and
00:32:17
geographic dislocation those individuals
00:32:20
are more vulnerable to addiction. So
00:32:22
environmental stresses uh definitely
00:32:24
play a role. We also know that
00:32:27
co-occurring psychiatric disorders um
00:32:29
make people more vulnerable to
00:32:31
addiction. Probably that means that
00:32:33
people who struggle with bipolar
00:32:34
disorder, depression, um anxiety,
00:32:37
schizophrenia
00:32:38
are at higher risk of becoming addicted
00:32:42
and probably it's because they're trying
00:32:44
to self-medicate.
00:32:46
>> What about ADHD?
00:32:48
>> So, kids with ADHD are at higher risk to
00:32:51
develop an addiction in adulthood than
00:32:52
kids without ADHD.
00:32:55
And the mechanism of action for that is
00:32:58
not well understood. But there are some
00:33:00
really interesting theories. One of the
00:33:03
theories is that kids with ADHD have uh
00:33:06
reward deficit at baseline. And that has
00:33:08
been shown in experiments that people
00:33:10
with ADHD when you show them rewarding
00:33:13
stimuli, their reward pathway isn't as
00:33:17
activated as healthy control subjects.
00:33:19
>> When you say rewarding stimuli, what's
00:33:21
what's that mean? images of cupcakes or
00:33:24
alcohol or anything that they will end
00:33:27
endorse is something that that's
00:33:29
pleasurable for them.
00:33:30
>> So their brain doesn't release as much
00:33:31
dopamine when they when they see
00:33:32
something rewarding.
00:33:33
>> That's right. So brain imaging studies
00:33:35
showing that not only do people with
00:33:37
ADHD not release as much dopamine in
00:33:40
response to rewards, but also have at
00:33:44
baseline fewer dopamine receptors. And
00:33:48
remember we talked about the decrease in
00:33:51
dopamine receptors being what happens as
00:33:55
people become addicted. So in some ways
00:33:58
people with ADHD you could conceptualize
00:34:00
them as already having craving at
00:34:03
baseline even before they've been
00:34:05
exposed to the kinds of intoxicants that
00:34:09
lead to downregulation of those D2
00:34:12
receptors. I had um Gabble Mate on the
00:34:15
podcast a few times and Gabble talks to
00:34:18
me about how ADHD could be perceived as
00:34:21
learning at a young age to kind of
00:34:24
distract yourself from the stress in
00:34:26
your life. So he was talking a lot
00:34:28
about, you know, his own experience
00:34:30
growing up in Nazi Germany times and his
00:34:33
mother giving him to someone else
00:34:35
because the he was at risk of the Nazis
00:34:38
and the stress of that moment and how he
00:34:40
had kind of leared to tune out of the
00:34:41
environment because of that. And I've
00:34:43
always wondered thought about that
00:34:44
theoretically. It's like, you know, if
00:34:46
you grow up in a household where there's
00:34:47
loads and loads of screaming and loads
00:34:48
of violence, for example, you kind of
00:34:50
learn to to tune out, but you you can
00:34:52
also develop a hypervigilance.
00:34:54
>> And um so it kind of does make sense to
00:34:57
me that so many of those people, if this
00:35:00
theoretically holds, would start with a
00:35:03
bit of a pain baseline. We we definitely
00:35:07
know that kids who are raised in
00:35:10
traumatic environments where there is
00:35:14
complex attachment with caregivers,
00:35:17
those kids are at higher risk for
00:35:20
developing addiction and this kind of
00:35:24
dissociative response to trauma. just
00:35:27
trying to escape the situation either in
00:35:29
your own mind um with your own mental
00:35:32
you know dissociation or distractions or
00:35:34
actually finding a behavior that gives
00:35:38
you comfort is well you know well
00:35:41
observed and well well documented just
00:35:44
getting back to our early conversation
00:35:46
about digital media and the dangers
00:35:48
they're in. So, a Pew survey report just
00:35:51
came out asking parents um how they
00:35:54
navigate exposing their kids to
00:35:57
smartphones. And in the cohort of
00:36:00
parents who said that yes, they do um
00:36:02
let their children under the age of five
00:36:05
play with a smartphone, uh when they
00:36:08
were asked why do they do that or in
00:36:10
what circumstances, one of the top
00:36:12
reasons was uh to soothe their child
00:36:16
when their child was unhappy or
00:36:19
distressed in some way. Now I I found
00:36:22
that very concerning because that is
00:36:25
basically setting up the child for the
00:36:30
perception action loop of using internal
00:36:32
distress as a cue uh for reaching for a
00:36:37
smartphone which is works. It definitely
00:36:41
works in the short term but the problem
00:36:43
again is that through this iterative
00:36:45
process of neuro adaptation ultimately
00:36:48
that smartphone will not be sufficient.
00:36:50
And now the kid will need a smartphone
00:36:52
and I don't know um you know an AI
00:36:56
tailored pet who will do whatever they
00:36:59
want whenever they they want it and then
00:37:01
by the time the kid is eight you know
00:37:04
that won't be sufficient and the kid
00:37:05
will need I don't know a slot machine um
00:37:08
or or whatever it is you know it's this
00:37:10
escalating phenomenon.
00:37:11
>> There's um a couple of startups at the
00:37:13
moment AI startups who are putting AI in
00:37:17
cuddly toys. Oh yes, right. AI and
00:37:20
cuddly toys.
00:37:22
>> And so you can just like you can speak
00:37:23
to chatbt using your devices, you can
00:37:25
come home, you can pick up your cuddly
00:37:27
toy. Your cuddly toy will talk to you.
00:37:29
It'll ask you how your day has been. It
00:37:31
will it can teach you things. What do
00:37:33
you think of of that from a neuroscience
00:37:37
or you know a dopamine or connection
00:37:38
perspective? I think that this is very
00:37:43
very dangerous because we're essentially
00:37:45
offloading the work of parenting and
00:37:49
creating those relationships. You know,
00:37:52
not again, I hate judging parents
00:37:53
because parenting is hard and I've made
00:37:55
many mistakes in my parenting, you know,
00:37:58
but what's h and I'm sure these the
00:38:00
parents have the best of intentions, but
00:38:02
instead of, you know, navigating
00:38:07
finding a way to communicate with their
00:38:09
child to figure out how to know what's
00:38:12
going on in that child's life, which can
00:38:14
be hard to do because, you know, even
00:38:16
young children aren't necessarily
00:38:17
[clears throat] willing to disclose. But
00:38:19
once they get to be teenagers, forget
00:38:20
it. Then you got to like wait until
00:38:22
they're ready to tell you, which is
00:38:24
almost always like at 10 p.m. at night
00:38:26
when you're exhausted after you've been
00:38:27
working all day, right? So, so, so
00:38:29
there's that piece of it, right? They're
00:38:30
they're not putting in the work,
00:38:32
spending the time with the child,
00:38:33
finding a common language, but you also
00:38:36
then then the second piece of it is now
00:38:38
you've got this child who is essentially
00:38:40
self soothing with a machine, right? And
00:38:43
again, this the the m the the machines
00:38:46
are designed to flatter, to validate, to
00:38:50
comfort. There's no friction there,
00:38:53
right? This is incredibly
00:38:56
um potent
00:38:58
social validation
00:39:00
uh and soothing, self soothing. It's
00:39:02
essentially a masturbation machine. And
00:39:05
then you've got this really weird
00:39:07
additional loop where now the parents
00:39:10
are finding about out about their
00:39:12
child's life through
00:39:16
reading and observing her interactions
00:39:19
with the AI. So it's like a game of
00:39:21
telephone. Now they've like filtered
00:39:23
this thing where they they think they
00:39:25
know what's going on in their child's
00:39:26
life, but of course they don't. And none
00:39:28
of that has gone toward fostering a
00:39:30
relationship between those parents, you
00:39:32
know, and their child. And
00:39:34
[clears throat] this is just, you know,
00:39:35
really really scary because it's going
00:39:37
to lead to this incredible fragmentation
00:39:41
of families, of social bonds.
00:39:45
I mean, it's it's it's I just we cannot
00:39:48
go in that direction. We really have to
00:39:50
fight against that. So with all this
00:39:54
said and with the knowledge that these
00:39:55
algorithms are going to get more
00:39:56
addictive because AI is going to know me
00:39:58
more and more and more and actually the
00:40:00
commercial model behind any of these big
00:40:02
technology companies is to keep my
00:40:03
attention on their product more so they
00:40:05
can deliver more ads or they can charge
00:40:07
me a higher subscription fee. Are you at
00:40:09
all hopeful? Because I can't see from an
00:40:12
incentive perspective when we're talking
00:40:14
about you know the commercial models
00:40:15
behind these companies why things aren't
00:40:17
are going to stop and go back.
00:40:19
>> I mean I agree with you. the genies out
00:40:21
of the bottle. We're we're not going to
00:40:23
go back. But I am hopeful because um I
00:40:29
think I'm just a realistic optimist. I I
00:40:32
do believe in the human capacity to
00:40:35
adapt and solve problems. And the simple
00:40:38
fact that we're talking about these
00:40:39
problems now, which we weren't doing,
00:40:41
you know, 10, 15 years ago, I think is a
00:40:44
good thing. there's much more awareness
00:40:46
in the population about the potential
00:40:48
dangers of digital media and and at the
00:40:50
forefront of raising the alarm um has
00:40:53
been parents because parents are seeing
00:40:56
the sort of disintegration of the
00:40:58
nuclear family in real time and and they
00:41:00
don't like it. So, I am hopeful because
00:41:04
I just I just think that we're going to
00:41:07
come together and we're going to try
00:41:09
different solutions and some of those
00:41:10
solutions will involve technology. Um,
00:41:13
you know, and and like trying to come up
00:41:14
with guard rails or or better
00:41:16
technology. I think the way that we're
00:41:18
going now, um, you know, with like the
00:41:21
erotic chatbot is is not the right
00:41:24
direction. But then again, we live in a,
00:41:26
you know, free democracy and consenting
00:41:29
adults, you know, can do what they're
00:41:31
going to do until we decide as a society
00:41:33
that the harms outweigh the potential
00:41:35
benefits. But I I really think in the
00:41:38
short term, we need to focus on kids
00:41:40
because kids are vulnerable. They're
00:41:43
vulnerable on so many levels. On a
00:41:45
neurobiological level, they're
00:41:46
vulnerable because their brains are
00:41:48
still rapidly evolving, incredibly
00:41:51
neuroplastic. They're cutting back on
00:41:53
the neurons they're not using. They're
00:41:55
mileelinating and making more efficient
00:41:57
the neurons they use most often. That
00:41:59
whole process ends at about age 25.
