00:00:00
there's a very famous experiment in which rats were engineered to have no dopamine and the scientists discovered
00:00:06
that if they put food in the rat's mouth the rat would eat but if you put the food even a body length away the rat will starve to death which tells us that
00:00:13
dopamine is fundamental to get the things that we need for our basic survival now every time we're doing
00:00:19
something that's pleasurable from sugar to video games work pornography social media that will affect dopamine and the
00:00:25
more dopamine that's released the more likely that drug or behavior is to be addictive but also the genetic risk of
00:00:31
addiction is about 50 to 60% so if you have a biological parent or grandparent with addiction you are more likely to
00:00:38
develop that addiction we have to keep it in balance in order to stay healthy Dr Anna lmy is Professor of Psychiatry
00:00:44
at Stanford chief of the Stanford addiction clinic and a world leading expert on the subject of doping she will tell you how this one powerful chemical
00:00:51
is controlling your life and what to do about it one of the most important findings in Neuroscience in the past 75
00:00:56
years is that the same parts of the brain that process pleasure also process pain and the balance wants to remain
00:01:02
level the problem is that we automatically seek out pleasure and avoid pain and we're exposed to all kinds of Pleasures that we have in the
00:01:09
modern world and our brains are reeling in response to try to compensate now I need more of my drug and more potent
00:01:14
forms to get the same effect which then leads to addiction and that's what happened to me when I got addicted to romance novels take me into that phase
00:01:21
of your life I was out of control and I needed to restore a level balance and take the advice I give my patients and
00:01:27
what is that advice the Diary of a CEO is independently fact
00:01:34
checked for any studies or science mentioned in this episode please check the show notes this has always blown my mind a little bit 53% of you that listen
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00:02:05
you so [Music]
00:02:11
much I've sat here for the last 20 minutes trying to figure out how to say this to you so I'm just going to say it
00:02:17
how it comes out my mouth and I apologize if this is messy but if there was ever an episode this year that you
00:02:22
should listen to it is this one I've since this episode was recorded about a month ago all I've been thinking about
00:02:28
is how on Earth I get you to watch this and I don't say this often the last time I said this was the first time Mo gordak
00:02:34
came on this podcast this is the second time I've said this in almost four years of recording this podcast on YouTube and
00:02:40
the reason for that is so many of the things that I know you're struggling with in your life that stand in the way
00:02:45
of the person you want to become that relationship you have with your phone the
00:02:50
procrastination the cycles of behavior that make you feel embarrassed and full of shame that you've just never been
00:02:56
able to crack all of them all of them I genuinely believe for many of you are
00:03:01
going to be understood today if you listen to this episode it has changed my life and it has changed much of the
00:03:07
lives of my team if if I'm wrong here you have the right to message me and
00:03:12
tell me that I was wrong please listen to this episode really really I mean that from the bottom of my heart and
00:03:18
just to make sure you do throughout this episode there's going to be these popups if you collect eight of these codes that are going to pop up on the screen and
00:03:25
put them in the document link below you'll unlock something very special some additional content please listen to
00:03:30
this episode Dr Anna
00:03:37
lmy you wrote one of the most iconic well-known books about dopamine which
00:03:43
propelled the subject matter of dopamine into the public Consciousness but I guess the most important question I should ask you
00:03:50
is why does dopamine matter ah good question good good place to start I mean
00:03:57
dopamine matters because it fundamental to our survival right so
00:04:03
it's the chemical that we make in our brain that tells us this is something we should approach explore investigate so
00:04:10
it's it's really almost the survival chemical so what is dopamine if you had to explain it to a 10-year-old how would
00:04:17
you go about explaining it so dopamine is a chemical that we make in our brain
00:04:23
um it has many different functions but one of its most important functions is
00:04:29
that it helps us experience pleasure reward and
00:04:34
motivation um it may be even more important for the motivation to do things than it is for the pleasure
00:04:41
itself so for example there's a very famous experiment in which rats were engineered to have no dopamine in the
00:04:49
brain's reward pathway and the scientists discovered that if they put food in the rat's mouth the rat would
00:04:55
eat the food would seem to get some pleasure from the food if you can deter that from watching a rat eat which I
00:05:01
think they felt like they could uh but if you put the food even a body length away the rat will starve to death the
00:05:09
idea being that without dopamine we're not motivated to seek out the things
00:05:15
that we need for our basic survival that's crazy so you get a rat you put
00:05:20
the food an inch from its mouth and it will starve to death because it doesn't
00:05:25
have dopamine the dopamine required to just reach out and eat yeah essentially maybe it's not an inch maybe it's a
00:05:31
little more than an inch but the idea being that dopamine is necessary to be
00:05:36
motivated to do the work to get the thing that we need and having an
00:05:43
understanding of dopamine how might that improve my life having a basic
00:05:48
understanding of how dopamine Works how we process Pleasure and Pain and also
00:05:54
what happens with dopamine as we go from adaptive recreational use to Mal adaptive addictive use is something that
00:06:02
is really useful especially for those of us living in the modern world where now we're exposed to so many reinforcing
00:06:09
substances and behaviors that we've all become vulnerable to the problem of addiction and what are the biggest
00:06:15
misconceptions of on the subject of dopamine because it's kind of thrown around in society I see it in my group
00:06:20
chats people saying I need more dopamine or whatever or you know that person just craves dopamine what what are the
00:06:26
biggest misconceptions you've come across the main miscon conception is that somehow we can get addicted to
00:06:32
dopamine we're not getting addicted to dopamine itself dopamine is neither good nor bad it's a signal to tell us whether
00:06:41
or not something that we're doing is potentially useful for our survival and
00:06:47
also it's related to what we predicted about how rewarding or pleasurable
00:06:53
something would be and so it's really um you know I sort of sometimes I joke it's like the um reward theory of relativity
00:07:02
DOP mean is in the sense that Pleasure and Pain really are truly relative to one another and so dopamine gives us
00:07:09
information about where we are in that relativity scale between Pleasure and Pain and when you say relative you mean
00:07:16
I mean it's it's quite fitting for anyone that can't see we have a a set of scales on the table and scales are
00:07:22
relative to each other because if you pour in one end the other end goes up and if you pour in the other end the other end goes up and this end goes down
00:07:29
and when you say relative that's what you're describing right yes that's what that's what I'm describing yes okay and
00:07:35
what activities that I do every day have an impact on my dopamine well probably almost everything
00:07:43
you know in some ways um I mean every time we are doing something that's
00:07:48
pleasurable reinforcing rewarding that will affect dope mean it's it's really
00:07:54
the primary signal that lets us know that this thing is potentially important
00:07:59
for our survival as I mentioned um but you know even um aversive stimuli can
00:08:06
trigger dopamine what's oh something that's painful or not pleasurable dopamine gets involved in in that um
00:08:14
equation anything that's novel or new is something that triggers our dopamine in
00:08:20
in our reward pathway dopamine is fundamental for movement so not just
00:08:26
pleasure and reward but also movement so for example Parkinson's disease which is
00:08:31
a disease related to stiffness and Tremor is caused by a depletion of
00:08:37
dopamine in a part of the brain called the substantia and as dopamine gets depleted in that part of the brain
00:08:44
people lose the ability to move their bodies and it's probably no coincidence
00:08:50
that the same neurotransmitter that is so important for pleasure reward motivation is also really important for
00:08:56
movement because most organisms have to to locomote toward the object of their
00:09:02
desire we want that thing we have to exert effort right we have to put in the work to go get it but in the world today
00:09:09
we really don't have to do that right we can swipe right we can swipe left and all of a sudden it magically appears at
00:09:16
the touch of a finger and that's very confusing for our brains because that's not how we evolved we really evolved for
00:09:23
for having to do quite a bit of upfront work for a tiny little bit of reward
00:09:29
I just want to before we move on talk about this point you said because I think it's quite foundational to everything we're going to talk about
00:09:35
about dopamine being relative to pain and I have this set of scales in front of me and here I have some chemicals
00:09:43
that are likely to produce dopamine in my brain I believe right so alcohol I
00:09:49
have some rum I have some whiskey I have some vodka and can you explain to me using this rum whiskey and vodka how
00:09:56
dopamine is relative to pain and what going on in my brain sure okay I'll slide this over to you oh
00:10:03
okay so one of the most exciting findings in Neuroscience in the past 75
00:10:09
years is that Pleasure and Pain are collocated in the brain so the same
00:10:14
parts of the brain that process pleasure also process pain and in a very simple
00:10:20
reductionist kind of way they work like opposite sides of a balance so imagine
00:10:26
that deep in your brain's reward pathway which is is another exciting Discovery right that there's this dedicated reward
00:10:33
pathway of the brain that consists broadly speaking of the prefrontal CeX which is this large gray matter area
00:10:39
right behind our foreheads that's so important for future planning for delayed gratification for appreciating
00:10:45
future consequences you might think of it as like the brakes on the car if we're going to analogize to to a to an
00:10:52
engine and then deep you know in the brain we've got what we call the limic
00:10:58
areas or the emotion brain and there you have the nucleus accumbens and the vental tegmental area that are rich in
00:11:06
dopamine releasing neurons right and they act like the accelerator on the car
00:11:11
so when you've got a healthy functioning brain you've got enough accelerator but
00:11:17
not too much right so enough dop Meine being released but not too much and youve got a healthy prefrontal cortex
00:11:23
putting the brakes on that dopamine release when people um become addicted
00:11:29
there's either a problem with the brakes the prefrontal cortex or the accelerator
00:11:35
the nucleus accumbens and vental tegmental area or both right what we're finding is that there's actually a
00:11:42
disconnect so there are large neuronal circuits and Pathways between those deep lyic structures and the prefrontal
00:11:48
cortex that literally get severed or disconnected when people become addicted
00:11:54
as we think about Pleasure and Pain being collocated in the same parts of the brain working like opposite sides of
00:12:00
the balance in order to understand what happens in the addicted brain is to
00:12:06
appreciate that there are fundamental rules governing this balance and one of
00:12:11
the most important rules is is that the balance wants to remain level it does not want to be tilted very long to the
00:12:17
side of either pleasure or pain and in fact what our brain does is first tilt
00:12:22
an equal and opposite amount to whatever the initial stimulus is so I'm going to try to illustrate that here so let's say
00:12:28
our initial stimulus is alcohol now alcohol Works through its own chemical pathway
00:12:35
it works on our endogenous opioid system the opioids that we make we have receptors for opioids in our brains it
00:12:41
works on our endogenous Gaba system which is our calming neurotransmitter and at the end of the
00:12:46
day it releases dopamine in the reward pathway so any potentially addictive
00:12:52
substance will release dopamine in the reward pathway the more that's released
00:12:57
and the faster that's released in a given individual the more likely that substance is to be
00:13:03
addictive now another important concept here is what we call drug of choice which is to say what releases a lot of
00:13:10
dopamine in your brain may not release a lot of dopamine in my brain and vice versa right which is this idea that
00:13:16
people have predictions to different kinds of drugs and by the way people can get addicted to behaviors too I should
00:13:22
emphasize that when you say drug of choice you mean the brain has a
00:13:28
particular sensitivity to that drug in terms of dopamine yes okay the more
00:13:34
dopamine that's released the faster that it's released the more likely that drug is to be addictive for a given
00:13:39
individual so you're holding some whiskey there I'm holding some whiskey there could be a brain that is very sensitive to Whiskey and there could be
00:13:46
a different brain that you could pull all the whiskey and you like and the dopamine response is sort of limited
00:13:52
exactly okay and for many of my patients who become addicted to alcohol they will
00:13:58
tell you that from the first moment they had alcohol they knew they were either in trouble or had met their best friend
00:14:05
or some combination it was a very potent experience for them all right so let's
00:14:11
let's go ahead and put this on the pleasure side of the balance dopamine is being released but
00:14:16
no sooner has that happened then my brain will work very hard to restore a
00:14:22
level balance and by the way a level balance is what neuroscientists call homeostasis okay and one of the
00:14:29
overarching physiologic drives for all living organisms is to return to homeostasis homeostasis is that
00:14:35
parameter of what's often called called affordances or states of being that are
00:14:41
adaptive and healthy for the organism for example like we have a certain homeostasis of body temperature and if
00:14:47
we go much too much beyond that either too high or too low we will disintegrate
00:14:53
and die right so homeostasis is that that states of being that are compatible
00:14:58
with existence and and potentially advantageous too sort of Baseline level that's right yeah
00:15:04
Baseline level and by the way we're always releasing dopamine at a kind of tonic Baseline level in our brains I sometimes think of it as the heartbeat
00:15:10
of the brain so what's happened here for people that can't see is you've poured a little bit of whiskey into one end of the scale the pleasure side of the scale
00:15:17
and the other side of the scale has risen because now there's whiskey um in the the pleasure side which I guess is
00:15:22
released dopamine exactly so now now we' released dopamine in the reward pathway
00:15:27
okay because the pain side went up does that mean there's now less pain in the brain well I think you know again this
00:15:34
is a metaphor it's an oversimplification the idea here is just when we press on the pleasure side we're releasing
00:15:40
dopamine in the reward pathway and experiencing pleasure okay okay but no sooner has that happened then our brain
00:15:47
will try to compensate or adapt to increased dopamine firing by down
00:15:52
regulating dopamine transmission for example by involuting post synaptic dopamine receptors that mean okay okay
00:16:00
so our brain is a bunch of wires you know um that conduct these electrical
00:16:06
signals and and these long spindly cells are called neurons and the thing about neurons is that they don't actually
