- Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of
neurobiology and ophthalmology at Stanford School of Medicine. Today I have the pleasure of
introducing Dr. Anna Lembke. Dr. Lembke is a psychiatrist
and the chief of the Addiction Medicine
Dual Diagnosis Clinic at Stanford University School of Medicine. She's a psychiatrist who treats patients struggling with addiction. She has successfully treated
patients dealing with drug addiction, alcohol addiction, and behavioral addictions, such as gambling and sex addiction, as well as other types of addiction. In fact, during our discussion, I learned that there are
a huge range of behaviors and substances to which
people can become addicted to, and that there is a common
biological underpinning of all those addictions. I also learned that there is a common path to the treatment and recovery from essentially all addictions. Dr. Lembke explained that to me and explained how to think
about and conceptualize our own addictions, as well as the addictions of other people who are struggling to get
treatment, move through treatment, and stay sober from their addictions. In addition to treating patients, Dr. Lembke is an author
and was featured in the 2020 Netflix documentary,
"The Social Dilemma". I'm excited to tell you that
she has a new book coming out called "Dopamine Nation, Finding Balance in the Age of Indulgence". The book comes out August 24th and is an absolutely
fascinating read into addiction and ways to treat various
types of addiction. I've read the book cover to cover, and all I'll tell you is that
at the very first chapter and throughout, you are going
to be absolutely blown away. The stories about her patients
are extremely engaging. It brings forward the
real struggle of addiction and the incredible, I think
it's fair to say heroic battles, that people fight in order
to get through addictions of various kinds. And all of that is woven through
with story, with science, in ways that make it very
accessible to anyone, whether or not you have a
science background or not. I can't recommend it highly enough. So again, the book is "Dopamine Nation, Finding Balance
in the Age of Indulgence", it comes out August
24th of this year, 2021. And you can pre-order that
book by going to Amazon. We will provide a link to
that in the show caption. Before we begin, I just want to mention that
this podcast is separate from my teaching and
research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer
information about science and science-related tools
to the general public. In keeping with that theme, I'd like to thank the
sponsors of today's podcast. Our first sponsor is ROKA. ROKA make sunglasses and eyeglasses that are of the absolute utmost quality. Founded by two All-American
swimmers from Stanford, everything about the
sunglasses and eye glasses that ROKA makes was designed
with performance in mind. First of all, they're very lightweight. You don't even really notice
that they're on your face. Second of all, even if you get
sweaty, they don't slip off. In fact, they were
designed to be worn at work or around the house, but also
if you're running or biking. So you can move seamlessly
between different activities without having to change your
sunglasses or eyeglasses. In addition, the lenses are designed with the science of the
visual system in mind. I've spent my career working on the science of the visual system, and I can tell you that it's
not trivial to build a lens that allows you to see
with perfect clarity, whether or not you're in bright sunshine and then move into shadows. But the ROKA glasses allow you to do that. You always see things
with absolute clarity. Another terrific thing about
ROKA eyeglasses and sunglasses is the aesthetic. A lot of so-called performance
sunglasses and eyeglasses, they're not really built
with the best aesthetic and they kind of make
people look like cyborgs. With ROKA, they have a
lot of different styles to choose from, but all
those styles are the sort that you could wear out
to dinner or to work, or when engaging in physical activity. If you'd like to try ROKA
glasses you can go to ROKA, that's R-O-K-A dot com, and enter the code Huberman at checkout. And if you do that, you'll
get 20% off your first order. Today's podcast is also
brought to us by InsideTracker. InsideTracker is a
personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and reach your health goals. I'm a big believer in getting
regular blood work done. And I've been doing that
for a number of years, for the simple reason that
most, if not all of the factors, that impact your immediate
and long-term health, can only be analyzed in detail
with a quality blood test. And now with the advent
of modern DNA tests, you can get further insight into what's going on beneath
the hood, so to speak. The problem with a lot of
blood and DNA tests, however, is you get numbers back, you get the levels back of various things and you find out if certain
things are too high or too low or right on target, but there are no directives
about how to move those numbers in the direction that you
would want them to go. With InsideTracker, they have a dashboard that makes all of that very easy, and that dashboard takes your numbers and can help direct you towards particular lifestyle factors,
nutrition factors, exercise, supplementation, et cetera, that can help you bring