00:42:01
Plus, you've got the buckets of hormones
00:42:04
that are going into kids. The the fact
00:42:06
that teenagers are natural risk taker
00:42:08
risktakers that they they should based
00:42:12
on their evolutionary milestone be going
00:42:14
out and meeting people and be curious
00:42:16
and making connections at that time. And
00:42:19
yet more and more teenagers are staying
00:42:21
at home and getting their needs met, you
00:42:23
know, digitally. So, we've got we've got
00:42:25
to look at kids. That's got to be like
00:42:27
the first priority. And we've got to
00:42:29
help parents because we can't leave it
00:42:30
up to to parents alone. So, I I'm
00:42:32
optimistic that we are going to, you
00:42:35
know, come up with solutions and I think
00:42:39
we just have to try a lot of different
00:42:41
things and see what works. But it's
00:42:43
can't just be an individual, you know,
00:42:45
solution. We can't just leave it to
00:42:46
individuals or parents or families
00:42:48
alone. The schools have to join the
00:42:51
solution. Uh governments, legislators,
00:42:54
and also the companies that make and
00:42:55
profit from digital media. They they
00:42:58
really are responsible for making a
00:43:01
product that um doesn't harm kids. And
00:43:05
right now, [clears throat]
00:43:07
you know, we have a product that harms
00:43:09
harms kids. You've recently been an
00:43:11
expert witness in certain trials in
00:43:14
court, right?
00:43:15
>> Yes. In ongoing litig litigation. Yes.
00:43:19
>> What can you tell me about about that
00:43:21
and and about the parties in play and
00:43:23
why you're being called to be an expert
00:43:25
witness?
00:43:26
>> I can't actually tell you too much. I
00:43:27
can't talk about it. Um but I can tell
00:43:30
you that the the basic premise is that
00:43:33
kids are a vulnerable group. that uh
00:43:36
social media is not safe for kids. That
00:43:40
it causes harm at many different levels,
00:43:44
but primarily through uh the medium uh
00:43:48
itself being addictive and engaging
00:43:52
their brains and exploiting their
00:43:54
motivational reward system with design
00:43:57
features that keep them clicking and
00:43:59
swiping.
00:44:00
>> And in that case, someone's suing the
00:44:02
social media companies.
00:44:03
>> That's right. So, you've got school
00:44:05
districts, counties, states, uh the
00:44:08
federal government, entities
00:44:09
representing the federal government, um
00:44:12
suing, uh social media companies. Yeah.
00:44:15
>> What outcome are they looking for?
00:44:17
>> They're looking for a safer product for
00:44:19
kids. They're looking to um help parents
00:44:22
and kids and schools um protect kids
00:44:27
from the harms of social media, which
00:44:30
again are are not just the harms of
00:44:31
addiction. You know that's sort of the
00:44:33
the process by which the engagement
00:44:36
becomes pathological and then the harms
00:44:39
multiply because of the sheer amount of
00:44:41
time spent. But the harms include things
00:44:44
like uh cyber bullying, sex
00:44:46
exploitation,
00:44:47
uh sexual abuse material,
00:44:50
the outcomes of depression, anxiety,
00:44:53
eating disorders, body dysmorphia, sleep
00:44:56
disruption.
00:44:58
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00:45:08
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00:45:10
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00:45:12
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00:45:13
Shopify is one of our long-standing
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00:45:54
So, if I'm if I'm coming out of
00:45:55
December, right,
00:45:56
>> and I've been eating a little bit too
00:45:58
much in December, maybe I've been
00:45:59
smoking a bit, whatever bad habit I
00:46:01
might have been doing, drinking too much
00:46:03
cuz it was New Year's, New, you know,
00:46:04
New Year's parties, etc., my brain is
00:46:06
currently going to be slightly out of
00:46:08
balance in terms of its dopamine
00:46:11
balance.
00:46:13
>> Yes. So, hypothetically, your brain will
00:46:16
be in a dopamine deficit state. What
00:46:19
you'll want to do is you'll want to
00:46:22
abstain from your drug of choice long
00:46:24
enough
00:46:25
>> in order to reset reward pathways.
00:46:28
>> Okay? So, if I've got a sugar problem,
00:46:30
>> then I need to just lay off the sugar
00:46:32
for a little while.
00:46:33
>> You need to lay off the sugar for at
00:46:36
least four weeks.
00:46:38
>> Four weeks?
00:46:39
>> Yeah. And why four weeks? Because on
00:46:41
average, four weeks is about the amount
00:46:43
of time it takes for people to get out
00:46:46
of the state of acute withdrawal and
00:46:48
begin to be able to take joy in other
00:46:51
more modest rewards and not be in a
00:46:53
constant state of craving.
00:46:55
>> Okay.
00:46:55
>> The worst part is those first 10 to 14
00:46:58
days. That's when we're in acute
00:46:59
withdrawal. And the reason for that is
00:47:02
when we first take our reward off the
00:47:04
pleasure side of the balance, right?
00:47:07
Which I'm going to do now. So when we
00:47:08
first stop the sugar or the AI or the
00:47:10
cigarettes,
00:47:11
>> that's right. The first thing that
00:47:13
happens is our pleasure pain balance
00:47:14
crashes down to the side of pain because
00:47:17
of this process of neuro adaptation.
00:47:19
Right now we're in the state of acute
00:47:21
withdrawal.
00:47:22
>> And I want of cravings.
00:47:24
>> Cravings. And yet what are the
00:47:25
characteristics of withdrawal? Anxiety,
00:47:27
irritability, insomnia, dysphoria or
00:47:30
depressed mood, and cravings. And it's
00:47:33
crazy because when I'm in that state,
00:47:35
when I've not had my drug of choice for
00:47:37
say a day or two, I look at the drug
00:47:40
differently. Like my it just looks
00:47:42
different to me. It's so crazy. I I'll
00:47:44
walk past, let's say, what's something I
00:47:46
really like? Maybe carrot cake. If I've,
00:47:48
you know, if I've been having a lot of
00:47:49
sugar, which is quite rare for me, but
00:47:50
just I have. When I look at the carrot
00:47:53
cake the day after I had carrot cake, it
00:47:56
looks amazing and it looks so delicious.
00:47:59
But when I'm in the ketogenic state
00:48:01
where I've not had carbohydrates for say
00:48:03
4, 8 weeks, I look at carrot cake and I
00:48:07
have no emotional connection to it.
00:48:09
>> Exactly. So that summarizes it
00:48:12
perfectly. Right. I had a patient with a
00:48:14
severe food addiction who when she
00:48:16
walked into the break rake room at work
00:48:19
and saw the donuts,
00:48:21
she broke out into a cold sweat and
00:48:23
actually had stomach pains. It was a
00:48:25
physiologic state of craving and
00:48:28
hyperarousal
00:48:30
just by looking at the donuts.
00:48:33
And that's what happens essentially,
00:48:35
right? Because we're we're in this state
00:48:37
of constant craving. Our brain has
00:48:39
overvalued this reward. We have euphoric
00:48:43
recall of our earlier use of the drug
00:48:45
when we first tasted it, how delicious
00:48:47
it was. And even now [clears throat]
00:48:51
if we even now when we eat it because of
00:48:53
tolerance it's not as good as earlier
00:48:55
use our brain still remembers
00:48:59
earlier use and and we have this
00:49:01
overweighted value of oh how delicious
00:49:03
it's going to be.
00:49:06
And so this is really important to
00:49:07
remember because when we're in that
00:49:09
acute state of craving it feels like it
00:49:11
will never end. It really does. And I'm
00:49:14
I've I'm still amazed in in my clinical
00:49:17
work how in early withdrawal people just
00:49:20
say the craving is is horrible. Like I I
00:49:22
just I can't live like this. And I think
00:49:25
that's really important to point out
00:49:26
that many people try to stop using their
00:49:29
drug of choice, but they don't try they
00:49:31
don't stop for long enough to be able to
00:49:33
get out of that vortex of craving to get
00:49:36
come get to the other side. And it feels
00:49:39
like the craving will never end. So I I
00:49:41
always have to reassure them that if
00:49:43
they can just wait long enough without
00:49:45
using, they will eventually get to that
00:49:48
place where they're not in that constant
00:49:50
state of craving. Now that's assuming
00:49:51
they have enough neuroplasticity to do
00:49:54
that. And [clears throat] not not
00:49:55
everybody does. And so what what what
00:49:57
what is the purpose then of abstinence?
00:49:59
It's again when our brain is no longer
00:50:02
getting this exogenous source of
00:50:06
stimulation or dopamine eventually the
00:50:09
brain gets the message oh okay I need to
00:50:11
start upregulating my own dopamine
00:50:13
transmission right I I need to remploy
00:50:17
or re I need to redeploy my postsaptic
00:50:20
dopamine receptors right I need to get
00:50:22
it from inside of my brain and so
00:50:25
eventually and I'm just going to take
00:50:27
the rocks now off the pain side of the
00:50:29
balance
00:50:31
You know,
00:50:36
could have made this easier. [laughter]
00:50:39
>> Here, let me do this. There we go.