00:16:13
touch end to end there's a little Gap or space between them and that Gap is called the synapse and that Gap or
00:16:20
synapse is bridged by what we call neurotransmitters and dopamine is one of those neurotransmitters okay and when
00:16:27
the pre synaptic neuron pulses and releases dopamine it crosses the synapse
00:16:32
and binds to a receptor on the post synaptic neuron which either continues
00:16:38
or aborts that electrical signal does that make sense yes okay so one of the ways that our brain can decrease the
00:16:46
effects of dopamine decrease dopamine transmission is by involuting or taking
00:16:51
inside the neuron the post synaptic receptor that way when dopamine is released it has nowhere to bind oh okay
00:16:58
so it's like removing the docking station exactly very good it's removing the docking station so essentially
00:17:04
getting back to our scale we've we've you know ingested alcohol we've increased dopamine firing in the reward
00:17:10
pathway but remember our pleasure pain balance wants to return to the level position level with the ground
00:17:16
homeostasis so it's going to decrease dopamine transmission by for example involuting those post synaptic dopamine
00:17:24
receptors but one thing about the brain in its process of trying to get back to
00:17:29
homeostasis and again I like to think of this neuro adaptation process as these Gremlins hopping on the pain side of the
00:17:36
balance to bring it level again you don't have Gremlins here you have these little rocks but let's go ahead and put
00:17:41
a rock on the pain side of the balance and the these rocks are are friends right their job is to level the balance
00:17:47
because remember we got to go back to homeostasis I'm going to put a rock on and you're going to see oh my gosh it
00:17:53
overshot right it now I've got it pressed down on the the pain side of the balance but that's exactly what happens
00:18:00
in our brains in this process of neuro adaptation those Gremlins hopping on the pain side of the balance don't get off
00:18:07
as soon as the balance is level they stay on until we're tilted and equal an opposite amount so is that what a
00:18:13
hangover is or a cown as they would say when people take drugs they say I have a
00:18:18
come down exactly that's exactly what it is that's the hangover the come down the
00:18:23
Blue Monday or on a much smaller scale just that moment of craving right that
00:18:29
moment of wanting to have one more shot right why does it overshoot why can't it just perfectly hit homeostasis such a
00:18:36
great question because then we'd feel fine yeah why did Mother Nature do that to us so cruel right yeah okay I'm going
00:18:45
to tell you an evolutionary just so story what we mean by that is we don't really know why you know this mechanism
00:18:51
exists but from an evolutionary perspective if you're living in a world of scarcity and everpresent danger this
00:19:00
is the perfect mechanism to make sure that we're never satisfied with what we
00:19:05
have that we're always wanting more it's made us the ultimate Seekers okay because immediately after
00:19:12
getting something I'm now feeling a lack of pleasure and I'm at a deficit you
00:19:17
know on the pain side of the scale which means that I'm going to go seeking out more dopamine and in a world where
00:19:23
everything is quite scarce that could mean going on another 4-Hour hunt the next day to go killer gazelle or
00:19:29
something perfect you got yeah you got it interesting yeah okay so that's going
00:19:34
to motivate me because this get so Jesus people that have hangovers don't seem
00:19:40
very motivated right so now that's a so why is that right it's because alcohol is a
00:19:49
product of human engineering that releases so much
00:19:54
dopamine all at once in the reward pathway that our brains are reeling to
00:20:00
compensate right we we really weren't evolved for this much pleasure with this
00:20:06
much easy access as you said yourself we were really evolved for to have to do
00:20:12
quite a lot of work upfront and to be hungry and to be lonely and to be tired
00:20:17
and then get a little bit of reward that would then bring us back up to homostasis so really we were evolved to
00:20:25
be pressing on the pain side of the balance in our effort to find pleasure and then when we find it that little bit
00:20:31
of food or clothing or shelter or a mate would bring us back to the level position does that makes sense yeah so
00:20:37
you're you're telling me essentially that we're all wired to be addicted
00:20:42
because if this is how our brain works in a world it's designed to seek out
00:20:48
more dopamine but the problem we have now is we have all the synthetic dopamine effectively like this so
00:20:53
synthetic chemicals and synthetic things and you know an Internet that is wiring us to give us so much dopamine so easily
00:21:01
that that means that our brains are effectively like mismatched to the world that we live in and therefore wired to
00:21:06
be addicted yeah I think you actually said that I found a quote you said in an interview where you said we all wired to
00:21:12
be addicted and if you're not addicted yet it's right around the corner right coming to a website near you yes I I
00:21:19
guess I would I would qualify that a little bit by saying we're wired for survival in a world of scarcity that's
00:21:27
not the world live in now we live in a world of overwhelming overabundance and so there is a mismatch between this
00:21:34
ancient wiring that has us relentlessly pursuing pleasure in order to survive
00:21:40
and a world that's so infused with pleasure and so many rewarding stimuli that now we're overwhelming our reward
00:21:47
system and our brains are reeling in response to try to compensate so what happens to this scale then in such a
00:21:53
world where I can get a big hit of dopamine all the time using some of these synthetic things or the internet
00:21:59
or pornography or whatever else what's going on with this scale over and over again okay great so let me get there let
00:22:04
me first say though that remember after we do something that's highly pleasurable our brain compensates with
00:22:11
neuro adaptation tilting an equal and opposite amount to the side of pain and then restoring our balance back to the
00:22:19
level position right or what we call homeostasis so this doesn't last forever right it's to pleasure then it's to pain
00:22:26
then it's back to the level position but if we continue to consume our drug of choice over days to weeks to months to
00:22:34
years and we add in a whole bunch of other drugs and now we're consuming you
00:22:40
know pornography and smoking pot and eating um donuts and you know you name
00:22:47
it all at the same time then essentially what happens is those Gremlins on the
00:22:53
pain side of the balance end up camped out there for anyone that see she put
00:22:59
all of the Rocks into the pain side to represent All Of The Addictive behaviors that this individual has now taken on
00:23:06
right and now we've entered addicted brain by which I mean that we've changed
00:23:12
our honic or Joy set point to the side of pain now we need more and more of our
00:23:21
drug in more potent forms not to get high and feel good but just to level the
00:23:28
balance feel normal and this is not going to be enough to level the balance I would have to like keep filling this
00:23:34
much more than this container can hold and that would be in Pursuit really of just trying to level that balance so
00:23:40
that we can feel normal and when we're not using we're walking around with a balance tilted toward the side of pain
00:23:47
experiencing the universal symptoms of withdrawal from any addictive substance
00:23:52
or behavior which are anxiety irritability insomnia depression and
00:23:58
crav so if I managed to get enough vodka whiskey rum and pour it into the
00:24:03
pleasure side of the scale now that all the rocks are in the pain side of the scale I managed to outweigh
00:24:09
it it would it would what would then happen more rocks more rocks would be
00:24:14
added yes more so momentarily yeah I would maybe be in a little bit of
00:24:19
pleasure yes but then my brain would remove those docking stations again remove more of them and more rocks would
00:24:24
go in and I'd slam down on the pain side again which means I need more alcohol to try and get up to
00:24:30
pleasure SL okay so really you want to you want to like dopamine fast you need
00:24:37
you need to just balance this and this is so difficult because of the world we live in it's almost it's it's it's funny
00:24:42
enough because this little scales experiment um analogy here has given me a huge amount of empathy for people that
00:24:48
are addicts oh gosh I'm so glad you said that because I think that is the key to
00:24:53
empathy for the disease of addiction as well as for people with the disease having empathy for themselves is
00:25:00
recognizing that on some level it it's it's out of their control right because
00:25:07
when we are tilted to the side of pain the overwhelming drive to restore a
00:25:12
level balance or restore homeostasis as quickly as possible overwhelms any other
00:25:18
rational thought about the consequences of my drug use right it's just like get back to the level position because if I
00:25:25
do that I'll at least feel temporarily better one of the things this analogy also
00:25:31
highlights for me is that people who are addicted aren't trying to self harm
00:25:37
right and this is kind of the prevailing narrative that if you're like why would you do that to yourself right whereas
00:25:43
when I look at this analogy I go actually what they're trying to do is to deal with pain and we're all trying
00:25:50
to find ways to deal with our pain and but in this analogy what ultimately happens and I guess is what's happening
00:25:56
with addicts is the way they're choosing to deal with their pain is becoming self-destructive and that's creating
00:26:01
more pain right and it's this vicious downward cycle yes and I think that sort of reframing of what's going on there is
00:26:07
really critical because again it begets more empathy absolutely I agree with you and and I think you know we this this
00:26:15
metaphor it makes an assumption that we all start with a pleasure pain balance that's level with the ground but
00:26:21
actually that's probably not true right some people at Baseline may actually be
00:26:26
more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction
00:26:34
and we know that people with co-occurring psychiatric disorders for example are at increased risk of
00:26:39
developing addiction probably because they're reaching for that substance to self medicate their psychiatric problem
00:26:47
the the issue with that is that it's not medicinal right it's not healing
00:26:53
although in the short term substances can help with those kinds of feelings
00:26:58
feelings of psychological and physical pain over time because of the way the
00:27:03
brain adapts as we've discussed substances and other addictive
00:27:09
behaviors just make psychiatric problems worse right as we drive ourselves further into the the kind of uh you know
00:27:16
the pain side of the balance so is this why trauma often leads to addictive behaviors because the trauma has caused
00:27:23
a a pain a stress and we're searching for ways to
00:27:29
medicate that pain or stress yeah to numb ourselves to not be present in our reality and have to deal with what's
00:27:35
going on there is dopamine what role is dopamine playing in it's all the same dopamine
00:27:41
originally was to help us find those things that we need to survive food clothing shelter a mate we call those
00:27:48
Natural Rewards but today that same reward pathway that
00:27:54
relies on dopamine has been hijacked by all of these artificial rewards that our brain
00:28:01
confuses as necessary for survival which is why people with severe addiction will
00:28:07
be willing to lose you know not consciously but unconsciously their loved ones their homes their jobs
00:28:15
everything they have in pursuit of their drug of choice it's because their brain has been hijacked and they now confuse
00:28:23
the drug as necessary for survival the other thing about drugs is that they're
00:28:28
incredibly potent they release a lot of dopamine all at once which again is confusing for our brain Natural Rewards
00:28:36
require upfront effort where we do a lot of work and then we get a little bit of dopamine and that's what our brains
00:28:43
evolved for I mean I can that makes sense in my own life when I'm most stressed or most challenged by something
00:28:50
professionally is when I I immediately notice that my diet goes out the window I start eating things that are bad I
00:28:56
actually stop going to the gym as much um and it's it be can form a bit of a
00:29:01
downward spiral can't it I guess as we've kind of seen from the dopamine scale um can I can I get back to that
00:29:07
your question though about trauma and stress so um there's a very series
00:29:13
there's a very interesting series of experiments in rodents mice and rats
00:29:18
where they first of all rodents very easily get addicted to cocaine they will
00:29:25
press a lever for cocaine until exhaustion or death but if that cocaine
00:29:31
is then taken away that behavior will extinguish which means that the mice
00:29:37
will eventually just stop pressing the lever right because they're not getting any cocaine totally makes sense and then
00:29:42
they'll go off and do something else in the cage but if they're then exposed to a very painful foot shock right so a
00:29:50
very extreme physical pain which you could equate to a serious life stressor
00:29:55
the first thing the rat will do is run over to the lever and start pressing for
00:30:02
cocaine which tells us that once our brain has discovered a drug that
00:30:08
releases a lot of dopamine in our reward pathway even after we stop using that
00:30:15
drug if we are exposed to an extreme stressor our brain will tell us
00:30:23
immediately go and do that thing that gives us a lot of dopamine because you are under stress and I need to be
00:30:30
relieved of stress does that make sense makes perfect sense yeah so if you especially so if you discover your drug of choice when you're younger and it's
00:30:36
food or it's pornography or if it's I don't know anything that really made you feel good for a moment a moment of
00:30:43
pleasure that will always become in the case of these rodent
00:30:48
experiments the thing you run back to when life gets hard right and we see
00:30:54
that again and again in people in sustained recovery from addtion that
00:30:59
when they are under stress that is a trigger potentially for them to relapse
00:31:06
so they have to be really thoughtful in their lives for number one trying to avoid stressful situations and and by
00:31:12
the way stress can come in many different forms there's a great acronym in in alcoholic synonymous called halt
00:31:19
hungry angry lonely tired those kinds of stressors everyday stressors which we
00:31:26
all experience hungry angry lonely tired can trigger us to want to use so people
00:31:31
in recovery have to be really thoughtful about not getting too hungry not getting too angry not getting too lonely and not
00:31:38
getting too tired at the end of this conversation I want to go through all of the sort of practical solutions that someone struggling with an addiction to
00:31:44
social media pornography food whatever it might be um Can Implement to try and
00:31:50
shift that cycle that they might be going through especially when they're halting hungry angry lonely or tired how
00:31:57
often have you worked with addicts have you spent much time working with addicts directly oh my gosh yeah so that's the
00:32:02
bulk of my career is working uh with people with all different kinds of addictions me an example of the most
00:32:09
obscure the most I had a patient who was addicted to water I know hard hard to imagine you
00:32:16
have to though understand her narrative so she had a very severe alcohol
00:32:21
addiction she got into recovery from that addiction and gave up alcohol but
00:32:26
she discovered that by drinking copious amounts of water she could become
00:32:32
hyponic meaning that she could lower the sodium levels in her bloodstream which
00:32:38
would then lead her to become delirious and so in her desire to just be checked out she would do that she would she
00:32:45
would drink a large amounts of water she's doing okay no sadly she's not um
00:32:51