those numbers into the ranges that are right for you. If you'd like to try
InsideTracker you can go to insidetracker.com/huberman. And if you do that, you'll get 25% off any of InsideTracker's plans. Just use the code Huberman at checkout. Today's episode is also
brought to us by Headspace. Headspace is a meditation
app that's backed by 25 published peer review studies and has over 600,000 5-star reviews. I've been meditating for a very long time. I'm 45-years-old now, almost 46, and I started meditating when
I was about 15-years-old. The problem, however, is keeping
up a meditation practice. I've experienced this myself. I've had periods of time
where I'm meditating regularly and then periods of time
where I just kind of fall off the rails and I'm
just not doing it at all. There's now tons of evidence,
evidence from neuroscience, evidence from psychology, evidence from areas of
biology focused on stress and the immune system,
that a meditation practice, when done regularly, is extremely beneficial for
mental and physical health, and things like focus and creativity. However, you have to do
the meditation practice, and so if you're not doing it regularly, that's a serious problem. And if you are doing it regularly, great. With Headspace, I find that I can stick to a meditation
practice very easily. In fact, that's why I started using it and that's why I continue to use it. I try and get a meditation
practice in every day, but sometimes that requires that it be a brief meditation practice. With Headspace, they have a huge range of different meditations
of different durations, and so that's really helpful
in building and maintaining these powerful meditation practices. If you want to try Headspace you can go to headspace.com/specialoffer. And if you do that, you'll get a free one month trial with Headspace's full
library of meditations. This is the best deal
offered by Headspace. Basically you get access
to everything they've got, completely free, for a one month trial. So if you'd like to try that, go to headspace.com/specialoffer. And now for my discussion
with Dr. Anna Lembke. All right, great to have you here. - Thank you for having me,
I'm excited to be here. - Yeah, I have a lot of questions for you. I, and many listeners of this podcast, are obsessed with dopamine,
and what is dopamine, how does it work? We all hear that dopamine is this molecule associated with pleasure. I think the term dopamine hits, like I'm getting a dopamine
hit from this, from Instagram, or from likes or from
praise or from whatever, is now commonly heard. What is dopamine, and what are maybe some
things about dopamine that most people don't know? And probably that I don't know either. - So dopamine is a neurotransmitter, and neurotransmitters are those molecules that bridge the gap between two neurons. So they essentially allow one neuron, the pre-synaptic neuron, to communicate with the
post-synaptic neuron. Dopamine is intimately associated with the experience of reward,
but also with movement, which I think is really interesting, because movement and
reward are linked, right? If you think about,
you know, early humans, you had to move in order
to go seek out the water or the meat or whatever it was. And even in the most primitive organisms, dopamine is released when food
is sensed in the environment. For example, C elegans,
a very primitive worm. So dopamine is this really powerful, important molecule in the brain that helps us experience pleasure. It's not the only neurotransmitter
involved in pleasure, but it's a really, really important one. And if you want to think about something that most people don't
know about dopamine, which I think is really interesting, is that we are always releasing dopamine at a kind of tonic baseline rate. And it's really the
deviation from that baseline, rather than like hits
of dopamine in a vacuum, that make a difference. So when we experience pleasure, our dopamine release goes above baseline, and likewise dopamine can go
below that tonic baseline, and then we experience a kind of pain. - Interesting. So is it fair to say that one's
baseline levels of dopamine, how frequently we are releasing dopamine, in the absence of some, I don't know, drug or food or experience,
just sitting, being, is that associated with
how happy somebody is, their kind of baseline of
happiness or level of depression? - There is evidence that shows
that people who are depressed may indeed have lower
tonic levels of dopamine. So that's a really reasonable thought, and there is some evidence to
suggest that that may be true. The other thing that we know, and this is really kind
of what the book is about, is that if we expose ourselves chronically to substances or behaviors that repeatedly release
large amounts of dopamine in our brains reward pathway, that we can change our tonic baseline and actually lower it over time, as our brain tries to compensate
for all of that dopamine, which is more really than we
were designed to experience. - Interesting and is, is it the case that our
baseline levels of dopamine are set by our genetics, by our heredity? - Well I think, you know,
if you think about sort of, you know, the early stages
of development and infancy, certainly that is true. You're kind of, you know,
born with probably whatever is your baseline level. But obviously your experiences