00:50:41
Eventually, if we abstain for long
00:50:43
enough, those that process of neuro
00:50:46
adaptation reverses itself.
00:50:49
>> And when you say neuro adaptation, you
00:50:50
mean the brain changing,
00:50:52
>> right? The brain changes. So the the
00:50:54
kind of neuroplasticity that we see with
00:50:57
addiction can be reversed in most cases.
00:51:01
>> And neuroplasticity is just the brain
00:51:03
again changing,
00:51:04
>> right? Changing, right? Or or going
00:51:06
back. Now, interestingly, you know, the
00:51:09
work of Edie Sullivan and others looking
00:51:11
at what happens in the brain during
00:51:12
recovery suggests that those addiction
00:51:16
neural circuits probably never go away.
00:51:19
But, but like the dying embers of a
00:51:21
fire, they quiet down and then recovery
00:51:24
is characterized by the development of
00:51:26
new neural networks that route around
00:51:29
those injured areas. But the bottom line
00:51:32
is that because of neuroplasticity, we
00:51:34
can eventually return to kind of
00:51:36
baseline levels of pleasure and pain. We
00:51:40
can restore our hydonic or joy set
00:51:43
point. And when we do that, we're in a
00:51:45
much healthier place because now we can
00:51:48
take pleasure in other rewards that are
00:51:51
not our drug, right? like watching a
00:51:53
sunset, talking to a friend, going for a
00:51:56
walk, things that we lost the capacity
00:51:59
to enjoy because our reward pathway was
00:52:02
hijacked by our drug of choice.
00:52:04
>> I think this is a really important point
00:52:05
as well when you say drug of choice
00:52:06
because one thing I learned from our
00:52:08
conversation last time is that me and
00:52:10
you will both be susceptible to becoming
00:52:13
more or less addicted to different drugs
00:52:16
of choice. So for me it might be
00:52:18
whiskey. For you it might I think you
00:52:19
said it was like erotic novels where one
00:52:21
of your things I don't drink whiskey
00:52:23
just [laughter]
00:52:24
but it might be I don't know it might be
00:52:26
opioids or AI I might be more
00:52:28
susceptible. is if me and you spend one
00:52:29
hour on Tik Tok, the way my brain is
00:52:31
wired, the things I've been through in
00:52:33
my life, whatever, might mean that I get
00:52:35
really addicted to Tik Tok, whereas you
00:52:37
don't feel that.
00:52:39
>> Exactly. And what distinguishes um you
00:52:42
know addictive drugs or intoxicants from
00:52:44
other substances is that they do release
00:52:46
a lot of dopamine all at once in the
00:52:48
reward pathway. So many if not most
00:52:52
people will find intoxicants
00:52:54
reinforcing, but that's not universally
00:52:56
true. Like there are some people who
00:52:57
take opioids and find them that they
00:53:00
feel very uncomfortable and it's not
00:53:02
doesn't make them feel euphoric, right?
00:53:04
And other people will drink caffeine and
00:53:07
not feel the stimulating effects and
00:53:08
other people will have alcohol and you
00:53:10
know get a headache and not not feel
00:53:12
relief. So a and so this differences in
00:53:16
our brains is a really important
00:53:18
concept.
00:53:18
>> What about this idea of having an
00:53:20
addictive personality? Is that a real
00:53:22
thing?
00:53:22
>> It is a real thing. We don't use that
00:53:25
terminology anymore. We talk about the
00:53:27
inherited or genetic risk of addiction.
00:53:30
We do know that if you have a biological
00:53:32
parent or grandparent uh with an
00:53:35
addictive disorder, you are at increased
00:53:37
risk of developing addiction compared to
00:53:39
the general population, even if you're
00:53:41
raised outside of that substance using
00:53:42
home.
00:53:43
>> Am I right in thinking you don't use
00:53:44
that term because it suggests one can't
00:53:46
change and that they're stuck? Or is
00:53:48
there another reason? You know, it's a
00:53:50
good question why that term has gone out
00:53:52
of favor. I think in general when we
00:53:55
talk about Yeah. when we talk about
00:53:57
personality, it does seem like a kind of
00:53:59
a fixed feature of somebody's um
00:54:03
character. And so we're probably trying
00:54:05
to avoid that.
00:54:07
>> One of the really liberating things
00:54:08
about what you've just said is maybe we
00:54:10
don't need to make New Year's
00:54:11
resolutions. Maybe we need to make just
00:54:13
a January resolution because that's 4
00:54:16
weeks long and if I can get to the end
00:54:17
of the four weeks then the cravings are
00:54:19
likely to have gone. And you know when
00:54:20
you think about a New Year's resolution
00:54:22
then you get like a week in and you're
00:54:24
like God am I going to be able to do
00:54:25
this for the whole 365 days. What you've
00:54:27
just said actually illuminates the fact
00:54:28
that maybe you should just set yourself
00:54:30
a four week resolution.
00:54:31
>> Exactly. And that's what we often do in
00:54:33
clinical care. If we were to ask people
00:54:35
to abstain for their whole lives, it
00:54:37
seems impossible. But if we ask them to
00:54:39
abstain for 30 days, it's kind of an
00:54:42
amount of time that they can wrap their
00:54:44
heads around. And also, not in all, but
00:54:47
in most folks who are willing and able
00:54:49
to do it. And also importantly, for whom
00:54:51
it's safe to do because it's not safe
00:54:52
for everybody, right? We wouldn't
00:54:54
recommend that for someone who is at
00:54:56
risk for life-threatening withdrawal
00:54:58
from alcohol or benzodasipines or
00:55:00
something like that. But for people who
00:55:02
are willing and able to do it, they
00:55:04
usually feel better at the end of th
00:55:06
those those uh 30 days and then they can
00:55:09
make a decision about whether they want
00:55:11
to continue to abstain or or they want
00:55:13
to go back to using. And if they do
00:55:15
decide to go back to using, they've
00:55:17
typically, you know, have lowered their
00:55:19
tolerance for their drug of choice,
00:55:21
which means that when they do use again,
00:55:23
they can get reward from it again, which
00:55:26
again because of neuro adaptation, we
00:55:28
lose the ability to do that with chronic
00:55:31
heavy use. So, so that you know that
00:55:33
that there is this whole concept of
00:55:36
moderating our use which didn't used to
00:55:40
be something that we even talked about
00:55:43
in the field of addiction when it was
00:55:46
thought that abstinence was the only
00:55:48
way. But more and more um you know we
00:55:51
are thinking about healthy ways to
00:55:53
moderate after a period of abstinence.
00:55:57
And the reason we recommend a period of
00:55:58
abstinence, even if the long-term goal
00:56:01
is moderation, is because we find that
00:56:04
people are more successful moderating if
00:56:07
they first um abstain for a period of
00:56:10
time.
00:56:11
>> What about if I'm trying to pick up a
00:56:13
new habit?
00:56:13
>> Mhm.
00:56:14
>> What what how do I need to be thinking
00:56:16
about this pain pleasure scale? And what
00:56:20
are what's a good strategy with this in
00:56:22
mind? So I want to start let's say I
00:56:24
want to start going to the gym.
00:56:26
>> Right? So you've chosen a habit going to
00:56:28
the gym that is hard to do and involves
00:56:31
effort. So that means that habit won't
00:56:34
happen easily the way that habits that
00:56:37
are related to the sudden release of
00:56:40
dopamine in the reward pathway because
00:56:42
th those are habits that are
00:56:43
frictionless. We we pick them up
00:56:44
instantaneously. But a habit that
00:56:47
involves
00:56:49
effort and for which the rewards are not
00:56:52
immediate. You can you can again think
00:56:54
about this pleasure pain balance. And
00:56:56
now instead of pressing on the pleasure
00:56:58
side, we're intentionally pressing on
00:56:59
the pain side by making ourselves get
00:57:02
out of bed in the morning, go to the
00:57:03
gym, engage in effortful exercise. And
00:57:06
what's interesting is that when we do
00:57:08
that, the neuro adaptation gremlins that
00:57:11
I talk about are these rocks that we've
00:57:12
used here today will actually go on the
00:57:15
other side of our balance. So on the
00:57:18
pleasure side, and we will get our
00:57:20
dopamine indirectly by paying for it up
00:57:23
front. And the way that that's probably
00:57:26
happening is that our body in sensing
00:57:29
injury is upregulating feel-good
00:57:32
hormones and neurotransmitters like
00:57:34
dopamine, but also indogenous opioids,
00:57:36
indogenous canabonoids.
00:57:38
And from an evolutionary perspective,
00:57:40
that's really how our pleasure pain
00:57:42
balance evolved. So, just to simplify
00:57:45
this for me,
00:57:46
>> yeah,
00:57:46
>> I go to the gym, I get up, I travel to
00:57:48
the gym, I lift up those weights, I do
00:57:50
my run,
00:57:51
>> I'm going to feel good, but it's going
00:57:53
to be delayed,
00:57:55
>> right? And importantly, you're not going
00:57:57
to feel good when you first start
00:57:59
exercising, right? At least most people
00:58:01
don't. It's it's painful and you're
00:58:03
thinking, how how many minutes am I am
00:58:05
am I, you know, how many minutes do I
00:58:07
have left? And we do know in fact that
00:58:09
exercise is immediately toxic to cells
00:58:12
which is really kind of strange because
00:58:14
we know exercise is good for us. But
00:58:16
again what's probably happening at a
00:58:18
molecular level is that the body is
00:58:20
sensing cellular injury and in response
00:58:22
upregulating all those feel-good
00:58:24
hormones and neurotransmitters. But it
00:58:26
takes time. It takes time. And so we're
00:58:30
going to have a delayed sense of reward.
00:58:32
And that's the runner's high, right?