she she ended up taking her own life so that was very sad
00:32:59
gosh in that situation was there was there a root cause of that behavior pattern further Upstream some kind of
00:33:06
trauma or experience that had set this sort of cascade cascading set of issues off yeah you know I'm just speaking
00:33:14
broadly um for for some patients with severe addiction trauma is a huge Factor
00:33:21
um especially severe Early Childhood trauma but there are also many folks we
00:33:27
see who have kind of great parents and have had happy childhoods and have great
00:33:34
social networks and and work that they enjoy and yet they still become addicted
00:33:40
and that's because we again we are wired to consume as much as possible of
00:33:47
whatever releases dopamine in our brains to have survived Evolution to this date
00:33:53
and yet we're living in this world where we have access to so many drug aied substances and behaviors that we've all
00:34:00
become vulnerable to this problem and the reason I highlight this is because one of the things that I think has
00:34:06
happened in the field of addiction medicine that maybe isn't the best is
00:34:12
that often times patients themselves as well as their providers are digging really deep to find the trauma or the
00:34:20
reason that someone has become addicted and I think that that's important to do
00:34:25
in some cases but in in other other cases it can lead to kind of manufacturing trauma where there really
00:34:32
isn't any furthermore I would say that when a person is in the throws of their addiction they're not going to be able
00:34:39
to really do the complex emotional processing of their trauma while they're still using their drug of choice that
00:34:46
they really need to get out of that Vortex of addiction and get into some degree of recovery before you would even
00:34:53
want to go tackle some of those early traumatic experiences how many people do
00:34:58
you think are struggling with some form of addiction well if you think of addiction as a spectrum disorder right there's
00:35:04
mild moderate and severe um and there's I would even say a kind of a pre- addiction state where we're all sort of
00:35:11
dabbling in compulsive overc consumption I would say the vast majority of us like
00:35:16
90 probably 95% have some degree of compulsive over
00:35:22
consumption and you know if and when it tips over into what we would call addiction there's not a brain scan or a
00:35:29
blood test to assess that it's not like you know switching a light a light switch and it's like oh yeah now you have addiction um it's not like that
00:35:36
it's you know it's a gradual often a gradual and Insidious thing and we don't in fact have a biological measurement of
00:35:42
addiction we Bas it on what we call phenomenology which is patterns of behavior that re repeat themselves
00:35:49
across time and broadly speaking the definition of addiction is the continued
00:35:54
compulsive use of a substance or a behavior despite harm to self and or
00:36:00
others and so you know that harm can be very subtle um or not right and it can
00:36:07
be a judgment call interesting because we do throw the word Addiction around a lot in society but but really the most
00:36:15
important part of that is to understand if it's harming yourself or someone else the behavior pattern yes that's right
00:36:20
and to also recognize that we're not very good judges of that when we're chasing dopamine okay so we sometimes
00:36:26
justify behaviors we have as being not harmful and it's fine and it's not impacting me at all and what do you mean
00:36:32
exactly and we don't we're not very good at seeing true cause and effect honestly when it comes to these behaviors which
00:36:38
is why often times people won't really see the harm until they've stopped using for a period of time in your book
00:36:45
dopamine Nation you talk about an addiction that you had yes and it was really surprising to me because I would
00:36:51
never have thought that being obsessed with erotic novels could be classified as an
00:36:57
addiction what happened what was the behavior take me into that that phase of your life so
00:37:04
I was in my early 40s um my kids were no longer little um I got a lot of my
00:37:10
self-worth and identity from being a mom and my kids were sort of entering
00:37:15
adolescence they were doing fine but they didn't need me as much um so I had
00:37:20
kind of a grief reaction you know in response to that was trying to figure out you know how to navigate this next
00:37:26
phase of my life I'd always been a reader and in particular a reader of novels um in my own way that was how as
00:37:33
a child I self soothed was to escape into uh the Fantasy Life of novels um
00:37:39
but I never had what what I would call a problem with it and then one day I heard
00:37:44
another mother at school said that she was reading this great book it was called Twilight it was about these
00:37:50
vampires and she was going on and on about it and I read it and I I can't tell you what it was but it was just
00:37:55
like the the the key in my particular it was completely transporting it just released a lot of
00:38:01
dope mean is all I can imagine in my brains reward pathway and so I read the whole series and then I read the series
00:38:08
again and I read it again and of course by the third or fourth time it wasn't as you know reinforcing and I thought to
00:38:14
myself I wonder if there are any more vampire romance novels and then for me
00:38:20
the real Tipping Point was I got an e-reader I got a Kindle because what happened was I I even before I got the
00:38:27
Kindle I started reading you know novels that I would say I would be slightly embarrassed to admit that I was reading
00:38:33
like kind of bodice Ripper novels as time went on I I needed more and more
00:38:39
like graphic kinds of descriptions in order to find it pleasurable and and by
00:38:45
the way that's classic for the addiction narrative right where you start out with
00:38:50
a little bit and it goes a long way and then over time you build up tolerance that's neuro adaptation the Gremlins
00:38:57
pressing down on the pain side of balance now I need more of my drug in more potent forms to get the same effect
00:39:02
gradually over time I started um reading you know more and more sort of graphic
00:39:09
erotic sexualized versions of this novel and I would I was embarrassed so I would
00:39:14
hide that I was reading them and that gets into the whole double life of addiction where now we're lying about
00:39:19
our use we're we're using our drug over here but pretending like we're not so my kids or my husband would walk in the
00:39:25
room and I would be you know hiding behind another book one book behind another book so it looked like I was
00:39:32
reading something you know I don't know more sophisticated and then the Tipping Point
00:39:38
for me came really when I got a Kindle or an e-reader and then my reading was totally Anonymous I could read these
00:39:45
books anywhere any time no one knew what I was reading and as soon as I finished one um I could read another one and I
00:39:53
almost overnight became a chain reader like literally when I was n doing something else that I had to do I was
00:40:00
reading romance novels one after another after another um which meant I was you
00:40:06
know less present for my kids less present for my husband I would often stay up till 2: 3 4 in the morning on a
00:40:12
week night reading romance novels have to get up two hours later go to work exhausted not able to be present for my
00:40:19
patience not enjoying my work gradually getting more depressed more irritable more anxious more insomnia we went on on
00:40:27
a a family vacation with an family friends of ours everybody together at this beach house all the kids playing I
00:40:33
was like hiding in a room reading romance novels so and this is exactly what happens with addiction is that our
00:40:40
Focus Narrows and the things that we used to enjoy are no longer pleasurable
00:40:45
only this one thing has salience for us we plan our whole whole day around getting it using it hiding our use um
00:40:54
and that's what happened to me it's so interesting because I was as you
00:41:00
were talking about that I was thinking about all the behaviors that I have that are maybe isolating me or you know I
00:41:08
just even things like spending a lot of time on the internet just watching video after video after video on YouTube or um
00:41:17
those kinds of things or just like spending tons of time in my WhatsApp group chat talking like roasting my
00:41:22
friends about nothing right how do you know if like this is it's cuz on end of the spectrum I could say okay well
00:41:28
that's harming my relationship with people in the real world but
00:41:34
it's helping making me feel good and it's you know maybe helping me in
00:41:40
another department because I'm learning more about vampires or you know like so
00:41:46
like you know because there's there might be net harm somewhere else but then an upside over here which and then
00:41:52
I start rationalizing this Behavior like how' you just distinguish between these behaviors and know what's bad and what's
00:41:59
good you know what it's really hard um these digital devices are powerful tools
00:42:07
but also very potent drugs there's no doubt that digital media lights up the
00:42:13
same reward pathway as drugs and alcohol these devices and platforms were designed to be addictive that is to keep
00:42:20
us scrolling and tapping long beyond what we plan for or what we want or even
00:42:26
what's pleasurable I think we can all relate to using this medium to a point where we don't even
00:42:35
like it anymore and yet have difficulty getting ourselves off of it that really speaks to the inherently reinforcing and
00:42:43
cognitively adherent nature of this medium it is a drug and so you know if
00:42:51
and when and how we're crossing into addictive use I think we need to be very Vig
00:42:58
about whether that's happened in our lives and one of the ways to do that is actually to try cutting out that
00:43:05
particular digital medium that website or that behavior for a period of time
00:43:11
long enough to experience withdrawal potentially reset reward Pathways and
00:43:17
then re-evaluate because when we're in the behavior as you yourself noted it's
00:43:22
very easy to rationalize oh I need to do this for work oh I need need to do this to stay in touch with my friends oh I'm
00:43:29
learning so much from this right and all of that may have been true initially but
00:43:35
may not be that true anymore and what I often point to is the subtler signs of
00:43:41
addiction which are things like depression anxiety in attention insomnia
00:43:47
restlessness these can be early signals for our consumption entering into that
00:43:54
addiction range but us not realizing it because again we don't see cause and
00:44:00
effect which is why doing an experiment like I did with my romance novels you
00:44:06
know following in the footsteps of my patients and taking the advice I give them and I gave my romance novels up for
00:44:15
30 days right just to see like okay I think this is a problematic Behavior can
00:44:20
I give it up how will I feel and the very first day that I the very first 24
00:44:26
hours hours that I did not read any romance novel any novel at all I was
00:44:32
astounded at my level of anxiety restlessness and utter insomnia I had
00:44:39
completely unlearned the art of putting myself to sleep without this digital
00:44:46
narrative and that lasted a good 10 to 14 days completely mapping on with the amount of time it takes typically to get
00:44:53
out of acute withdrawal that is to say for those neuro adapt PA Gremlins to hop off the pain side of the balance and for
00:44:59
homeostasis to to begin to be re restored um but by the time I got to
00:45:05
weeks three and four I felt not just better than I had in the first two weeks but actually better than I had felt in a
00:45:12
really long time I enjoyed my kids more I was more present for them I enjoyed my
00:45:18
husband more my work seemed salian again I had started to think oh maybe I should do something else you know maybe maybe I
00:45:25
you know this work I've been doing it a long long time I don't it's not that interesting anymore all of a sudden it was interesting again right so you see
00:45:33
the relativity of that honic pathway and how when we're doing that behavior or
00:45:38
substance that's so reinforcing that everything else loses its salience we can really
00:45:44
misidentify what is causing our irritability anxiety insomnia until we
00:45:51
stop that substance for long enough to see its impact on our lives how is it making you feel because I think a lot of
00:45:58
a lot of people can't understand how you could get addicted to a book I'm sure
00:46:03
some people understand that but but for me it's not something I've ever become addicted to so how how did it feel was
00:46:09
it like exciting is it arousing is it somewhere in between I mean I think that romance
00:46:17
novels are essentially socially sanctioned pornography for women okay and the medium is narrative and if
00:46:24
you're a person for whom narrative is a powerful drug as it is for me a story a narrative a fiction um very potent since
00:46:32
I was a child then you know it was a natural that that that would be the
00:46:37
thing that I would get addicted to and basically just like we've hacked and bioengineered everything to make it more
00:46:44
potent I mean people there's a formula for writing romance novels like if you take a physical copy if you go to a
00:46:50
store and you pick up a romance novel and you literally physically open it to 2third of the way through you will get
00:46:56
to the climactic scene pun intended right it's it's like it's engineered I mean I got to a point where
00:47:05
I wouldn't even read it read after I wouldn't finish the book I would go on to the next book just to get to the
00:47:10
climax part and then you'd move yeah and I wouldn't even read the danum ma or like what happens to the characters I
00:47:15
didn't care you didn't care about no and also I didn't I got to point where I didn't care about the quality of the writing or the depth of the car it
00:47:22
didn't matter it was it was the drug it was that moment I was looking for and you know there are a lot of free books
00:47:28
on Amazon some some of which are high quality and some of which are not but like you know any good drug dealer knows
00:47:33
free samples that's the way you hook people I would search for these free samples and that's part of it too like
00:47:39
the searching for the drug so the Working The Upfront work you do for the drug is part of the drug right it's all
00:47:46
that you know the machinations and the hiding and the this and the that that gets to be part of like all of the
00:47:53
rituals surrounding it as you were talking as well I thought about work and work addiction yes because you earlier
00:47:59
used the term excessive consumption and when I think about work even my work I Think Jesus I excessively consume work I
00:48:08
start so many bloody businesses and invest in so many things and if you look to that behavior objectively if you're
00:48:13
like an alien looking down at me you'd go this guy's got a problem do you know what I mean you think you think
00:48:18
that's funny joking you
00:48:24
know I feel for you and it's funny cuz in society we then those people are
00:48:29
reinforced we clap that's right we clap we got this guy's not sleeping he's working 18 hours a day clap clap clap
00:48:36
give him a trophy an award name a thing after him or her or right you know um
00:48:42
and it's just really interesting that that that addiction of work and you tell me if it is it can be an addiction it's
00:48:48
certainly in the scale of one end being sort of consumption excessive consumption in the other hand being addiction it's on there somewhere people
00:48:55
can get addicted to work and part of the reason is that we've drug aied work right when when I say
00:49:01
drug aied what do I mean we've made it more potent and this is true for all all these drugs we've made them more potent
00:49:06
more novel more Bountiful meaning there's more of it and more accessible so if we if we break that down with work
00:49:13
how is work more potent well certain types of work are more reinforcing not
00:49:18
all types of work so for example Works work White Collar work is often now
00:49:24
associated with stock options and bonuses right um there's often like a social media aspect to it or maybe even