can have a huge impact on where your dopamine level
ultimately settles out. - So if somebody's disposition is one of constant excitement and
anticipation, or easily excited, I think about the kind of
people where you say hey, do you want to check out
this new place for tacos, and they're like "Yeah, that'd be great!" And other people are a little
more cynical, harder to budge. Like my bulldog Costello. Very, very stable, low levels of dopamine with big inflections in his case. Do you think that's set
in terms of our parents, and obviously nature and
nurture interact, but is that, is dopamine at the core
of our temperament? - I don't really think we
know the answer to that, but I will say that people
are definitely born with different temperaments, and
those temperaments do affect their ability to experience joy. And, you know, we've known
that for a long time, and we describe that
in many different ways. One of the ways that we
describe that in the modern era is to use psychiatric nomenclature. Like this person has a dysthymic
temperament, or, you know, this person has chronic
major depressive disorder. In terms of looking specifically at who's vulnerable to addiction, that's an interesting sort of mixed bag because when you look at the research on risk factors for addiction, so what kind of temperament of a person makes them more vulnerable to addiction, you see some interesting findings. First you see that people
who are more impulsive are more vulnerable to addiction. So what is impulsivity? That means having difficulty
putting space between the thought or desire to do something, and actually doing it. And people who have difficulty
putting a space there, who have a thought to do something and just do it impulsively, are people who are more
vulnerable to addiction. - Interesting. Could I, in terms of impulsivity, is this something that relates literally to the startle reflex? Like I, for instance, as a lab director, I'm familiar with walking
around my lab and when I decide, deciding I'm going to talk to my people, of course when they knock on
my door it's always like wait, why am I being bothered right now? Even though I love to talk to them. But I walk around my
lab from time to time, and some people I notice, I'll
say, do you have a moment, and they'll slowly turn
around and say, yeah, or no, in some cases. And other people will jump
the moment I say their name. They actually have a, a kind
of a heightened startle reflex. Is that related to impulsivity, or is what you're referring to an attempt to withhold behavior
that's very deliberate, under very deliberate conditions? - Yeah, so I don't think
that that startle reflex is necessarily related to impulsivity. That can be related to anxiety. So people who are high anxiety people will tend to have more
of a startle reflex. Impulsivity is a little bit different. And by the way, impulsivity
is not always bad, right. Impulsivity is that thing where there's not a lot of self-editing or worrying about future consequences. You know, you have the idea
to do something and you do it. And of course we can
imagine many scenarios where that's absolutely wonderful. You know, there can be a sort of, let's say intimate
interactions between people, where you wouldn't really want to be super inhibited about it, right. You would want to be
disinhibited and impulsive. I can also like imagine like sort of fight or flight scenarios, like battle scenarios, right, where it would really
be good to be impulsive and just go rhino! - Where hesitation can cost you your life? - Right, yes, that's right, that's right. But, you know, and I think this brings up a really, something that I've come to believe after 25 years of practicing psychiatry, is that what we now conceptualize
in our current ecosystem as mental illness, are actually traits that
in another ecosystem might be very advantageous. They're just not advantageous right now, because of the world that we live in. And I think, you know, impulsivity is potentially
one of those, right? 'Cause we live in this
world that's sort of like, you have to constantly be
thinking sort of rationally about the consequences of X, Y, or Z. And it's such a sensory
rich environment, right, that we're being bombarded with
all of these opportunities, these sensory opportunities. And we have to constantly check ourselves. And so impulsivity is
something that right now can be a difficult trait, but isn't in and of itself a bad thing. - I see. And it's, I'm beginning to
realize it's a fine line between spontaneity and impulsivity. - Yeah. - What is pleasure and how does it work, at the biological level,
and if it feels right, at the psychological level? And if you don't mind
painting a picture of sort of the range of things that you
have observed in your clinic, or in life, that people
can become addicted to. But just to start off really simply, what is this thing that we call pleasure? - Well, I think it's actually
really hard to define pleasure in any kind of succinct way, because certainly there is
the seeking out of a high, or a euphoria, or I think, you know, the kind of experience that
almost anybody would associate with the word pleasure. But also the seeking out of those same substances and behaviors is often a way to escape pain. So for example, when I talk