00:58:34
that kind of comes after uh the exercise
00:58:36
is over or maybe for some people it
00:58:38
comes in the middle of exercise when
00:58:40
you're a little bit into it or halfway
00:58:42
through but at some point you know you
00:58:44
get the endorphins and that feels good.
00:58:47
>> How would one go about gaming this so
00:58:49
that
00:58:51
I'm more likely to do it because you
00:58:54
know the reward comes after which is not
00:58:57
not incredibly useful. You almost almost
00:58:59
have to have like a religious belief in
00:59:00
exercise because you go, "Look, I'm not
00:59:02
going to want to do this, but it's going
00:59:03
to I'm going to be glad I did
00:59:04
afterwards."
00:59:05
>> Right?
00:59:06
>> So, is there anything I can do? Like, do
00:59:07
I have a Mars bar when I get to the gym
00:59:08
or something? I don't know.
00:59:11
>> You know, there are so many ways and so
00:59:13
many tricks that people use to kind of
00:59:15
create new healthy habits. Um, one of
00:59:18
the ways that we can do it is to prepare
00:59:21
in advance for that moment when we want
00:59:26
to do something that's hard. Because if
00:59:28
we wait till that moment to decide
00:59:31
whether or not to do something that's
00:59:33
hard, we almost always choose not to do
00:59:35
it. But if we make a plan in advance,
00:59:38
let's say the day before that tomorrow
00:59:40
I'm going to get up at this time. I'm
00:59:42
going to, you know, get my stuff
00:59:44
together and I'm going to go to the gym,
00:59:46
we're much more likely to engage in that
00:59:48
activity. And that can also include then
00:59:50
rituals around that activity that we
00:59:52
prepare in advance. So for example,
00:59:54
packing our bag, right? the schedule
00:59:57
itself, setting up a time, um maybe
01:00:00
planning to meet a friend, right? So, we
01:00:02
connect friendship or socialization with
01:00:06
the thing that's hard to do. It's much
01:00:07
easier to do these difficult things with
01:00:10
other people um than than to have to do
01:00:14
it alone.
01:00:15
>> How does that link to the the pain side
01:00:17
of the balance? Or does it at all link
01:00:19
to the pain side of the balance? this
01:00:20
idea that if I put my clothes out the
01:00:22
night before and I I schedule it and I
01:00:24
really plan for it, is it it's reducing
01:00:26
the pain involved and that's going to
01:00:28
increase the probability of the behavior
01:00:30
occurring? Is that what you're saying?
01:00:30
Or is there something else? Or is it not
01:00:32
linked?
01:00:32
>> I I don't think so. I think instead, you
01:00:35
know, the prefrontal cortex is the large
01:00:37
gray matter area right behind our
01:00:39
foreheads that's so important for future
01:00:41
planning and delayed gratification also
01:00:44
for auto autobiographical narrative. And
01:00:46
I think by putting these, you know,
01:00:49
pieces in place that allows our
01:00:52
prefrontal cortex to plan for this
01:00:55
future event that we know we're not
01:00:57
going to want to do, but that we want to
01:00:59
do.
01:01:00
>> It allows us to kind of put the brakes
01:01:03
on our short-term desires and
01:01:10
project ourselves into the future to
01:01:12
achieve our long-term desires. So Sam
01:01:15
Mccclure, a neuroscientist, has shown
01:01:17
that in response to immediate rewards,
01:01:20
the emotion brain gets activated.
01:01:23
>> In response to long-term rewards, the
01:01:25
prefrontal cortex gets activated. So, by
01:01:29
planning in advance all of these little
01:01:31
pieces, sometimes called habit stacking,
01:01:34
we're essentially activating our
01:01:35
prefrontal cortex, projecting ourselves
01:01:38
into the future, um, and anticipating a
01:01:41
long-term reward, which then allows us
01:01:44
to do hard things and avoid short-term
01:01:49
rewards in the service of our future
01:01:51
selves. So many people might have an
01:01:54
experience where they kick the habit for
01:01:56
a little while and then they relapse.
01:01:59
>> You know, it might take might be a
01:02:00
month, might be two months, might be
01:02:02
three months. Is there is there any art
01:02:05
to avoiding the relapse? So it's very
01:02:08
common to relapse especially living in
01:02:10
the world that we do today where we're
01:02:12
constantly being invited to consume
01:02:15
really these stimuli you know getting us
01:02:17
to to drink or to smoke or to do various
01:02:21
forms of entertainment chase us down we
01:02:23
we can't avoid them or it's very
01:02:25
difficult to so I talk a lot about
01:02:28
self-binding strategies with my patients
01:02:31
and self-binding strategies are a way of
01:02:33
putting both a literal and a
01:02:35
metacognitive barrier between ourselves
01:02:38
and our drug of choice.
01:02:39
>> What's a metacognitive barrier?
01:02:41
>> Oh, so it's like a it's a thought,
01:02:44
right, or a narrative. So, instead of it
01:02:47
being a physical barrier, like a
01:02:48
physical barrier would be, for example,
01:02:50
getting the smartphone out of the
01:02:52
bedroom or deleting an app, right? Or
01:02:55
getting alcohol out of the house or
01:02:57
whatever it is, creating both a a
01:02:59
physical barrier between myself and my
01:03:01
drug of choice. A metacognitive barrier
01:03:04
is something like more like a thought
01:03:06
process. For example, we were talking
01:03:08
about thinking about long-term goals or
01:03:12
um you know what are my what are my
01:03:14
values, right? And how do my values
01:03:17
trump my immediate desires or how can I
01:03:21
um co-regulate with other people? These
01:03:23
are all self-binding strategies that we
01:03:25
can use so that we're not relying on
01:03:28
willpower alone because if we wait to
01:03:33
rely on our willpower alone,
01:03:36
we will not make it. Especially in this
01:03:38
world of overwhelming overabundance,
01:03:41
there are just too many temptations.
01:03:43
Willpower is an exhaustable resource,
01:03:46
meaning that it doesn't last forever. It
01:03:47
eventually runs out. So, we've got to
01:03:49
actually create barriers between
01:03:51
ourselves and our drug of choice. so
01:03:53
that we can have a little bit more time.
01:03:56
And that little bit more time, that
01:03:58
slowing things down is sometimes just
01:04:01
enough to allow ourselves to surf the
01:04:04
cravings and get through them without
01:04:07
actually using.
01:04:09
>> Is it possible to become addicted to
01:04:11
good things, too?
01:04:13
>> So, when I use the term addiction, I'm
01:04:15
really talking about a disease process,
01:04:17
a form of mental illness. It's a very
01:04:20
common term that's used in everyday life
01:04:23
and people don't always use it in that
01:04:25
way. But when I'm using it, I I'm really
01:04:27
talking about the problem of compulsive
01:04:30
overconumption despite harm to self and
01:04:32
or others. And it's important to
01:04:34
distinguish addiction from something
01:04:37
like a habit, which I don't consider to
01:04:40
be, you know, an addiction or even a bad
01:04:42
habit, right? Doesn't meet threshold
01:04:44
criteria for addiction. And also it's
01:04:47
important just to distinguish all of
01:04:48
that from a passion, something that we
01:04:50
really invest in and that we love to do,
01:04:53
but that's helpful for ourselves and or
01:04:56
other people is not consistently causing
01:04:58
harm.
01:04:58
>> Are there any daily practices like a
01:05:01
morning ritual that you would advise
01:05:03
someone to consider if they were trying
01:05:05
to set themselves up to kick a habit or
01:05:07
to kick an addiction?
01:05:08
>> So, I recommend doing the hard things
01:05:11
first. Um, a shorthand way of saying
01:05:14
that is to start your day with pain.
01:05:17
Meaning, for example,
01:05:20
do the hard things when you first get up
01:05:22
as part of your morning routine, like
01:05:25
exercise,
01:05:25
>> like exercise, make your bed,
01:05:28
>> um, eat breakfast, brush your teeth,
01:05:30
plan your day, plan what you're going to
01:05:32
do if you haven't done it already, and
01:05:34
do all of those things before, for
01:05:36
example, you have your morning cup of
01:05:38
Joe or before you touch a single screen
01:05:41
or digital device. Why? because those
01:05:45
are reinforcers that are so powerful
01:05:48
that we're all vulnerable to having our
01:05:51
goals and desires be hijacked by them.
01:05:53
So really important to take the time in
01:05:55
the morning to set up a good morning
01:05:58
routine before you expose your brain to
01:06:01
these incredibly reinforcing substances.
01:06:04
>> I wasn't clear on why wasn't clear on
01:06:06
the why I would do why I would go to the
01:06:08
gym early or why I do hard things first
01:06:10
before I get into Tik Tok or social
01:06:12
media. If you do intoxicants first,
01:06:16
right? If you expose your brain first
01:06:18
thing in the morning to things that are
01:06:19
incredibly pleasurable, you have nowhere
01:06:23
to go from there. And in fact, if any if
01:06:25
anywhere, you're going to have a
01:06:26
comedown from that. And then you're
01:06:28
going to be starting from a place of
01:06:30
compromise where then doing the hard
01:06:32
things is is even harder. Whereas, if
01:06:34
you start with the hard things, you will
01:06:37
potentially get rewards from having done
01:06:40
those hard things, right? and also feel
01:06:43
a sense of competence, right? And and
01:06:46
accomplishment that then allows for you
01:06:50
to move through your day in a way that's
01:06:53
better if you just start with something
01:06:55
that's incredibly pleasurable.
01:06:57
>> If I am getting ready to kick a habit, a
01:06:59
big one, a big, you know, one that's
01:07:00
really hung around for a long time, is
01:07:02
there something I should do in
01:07:04
preparation to plan for my dopamine fast
01:07:07
or for kicking that habit? because you I
01:07:09
know you said, you know, from day one it
01:07:11
will take about four weeks to start to
01:07:13
to feel the cravings diminish, but is
01:07:16
there something I should be doing before
01:07:17
I even start those four weeks?