00:49:32
a Fame aspect or as you point out those are our cultural Heroes right so you get all this you know agulation for being a
00:49:41
workaholic and that also because we're such social creatures right and human connection stimulates dope mean that
00:49:47
that also makes work more of a potent drug personal brand right so you're
00:49:52
LinkedIn oh my God this person got a promotion we all clap we the likes the comments you're amazing the agulation
00:49:58
the a as you said the awards the trophies and then you've got um the fact
00:50:04
the fact of novelty so once we've exposed our brains enough times to a
00:50:09
certain drug as I said we develop tolerance right and then we need more potent forms or novel forms one of the
00:50:15
ways we overcome tolerance is by taking our drug and then changing it slightly like adding a little new molecule on
00:50:23
this chemical right or on the Internet you know when we're searching videos we want something similar to what we liked
00:50:29
before but just a little bit different and that's what the algorithm does automatically right it offers oh you should check this out oh how about this
00:50:35
oh check that out right and that engages our treasure seeking function we're looking for that that novel thing but
00:50:41
that's not too novel right it has to be in our category of things we like and I think for work we have that too like
00:50:47
there are so many ways now that people can engage in their work and it's not all bad that it's novel but you know
00:50:52
certain types of work it makes it very enticing then you have quantity right I mean work never ends there's
00:50:59
like no natural stopping point for work you know you do a line of cocaine you run out of money you run out of cocaine
00:51:05
you're done right but that's not true for work everywhere anytime and then
00:51:11
that gets to accessibility one of the biggest risk factors for addiction to any drug or
00:51:16
behavior is simple access we know that if you grow up in a neighborhood where drugs are sold on a street corner you're
00:51:22
more likely to try them more likely to get addicted if you live in a world where you have access to work
00:51:29
24/7 you're more likely to expose your brain to more work and more likely to get addicted to work again especially if
00:51:36
it's got all those other reinforcing qualities this is probably in part why people quit their
00:51:42
jobs you mean if they just get overwhelmed or it's it's partially why people can never quit but I think it's
00:51:48
important to make a distinction between work that's reinforcing in those ways and then work that's completely not
00:51:55
reinforcing yeah alienating mind-numbing work in which
00:52:00
the the actual task is separated from the meaning of a task I mean they quit their jobs either in search of more
00:52:07
dopamine so if I'm working in a job where I don't know maybe it once gave me dopamine and now it's become monotonous
00:52:13
and the same right I I need to quit to go find but there's novelty for you that's right yeah and that's true people
00:52:19
many people change jobs every two to three years I I recently read that the the average life of a business now is
00:52:26
like 15 years whereas you know 50 years ago it was 50 years and there's all this
00:52:32
turnover all this churn chasing novelty also you know I I do want to emphasize that people who are in work that's not
00:52:38
like intrinsically rewarding but is the opposite kind of soul sucking that's
00:52:44
also a risk factor for addiction because people just wait till the end of the day till they can go home and then use a
00:52:50
drug to numb themselves from the stress of work so it's it's plausible that
00:52:55
people who are in lower pleasure jobs are more likely to be overweight or addicted or dependent on alcohol yeah or
00:53:02
simply opt out of the workforce as many young men are doing now in the United States and what we know from data that's
00:53:08
been collected is many of them are playing video games right they've just completely opted out of the workforce I
00:53:14
guess this in part explains why there's a drinking culture that's associated with people who are potentially lower
00:53:21
class um because they're doing um potentially
00:53:27
less pleasurable work and they're therefore they if we think
00:53:33
about the scale that they would then end up in the pub after work you know maybe that's partially true but even people
00:53:40
doing like doctors and lawyers they're are oh okay yeah equal rates of alcoholism among those groups I think
00:53:47
what's happening there though is that the nature of the work is just so stressful whether it's white collar or
00:53:53
blue collar that there's this kind of work hard play hard right I'm going to work all day and at the end of the day I'm going to reward myself so now you've
00:53:59
got a pleasure pain balance that's going pleasure pain pleasure pain and and remember the biological definition of
00:54:04
stress is any deviation from neutrality so that every time our brain
00:54:11
has to work to restore a level balance we're actually triggering our stress response triggering our own adrenaline
00:54:18
it's stressful to have to restore the balance from those extremes of Pleasure and Pain I read in um your book you were
00:54:25
talking about how different behaviors and sort of chemicals and substances have different impacts and I was on page
00:54:31
50 of dopamin nation in a study of mice sex increases the release of dopamine by 100% And amphetamines which is like
00:54:39
drugs right hardcore drugs increases it by 1,000% by this accounting one hit of
00:54:45
a meth pipe is equal to 10 orgasms yes it's interesting to think about that the
00:54:50
different behaviors we have and how they'll have a bigger impact on our dopamine is there like any in an in in
00:54:58
typical order of things that are like extremely dopamine inducing and things that aren't what's it like the top and
00:55:03
bottom of the list but in your view you know I really think that it depends on
00:55:09
the person and we've got to look at drug of choice right I mean potent drugs like
00:55:15
methamphetamine like opioids like alcohol like nicotine like cannabis um
00:55:21
are are going to be very reinforcing for many people but not for all people and
00:55:28
most people do have their one drug that they sort of prefer above all others so
00:55:33
although generally speaking intoxicants release a lot of dopamine in the reward pathway um I think every person is going
00:55:40
to be different and also we we don't really have good ways of measuring absolute values of dopamine in human
00:55:47
beings right we can do that in rats but we can't really do that in humans it's it's relative values I've got this um
00:55:54
picture here which shows what looks like brain scans in uh normal person but then
00:56:00
in someone who's addicted to different substances I'll put this on the screen and I'll link it below in the description for anyone that needs it and
00:56:06
wants to see it but it effectively shows the impact that like cocaine has on the brain meth um alcohol and heroin what is
00:56:13
what is going on here so the red in this image represents dopamine transmission
00:56:19
okay so how much dope mean is being released from the pr synaptic neuron Crossing that synapse binding to
00:56:25
receptors on the Sy aptic neuron how much dopamine is kind of swirling around in the reward pathway part of the brain
00:56:32
and what this image shows is that on the left hand side in healthy control
00:56:37
subjects who do not have addiction there's plenty of red right so there's
00:56:43
plenty of dopamine Transmission in the reward pathway specifically here in the nucleus accumbens but if you look at the
00:56:50
right hand column you'll see that in these individuals who have been using cocaine meth amphetamine alcohol and
00:56:57
heroin in addictive ways there's almost no red which means there's decreased or
00:57:05
below normal levels of dopamine transmission they are in a chronic
00:57:11
dopamine deficit State this is evidence of the brain
00:57:18
trying to compensate for too much dopamine being
00:57:24
triggered by down regulating its own dopamine production and transmission not
00:57:29
just to Baseline but below Baseline and importantly these
00:57:34
individuals who are addicted to these substances these brain scans were done two weeks after they stopped
00:57:41
using oh wow yeah which tells us that this dop dopamine deficit State persists
00:57:48
for some period of Time how long well it depends on the person but we know at
00:57:53
least from this experiment that the first two weeks are this persistent dopamine deficit state which is
00:58:00
consistent with acute withdrawal right people feel when they first stop their drug of choice they feel terrible right
00:58:07
they experience all of the symptoms of physical withdrawal that correspond with that particular drug they were using
00:58:14
usually the opposite of what the drug did plus the universal symptoms of withdrawal from any addictive substance
00:58:20
or behavior anxiety irritability insomnia depression and craving now if
00:58:25
they can get through the first 10 to 14 days what we see clinically is those
00:58:31
acute withdrawal symptoms slowly start to get better and we think that that is
00:58:37
mapping on to regenerating dopamine Transmission in the reward pathway and
00:58:43
if they can make it to a month that's usually the point for for on average in
00:58:48
based on clinical experience when people really can start to get out of that
00:58:54
constant state of craving for their drug of choice and begin to see some light at the end of the tunnel for what their
00:59:00
lives might look like if they can maintain abstinence from their drug and
00:59:05
we can't just inject or drink dopamine I mean I guess that would be like drinking alcohol we can't just artificially mess
00:59:11
with the the balances to try and restore the dopamine levels in an addict can we can't just add a little bit of dopamine yeah it's it's a great question because
00:59:18
we have some natural experiments that suggest what what might happen if we do that so as I mentioned before people
00:59:25
with Parkinson's have depletion of DOP mean in the substan That's What Causes That that motor disease the
00:59:32
treatment for it is to give L Doopa which is a dopamine precursor if I were
00:59:38
to give you a spoonful of dopamine it would do absolutely nothing because it doesn't cross into the bra the brain it doesn't cross the blood brain barrier
00:59:44
but I could give you lopa which is a precursor chemical that would cross your blood brain barrier and get turned into
00:59:51
dopamine and then diffusely bind dopamine receptors in your brain in the reward pathway but also in the movement
00:59:58
Pathways when we give patients with Parkinson's dopamine in this form that
01:00:06
can temporarily improve their movements but in about one in four Parkinson's
01:00:11
patients they will develop a denovo addictive disorder shopping addiction
01:00:17
sex addiction other types of addiction because we have the same problem we are
01:00:23
stimulating the reward pathway with dopamine that is
01:00:29
ingested exogenously from the outside and our brain reads that as oh
01:00:35
boy got to compensate by downregulating dopamine transmission to below Baseline
01:00:41
which then puts us in that addiction Vortex does that make sense it does so we have to I mean it tells me that we
01:00:47
have to live lives in a certain sense of we have to live our lives in a certain
01:00:53
sort of homeostasis and it's so easy not to in the world we live
01:00:58
in it's like it's like impossible to live in a perfect homeostasis balance in
01:01:04
the world we live in right even more than having to try to live within this
01:01:09
sort of narrow range of homeostasis in the world we live in today we probably have to intentionally do things that are
01:01:16
painful do things that are hard pleasure pain balance like we learn that when we
01:01:21
press on the pleasure side of the balance like with alcohol or pornography
01:01:26
or romance novels or cannabis or whatever it is right no sooner does that happen than our brain adapts by those
01:01:35
neuro adaptation Gremlins hopping on the pain side of the balance to bring it level again but they like it on the balance so they don't get off right when
01:01:41
it's level they stay on until we're tilted an equal an opposite amount to the side of pain that's the come down
01:01:46
the hangover Etc but it turns out the opposite is also true if we intentionally press on the pain side of
01:01:53
the balance for example with exercise or an ice cold water bath or intermittent
01:01:58
fasting those Gremlins will hop on the pleasure side of the balance and we will get our dopamine indirectly by paying
01:02:05
for it up front and there are studies in humans showing that when humans expose
01:02:12
themselves to exercise for example dopamine levels gradually rise
01:02:18
over the latter half of the exercise and then when the exercise stops dopamine levels will remain elevated for hours
01:02:25
after afterwards before going back down to the Baseline level position without
01:02:31
ever going into that dopamine deficit state so it's a great way to get our dopamine in directly because it's much
01:02:37
less vulnerable to that compulsive craving phenomenon of overuse so you're
01:02:43
not going to get an exercise come down you can butc and people can get addicted
01:02:49
to exercise right but typically it's it's very unusual because The Upfront
01:02:55
cost to to do the work and endure the pain of exercise in the first place mitigates
01:03:02
our vulnerability to an exercise addiction and in general H okay CU it's so hard to do that it's going to be it's
01:03:09
not like pulling a lever on a slot machine or clicking on a porn website is difficult yes okay so fighting for the
01:03:16
dopamine is insulates us against the chance of an addiction having to really fight hard
01:03:22
for it okay yeah and this kind of explains I guess in part why I pulled out some stats ahead of our
01:03:28
conversation today that from 1996 to 2008 participation in ultramarathons has
01:03:35
increased by 1,676 the ice bath Market is expected to
01:03:42
rise from 350 million in 2024 to to nearly half a billion by 2030 the number
01:03:49
of people taking part in obstacle course races like tough mut or hrock etc etc
01:03:54
has increased by almost 7x from 2010 to 2017 it seems like in society there's
01:04:00
this counter movement towards people seeking out hard dopamine chasing pain
01:04:06
yeah those are amazing I didn't know that those are amazing numbers um you know in general there's a part of me
01:04:11
that wants to say well that's a good thing um but there there's another part of me that's wary also because we're so
01:04:18
good at drug aying everything that we do that there's a way in which these types of behaviors can also be drug aied right
01:04:26
made more potent with all of the technology the way that we count ourselves the leaderboards the social
01:04:32
comparisons all of that takes this thing which is really in its natural state
01:04:38
kind of impervious to addiction like you just typically wouldn't get addicted to these types of painful physical
01:04:44
activities you would do what you needed to do for survival but we've managed to make them addictive in all these
01:04:51
different ways I still think it's a better way to get your dopamine like I really encourage exercise we always talk
01:04:57
about movement as medicine and in general our our life is so convenient so
01:05:02
easy so passive so sedentary that I'm telling patients all the time you know get up off the couch move your body walk
01:05:10
around the block I think that's the bigger obstacle right now is just getting people to move but I do think we
01:05:16
need to be wary of not going too far in the direction of like the ultra Ultra Ultra whatever it is so what is a better
01:05:23
way to live if we're trying to optimize happiness and to keep our dopamine in balance and not have the crashes Etc and
01:05:29
come downs and hangover what is a optimal way to live our lives do we have to look back at our caveman ancestors
01:05:36
and live like them I think that part of the problem is that we've
01:05:41
organized Our Lives now around rewards almost everything that we do is
01:05:49
predicated on the Feelgood moment we'll have at the end of it and because of
01:05:55
that that we are missing out on the process we're projecting our psyche
01:06:02