to people with addiction, sometimes their initial
foray into using a drug is to get pleasure, but very often it's a way
to escape their suffering, whatever their suffering may be. And certainly as people become addicted, even those who initially
were seeking out pleasure are ultimately just
trying to avoid the pain of withdrawal or the
pain of the consequences of their drug use. So I think it's, you know, very
hard to actually, you know, define it as this unitary thing. And it's certainly not
just getting a high. There are so many ways in which people sort of want to escape, which is not the same thing
as sort of this hedonic, you know, wanting to feel pleasure. - So someone could decide that
they want to go out and dance, or get up and dance, because
of the pleasure of dancing. I can imagine that. But, and maybe it's very
difficult for them to stay seated when a particular song
comes on, for instance. But seeking what we would call pleasure in order to eliminate pain, that evokes a different
picture in my mind. That evokes a picture of
somebody that feels lost or depressed or underwhelmed. I definitely want to get into the precise and general description of
addiction and what that is, but in a previous conversation we had, you said something that
really rung in my mind, which is that many people who
become addicted to things, let's call them addicts, have this feeling that normal
life isn't interesting enough. That they are seeking a
super normal experience, and that the day-to-day routine balance, which is actually in
the title of your book, "Dopamine Nation, Finding Balance
in the Age of Indulgence", that the word balance itself
can sometimes be a bit of an adversive term for people. And I'm struck by this idea, and the reason I want to explore it is because so much of what I see online is about generating a lack of balance, about being tilted forward at all times, really leaning into life
hard, experiencing life, you know, living a full life. Even the commencement
speech given by Steve Jobs on this campus was really
about finding passion, digging. You know, that's so much
in the narrative now. So maybe you could just
tell us a little bit about your experience
with this association, if it really exists, between
people's sense of the normalcy, or maybe even how boring life can be, and their tendency to
become addicts of some sort. - Yeah, well, I mean, I think that life for
humans has always been hard, but I think that now it's
harder in unprecedented ways. And I think that the way
that life is really hard now is that it actually is really boring. And the reason that it's boring is because all of our survival
needs are met, right? I mean, we don't even
have to leave our homes to meet every single physical need, you know, as long as
you're of a certain level of financial wellbeing,
which frankly, you know, we talk so much about,
you know, the income gap, and certainly there is this enormous gap between rich and poor. But that gap is smaller
than it's ever been in like the history of humans. Even the poorest of the
poor have more excess income to spend on leisure goods, than they ever have
before in human history. If you look at leisure time, for example, so people without a high school education have 42% more leisure time than people with a college degree. So my point here is that life is hard now in this really weird way, in that we don't really have
anything that we have to do. So we're all forced to
make stuff up, you know, whether it's being a
scientist or being a doctor, or being an Olympic athlete, or, you know, climbing Mount Everest. And people really vary in
their need for friction. And some people need a
lot more than others. And if they don't have it,
they're really, really unhappy. And I do think that a lot
of the people that I see with addiction and other
forms of mental illness are people who need more friction. Like they're unhappy, not necessarily because
there's something wrong with their brain, but because their brain is
not suited to this world. - And do you think they have that sense, my brain isn't suited to this world, or they simply feel a restlessness and they're constantly
seeking stimulation? - I think that's right, yeah. I think it's not really
knowing what's wrong with me, and why am I unhappy,
how can I be happier? And of course, as you talk about, what's so pervasive in our narrative now is like find your passion,
you know, find your, you know, out of whatever it is, to save the world. And in a way that's good because it has people out
in the world and seeking. But in a way it can also be
misleading in the sense that I think people aren't entirely aware that the world is a hard
place, and that life is hard, and that, you know, like we're
all kind of making it up. Do you know what I mean? - Yeah. Well there's a book by Cal Newport, I don't know if you
know Cal Newport's work, but you guys are very
symbiotic in your messages. He's a professor of computer
science at Georgetown. Yes, at Georgetown. And wrote a book some years
ago, really ahead of its time, called "So Good They Can't Ignore You", which is about not
meditating or doing much work to try and figure out what
one's passion is by thinking, but rather go out and acquire skills, - Right. - and develop a sense
of passion for something by your experience of hard work and getting better end feedback. - Right.