01:07:19
>> Yeah. So, I strongly recommend preparing
01:07:21
for the dopamine fast in advance. And
01:07:24
the things to do are first figure out
01:07:26
what is your drug of choice. That is to
01:07:28
say, what is the thing that you're
01:07:30
consuming too much and too often such
01:07:32
that you regret it later
01:07:34
>> or the thing that's leading to obvious
01:07:36
negative consequences or the thing that
01:07:38
just has opportunity costs associated
01:07:41
with it. That is to say, um you're
01:07:43
spending so much time consuming this
01:07:45
drug that you're not doing other things,
01:07:47
other hobbies, investing in other things
01:07:49
that are meaningful to you like your
01:07:51
primary relationships. So, that's very
01:07:54
important to just figure that out first.
01:07:56
And I usually recommend something called
01:07:58
the timeline followback method. That's
01:08:01
where you start today and you count
01:08:04
backwards for every day of the week.
01:08:07
What did you consume in terms of your
01:08:09
drug of choice? Um how much and how
01:08:11
often. So really looking at quantity and
01:08:14
frequency and then adding that up over
01:08:18
those seven days.
01:08:20
And the reason that's important is
01:08:22
because we can really lose track of how
01:08:25
we're consuming our drug of choice when
01:08:28
we're chasing dopamine. We're very bad
01:08:30
self-observers. So, just to give a a
01:08:32
personal example, um I had gotten into
01:08:35
this habit of watching YouTube after
01:08:38
work as a way to relax,
01:08:40
>> especially on my long clinic days when I
01:08:42
was more tired. And I thought it was
01:08:45
just that I was watching for maybe half
01:08:47
an hour a couple times a week. And then
01:08:49
my daughter, a teenager, came up to me
01:08:51
and she said, "Mom, you're always
01:08:52
watching YouTube now." And I said, "No,
01:08:54
I'm not." And I was really kind of
01:08:56
insulted because in my mind it was not
01:08:58
very much. I thought, "Geez, can I relax
01:09:01
every once in a while and watch some
01:09:02
YouTube?" But then after she left me, I
01:09:06
thought to myself, well, okay, how much
01:09:08
have I been watching right now? And it
01:09:09
turned out, oh, I've been watching for
01:09:11
an hour and a half. And then I thought
01:09:13
about the day before that, oh, it was
01:09:15
probably two hours. And the day before
01:09:17
that, it was probably about the same.
01:09:18
And over the course of a whole week, it
01:09:20
was probably about 14 hours of YouTube,
01:09:23
which is a whole day. A whole day,
01:09:26
right? And so,
01:09:28
>> what were you watching?
01:09:30
>> Gosh, so embarrassing
01:09:33
for I I I got into this jag of watching
01:09:37
Dr. Pimple Popper, which I know is
01:09:39
really weird. You don't even know what
01:09:41
that is, right? Yeah. So, it's people
01:09:44
popping other people's pimples. Oh my
01:09:46
god. [laughter]
01:09:51
>> So bad. So bad.
01:09:52
>> That's not what I expected you to say.
01:09:54
>> Yeah. Right.
01:09:55
>> I thought it was going to be AI, some
01:09:57
psychology things, some science.
01:09:59
>> No. No.
01:10:00
>> People popping other people's pimples.
01:10:01
>> Yeah. Yeah. Yeah. You don't
01:10:03
>> spent a whole day watching that.
01:10:05
>> Yeah. When I added it up over a week, it
01:10:07
was a whole day of watching Dr. Mimple
01:10:09
Popper. [laughter]
01:10:12
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01:11:17
>> Come in.
01:11:17
>> Oh my god. Steve,
01:11:20
>> what are you doing?
01:11:21
>> This is uh the Bontage face mask. It's
01:11:23
good for blemishes, wrinkles, uh clears
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not used it before?
01:11:29
>> No.
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>> Tried this before. It's um it's really
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found it out because of the misses. Seen
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>> Wow.
01:11:51
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01:12:11
And on on um page 64 of your workbook of
01:12:14
Dopamine Nation, there's this really
01:12:16
interesting um image here which I I'll
01:12:19
throw up on the screen. It shows a brain
01:12:23
and that's as far as I'm going to go
01:12:24
with my me explaining it. Over to you.
01:12:27
[laughter]
01:12:27
>> Okay. So, this is uh these are human
01:12:30
brain imaging studies. This is adapted
01:12:33
from the work of Nora Vulov and her
01:12:36
colleagues. She's the head of the
01:12:37
National Institute of Drug Abuse, an
01:12:39
amazing researcher and scientist, and
01:12:41
she looked at dopamine transmission
01:12:44
levels in the reward pathways of healthy
01:12:48
control subjects on the left versus
01:12:50
people addicted to a variety of
01:12:52
substances on the right, cocaine, meth,
01:12:55
alcohol, etc.
01:12:57
Basically what she found was in the in
01:13:00
the brains of healthy control subjects
01:13:03
there was plenty of dopamine
01:13:04
transmission as represented here by red
01:13:07
or the darker color
01:13:10
in the brains of people who had been
01:13:12
using these substances in an addictive
01:13:14
way meaning heavily and chronically
01:13:17
there was almost no dopamine
01:13:19
transmission in the nucleus encumbent.
01:13:22
In other words, these individuals are in
01:13:24
a chronic dopamine deficit state. They
01:13:27
have below
01:13:29
normal levels of dopamine transmission.
01:13:32
>> Isn't this just kind of the story of how
01:13:35
the human body works where if you give
01:13:37
it too much of something through an
01:13:40
external source, an exogenous source.
01:13:43
So, if you're taking lots of dopamine
01:13:46
via Tik Tok or from porn or from
01:13:50
alcohol, your brain goes, "Well, if
01:13:52
you've got enough of that, then I won't
01:13:53
make any."
01:13:55
>> You know what? You just summed it up.
01:13:57
That That's exactly right. That
01:13:59
essentially too much of anything is bad.
01:14:03
And that our brain which is designed to
01:14:09
return to homeostasis, homeostasis being
01:14:12
a finite number of physiologic states
01:14:16
that the organism must maintain in order
01:14:20
to survive.
01:14:21
>> Is this the case with things like
01:14:22
melatonin as well? Because there's
01:14:24
people are struggling a lot with sleep,
01:14:25
so they're taking a lot of these
01:14:26
melatonin pills. I don't know. Someone
01:14:28
offered me one one time and I remember
01:14:30
thinking, well, if I start taking this,
01:14:32
then isn't my body going to stop making
01:14:35
it and then I'm going to become
01:14:36
dependent on these [ __ ] pills?
01:14:38
>> So, that is the potential with I think
01:14:41
any exogenous source that we that we
01:14:47
use, right?
01:14:49
Anything that we ingest,
01:14:52
our brains and our bodies will want to
01:14:56
adapt to bring us back to whatever our
01:14:59
baseline is. But the the difference
01:15:01
between addictive substances and
01:15:04
behaviors um and non-addictive ones is
01:15:07
that the the release of dopamine and the
01:15:10
reward pathway is so fast and so strong
01:15:14
that this process of neuro adaptation is
01:15:17
equally strong to bring us back down to
01:15:19
baseline.
01:15:21
Because we we do know that there are
01:15:23
medications that people can take for
01:15:26
very long periods of time and actually
01:15:28
not develop tolerance to them, right?
01:15:31
They can continue to work for for them
01:15:33
over the long period of time. We don't
01:15:35
actually know exactly why it is that
01:15:39
some some people develop tolerance and
01:15:41
and not others. And again, it probably
01:15:44
has to do with the amount, you know, the
01:15:46
dose, exactly how it's working on the
01:15:48
brain. But in general, things that are
01:15:51
highly reinforcing, our brain tends to
01:15:53
adapt to them over time.
01:15:55
>> And testosterone is another one people
01:15:57
often talk about where if you take
01:15:58
external testosterone consistently, your
01:16:01
brain will decrease the natural
01:16:02
production of it. And as a result,
01:16:04
natural testosterone shuts down and
01:16:06
testicular size can shrink. But then if
01:16:09
you stop the TRT, the external
01:16:11
testosterone abruptly, your natural
01:16:12
system might take a long time to
01:16:14
recover. And in some cases, it may never
01:16:16
fully recover back to baseline. I think
01:16:18
this is just like a really important
01:16:19
principle for
01:16:20
>> Yeah.
01:16:21
>> drugs, chemicals. Yes.
01:16:23
>> Or messing with the natural balance of
01:16:25
one's body.
01:16:26
>> Yes. Yes. Exactly. And by the way, Nora
01:16:29
Volkoff and her team did a follow-up
01:16:30
study in individuals who abstained from
01:16:34
methamphetamine for 14 months and then
01:16:37
rescanned their brain and showed that
01:16:39
they had restored healthy levels of
01:16:42
dopamine transmission. It took 14 months
01:16:45
in in those individuals who had been
01:16:46
very addicted to methamphetamine, which
01:16:48
I think is also an important message
01:16:50
here. You know, for individuals
01:16:52
struggling with severe addiction, it's
01:16:53
not like four weeks of abstinence is
01:16:55
suddenly going to, you know, make your
01:16:57
brain better. But what I have found in
01:16:59
clinical care is that that's typically
01:17:02
enough time to begin to see the light at
01:17:05
the end of the tunnel. And that indeed
01:17:07
there's enough
01:17:09
restoration of sort of baseline levels
01:17:13
of
01:17:14
joy or capacity to experience reward
01:17:17
that that people can begin to have hope
01:17:20
to get out of that state of craving.
01:17:22
What is the most interesting because you
01:17:24
know you've been exposed to so much
01:17:25
research on the subject of dopamine and
01:17:27
human behavior.
01:17:29
Is there a particular study that always
01:17:31
stands in your mind as being the most
01:17:35
informative or interesting or surprising
01:17:38
that you've encountered?
