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