- A little bit of the growth mindset, think of our colleague Carol Dweck. But he's gone on to
write books, "Deep Work", which is all about removing
yourself from technology and doing deep work. - Yes, right. - And he's been a big proponent of the evils of context switching
too often throughout the day. - [Anna] Yeah. - For sake of productivity, mostly. His new book is called
"A World Without Email." I'm beginning to realize,
as I cite off these books and your book, "Dopamine Nation, Finding Balance in the Age of Indulgence", that maybe the reason why you two don't know about one another is because neither of
you are on social media. - That's it. - Right.
- That's it. - And yet you're two of
the most productive people that I know, including productive authors. So that's a discussion unto itself. But I find this fascinating. So let's talk about the pleasure
pain balance and addiction. And I've heard you use this seesaw or balance scale, - Right.
- analogy before. And I think it's a wonderful
one that really, for me, clarified what addiction is, at least at the mechanistic level. - Yeah, so to me, one of the
most significant findings in neuroscience in the last 75 years is that pleasure and pain are co-located, which means the same parts of the brain that process pleasure also process pain. And they work like a balance. So when we feel pleasure,
our balance tips one way, when we feel pain, it tips
in the opposite direction. And one of the overriding
rules governing this balance is that it wants to stay level. So it doesn't want to
remain tipped very long to pleasure or to pain. And with any deviation from neutrality, the brain will work very hard
to restore a level balance, or what scientists call homeostasis. And the way the brain does that is with any stimulus to one side, there will be a tip in equal and opposite amount to the other side. - It's like the principle laws of physics. - Yes, right, right. So like, I like to watch YouTube videos. When I watch YouTube videos
of "American Idol", you know, it tips to the side of pleasure. And then when I stop watching
it, I have a comedown, right, which is a tip to the
equal and opposite amount on the other side. And that's that moment of wanting to watch one more YouTube video, right. - Yeah, and I just want
to interject there. So this moment of
wanting to watch another, that is associated with pain, I think, is, are we always aware of that happening? Because you just described
it in a very conscious way. - Right. - But when I indulge in something I enjoy, I'm usually thinking about just wanting - Yes, yes.
- more of that thing. I don't think about the pain, - Yes.