forward into the future toward the reward and not able to really be here in
01:06:08
the moment okay this is going to be sound weird I'm going to give you a weird example so driving over here today
01:06:13
I found I was nervous for this interview and in a way looking forward to it but
01:06:19
in a way wanting it to be over right and and in seeing that in myself I thought
01:06:24
that's so sad like that's that's so sad that we live our lives that way myself included always this weird blend of
01:06:31
wanting whatever we're doing to be over so that in a way we can just go hide and do whatever that self- steem thing is
01:06:37
that we do where we're safe and we're like you know stimulating ourselves in some way and then I thought well what if
01:06:44
I knew that I was going to die right after this going come off really weird
01:06:50
now but what if I knew that I was actually going to die right after our conversation today
01:06:56
that totally changes my perspective doesn't it because this time you and I have that's all I got it's over for me
01:07:02
when this so this this conversation is it I really better be right here right now and really taking joy in whatever
01:07:10
you and I can find together and and I think the more we can do that the better
01:07:17
what's happening there you're removing the thought of the outcome the rewards the potential you know failure or
01:07:22
whatever and you're focusing on just being present and in doing so what is happening it's a great question and I've
01:07:29
actually given this quite a lot of thought because I remember when I was in college and I you know met some like Zen
01:07:36
people and they were like be here now be here now and I thought well whenever I'm
01:07:42
here now I'm miserable like I I I don't like me and I don't like being in the
01:07:48
world I I don't want to be here now I want to be somewhere else so I didn't
01:07:53
really understand what they were getting at it really took me you know till I had lived quite a lot of life and had some
01:08:00
you know some significant experiences and given it some thought that I realized oh be here now means be here
01:08:07
now and be uncomfortable and be okay with being uncomfortable and being okay with not
01:08:14
being able to control my pleasure or my pain or my comfort level but just being open to
01:08:21
whatever comes and I think that's a really a key shift that I'm not trying to control my
01:08:29
experience in the moment and that it's okay to be unhappy or Restless or
01:08:35
uncomfortable and not trying to run away from that but just really turn and face it and embrace the discomfort which I
01:08:42
also think is quite Universal I don't think I'm I'm alone in that and then the
01:08:48
key piece about not not anticipating the reward is helps me be in the moment
01:08:54
right because I'm not just waiting for the good thing to come after I'm saying to myself imagine there's nothing good
01:09:00
coming after nothing at all right there's just there aren't rewards this is it and then also being able to say
01:09:07
and it's okay if in the moment like it's not great like I I can Embrace that you
01:09:13
know I can be unhappy or Restless or anxious or whatever it is and then when
01:09:20
I do that you know I feel like there's a funny funny thing that happens and all the sudden I I'm not as anxious right
01:09:28
and I am present and it there is some Joy there interesting so when you allow
01:09:35
yourself to deal with being uncomfortable in the moment it turns out you it removes the thing that was making
01:09:41
you uncomfortable in the moment which is like the avoidance or the worry or overthinking whatever else yeah I I
01:09:48
think we have this and it's fed by modern culture this kind of expectancy that really we should be happy all the
01:09:54
time and if you know if we've arranged things appropriately for our lives and if we've done our work and you know
01:10:01
aimed true then we should just be like life is great and I don't believe that
01:10:07
anymore I think that you know I mean like Buddha said life is suffering but I
01:10:13
really think that fundamentally like it's uncomfortable to
01:10:19
be alive and that it's a kind of a constant state of restlessness and discomfort if
01:10:25
we're being really honest and and tuning in when I really let myself see that and
01:10:30
feel that all of a sudden I'm I'm freed from from some of
01:10:38
that what has caused your anxiety throughout your life in the moment you you referenced earlier that some things
01:10:43
have happened that have led you to understand this better and understand yourself better what is what am I
01:10:49
missing from this jsaw puzzle yeah well you're you're good you could have been a psychiatrist oh really yeah it's always
01:10:55
time this doesn't work out there's still time right it's not too late you get a new profession yay um I think you know
01:11:01
for me the the big Turning Point um was that we lost our we lost a child and um
01:11:10
in the immediate aftermath of our child's death I was just determined to
01:11:16
like sort of undo the experience and um you know get enough Psychotherapy
01:11:24
and enough whatever whatever it took to sort of not feel that pain and it wasn't
01:11:31
until I really just said oh like I'm going to feel this pain for the rest of my life it's never going away that
01:11:36
suddenly I felt some relief from that pain and that was a real window for
01:11:42
me so interesting that the it's
01:11:49
acceptance yeah and and you know and and I think you know one of the reasons I love treating patients with addiction is
01:11:56
because I really relate to that hitting bottom moment you know that moment when
01:12:01
it's like you just have the feeling that like everything I try to do to manage
01:12:08
this Behavior or to make my life better only makes it worse I felt like I had a very similar
01:12:14
experience um and that it was only when I kind of realized oh I yeah I I can't
01:12:22
run from this I cannot run this pain uh that I I begin to have some the
01:12:27
beginnings of relief from that experience I can't outrun this
01:12:32
pain it's all natural sort of disposition to try and outrun pain isn't it that's the irony right we're really
01:12:39
wired to outrun the pain we are like we reflexively seek out pleasure and avoid pain and yet that's the very thing thing
01:12:46
that doesn't get us to where we want to go but we do now live in a world where
01:12:52
it's very easy to outrun the pain yes this is a lion that's chasing me this could be a bad email and then I open up
01:12:58
a tab and start Doom scrolling or open up a tab and start watching video playing video games or pornography or
01:13:05
whatever yeah that's exactly right there are so many ways that we can now distract ourselves from you know our own
01:13:12
suffering or our own awareness and where do you find yourself now with dealing with that grief and the
01:13:18
pain as we sit here yeah I mean I I feel like in many ways it's been a real gift
01:13:24
in my life you know it's really informed my life in in ways that um I mean I I've
01:13:31
learned things from that experience that I think it would have been almost impossible for me to learn otherwise you
01:13:38
deal with a lot of people that are in a state of suffering
01:13:44
I imagine that's a weight because I um even hearing the
01:13:50
story of the lady that passed away after that water addiction it was like a it was like a weight on my shoulders just to hear it
01:13:55
so if your profession puts you right at the heart of this type of suffering how do
01:14:01
you manage that to to hold that weight a couple things um first of all a
01:14:09
lot of people get better and when people with addiction get better it's so much better that it's incredibly
01:14:17
rewarding to see and they're amazing people Absolut like the most tenacious
01:14:22
talented people you'll ever meet and when they get better it impacts so many
01:14:28
other people right their friends their family the people they work with so it's very rewarding work and and not at all
01:14:35
burdensome of course you know for patients who don't don't get better or
01:14:41
patients who die it's a terrible feeling and there is a sense of um
01:14:47
responsibility and and guilt even when I feel like there was nothing that I could have done otherwise um you know I carry
01:14:53
those losses with me so it's hard is there any particular cases that have stayed with you the most I mean every
01:15:00
patient I've had who's died while under my care those are incredibly painful um
01:15:07
and I will never you know those are sort of a those people will be with me as a
01:15:14
part of me for all of my life young and old yeah young and old yeah it's especially tragic to you to lose young
01:15:21
people and it always feels like their second gu ing like oh if only I had done
01:15:26
that or if only we had intervened here but I just think that's the nature of death we we can't get away from the
01:15:33
feelings of guilt around it no matter who we are and no matter the circumstances how young can addiction
01:15:40
and the consequences of addiction ruin someone's life like how young can someone be when their life is
01:15:46
ruined from from the work you've done and the the patients you've worked with and what are those addictions typically
01:15:51
that seem to be most um susceptible to those that are young
01:15:56
well I mean you know some some kids start with drugs and alcohol you know
01:16:03
five six seven eight five six yeah I mean it's you know some some some kids
01:16:08
use with their parents or their caregivers they're exposed very early if we seriously conceptualize digital media
01:16:16
as a drug I mean then we've got you know even younger cohorts starting with that and we do know that kids can get
01:16:23
addicted to digital media and as a result um die from that I mean
01:16:29
there was just this tragic case of a young man who essentially got addicted
01:16:34
to a chat box I think he was 14 not my patient it was written up um in the New York Times in the Wall Street Journal
01:16:41
and he fell in love with this chat box started to isolate wasn't spending time with his family or friends and then
01:16:47
eventually took his own life purportedly so he could join this imaginary person
01:16:55
what's the youngest patient you've ever seen the youngest I've seen is probably around 15 14 15 and they had an
01:17:02
addiction yeah usually cannabis alcohol nicotine can you get addicted to
01:17:07
cannabis oh yeah oh my gosh cannabis is very addictive really oh yeah
01:17:15
yeah harmful very harmful the target organ that it damages the most is the
01:17:22
brain um it's harmful in many ways I mean it number one it demotivates people
01:17:29
often and so they can have the feeling that they're getting stuff done or that they're creative when in fact they're
01:17:35
not doing anything um it most people smoke it and
01:17:41
so it can be damaging to the lungs and and other other organs um a lot of
01:17:46
people say that well cannabis isn't addictive because I don't have this standard withdrawal phenomenon when I
01:17:51
stop like I don't have the shakes or anything like that but keep in mind the universal symptoms of addiction are
01:17:57
psychological symptoms anxiety irritability depression insomnia craving and people have that in Spades when they
01:18:04
try to stop using cannabis plus we often see something called the hyperemesis syndrome so cannabis can help with
01:18:12
nausea and vomiting it can help decrease the feeling of wanting to vomit but
01:18:18
again as the brain continues to be exposed to it there's this process of neuro adaptation it stops working and it
01:18:25
can even turn on them and do the opposite So eventually people can actually have a cyclical vomiting
01:18:31
syndrome as a result of cannabis so they'll show up in the emergency room and say I can't stop I can't stop
01:18:37
vomiting and the reason is because of the Cannabis that they maybe initially started uh to stop feelings of
01:18:45
nausea on page 40 of dopamine Nation you say we've lost the ability to tolerate
01:18:50
even minor forms of discomfort yeah and as I was reading through this section of your book I was thinking it sounds like
01:18:56
we've gone a little bit soft in society um we've reset our pleasure pain
01:19:02
threshold to the side of pain that even the slightest thing feels like trauma to us even things that objectively speaking
01:19:08
a generation or two ago would not have been considered traumatic are now trauma we live in a bit of a trauma Society uh
01:19:15
one that doesn't appear to be very resilient and the only measure of that that I have is if I think about the work that my grandfather had to do versus the
01:19:21
work that you know people maybe in my generation do in complain about and seem to be like objectively suffering over
01:19:28
and stressed about it seems like there's been a shift in our threshold our tolerance levels can this be explained
01:19:34
through dopamine what's going on here and do you believe that's true have we gone a bit soft I would say succinctly
01:19:40
yes I do believe we have gone a bit soft but I don't think it's a moral problem or a character problem I actually think
01:19:47
it's a physiological problem based on the fact that we're insulated from Pain and we're exposed to all kinds of
01:19:53
Pleasures so I really think that we have individually and collectively reset our reward Pathways to the side of pain
01:20:00
meaning that the Gremlins have now accumulated on the pain side we've tipped ourselves to the side of pain
01:20:06
because we've had so much pleasure because we've had so much pleasure yes thanks for having me clarify so that you
01:20:11
now we need more and more pleasure to feel any pleasure at all and the slightest little pain and we're you know
01:20:17
experiencing excruciating pain you add to that the fact that we have a culture
01:20:22
that tells us we should never be in pain and that if we are something's wrong with our life or something's wrong with our wife or something's wrong with our
01:20:30
job and so now you've got you know a whole generation of folks who feels
01:20:35
like they're experiencing more pain because they're literally don't do not have the mental calluses to tolerate
01:20:42
pain and now they're being told and if you have any pain at all you must have you know something wrong with your brain
01:20:48
go see a doctor go take a pill and I think this is really uh this is not a direction we want to keep going in
01:20:55
we have a mental health culture where we assume most things are mental health illness um in page 186 of your book you
01:21:03
say I've become convinced that the way we tell our personal stories is a marker and predictor of mental health now if
01:21:09
you live in a society where everything has a label and it's a it's a disease or an illness or you know I I don't feel
01:21:15
good today so I've got this disorder and therefore I need this medication I guess there's two questions
01:21:22
is my assessment of this situation correct and be is this a bad place to be in a
01:21:28
society where we think everything every feeling we have every you know we think everything that makes us different is a
01:21:34
deficiency let me let me start let me let me answer this by talking a little bit about the role of language and
01:21:41
narrative because I think this is very fascinating and you know as a psychiatrist and a therapist that is my
01:21:47
bread and butter right is is narrative how people tell their stories by by giving language to our experience
01:21:55
we gain awareness of our conceptual models of the world okay okay and what I
01:22:03
have learned over time is that the way people tell their stories is a window
01:22:09
into their model of the world and that there are healthy narratives and not so healthy narratives and in general in my
01:22:17
clinical experience when people come into the room and they tell their life
01:22:23
story in such a way that they're always the victim of other people and
01:22:28
Circumstance in the world those are people who are number one not doing well
01:22:36
and number two not going to do well going forward unless they change that
01:22:41
narrative to acknowledge what they've contributed to the problem and the reason for that is because the way that
01:22:48
we narrate Our Lives is not just a way to understand our past it actually is
01:22:55
our road map for the future so if I see myself as a victim and that's my
01:23:01
narrative I will literally create victimhood for myself going forward I
01:23:06
will literally change my sensed experience so that whatever happens I'll