01:17:39
>> A study that um that keeps coming back
01:17:42
to me. There are a couple. I mean
01:17:45
there's so many but
01:17:46
>> give me them.
01:17:46
>> Okay. So, if you put a rat in a cage
01:17:50
with a rat trapped in a plastic bottle,
01:17:53
that rat will that rat will work very
01:17:56
hard to free the trapped rat.
01:18:00
But if you then allow that rat to
01:18:04
administer, self-administer heroin,
01:18:08
it will not work to free the trapped
01:18:10
rat. To me, that's really powerful
01:18:14
because it it suggests how
01:18:19
addictive substances like opioids, which
01:18:23
heroin is,
01:18:25
can usurp our desire for human
01:18:29
connection,
01:18:31
and essentially become the object of
01:18:34
attachment. And we often talk about
01:18:37
loneliness and isolation as a risk
01:18:40
factor for addiction, which it
01:18:42
absolutely is. But the reverse is also
01:18:44
true. That getting addicted will cause
01:18:48
us to isolate and be lonely. We will
01:18:52
stop caring about other people. So for
01:18:56
me that's that's a really a really
01:18:59
powerful you know kind of experiment
01:19:02
that I think does map on to human
01:19:05
behavior. something really interesting
01:19:07
this on just a day-to-day level which
01:19:08
mean which in your head I was trying to
01:19:10
relate that to my my own life and
01:19:12
thinking you know if I get really
01:19:13
addicted to my screens and my devices
01:19:16
when my partner needs me
01:19:18
>> right
01:19:19
>> I might be so distracted and so
01:19:22
connected to the thing that's giving me
01:19:24
dopamine upstairs in my bedroom like my
01:19:26
laptop or whatever on my work that I
01:19:28
might completely miss her call for help
01:19:30
and I kind of you know I hate to say it
01:19:32
but sometimes I do feel like maybe that
01:19:35
is I've been guilty of that.
01:19:37
>> Yeah. Yeah.
01:19:38
>> You know, I've been so, dare I say the
01:19:40
word, addicted to
01:19:44
my work or devices or whatever that, you
01:19:46
know, sometimes I'm not present with
01:19:48
meeting other people's needs.
01:19:50
>> Absolutely. And you know, that certainly
01:19:52
happened to me with my addiction to
01:19:54
romance novels, right? We I stopped
01:19:57
paying as much attention to my kids and
01:19:59
to my husband. We um went on a
01:20:04
vacation with another family at the
01:20:05
beach and instead of joining folks on
01:20:07
the beach, I stayed in the room and read
01:20:09
romance novels. We went to a neighbor's
01:20:11
party and I actually found a room in the
01:20:14
house and read romance novels instead of
01:20:16
socializing and didn't even think that
01:20:18
was weird, even though that's obviously
01:20:20
really strange. So it is this kind of
01:20:23
coming to overvalue our drug of choice
01:20:27
and undervalue other
01:20:30
more meaningful um good things in our
01:20:33
lives.
01:20:35
>> Could you theoretically say it's making
01:20:36
the world less empathetic or less
01:20:39
sympathetic or less
01:20:42
what's the adjective of like of actually
01:20:45
being there for other people? I guess
01:20:47
connection in relationships. It's it's
01:20:48
it's hurting our ability to connect to
01:20:51
others and be have empathy for them and
01:20:52
be there for them because we're
01:20:55
possessed by
01:20:57
the thing giving us the most dopamine.
01:20:59
>> Yeah. I would go even further and say
01:21:01
not only is
01:21:04
is it making us less empathetic, but
01:21:07
it's actually making us sociopathic.
01:21:11
In other words, when people are in their
01:21:13
addiction, they can deviate from their
01:21:15
moral compass um because they so
01:21:19
overvalue this drug of choice that they
01:21:21
lose sight of their their own values.
01:21:24
And we see this um with kids who become
01:21:28
addicted to video games or or social
01:21:31
media. They stop participating in family
01:21:34
life. They stop treating their parents
01:21:36
with respect. They stop participating in
01:21:41
household chores. Um they become
01:21:44
essentially antisocial.
01:21:46
And when they get off of digital media
01:21:48
and they go through that terrible
01:21:50
withdrawal period, it get all that gets
01:21:52
worse and and even they will endorse
01:21:55
things like wanting to hurt their
01:21:57
parents or wanting to hurt themselves.
01:21:59
But if they can just go long enough and
01:22:02
abstain uh you know from digital media,
01:22:05
they will they will come out the the
01:22:07
other side. And parents will talk about
01:22:09
getting their child back, you know, and
01:22:11
getting back, you know, this person that
01:22:14
that they recognize as their child. So,
01:22:16
I think this is this is really
01:22:17
important. When people are in their
01:22:19
addiction, they can look very
01:22:21
personality disordered, very
01:22:22
narcissistic, very borderline,
01:22:26
very sociopathic.
01:22:28
And when they get into recovery, that's
01:22:31
not who they are at all. And they can
01:22:33
they can really become themselves again.
01:22:36
I read about a really extreme case where
01:22:39
that drug I believe it's called pramoxyl
01:22:43
>> pramipaxel
01:22:44
>> pramipaxel which is a dopamine agonist.
01:22:47
>> Yes.
01:22:48
>> Which essentially means I guess the
01:22:50
molecule is the same shape as dopamine.
01:22:52
So it kind of the brain treats it like
01:22:53
dopamine.
01:22:54
>> Yes.
01:22:54
>> And these people were given it for
01:22:56
twitchy leg or something.
01:22:57
>> Right.
01:22:58
>> And then they like so many of them lost
01:23:00
their minds. They became obsessed with
01:23:03
like compulsive impulsive behaviors. And
01:23:05
I was reading about one particular lady.
01:23:07
She would leave the house in the early
01:23:09
hours of the morning when she was taking
01:23:10
this drug, which kind of is the same as
01:23:11
dopamine.
01:23:12
>> And she would wear see-through tops.
01:23:16
This was like a normal woman who
01:23:17
otherwise [clears throat] had a normal
01:23:18
life.
01:23:19
>> And go to very dangerous places to try
01:23:22
and have sex with strangers.
01:23:24
>> And it was because she was her brain was
01:23:26
um
01:23:28
full of this this drug which simulated
01:23:30
dopamine. But there's so many examples.
01:23:31
There was one from Australia where a
01:23:32
woman was taking this drug which sim
01:23:35
which which is like dopamine in terms of
01:23:36
it molecular structure. And she would
01:23:38
sit on these slot machines until she
01:23:42
soiled herself and urinated on herself.
01:23:44
She ended up losing her house, losing
01:23:45
her car, losing her marriage just
01:23:47
because they'd given her this drug which
01:23:48
is the same as dopamine. And it made me
01:23:50
realize that that dopamine isn't
01:23:52
necessarily the the drug of um reward,
01:23:54
but more of like
01:23:57
wanting and impulse and desire. Is that
01:24:00
an accurate assessment of it? Like it
01:24:02
makes you desire things. And there was
01:24:03
other examples when I was reading about
01:24:04
it where people would a guy would take
01:24:08
this drug and
01:24:11
started engaging in homosexual
01:24:15
sex acts whereas otherwise he'd been in
01:24:17
a heterosexual relationship.
01:24:19
>> It was all very confusing but it says
01:24:22
something to me about what dopamine is
01:24:24
actually doing.
01:24:26
>> Yeah. I mean, I think, you know, when
01:24:27
we're talking about
01:24:30
addictive substances and behaviors,
01:24:34
the initial response of the brain is to
01:24:37
release a lot of dopamine all at once in
01:24:38
the reward pathway. But with repeated
01:24:42
use,
01:24:44
dopamine, dopamine release gets weaker
01:24:46
and shorter in duration and eventually
01:24:49
it leads to this dopamine deficit state.
01:24:52
And that's often what we call wanting
01:24:54
but not liking. So, and George Coupe has
01:24:57
called this dysphoria driven relapse
01:25:00
where now they're using, you know, not
01:25:03
to feel good but just to stop feeling
01:25:06
bad and feel normal. So, in that sense,
01:25:08
I dopamine is
01:25:12
I mean is part of pleasure. I mean that
01:25:14
that's it's that's not you know
01:25:17
it's not its sole function. But when it
01:25:20
comes to addictive substances and
01:25:21
behaviors, the initial encounter has to
01:25:25
feel good or be reinforcing or get
01:25:27
someone out of pain, right? It has to
01:25:29
solve that problem. But again, the issue
01:25:32
is that with repeated use, it stops
01:25:35
doing that, but there's still that
01:25:37
motivation to reuse again and again. And
01:25:41
when we're thinking about like exogenous
01:25:43
or external sources of just giving
01:25:45
someone dopamine, that's not going to
01:25:48
work to treat that dopamine deficit
01:25:50
state because it's going to bind
01:25:53
indiscriminately to dopamine receptors
01:25:56
throughout the brain. And the brain will
01:25:58
respond with that same process of neuro
01:26:00
adaptation where it's downregulating you
01:26:03
know dopamine receptors which is again
01:26:06
what is setting us up for this
01:26:09
repeated addictive pattern.
01:26:11
>> Is there any other studies that were
01:26:14
shocking to you and that have always
01:26:15
stayed with you? Another really
01:26:17
interesting study is if you um expose a
01:26:21
rat to a single injection of cocaine and
01:26:24
then slice open its brain, you'll see
01:26:26
this arborization of dopamine releasing
01:26:28
neurons in the reward pathway. So that
01:26:30
means a proliferation of uh neurons that
01:26:33
release dopamine, a kind of growth of
01:26:35
the dopamine forest, so to speak. But by
01:26:38
the way, you'll see that same
01:26:39
arborization or growth of dopamine
01:26:42
releasing neurons if you put a rat in a
01:26:44
complex maze, right? Which is to say a
01:26:47
maze where they can explore and find
01:26:49
different things and have challenges. If
01:26:53
you then cut that rat's brain open,
01:26:55
you'll see that same arborization of
01:26:56
dopamine. So in other words, learning is
01:26:59
highly rewarding and dopamine is
01:27:01
released in response to novelty and new
01:27:04
things and new challenges. But if you
01:27:06
then take that rat and pre-treat it with
01:27:10
methamphetamine and put it in the maze
01:27:13
and then look at its brain, you don't
01:27:14
see any additional arborization beyond
01:27:17
what you got with methamphetamine.