- I just think about more. - Right. So really excellent point because we're mostly not aware of it. And it's also reflexive. So it's not something
that consciously happens, or that we're aware of, unless we really begin to pay attention. And when we begin to pay attention, we really can become very
aware of it in the moment. Again, it's like a falling away. You're on social media and, you know, you get a good tweet of something, and then you can't stop yourself because there's this
awareness, a latent awareness, that as soon as I disengage
from this behavior, I'm going to experience
a kind of a pain, right. A falling away, a missing that feeling, a wanting more of it. And of course, one way to combat that is to do it more, right, and
more, and more, and more. So I think that is really what
I want people to tune into and get an awareness around. Because once you tune into
it, you can see it a lot. And then when you begin
to see it, you have an, if you keep the model
of the balance in mind, I think it gives people
kind of a way to imagine what they're experiencing
on a neuro-biological level, and understand it. And in that understanding,
get some mastery over it, which is really what this is all about. Because ultimately we do
need to disengage, right? We can't live in that
space all the time, right. We have other things we need to do. And there are also serious consequences that come with trying
to repeat and continue that experience or that feeling. - Yeah, so if I understand this correctly, when we find something, or
when something finds us, that we enjoy, that feels
pleasureful, social media, food, sex, gambling, whatever it happens to be, and we will explore the
full range of these, there's some dopamine release when we engage in that behavior. And then what you're telling
me is that very quickly, - [Anna] Yes. - and beneath my conscious awareness, there's a tilting back of the scale where pleasure is reduced,
by way of increasing pain. - Right. - And I've heard you say before that the pain mechanism has
some competitive advantages over the pleasure mechanisms, such that it doesn't just
bring the scale back to level. It actually brings pain
higher than pleasure. Could you tell us a little
bit more about that? - Yeah, yeah. So what happens, again, so the hallmark of any
addictive substance or behavior is that it releases a lot of dopamine in our brains reward pathway. Like, right, like broccoli
just doesn't release a lot of dopamine, just doesn't, right. - I'm trying to imagine, I
was about to say, maybe you, and I stopped myself because. Broccoli's good, it can be really good, but broccoli is never amazing. - Right. Broccoli's never amazing. - We're never like,
- I mean- - this is the most amazing broccoli. - Honestly we can probably
find somebody on the planet for whom broccoli is amazing. And of course if I'm
starving, broccoli is amazing. - Rich Roll. Rich Roll is big on plants, and he has a good relationship to plants. Rich, tell us how to
make broccoli amazing. If anyone could do it it'd be Rich. - Yeah, yeah. But what happens right
after I do something that is really pleasurable and
releases a lot of dopamine, is again, my brain is going
to immediately compensate by down-regulating my
own dopamine receptors, my own dopamine transmission,
to compensate for that, okay. And that's that come
down, or the hangover, that after-effect, that moment
of wanting to do it more. Now, if I just wait for
that feeling to pass, then my dopamine will re-regulate itself and I'll go back to whatever
my chronic baseline is. But if I don't wait, and
here's really the key, if I keep indulging again
and again and again, ultimately I have so much
on the pain side, right, that I've essentially reset my brain to what we call like an anhedonic, or lacking in joy type of state, which is a dopamine-deficit state. So that's really the way
in which pain can become the main driver, is because
I've indulged so much in these high reward
behaviors or substances, that my brain has had to compensate by way down-regulating my own dopamine, such that even when I'm
not doing that drug, I'm in a dopamine deficit state, which is akin to a clinical depression. I have anxiety, irritability,
insomnia, dysphoria. And a lot of mental
preoccupation with using again, or getting the drug. And so that's the piece
there, there's the single use, which easily passes, but it's
the chronic use that can then reset really our dopamine thresholds, and then nothing is enjoyable, right? Then everything sort
of pales in comparison to this one drug that
I want to keep doing. - And that one drug
could be a person, right? I mean, I
- Yes. - I know people in my life that are still talking
about this one relationship, this one person that was just so great, despite all the challenges of that thing. It's almost like they're
addicted to the narrative. - Yeah. - They were maybe, or still
are, addicted to the person. So it could be to any number
of things, video games, sex, gambling, a person, a narrative. To me, and because of the way
you describe this mechanism, this pleasure pain balance, that all speaks to the
kind of generalizability of our brain circuitry. And this is something that fascinates me, and I know it fascinates you as well, which is that nature did not
evolve 20 different mechanisms for 20 different types of addiction. Just like anxiety is a couple
of core sets of hormones and neurotransmitters and pathways, and one person is triggered
by social interactions, another person is triggered by spiders. But the underlying response is identical. It sounds like with addiction as well, there may be some nuance, but that there's sort of
a core set of processes. So it doesn't really matter if
it's gambling or video games or sex or a narrative
about a previous lover or partner, whatever. It's the same addictive
process underneath that. Is that correct? - Yes, exactly. And that's where this whole idea of cross-addiction comes in. So once you've been
addicted to a substance, severely addicted, that makes you more
vulnerable to addiction to any substance. - And when you say
substance, does the same, is what you just said
also true for behaviors? - Yes, so, when I use the word drug I'm talking about substances
and behaviors really. I'm talking about behaviors
like gambling, sex, you know, - Porn.