01:23:12
make sure I end up as a victim when people with severe addiction get into recovery one of the most palpable
01:23:19
changes that I see is the way that they narrate their lives they go from in
01:23:25
addiction talking about their lives as if it's always everybody else's fault to in recovery talking about their lives in
01:23:33
a way that says oh you know what I could have done better here or you know what that's something that I keep doing that
01:23:41
really messes with my life that I want to change and I'm going to figure out how to change that why is it so hard to
01:23:46
take responsibility in such a way great question we just hate to do it because when we do it we feel shame and shame is
01:23:53
an incredible painful emotion it's like a gut punch of an emotion that is associated with fear of Abandonment fear
01:24:01
of being shunn by our tribe we'd much rather paper that shame over with anger
01:24:07
and resentment toward others it's it's interesting because there'll be a different groups
01:24:13
of people listening to this now there'll be the high responsibility group that just love and revel and taking responsibility because they think taking
01:24:19
responsibility means that they are strong it means that I'm so strong I can take the blame and withstand it and it's
01:24:26
funny cuz the more I've learned to take responsibility for things in certain areas of my life The more I've become
01:24:31
proud of myself and the more I think I'm strong and I'm like oh look at me I can take responsibility for anything and it doesn't and then if you go down this
01:24:37
spectrum you'll eventually get to the end of the spectrum where you've got people who even as they heard you say that will feel cognitive dis they'll
01:24:45
feel a sense like a little it'll irritate them it'll piss them off and they will be the whatab about gang
01:24:50
they'll be saying yes but what about Dave he did this to me and you know they'll immed like the immediate
01:24:57
reaction would be they they're pissed off they've probably gone now they've gone so we're not even talking to them anymore but if you but it's fine we can
01:25:04
talk about them they're no longer here but that group of people my question really is how do you speak to that group
01:25:10
of people and convince them that actually taking personal responsibility is a good thing for them and if they're
01:25:15
focused on what their core values or their North Star is in their life then personal responsibility is the path
01:25:20
there not blame not victimhood you know like how do you turn those people around great question and I have to say what I
01:25:28
know about this I learned from Al Alcoholics Anonymous and what they do because they do something that's really
01:25:34
incredible first of all it's necessary to validate somebody's victimhood so
01:25:42
this is to say you have been wrong if if they really have been wronged to validate that or you experience this
01:25:48
trauma or you were born into this crappy situation and you were just a kid and you had no choice about that and to
01:25:55
really acknowledge that but then the fourth step of the 12 steps of Alcoholic
01:26:01
Anonymous talks about looking at each of those situations and after writing down like
01:26:09
this person wronged me and exactly what they did so you know taking time to focus on the resentment
01:26:16
right then only after that to say okay but is there
01:26:22
anything that I did that contributed to that problem is there anything at all
01:26:28
that I could have done differently and for a little kid you know born into a horrific situation you there's not much
01:26:36
right that that a kid could have you know we don't we don't expect a child to take responsibility but the adult who
01:26:44
was that child who continues to perpetuate some of th the harms they
01:26:49
experienced on other people now we're talking now you can begin to take
01:26:54
responsibility for your actions in the world so I think starting with
01:27:00
validating you know the trauma or the victimhood or the way in which we were
01:27:05
wronged processing it so giving it airtime right but not stopping there
01:27:11
which is by the way which is by the way often you know in therapy certain types
01:27:18
of therapy that's often where we stop we don't then take it that very important
01:27:23
next up and say but you know let's go and look at that again and like is there
01:27:29
anything at all that you're contributing to this problem maybe it's just that you continue to ruminate about it right that
01:27:37
like you're ruminating on your resentments is in a way your happy place and maybe that's what you need to stop
01:27:43
doing so that form of sort of psychotherapy that stops there can help keep us sick and make us sick it it it's
01:27:52
interesting because someone that's in that therapy room who has ruminated themselves all the way down to having a
01:27:57
low self-esteem being depressed or whatever um it appears to me that people who are at that sort of ground floor
01:28:03
State find it hardest to take responsibility for some reason just that's an observation in my life that
01:28:09
the the people that I have met that are the worst or that struggle the most with taking responsibility are those that
01:28:15
have a very low self-esteem so it's almost this double-edged like Catch 22 and then I I've also P pondered whether
01:28:22
you know someone that never takes responsibility is more likely to have bad things happen to them make mistakes
01:28:28
which are then going to further hurt their self-esteem which are going to make it even harder to take responsibility so I guess the question
01:28:33
is is there this Rel is there a relationship between my current self-esteem and my ability or inability to take responsibility for a situation
01:28:41
yeah great great question it brings to mind a a patient of mine who um who said
01:28:46
to me that um you know that and he had very very low self-esteem and he said essentially
01:28:54
Dr ly I'm the piece of crap around which the universe
01:29:00
revolves meaning that he had his own brand of
01:29:06
narcissism in which he wasn't the most successful person he was the most successful at being the least successful
01:29:13
person and that became his identity right that was sort of how he saw
01:29:20
himself and also how he saw the world and it became very entrenched and it was
01:29:25
a kind of a narcissism because he created then situations in
01:29:31
order to perpetuate like I'm the worst of the worst so I think the ways in
01:29:37
which we get these sort of entrenched ideas about ourselves and the world can really hold us back from seeing clearly
01:29:45
Who We Are Who other people are and what what the possibilities are does our
01:29:50
personal narrative need to be positive I mean what do I guess what do you mean by positive like ra I'm great almost like
01:29:56
have a have a positive ending because I was thinking about the personal narrative I've created in my life and my personal narrative is like kid born in
01:30:02
Africa came to the UK little bit of racial abuse here and there felt different shame insecurity parents
01:30:08
weren't around this made me independent the shame made me motivated and then I did this this this and it went well
01:30:14
that's like my personal narrative um but if my personal narrative was moved to Plymouth from Botswana in Africa a
01:30:21
little bit of Shame little bit of pain parents weren't around my parents didn't love me people don't love me right right
01:30:28
if my personal narrative ended there would it be you know would it be detrimental to me ever becoming
01:30:33
successful happy healthy I'm just wondering if because we all have a personal narrative we have like a story
01:30:39
if we're up on stage and someone passes a mic to us and says tell us your story we'll narrate this version of events um
01:30:45
skewed towards victimhood to heroism to you know yeah I mean as I said before how we narrate Our Lives is important
01:30:53
right it's it's not trivial and there are healthier narratives and there are
01:30:59
not healthy narratives and and I would argue that the you know the victim narrative where you know perpetuates
01:31:05
victimhood you could make the same argument that the the hero's journey narrative perpetuates hero good having
01:31:12
said that if we get too stuck in any fixed Identity or any narrative I think
01:31:19
that can become its own trap right and then we wall ourselves off feeling like we have to show up in a certain way or
01:31:25
be a certain person and I wonder if you have that experience like you know you have this hero's journey and now you got
01:31:31
to be this hero and I mean I could imagine that that would be burdensome at times yeah I think it causes a lot of
01:31:37
like dissonance internally what I mean like dis so when I say dissonance I mean discomfort internally because people
01:31:43
meet a version of you that doesn't reflect the version of you that you know so like that the experience you have
01:31:48
when you go like I go to the gym or something yes and I say this to my team all the time anyone that knows me personally his head me say this 50 times
01:31:55
I will say the phrase I just don't understand what these people are talking about like I just don't get it and I
01:32:00
said to my team the other day in the office I went it's almost like I think they're lying to me and I said I was in this I was in this meeting group when
01:32:06
you say you don't understand you mean when they when they praise you or okay yeah yeah it's so yeah unbelievable what
01:32:13
they're saying to me that it um that it feels like you're I've not
01:32:19
even watched the trumman show I just know what it means but it feels like this is these people are just all lying
01:32:24
to you yeah and I I was I think I was talking to Jack and the team the other day about going to Thailand and being so
01:32:29
far away from home and people coming up to you like thousands of people we doing this meet and greet thing and saying
01:32:34
these things to you and you and I said to the team I was like I think it's like it's part of my brain that's like these people are lying to me and also
01:32:41
um yeah you can see how it can be a slippery slope to slide in to their
01:32:47
Narrative of you right and you've got to do quite a lot to just like stay at home
01:32:52
what I mean by stay at home I don't mean like physical location I mean like staying grounded in like who you actually are right um and this goes for
01:33:00
people that obviously you know have a a public platform or don't it's very easy for one person on the internet to say
01:33:05
something to you and then you to start to accept that as your narrative it's easy for your parents to tell you that
01:33:10
you should be a doctor and then you go to university and you study to be a doctor and you become a doctor and then you start thinking you're a doctor and
01:33:17
how that can sway you away from the full array of things that make you who you are the music you know the the whatever
01:33:24
Hobbies you had yeah narratives are comfortable sometimes they make us feel
01:33:30
heard and understood they make us fit yeah but they also are a double-edged sword because they can take us away from
01:33:36
like who we actually are yes yeah so when I think about you know your experience of feeling like people must
01:33:43
be lying to you I mean sometimes we call this something like the impostor syndrome where you never thought of it
01:33:50
like that you know it yeah projected personal that is is you know true in a way but
01:33:58
also doesn't capture the fullness of who you are or maybe is so extreme in terms
01:34:04
of um looking good that it's inevitable that you'll feel some dissonance with
01:34:10
that kind of heroic figure and I think the way to think about that and
01:34:16
also you know um not become like cynically suspicious of people who who
01:34:22
who praise you when they meet you is just to recognize that you have become a
01:34:27
kind of Cipher or a vehicle for their projections so they've listened to you they've had a very positive experience
01:34:33
or maybe they learned something and it meant a lot in their lives and you were the vehicle for that and so you're a
01:34:39
symbol for them and they're projecting positive feelings onto you and because
01:34:45
you're now integrated in their mental tapestry as kind of a you know a totemic
01:34:51
figure or a token something important Sy interesting cuz part of what you just as
01:34:56
you were talking I was thinking you know what's interesting I don't even I'm not even the smart one in this I'm interviewing these smart people
01:35:02
no and the smart people are changing their lives and then someone comes up to me in Thailand and says well you're
01:35:08
wrong about that so you're obviously really smart and you also have you know a really high emotion quotient right
01:35:15
which is its own kind of underappreciated smarts where you read people really well and you have
01:35:21
intuitive reasoning and I mean I don't know you but you also seem very humble and real and so all of
01:35:28
these things that people have a craving for you know authenticity someone they can relate to um someone familiar I mean
01:35:36
keep in mind too that more and more people live alone and have maybe fewer
01:35:43
close contacts so a person like you with a regular show that they tune into to
01:35:48
regularly you become you're in their living room yeah you're not just some
01:35:55
distant celebrity like you are your voice is there your face is there they feel they know you because they've seen
01:36:01
you in all these different situations and I think that's really natural and normal and not a bad thing so you just
01:36:07
have to realize when you go out into the world you know you You' become a symbol
01:36:14
for people they're projecting onto you you don't have to necessarily identify
01:36:19
with that but it's okay to let them have you know their experience through you if
01:36:24
that makes any sense it makes a lot of sense okay yeah no it makes a lot of sense I felt the same imposter syndrome as you said everything there I was like
01:36:30
that's um very kind of you to say but it's it's just very I think part of the dissonance comes from the fact that I sit here in a room with you and there's
01:36:37
only the person in this whole room we're in this big Studio here in Los Angeles is Jack yeah and so there's part of your
01:36:44
brain the like prehistoric brain that thinks the three people that are aware of what happened in this room are me you and Jack that's it yeah and then you you
01:36:51
go to you go to Kuwait right amazing and a comes up to you in the gym and goes that conversation that you had
01:36:58
about addiction right and that that's the dissonance like you went there yeah but it's I don't know the preo brain
01:37:04
might might not be able to fully comprehend the idea of cameras and numbers you know people are listening at the moment oh no they feel that they're
01:37:10
there and they and and again you you know the guests are totally secondary because they're watching because they're
01:37:17
identifying with you and the questions that you ask as you yourself said are questions that you anticipate they would
01:37:24
want to ask right you said that so you are also channeling them when it comes to food I trust my
01:37:31
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01:38:27
on this point of how we help someone in our lives who's suffering with some of the things we've talked about
01:38:33
today what is a bad way to try and help someone because we're in our in our love for them sometimes we do things which
01:38:40
even in my own experience of people that are struggling in my life I think actually I think in my pursuit of helping them I've actually hurt them in
01:38:46
some way yes well you know there's this whole uh sort of area of the addiction
01:38:52
field called codependency and codependency refers to
01:38:57
the ways in which a loved one of the addicted person can actually enable or
01:39:03
make their addiction worse without realizing it and without intending to
01:39:09
and the way that essentially happens is that we can well number one addiction
01:39:14
can is very often a family systems problem so the person who gets addicted their addiction affects everybody in the
01:39:21
family and in order to cope and compens say families can end up in these very strange maladaptive places but they
01:39:28
often have difficulty seeing how to get out of those situations or how their behavior is harming their addicted loved