01:27:20
And the interpretation there is that
01:27:24
drugs actually may usurp or steal our
01:27:29
ability to learn, right? because they've
01:27:33
again this idea of sort of they've taken
01:27:35
over. It's such a powerful dominant
01:27:38
stimulus that there's no additional
01:27:41
growth or neuroplasticity in response to
01:27:44
something like learning a maze.
01:27:46
>> And does that mean that when that rat
01:27:49
was in the maze the first time and its
01:27:51
brain was full of dopamine, dopamine was
01:27:53
therefore playing a role in helping it
01:27:55
to learn?
01:27:56
>> No. So the learning itself
01:28:00
actually caused proliferate. So, so
01:28:01
dopamine is is responsive not just to
01:28:05
rewards, not just to pleasurable things,
01:28:07
but it's actually responsive to pain,
01:28:10
it's responsive to novelty. So, it's
01:28:12
responsive to any emotionally powerful
01:28:15
experience. So when you put a rat in a
01:28:18
maze and it explores that maze, that's
01:28:21
an enriching,
01:28:23
exciting experience for the rat because
01:28:26
we are creatures who are evolved to seek
01:28:30
and explore and learn new territory and
01:28:34
then move on and do the same thing.
01:28:36
>> Ah, so you could say then that if I'm
01:28:38
taking an addictive substance like
01:28:40
cocaine, I'm going to be much less
01:28:42
likely to go out and explore the world.
01:28:46
>> Yes. Exactly. Or if you do explore the
01:28:48
world, you'll there you capacity to be
01:28:52
rewarded by that experience will will
01:28:55
decrease or will not be there.
01:28:57
>> So I'm less likely to do it then.
01:28:59
>> Right. Yes. Yeah.
01:29:01
>> I mean this highlights a bit more of a
01:29:02
fundamental link around like motivation.
01:29:04
Like if you're addicted to something, if
01:29:05
you're addicted to pornography, your
01:29:06
ability to like get up and go out and
01:29:09
get a job might be diminished.
01:29:11
>> Absolutely. I mean what what happens
01:29:13
with addiction is that we have a
01:29:14
narrowing of our focus on our drug of
01:29:16
choice such that that's the only thing
01:29:18
that's reinforcing for us and other
01:29:21
things lose their rewarding potential
01:29:24
and eventually they fall away altogether
01:29:26
and we're spending all of our time
01:29:27
getting our drug using our drug trying
01:29:29
to get more as we come down. Can I talk
01:29:32
about another experiment which I think
01:29:33
is interesting. Another really
01:29:35
interesting experiment is the rat park
01:29:37
experiment. And this is the work of
01:29:39
Bruce Alexander. And he essentially
01:29:41
said, well, if you put a rat in a cage
01:29:43
with nothing else to do but press her
01:29:45
press a lever for cocaine, of course,
01:29:47
that's what they're going to do because
01:29:49
there's nothing else happening. But what
01:29:51
if you put a rat in a very enriched
01:29:53
environment with a lever to press
01:29:56
cocaine, but also lots of other things
01:29:58
to do, other rats, uh, shoots in mazes,
01:30:02
little, you know, sawdust balls. What he
01:30:06
discovered was that the rat is much less
01:30:09
likely to press that lever as often
01:30:12
because it has other reinforcing things
01:30:15
to do. And I think that that was really
01:30:18
groundbreaking
01:30:20
in the sense that
01:30:22
it is true that addictive substances and
01:30:25
behaviors work on the brain in this very
01:30:28
predictable way that's so reinforcing
01:30:30
that even if you have a great life, you
01:30:32
can get addicted. But it's also true
01:30:35
that our environment really matters. And
01:30:39
if we're living in an impoverished
01:30:41
environment like that single rat in a
01:30:43
cage with nothing else to do, we're much
01:30:46
more likely to get addicted than if we
01:30:48
live in this really enriched environment
01:30:51
where we have lots of other sources of
01:30:54
reward, lots of other uh sources of
01:30:57
dopamine. And based on that work, there
01:31:01
was something then called the Icelandic
01:31:02
experiment. And this is quite some years
01:31:04
ago now, but Iceland had a significant
01:31:08
youth drug problem. And the way that
01:31:10
they decided to intervene was to build a
01:31:13
lot of gymnasiums and emphasize youth
01:31:16
sports. And as we've talked about,
01:31:19
exercise and sports are a healthy way in
01:31:23
general, if you don't overdo it, to get
01:31:25
dopamine because you're paying for it up
01:31:26
front, right? You're working for it. And
01:31:29
um Iceland saw a significant reduction
01:31:33
in their youth drug use problem after
01:31:36
the implementation of this youth sports
01:31:39
system. So I think that's a nice way to
01:31:42
that's it's a nice example of how an
01:31:44
animal model can actually provide some
01:31:48
kind of fundamental
01:31:50
frame to understand what's happening in
01:31:52
the brain that can be then translated to
01:31:54
a real world implementation.
01:31:57
>> Radical honesty. Okay. So, um, radical
01:32:01
honesty is something that I learned
01:32:02
about from my patients and it was the
01:32:05
observation that my patients who were
01:32:08
able to get into sustained recovery from
01:32:12
severe addictions had learned that they
01:32:17
couldn't lie.
01:32:19
And it wasn't just that they couldn't
01:32:21
lie about their drug use. They couldn't
01:32:25
lie about anything. So they couldn't lie
01:32:27
about why they were five minutes late
01:32:29
for a meeting. They couldn't lie about
01:32:31
why they couldn't go to a party. They
01:32:33
had to tell the truth in all things
01:32:35
large and small.
01:32:38
And to me that was fascinating. And it
01:32:41
was an idea that I started to play with
01:32:43
and experiment with in my own life. And
01:32:45
I realized that telling the truth is
01:32:47
actually really hard because we're all
01:32:50
prone to little lies to kind of cover up
01:32:53
our shortcomings. Um, you know, these
01:32:56
are things that we hardly even notice.
01:32:58
They're also like lies of exaggeration
01:33:01
to make ourselves more interesting, lies
01:33:03
of flattery where we tell other people
01:33:05
how great they are, even though we don't
01:33:06
necessarily believe that. So, all these
01:33:09
little lies that we tell, um, I think
01:33:12
even if you're not struggling with
01:33:14
addiction, these lies can erode our
01:33:18
lives, make our lives more impoverished.
01:33:21
Um and I think you know it's working
01:33:23
through many different mechanisms you so
01:33:26
the question then becomes why is
01:33:29
truthtelling or radical honesty
01:33:30
protective and I think it's working
01:33:33
across many different levels but one of
01:33:36
the important levels that it's working
01:33:39
across is simple awareness
01:33:42
because when we're lying to other people
01:33:46
we're also actually lying to ourselves.
01:33:50
Um, and when we're lying to ourselves,
01:33:53
we actually don't know what we're doing,
01:33:55
right? And when it comes to our
01:33:57
consumptive behaviors, on the one hand,
01:33:59
you know, I may know that I'm watching
01:34:02
too many videos on on the same at the
01:34:05
same time really not know that I'm doing
01:34:06
that, right? So, but when I tell another
01:34:11
human being exactly what I'm consuming,
01:34:13
how much, and how often, then it becomes
01:34:16
real to me in a way that it's not. when
01:34:18
it's sort of pinging around in the dark
01:34:20
recesses of my my own mind. So that
01:34:23
awareness is really important because we
01:34:25
can't change our behaviors unless we're
01:34:28
aware um of what we're doing.
01:34:31
The other aspect of that that's really
01:34:33
important that I've learned over many
01:34:35
years of being a psychiatrist is that
01:34:38
the way that people tell their
01:34:40
autobiographical narrative is really
01:34:43
important and that there are healthy
01:34:45
ways we can tell our stories and also
01:34:48
not so healthy ways. And what I have
01:34:51
observed is that when when people are
01:34:54
telling stories in which they're always
01:34:57
the victim of other people or
01:34:59
circumstance,
01:35:01
I know pretty well that they're not
01:35:02
going to get into recovery. But if they
01:35:05
start telling a story that acknowledges
01:35:08
their own contribution to their problem,
01:35:11
whatever it is, including the problem of
01:35:13
addiction, then I'm pretty confident
01:35:15
that we're headed in a good direction.
01:35:18
And that's really interesting because
01:35:20
what it means is that our
01:35:23
autobiographical narratives provide a
01:35:26
template for our lives. They're not just
01:35:28
a way to organize past experience. They
01:35:31
actually provide a roadmap for the
01:35:33
future. And if we're telling self
01:35:36
stories that are
01:35:38
a more accurate representation of what's
01:35:41
actually happening in our lives, we will
01:35:44
have more information from which to make
01:35:47
better decisions going forward.
01:35:49
>> So victimhood keeps you stuck.
01:35:51
>> It keeps you stuck because it decreases
01:35:53
your awareness of what is actually
01:35:56
happening.
01:35:59
And it is our awareness of what is
01:36:01
actually happening that allows us to
01:36:03
have the data we need to make better
01:36:05
informed decisions.
01:36:07
>> Does it also in to some level rob you of
01:36:09
responsibility?