- gaming, porn, absolutely, shopping. - Work. - Work. - You've accused me, I'll
just, for the record, Anna, Dr. Lembke's accused
me, not accused me, has diagnosed me outside the
clinic, in a playful way, of being work-addicted. You're probably right. The first thoughts I have when I wake up are typically about work. Certainly within 50
milliseconds or so of waking. And probably the last thoughts I have, I would hope are not about work, but yeah, I work constantly. I do other things, but I have
to actively turn that off. - Yes. That's exactly right. And you're certainly not alone in that. And of course- - At Stanford, no, no no no. - And we're here in Silicon Valley, right, it's highly rewarded, right. So that kind of addiction. - It's embedded in the culture.
- Oh yeah, absolutely.
- Absolutely, yeah, yeah. And there's this other city, I think it's called New York, where they also work a lot I hear, and it's heavily rewarded. I once said, and I'm sure
that I'm not the first person to say it, but I was
thinking about addiction, and I was thinking about
the underlying circuits and I posted something to
social media which said that addiction is a progressive narrowing of the things that bring you pleasure. That was the way that
I kind of crystallized the literature in my mind. And then we met and you of course came and gave these amazing lectures
in the neuroanatomy course for the medical students,
and the rest is history. But I tossed out a kind of
mirroring statement for that as well, which was a bit
overstepping, I admit, which I said, addiction
is a progressive narrowing of the things that bring you pleasure. And I said, dare I say, enlightenment is a progressive expansion of the things that bring you pleasure. Not that anybody knows
what enlightenment is, but it was my attempt to
take a little bit of a jab at the fact that nobody knows. And so why not, why wouldn't I throw a neurobiological explanation? Just to kind of sample the waters. And people had varying levels
of response but I would've, the reason I bring that up is that I would imagine that being
able to derive pleasure from many things would
be a wonderful attribute. You know people like this, that can experience
pleasure in little things and in big events. Not just, you know, the
big milestones of life, but also the subtle, you know, as the, like the yogis would say,
the subtle ripples of life. If such an ability exists, do you think that that reflects a healthily tuned dopamine system? One that can engage and
enjoy, but then disengage. Is that what we should be seeking? And to underscore, I know nothing about enlightenment
meditation, or any of it. I just, I use these as
opportunities to explore. - Yeah, so it's a great question and I understand the question as, so what should we be striving for, right? Where should we settle out? And, you know, in my book, I really hold out people in
recovery from severe addiction as sort of modern day
prophets for the rest of us, because I do think that
people who have been addicted and then get into recovery, do have a hard won wisdom
that we can all benefit from. And the wisdom, I guess, you
know, to distill it down, I mean it's many things. But in terms of, you know, dopamine, the wisdom is there are adaptive
ways to get your dopamine. And there are less than adaptive ways. And in general, you could
describe the adaptive ways as not too potent. So not tipping that balance
too hard or too fast to the side of pleasure. - So does that mean never allowing myself to be absolutely in complete bliss? Or does it mean not allowing myself to stay in that state too long? - The latter. I think the latter. Then that gets to temperament, so I'm going to get that to a second. So, in general, what we want is some kind of flexibility in that balance, and the ability to easily
reassert homeostasis. We don't want to break our balance, which is possible if we overindulge for enough period of time and end up with a balance
tipped to the side of pain, this dopamine deficit state
we've been talking about. We want a flexible,
resilient balance, right, which can be sensitive to things going on in the environment, which can experience
pleasure and approach, which can experience
pain and recoil, right? This is all adaptive and
healthy and necessary and good. We would never want a
balance that doesn't tilt. - Right. - That would be a disaster,
we wouldn't be human. And we wouldn't want that,
it'd be really, really boring. On the other hand, what people in recovery from
addiction talk about is, to some extent having
to learn to live with things being a little boring
a lot of the time, right? So trying to avoid some of this intensity and thrill-seeking and escapism, that really is at the core
of addictive tendencies. - Sorry to interrupt,
but when you say boring, can we add stressful and boring? - Yes. - Because there are days where I'm not, I'm one of these people
that have to remind myself to have fun, - Yes.