01:39:35
one because in a sense they themselves get addicted to the addicted person and
01:39:41
then use that addicted person to regulate the way that they feel so for example I treat a lot of families where
01:39:47
like the adult child is deep in their addiction the parents know that the
01:39:54
money they're giving the child is mostly going to drugs and yet cannot bring themselves to stop giving the money and
01:40:02
often they're manipulated by the child the child saying well the adult child saying something like well if you don't give me money for drugs I'm going to go
01:40:08
get it off the streets and it's going to be laced with fentel then I'll I'm going to die and it's going to be on your hands so this kind of like emotional
01:40:14
hostage taking but even when it's not that blatant what can happen is just this very
01:40:21
fascinating very twisted and meshed relationship between the addicted person
01:40:27
and the codependent person where again having the person engage in their
01:40:33
Addiction in a way is a predictable scenario for the codependent person so
01:40:39
even though they may say on the face of it they want this person to stop their Addiction on another another level they
01:40:44
really don't they get to be the Martyr they get to be the Savior or they even just get
01:40:49
to predict what that person is doing based on their use I've had experiences in my
01:40:57
life and this is why I really wanted to ask this question where I thought I was helping someone yeah and then the minute
01:41:04
I withdrew the help and basically completely gave up the person got better yes but for six seven eight years this
01:41:11
person struggled and the minute I stopped helping they got better I was like so I I I said to my partner before
01:41:18
when I was talking about this I was like it's possible to prop someone up in their like compulsive behavior and not
01:41:23
realize you're doing it in fact there's three examples which me and my friends are aware of and one of my friends talks openly about this where I was propping
01:41:30
him up yeah I was letting him stay at my house I was providing for him while he was in his struggles the minute I had a
01:41:35
difficult conversation with him when he was I think I was 25 years old and he was 30 and I said you got to go you got
01:41:41
to go you got to get out of my house he went back moved in with his parents in his childhood room he built up his whole
01:41:47
life again he's out of the compulsive behaviors he's very successful very rich living abroad now I was like God if I
01:41:53
hadn't have pushed him out my like basement he probably would still be there I thought I was doing him a favor
01:41:59
and there's another really poent example to me quite recently where someone who I've known for many many many years um
01:42:05
minute I said to them listen and this sounds really harsh right because I tried paying for their therapy tried
01:42:11
paying for everything for this person and eventually I got to the point where I said honestly I tried don't talk to me
01:42:16
about this anymore yeah stop talking to me about it just don't message me about it don't talk to me about it anymore they got better yep yeah it's really F
01:42:23
so so there um Kai Erikson wrote this book on deviants where he studied Puritan societies and found that no
01:42:30
matter what group of humans you looked at there was always there were always going to be people who were on the
01:42:37
margins of the society he he use the word deviant his point being that groups of
01:42:44
humans we just have these roles and we have these hierarchies and there's always somebody on top and always
01:42:50
somebody below and when when we're occupying a certain Niche or when we
01:42:56
stop occupying it we make room for somebody else so when you stop being the hero and the Savior that person had room
01:43:03
to stop being the sick victim interesting yeah and my last question on
01:43:09
this then is how do you approach that conversation with that person because so often it's approached through frustration or shame or blame um what's
01:43:17
the best way to approach someone who's struggling with a behavior to express that your concerned and to I don't know
01:43:22
offer your help if that's a good thing I think we can always try to find our
01:43:28
empathy for them without necessarily um doing things that would
01:43:33
perpetuate or enable that behavior and we need to recognize that for many
01:43:39
people with severe addiction the the the only thing that will get them into
01:43:44
recovery is real life consequences real life negative consequences and that our trying to
01:43:51
protect them from that is not protecting them at all we've got to let them hit the rock bottom I mean this is a hard
01:43:57
one because you have a lot of families now dealing with children who are severely addicted to opioids for whom
01:44:04
you know being out on the streets might really result in their death so this is not for every situation but I can tell
01:44:12
you in my clinical experience after 25 plus years the majority of people with severe
01:44:19
addiction who get into recovery get into recovery as the result of a real life negative consequences
01:44:26
lost their job lost their partner ended up in jail what whatever it was until there are those significant consequences
01:44:33
for some people they just won't be able to have the motivation to make a change
01:44:38
guys back to a quote I had a long time ago some 10 years ago that said change happens when the pain of staying the
01:44:44
same becomes greater than than the pain of making a change there you go that's a good one I want to talk about digital
01:44:51
drugs one of the subjects that's been recurring theme on this podcast inspired initially I think it was mentioned in an
01:44:56
episode we had but then it was um such a huge amount of the feedback we got in the comment section that I thought we
01:45:02
need to talk about this more because clearly there's a lot of people suffering we also then used a tool um
01:45:07
which looks at what people are Googling in searching a lot and one of the most popular searches around the subject matter of addiction is pornography
01:45:14
addiction yeah it's actually it was number number one and four in the The
01:45:19
Search tool that we used and the phrases people are using are how to stop pornograph addiction how to help someone
01:45:24
with pornography addiction how to rewire my brain which are sort of all sort of correlated themes so pornography
01:45:31
addiction something you see a lot oh my gosh I have to create a little bit of a space actually before I ask this question because I did a porn debate on
01:45:38
the show and I got a very long voice note from a good friend of mine who said just watch the porn debate there was two
01:45:44
women there and a guy and me stevenh um but I just wish someone had mentioned
01:45:49
that women get addicted to addicted to porn too yeah and then on the episode one of the top three comments on the
01:45:56
episode is I'm a woman um it wasn't mentioned but I also have a pornography addiction and you've also kind of echoed
01:46:02
that with the erotic like novels that you you mentioned romantic novels so pornography addiction do you see that
01:46:08
often and I guess critically how does one go about overcoming that and how do
01:46:13
you know it's a pornography addiction I guess it goes back to the point of harm but yeah yes yeah so um I do think that
01:46:20
pornography addiction is one of the biggest addictions and the
01:46:27
most silent and the most shameful addictions that we have now in the modern world um we will not infrequently have a
01:46:35
patient come in to the clinic who claims to have other problems and it's not
01:46:40
until visit three or four that they finally fess up I'm really here for a pornography addiction there's so much shame around
01:46:47
it it's so incredibly shameful for people to admit that they are spending
01:46:53
their time looking at these images often associated with compulsive
01:46:58
masturbation some people their addiction manifests by actually pursuing Partners
01:47:04
so dating apps are highly addictive and and meetups all of this is related to
01:47:10
sex an orgasm which releases dopamine in the reward pathway but it's not just the moment of orgasm it's all of the rituals
01:47:17
and the buildup and the searching um that's related to it women can get
01:47:23
addicted to pornography as well as men although I would say that men outnumber women um probably you know in my
01:47:29
clinical experience um I don't know 10 to one women however are much more
01:47:36
vulnerable to love addiction which is also real right uh the pathological
01:47:43
compulsive falling in love with Partners um and then getting into these relationships that are really dramatic
01:47:49
and not healthy and then falling out of love and then pursuing doing another love partner so the these addictions are
01:47:56
real um they are very harmful for people who get addicted ultimately they're not
01:48:03
even about sex they're about human attachment and the desire for human attachment and also just as a way to
01:48:10
self- soothe and Escape our own everyday suffering and I'm particularly concerned about
01:48:17
girls and boys who now have access to all kinds of sexual images that would
01:48:24
not have been possible for them to get access to a generation or two ago and now you know a child with five with an
01:48:31
iPad can accidentally end up um on a site that has very graphic uh sexual
01:48:38
images and videos so what's the harm of pornography watching
01:48:43
pornography well there's a lot lot of potential harms one of the harms especially if combined with you know
01:48:50
compulsive masturbation is that just simply addictive which means that the more people do it the more they want to
01:48:56
do it then they have the come down where they don't feel good and then pretty soon it becomes like a a compulsive
01:49:02
repetitive Loop where they're spending large amounts of their day uh engaging
01:49:07
in this activity and that that in itself is highly debilitating but other harms um I think
01:49:15
that are significant are it really does change a person's conceptualization of
01:49:21
what sex is is and what sex is for and I don't want to get into the whole thing
01:49:26
of like you know sex is exercise or sex is recreational fun compared with sex
01:49:33
you know as something that's maybe more sacred because I I I I'm not here to judge any of that except to say that if
01:49:41
a main pathway for a young person to learn about sex is through watching
01:49:46
pornography that's going to give them a very distorted view of what you know real sex uh is like not to mention what
01:49:55
relationships are like right and how sex um becomes a part of um an intimate
01:50:02
relationship I've heard a few people say that pornography lowers our motivation
01:50:08
to go out there in the world and to pursue getting a job and getting a career and going to the gym etc etc and
01:50:13
through the lens of what we've talked about today where dopamine was this motivating force for those rats to just
01:50:19
reach out and eat the food if you remove the dopamine from the rat's and it wouldn't even eat food in front of it and it will starve to death when we
01:50:26
think about men you said roughly in your practice about 90% of the people that come in with a pornography addiction of
01:50:32
men this all kind of overlaps to create this picture that in the modern world
01:50:37
when we think about why more men are lonely why they're more often in their
01:50:42
basements playing video games now or watching pornography than ever before why they're having less sex and having
01:50:49
sex later um why they're struggling to form Rel relationships um why less men are
01:50:55
potentially in college at the moment um maybe some of the answers are in the
01:51:01
fact of just like how men are wired because if they've thinking this through if men are more likely to have a
01:51:07
disposition to these kinds of behaviors then these kinds of behaviors are more likely to impact and demotivate and
01:51:14
destabilize men is that all like rough broadly accurate I absolutely agree
01:51:19
which is why I've talked about the smartphone as a masturbation machine
01:51:25
essentially these devices have become the way that we meet our physical
01:51:30
emotional sexual intellectual needs and taken to the extreme that would mean
01:51:36
that we're no longer relying on other people to meet those needs we're meeting
01:51:42
the needs ourselves with with this technology and with the devices and I don't think that's a future that anybody
01:51:47
wants taken to the extreme right because we are social creatures we need to connect with each other human connection
01:51:55
is vital to a thriving life and survival in general so yes I have a lot of
01:52:01
concerns that that pornography is now replacing intimacy with people in real
01:52:08
life or disrupting our expectations of intimacy with people in real life when
01:52:13
you say expectations do you mean like hard work we have to do to create and find intimacy that too and also just
01:52:20
expectations around sex a lot of folks that I work with with sex
01:52:26
addiction as they try to give up pornography compulsive masturbation or whatever they Define as their uh sexual
01:52:33
adct sexually addictive behaviors what they find is that they almost go in the opposite direction and
01:52:39
they kind of have zero interest in sex or they just don't have interest in sex
01:52:45
with their real life partner or they can't enjoy sex with their real life partner you know which all kind of makes
01:52:50
sense right when you hijack the reward pathway with this incredibly potent version of sex you come back down to
01:52:57
earth with your actual partner who's got his or her own needs and you know aging
01:53:02
bodies or whatever it is um it's hard to experience pleasure in that realm in
01:53:11
an attempt to offer people out there now that are struggling with some kind of form of compulsive Behavior or addiction
01:53:17
a pathway to turn this around what is step one in your book I talk I've read all these incredible ideas is around the
01:53:23
wisdom we can learn from addicts I learned about dopamine fasting and I also learned about radical honesty in
01:53:28
the role that that plays what is the process so someone listening to this right now they're struggling with one of these addictions they've got a
01:53:33
pornography addiction they're addicted to gaming maybe it's food maybe it's erotic novels maybe they're on they Twilight the reading Twilight at the
01:53:39
moment what what do you say to that person at the step one is step one is really just acknowledging
01:53:46
the behavior that it's problematic and that it might require some changing in our lives um um the next step is being
01:53:54
honest with ourselves and maybe another person about why we do the behavior what we get out of it what's positive uh step
01:54:02
three would be honestly making a list of all of the problems with the behavior how is it interfering with my goals and
01:54:09
as we talked about my values what do other people say to me about how it's problematic is one of the problems
01:54:15
potentially that it's just not working anymore the way that it used to right I'm developing tolerance I need more to
01:54:21
get the same effect it's doing the opposite of what I want it to do and after we've done all that really done a
01:54:27
really honest self assessment about the behavior I recommend a 30-day dopamine
01:54:35
fast now we're not really fasting from dopamine right because we're not really ingesting dop me what we're doing a fast
01:54:41
from is whatever that substance or behavior is that is causing these kinds of problems potentially maybe we aren't
01:54:48
even really sure but we think it might be give it up for 30 days why 30 days well we know that two weeks is not
01:54:55
enough right we know that from this Imaging study right that people are still in that dopamine deficit state two
01:55:02
weeks after stopping but 30 days based on clinical experience not just mine but
01:55:08
that of many other people who do this work that no for most people no matter the drug and no matter sort of the
01:55:14
severity and chronicity once they get to about 30 days they begin to feel better
01:55:21
they begin to come out of of that tunnel of constant craving they begin to be able to imagine a life in which they
01:55:29