01:36:10
>> Absolutely. Because although addiction
01:36:13
is characterized by a loss of agency
01:36:16
around our consumptive behaviors, we
01:36:19
still have some degree of agency always,
01:36:22
even if it's only enough to reach out
01:36:24
and ask for help. And as people get into
01:36:29
sustained recovery, they have a lot more
01:36:31
agency, right? As they get out of that
01:36:33
vortex of addiction. And it is that
01:36:35
agency that that we must employ to make
01:36:39
the next best decision so that our lives
01:36:42
will be this accumulation of small good
01:36:45
decisions that then lead to good weeks
01:36:48
and week good months and good years.
01:36:50
>> I think that point is so important. this
01:36:52
this idea of agency which essentially
01:36:53
means like having control in in my life.
01:36:56
Feeling like I have a sense of control
01:36:57
in my life. Is that like a definition of
01:36:59
agency? How would you define it?
01:37:01
>> I I wouldn't define it so much as
01:37:04
control because there are so many things
01:37:06
that happen in our lives that are out of
01:37:08
our control.
01:37:10
But when we reduce our decision down to
01:37:15
today, you know, and what I can do
01:37:17
today, the things that I actually can
01:37:19
control today, then yes, recapturing our
01:37:23
agency around the things that we
01:37:24
actually have control over is really
01:37:27
really is really important for recovery.
01:37:30
>> The definition I've pulled up here is
01:37:31
agency means the capacity to act
01:37:33
intentionally and make choices that
01:37:34
influence outcomes. And um it does tend
01:37:37
to be the case from my observations that
01:37:39
people that have a high degree of
01:37:40
agency, i.e. they believe they have uh
01:37:43
capacity to act intentionally and make
01:37:45
choices that influence their outcomes
01:37:47
seem to be the most successful and on
01:37:49
average seem to be a little bit more
01:37:50
happy.
01:37:51
>> I think that sense of competence and and
01:37:54
agency is definitely one that makes us
01:37:57
feel good. The danger a little bit when
01:38:00
we're dealing with severe addiction is
01:38:03
that in our addictions, we often tell
01:38:06
ourselves that we have agency and
01:38:08
control when we really don't.
01:38:10
>> And so that can be part and parcel of
01:38:12
denial, which means that getting into
01:38:15
recovery is often about admitting that
01:38:19
we may have agency in many aspects of
01:38:21
our lives, but when it comes to our
01:38:22
addictive behavior, we've lost some
01:38:24
degree of agency.
01:38:26
>> And that's part of the 12step program,
01:38:27
right? Yeah, that is a really important
01:38:29
part of the 12step program is that admit
01:38:32
admitting that our lives have become
01:38:34
unmanageable
01:38:36
uh when it comes to our drug of choice.
01:38:38
>> The 12step program being Alcoholics
01:38:40
Anonymous, very famous program to to
01:38:43
help you through an addiction. Is there
01:38:44
anything else we should have talked
01:38:45
about that we haven't? you know, when it
01:38:47
comes to
01:38:49
New Year's resolutions and and wanting
01:38:52
to change habits,
01:38:55
sometimes these sort of all or nothing
01:38:57
thinking
01:38:58
can
01:39:01
be something that's not helpful for
01:39:03
people, right? this idea that okay I'm
01:39:06
gonna abstain from this and I'm going to
01:39:07
go a month and you know I'm going to do
01:39:09
it and then they find that they're not
01:39:11
able to do it and there's then a lot of
01:39:13
shame and self self-inccrimination.
01:39:16
So you know that that approach is is not
01:39:18
for everybody and for some a better
01:39:21
approach is sort of self-compassion
01:39:24
and a goal of moderation. Yeah,
01:39:27
moderation is an interesting one because
01:39:28
most of us will just be like, I'm going
01:39:29
to go to the gym every day or I'm I'm
01:39:31
going to have no sugar ever again or no,
01:39:33
I'm going to abstain from alcohol
01:39:34
completely, but
01:39:36
>> maybe moderation for some of these
01:39:37
things is more realistic and therefore
01:39:38
more effective and important.
01:39:40
>> Yeah. And we find that moderation
01:39:42
typically is more successful if period
01:39:45
if people have abstained for long enough
01:39:47
to kind of reset reward pathways. But,
01:39:50
you know, even just reducing use can be
01:39:53
a laudable goal.
01:39:55
We have a closing tradition on this
01:39:57
podcast where the last guest leaves a
01:39:58
question for the next guest not knowing
01:40:00
who they're leaving it for. The question
01:40:01
is, what's the one thing the universe
01:40:03
keeps putting in front of you and what
01:40:06
is the thing that it keeps you learning?
01:40:10
>> Um, so right now in my life, the thing
01:40:13
that the universe keeps putting in front
01:40:15
of me is the importance of letting my
01:40:19
kids go and have their own life
01:40:23
experience.
01:40:25
um rather than
01:40:27
trying to cling to the relationships
01:40:30
that we had before as they were growing
01:40:34
up, which for me was a really joyful
01:40:37
time. But I'm recognizing that they need
01:40:41
to be in the world on their own and I
01:40:44
need to figure out what I'm going to do
01:40:47
um as an empty neester. So that's not
01:40:50
that deep, but that is what I'm
01:40:51
struggling with right now.
01:40:54
And how is that struggle manifesting?
01:40:57
Well,
01:40:59
I mean, if I'm being totally honest, um,
01:41:03
social media and digital media and those
01:41:06
commu modes of communication
01:41:09
have probably made this worse for me
01:41:12
because, for example, the find my
01:41:15
iPhone, I keep checking where my kids
01:41:17
are and thinking that in a way um, we're
01:41:22
connected because I know where they are,
01:41:23
but we're not. and also they don't
01:41:26
particularly like it that I'm checking
01:41:28
where they are. So there's this kind of
01:41:29
weird phenomenon of wanting connection
01:41:34
and through text and other technology
01:41:38
trying to recreate that connection. And
01:41:40
yet in some ways I think I might be
01:41:43
better off and they might be better off
01:41:45
if we didn't actually text and I didn't
01:41:48
actually track where they are.
01:41:51
>> Does that make sense?
01:41:52
>> It does. And I I was I think I was
01:41:54
laughing cuz I just had this picture of
01:41:55
you sat there with like one screen is
01:41:57
tracking them and the other one is like
01:41:59
watching the pimples being popped.
01:42:00
>> Yes.
01:42:01
>> Both are comparable, right? These these
01:42:02
are both sort of related to sort of
01:42:05
habits or behaviors that are self
01:42:08
soothing but ultimately not not good for
01:42:11
me and you know not good for other
01:42:13
people. Do you think much about how
01:42:16
other behaviors that we take part in
01:42:18
like sleep um and meditation
01:42:22
um and our nutrition have a big impact
01:42:24
on our ability to kick the bad habit to
01:42:26
start a new one?
01:42:27
>> Oh, absolutely. Um there's a great
01:42:29
acronym from Alcoholics Anonymous called
01:42:32
HALT. Hungry, angry, lonely, tired. You
01:42:35
know, when we're feeling those things,
01:42:37
we're more likely to crave our drug of
01:42:40
choice. Um, so importantly, we've really
01:42:42
got to make sure we take care of
01:42:44
ourselves physically and emotionally so
01:42:46
that we're as well as we can be so that
01:42:48
we don't um get into that state of
01:42:51
wanting to escape or self soothe or numb
01:42:53
ourselves. And by the way, that's true
01:42:55
in the work that we do as mental health
01:42:57
care providers, right? We have to really
01:42:59
come to patients or clients with our
01:43:02
needs met, um, our cup full so that we
01:43:05
can be fully present for for our
01:43:07
patients.
01:43:08
>> Dr. Anna Lemi, thank you so much for
01:43:12
coming back on the show. It was
01:43:13
incredible the conversation we had last
01:43:15
time and it was so unbelievably
01:43:16
wellreceived. Um, it's done probably
01:43:18
closer to 10 million views across all
01:43:20
platforms now. Um, five just over 5
01:43:22
million views on YouTube alone. And I
01:43:24
can't begin to imagine all the the
01:43:26
people that you've had a profound impact
01:43:27
on by making these complicated things
01:43:30
accessible. And I know we we simplify
01:43:32
this to a point that it might be quite
01:43:35
>> difficult for because I I know the
01:43:38
science is much more complicated, but
01:43:39
just having a simple mental model for me
01:43:40
is has helped me so much since we last
01:43:42
spoke understand what's going on inside
01:43:44
my body and inside my brain
01:43:46
>> in a simplified way. And that's exactly
01:43:48
what was reflected by the millions of
01:43:50
people that watched last time. your book
01:43:51
is the the book to read and your
01:43:53
workbook as well is a crit critical to
01:43:55
read alongside it um on this subject if
01:43:57
people want to learn more and get an
01:43:58
even deeper understanding of everything
01:44:00
we've talked about today and also if
01:44:02
they're struggling with addictions
01:44:03
because these book books provide a
01:44:06
really I'd say nuanced um empathetic and
01:44:11
shame avoiding set of ideas and
01:44:15
solutions to some of the things that
01:44:17
hold us hostage in our lives whether
01:44:18
it's opioids or technology or other
01:44:20
behaviors is that we know at some level
01:44:22
are getting in the way of what we'd
01:44:23
rather be doing and who we'd rather
01:44:25
become. So, thank you so much for your
01:44:26
work. It's such an important work and I
01:44:27
know you're working on another book
01:44:28
which we didn't talk about this time,
01:44:30
but when that book does come out, I'd
01:44:31
love to have you back on to talk about
01:44:33
all the things in that cuz I um little
01:44:35
Bernie told me the subject matter and
01:44:36
it's absolutely fascinating. So, I'm so
01:44:38
excited.
01:44:39
>> Thank you so much. [music]
01:44:43
>> This is something that I've made for
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[music]
01:46:00
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Heat. Heat. N.
01:46:07
[music]
01:46:10
[singing]