would um you know not necessarily have to rely on this substance or on this Behavior what I always tell folks when
01:55:37
they're preparing for the dopamine fast is just remember you will feel worse before you feel better but that is
01:55:43
withdrawal mediated suffering once you get through those first 14 days you'll begin to feel better and potentially by
01:55:50
30 days you'll feel much better than you have in a really long time now this is not to say that 30 days of fasting is
01:55:56
going to cure your addiction not at all um but it's the beginning it's the beginning of being able to see causality
01:56:02
getting some insight it's an experiment right our lives are one big experiment
01:56:08
what better way to understand the variables in our lives than to change one thing one variable and see what
01:56:14
happens do we then need to you talk about this concept of self-binding yes self-binding right what
01:56:21
role not PL what this self-binding is a way of acknowledging that if we rely on
01:56:27
Willpower alone we will not be successful especially living in this drug aied world and what we need to do
01:56:34
is anticipate desire before we're in the throws of Desire by creating both
01:56:40
literal and metacognitive or thought you know gunan experiment like barriers
01:56:46
between ourselves and our drug of choice so these barriers can be actual physical barriers like putting our
01:56:52
device into a kitchen safe and locking it up over the night or leaving it outside of our bedroom or getting the
01:56:59
potato chips the alcohol the Cannabis out of the house deleting our contact drug dealers information and telling our
01:57:06
drug dealer don't call me and I won't call you um because these are all cues these are all cues that's right and the
01:57:14
cues can be physical things so someone I see can cues cues can also be basically
01:57:19
an emotion you talked about halt hungry angry tired I eat well during the day
01:57:25
like now as I leave here there'll be a salad I reckon in the in the Green Room over there for me and the only time
01:57:31
where I'm susceptible to not eating well is if it's late and so when you said the hungry angry lonely tide thing that is
01:57:39
probably the state that I'm in sometimes when I get home certainly hungry
01:57:44
certainly tired probably a little bit lonely as well but certainly those two things and that seems to be when I'm
01:57:50
most susceptible to making a regrettable decision as it relates to my dopamine I've also wondered if if dopamine is
01:57:56
responsible for what people almost call like the sugar Cravings that we have so
01:58:01
what I've observed is in previous years of my life when when I was eating lots of sugar I would then go into about like
01:58:08
a two week cycle of like binging the sugar and right now I'm in like a really great cycle of with my food where I have
01:58:14
no cravings for the sugar I'm I'm in a staying in a hotel here in La there's a mini bar in the room with Oreos and
01:58:19
gummy all these chocolates and all these things and I haven't touched them because for some reason in this like
01:58:26
couple of weeks of my life or whatever I just don't have the Cravings anymore but I kind of suspect that if I start eating
01:58:32
them yes then the next four weeks will be a car crash yes why does this happen
01:58:38
yeah it's so fascinating and and I think this is sort of a universal experience so first of all sugar is addictive it
01:58:46
lights up the same reward pathway as drugs and alcohol clear dopamine release in the nucleus bins part of the reward
01:58:53
pathway in response to sugar and when we quit sugar we have a come down right we
01:58:59
go into withdrawal and it's manifested in all the different ways that we've talked about and it lasts for about two
01:59:05
weeks and one of the most Salient symptoms is intense craving for sugar and it's so amazing how intense it is
01:59:12
but if we can get through that period and get out of that Vortex of addictive craving the craving gradually gets
01:59:19
better and then eventually goes away which is by the way very paradoxical because whatever our drug is when we
01:59:26
first stop it we have intense cravings and we have the feeling that the Cravings will only get worse with time
01:59:34
even though we logically may have experienced otherwise by giving it up before we have the feeling this is going
01:59:40
to last forever it never does right with time the craving goes away and once we
01:59:47
are in that Arena where we're not constantly craving we might have something that triggers the craving
01:59:53
right but like stress but generally we're not dealing with a craving if we were then to reexpose our brains to a
02:00:00
little bit of sugar immediately back in the vortex of craving and there's an experiment I love that illustrates this
02:00:07
it's an experiment in rats where rats were injected with cocaine the same
02:00:13
amount of cocaine every day for seven days and over the course of those seven
02:00:19
days the rats went from kind of hiding in the shadows of the cage to progressively running a little bit more
02:00:25
and a little bit more and by day seven they were in a running frenzy right as measured by these beams of light that
02:00:31
they were crossing then there was no more cocaine injected after seven days and no cocaine
02:00:38
or any addictive substance administered to the rats for a year which is a rat lifetime a really long time that would
02:00:45
make you think oh you know that there's no more cocaine in the system no none of
02:00:50
that and then the rats were injected with a single dose of cocaine and immediately they were plunged back into
02:00:56
that running frenzy that you saw on day seven really important information
02:01:02
because it tells us that there's some kind of permanent latent echo in our brains once we've been
02:01:10
exposed to and especially if we become addicted to a particular substance such
02:01:15
that even with sustained abstinence on the order of years and decades if we are reexposed to that drug we can
02:01:22
immediately be plunged into the depths of our addiction there's no ramp up period that happens and of course we see
02:01:29
this all the time you know people with alcohol addiction who are then exposed to alcohol and right back to their Max
02:01:36
use or even exposed to something like opioids and alcohol also works on our
02:01:42
endogenous opioid system so there's some homology or similarity between alcohol and opioids and then immediately being
02:01:49
plunged into opioid addiction which then leads them back to their alcohol whole addiction it made me think about
02:01:54
children it made me think about children because if I'm a 5-year-old and I'm
02:01:59
binging on sugar yeah this sets me up for a life where I'm going to be I mean
02:02:04
based on the analogy I just the experiment I just had based on the experiment I just heard there it sets me up for a life where I'm going to so
02:02:11
easily slip right back into that addiction for sugar um and also I know
02:02:16
that the brain isn't fully developed when we're children so maybe the effect is even more um lasting
02:02:24
significant is any of that true yeah it's all true which is why a big focus of the addiction medicine field is
02:02:30
prevention and trying to make sure that we protect kids brains from the harms of
02:02:36
these addictive substances and behaviors like what from sugar to digital media
02:02:43
video games pornography social media or any other drug you know nicotine so many
02:02:48
kids are vaping now you know taking 50 plus Puffs a day on their nicotine Vape cannabis alcohol
02:02:55
what's going on in the brain if we if a kid is exposed to those things so essentially at age five we have more
02:03:03
neurons and neuronal connections than we have in the rest of our adult lives about 50% more neuronal
02:03:09
connections than we'll have it as adults which is what makes us such good Learners when we're kids kids can just
02:03:14
absorb anything because they're sort of like these Tod potent sponges with all these neurons and all these neuronal
02:03:20
connections but we age through adolescence to about age 25 we cut back
02:03:26
or what's called prune the neural circuits that we don't use and we myelinate or make more
02:03:33
efficient the neural circuits that we use most often such that by age 25 we
02:03:38
are left with the neurological scaffolding that will serve us for the rest of our adult lives that means that
02:03:44
if we're engaging in addictive maladaptive coping at a young age we're elaborating a neural circuitry based on
02:03:52
that maladaptive coping which is going to set us up for addiction in adulthood
02:03:57
I always like to emphasize though that because the Child and Adolescent brain
02:04:02
is so plastic or Tod potent or so changeable that's also a very hopeful
02:04:07
message it means that even a young person exposed at a young age to an addictive substance if we can get in
02:04:13
there early enough while their brain is still plastic enough we can rewire them whereas when I treat people in their 70s
02:04:21
and ' 80s who have been you know smoking pot their whole lives or drinking alcohol mainly it was manageable now all
02:04:28
of a sudden they retire they're in their 60s all this time the pot's a lot more potent they can develop these full-blown
02:04:35
addictive disorders late in life and it's very hard to treat them because they've lost a lot of that plasticity
02:04:42
that would allow them to regenerate new neural Pathways once they
02:04:48
abstain what is the most important thing that we didn't talk about that we should have as it relates to dopamine oh my God
02:04:55
we talked about so much I I don't even know it seems like it was a lot of stuff
02:05:00
I guess based on the questions you're exposed to from the general public is there anything that we missed that
02:05:06
someone at home right now is going to be screaming at the screen um talk about
02:05:11
yeah well I mean I guess I would emphasize that when I talk about the dopamine fasting it's an early
02:05:17
intervention it's not an intervention that I would recommend for someone who had repeatedly tried to quit on their own and been unable to you know clearly
02:05:24
that would be an exercise and futility that person should go and get professional help maybe they need to go to a residential treatment center I also
02:05:32
wouldn't recommend dopamine fasting or just quitting your drug of choice if you're at risk for a lifethreatening
02:05:37
withdrawal so we can have life-threatening withdrawal from alcohol and benzo isipin like clopin Xanax
02:05:44
adaman again in those cases go see a professional get help with a medical
02:05:49
detoxification before you try to you know sustain absence for a period of
02:05:54
time so you know I would blanket the whole thing with like the caveat go see your addiction you go see the addiction
02:06:00
medicine specialist near you thank you so much you're wel it's been so unbelievably um
02:06:06
thought-provoking for for me in so many ways I thought I knew what dopamine was I thought I had covered all the ground
02:06:12
there was to cover on these subjects of sort of compulsive behaviors but I was so unbelievably wrong and it wasn't
02:06:17
until I got into your book and started reading through your work that I was like oh my God most people have a clue
02:06:22
about dopamine and the role it plays on us and this scale analogy is particularly memorable because that
02:06:28
helps me to Think Through um many of the behaviors that I have in my life that I've either struggled with or become quite stubborn in various ways but also
02:06:35
has turned a couple of lights on to some of the things I said about like my sugar um eating sugar and um even like going
02:06:42
to the gym and why like my motivation can seem to fluctuate with the gym sometimes it's so unbelievably important
02:06:48
because this little neurotransmitter seems to control so much of our lives um and we never taught anything about it so
02:06:55
we become these kind of puppets and the puppet master is this this brain which is firing off all of these
02:07:00
neurotransmitters that are determining who we are who we become and also who we don't become um thank you so so so much
02:07:07
I I know you were nervous coming here today but I have to tell you you are very brilliant you're exceptionally brilliant in so many ways you you that's
02:07:14
why I said you should start a podcast because you're really Built For This medium thank you you have a a certain
02:07:19
warmth and empathy to you while while also being incredibly smart and accessible in the way that you communicate so please carry on because I
02:07:27
I don't think although you overcame that the difficulty of those nerves I think there's so many hundreds of thousands
02:07:33
and millions of people listening now that are so thankful that you did oh like really thankful that you did and if youve just nudged their life a little
02:07:39
bit in a better Direction that's that's worthwhile so thank you um we have a closing tradition on this podcast where
02:07:45
the last guest leaves a question for the next guest without knowing who they're going to be leaving it for what is the
02:07:51
most recent piece of information that changed your
02:07:58
life I think the most recent piece of information that was very impactful for
02:08:04
me was the realization
02:08:10
that we are probably going to be cybernetically enhanced in the
02:08:17
future and interfacing with technology in a way that's completely
02:08:26
seamless and that this is inevitable we're going to become cyborgs or at
02:08:31
least we're going to be surrounded by the technology in a way that's
02:08:37
invisible um and it's going it's going to be just completely integrated into
02:08:44
our lives whether we'll it'll actually be under the skin I think it will be um
02:08:50
but I can see in that so much potential good and promise and and so much that's
02:08:57
really terrifying especially when I think about the way it's going to change us as humans and my big fear about it is
02:09:04
that we will become more and more isolated and that we'll end up sort of
02:09:10
in these little cubicles of our own making scattered alone all across you
02:09:16
know planet Earth I I hope it doesn't lead to that but that's that's my word
02:09:23
it's interesting when we become connected to the internet and we truly interface with the internet we really don't need to use our physical being
02:09:30
anymore because we can experience all the joy and adventure and travel digitally and that's I mean it just
02:09:36
messes with the incentive structures like we've talked about with dopamine yeah changes our ability to to get up
02:09:42
and go and to do things I mean that's a lovely hopeful ending for
02:09:49
us thank you so much yeah thanks for the opportunity to you know teach people about this information
02:09:56
I hope it's helpful for people super helpful and I'm going to link both of these books below I've got the dopamine Nation book which was the original I
02:10:02
believe yes um and then following That You released dopamine Nation workbook which is a practical guide to find
02:10:07
balance in an age of indulgence I highly recommend everybody reads these I'm
02:10:13
going to go and reread them on my journey home back to London tonight so I really really appreciate you read these
02:10:18
books and honestly everyone needs to go read these books I'm sure they will so thank you than you so much thank you so much do you know that 80% of New Year's
02:10:25
resolutions fail by February it's because we focus too much on the end goal and we forget the small daily
02:10:31
actions that actually move us forward those actions that are easy to do are also easy not to do in life it's easy to
02:10:36
save a dollar so it's also easy not to making one small Improvement each day one tiny step in the right direction has
02:10:43
a big difference over time and that is the 1% mindset which is why we created the 1% diary a 90day journal designed to
02:10:51
help you stay consistent and focus on the small wins and make real progress over time it also gives you access to
02:10:57
the 1% Community a space where you can stay accountable motivated inspired along with many others on the same
02:11:03
Journey we launched the 1% diary in November and it sold out so now we're doing a second drop join the wait list
02:11:10
at the diary.com and you'll be the first to know as soon as it's back in stock I'll put the link below
02:11:15
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02:11:21
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