- because I sort of forgot what the term means, because I like to think that I experience a lot of pleasure in little things, but I'm a pretty hard-driving guy. I like goals and big
milestones and all that stuff. Anyway. The point being that
many days I'm not bored thinking oh, there's nothing to do, but I am kind of overwhelmed
by the number of things that are really not pleasureful that I have to do.
- Yeah, right. - I won't mention what they are, 'cause I don't my colleagues to be like that's why you don't respond to emails. No, just your email. Not yours Anna, but theirs. In any event, so anxiety and boredom can
hang out together, right? Am I correct in? - Oh, for sure. I mean, actually boredom is
highly anxiety-provoking. - Okay. That's good to know, 'cause
I think people hear boredom and they think like, oh,
there's nothing to do here. - [Anna] Right. - There's nothing. I feel like we have a ton to do, we just don't really want to do it. - Right, right. - As opposed to something
that we're excited to do. - Right, okay, so this gets to sort of some of the core things. Also we were talking about earlier about finding your passion. So I'm going to try to
link it all together. But basically boredom, first of all boredom is a rare
experience for modern humans, because we're constantly
distracting ourselves from the present moment, and we have an infinite number
of ways to do that, right. But boredom is really, I think, an important and necessary experience. But it is scary because when
you allow yourself to be bored, let's say you were, had
that list of all the things you hate to do, but you
actually got them all done. Imagine that. And you got your forthcoming book done, and you did all your interviews. - It could happen! Lightning could strike.
- Right. And you walked your dog,
and you cleaned your house, and you went shopping. Imagine that for a moment. You would be sitting in your house, and my guess is you would
be terrified because, wow, what am I supposed to do now, right? There's nothing I really have to do. And that is really, really scary. That can feel like free fall. And yet that's really an important and good experience to have. And I think that is an experience out of which we can have a
lot of creative initiative, but also really consider
our priorities and values. Okay, here I am on planet Earth. What the he-haw am I
going to do with my life? What do I really care about? How do I really want to spend my time, when I'm not distracting myself, you know, in order to spend it. And, you know, then this
gets back to our conversation a little bit earlier about
finding your passion. So I think that one of
the big problems now that's very misguided about this idea of finding your passion, it's almost as if people
are looking to fit the key into the lock of the thing
that was meant for them to do. - Right, and then
everything will feel like a natural progression? - Right, and then everything
will be wonderful. - I can attest to the fact
that is not how it works in any endeavor.
- Yeah, right. And that you'll have all
this great success or. And here's where I really
think the answer lies. And I really, really believe this. Stop looking for your passion and instead look around
right where you are. Stop distracting yourself, look
around right where you are, and see what needs to be done. So not what do I want to do, but what is the work
that needs to be done? And more importantly, it doesn't have to be some grandiose work. Like does the garbage need
to be taken out, right? Is there some garbage
on your neighbor's lawn that someone threw there, that you could actually
bend over and pick up and put into the garbage can? Look around you. There is so much work
that needs to be done that nobody wants to do. That is really, really important,
and if we all did that, I really think the world
would be a much better place. And this is what people
who have severe addiction, who get into recovery, realize. They're like, it's not
about me and my will and what I'm going to will
in my life or in the world. It's about looking around
what needs to be done. What is the work that I am
called to do in this moment? Which also is incredibly freeing because I don't have to
search for the perfect thing. There's a lot of burden
now on young people, that they have to find that perfect thing, and until they've found
that perfect thing, they're going to be miserable. You don't have to do that. Look at the life you were given, look at the people around you, look at the jobs that
present themselves to you and do that job simply and
honorably, one day at a time, with a kind of humility. I think this is really
what's so striking to me about the wisdom of people in recovery. There's this incredible humility that comes out of that experience. You feel so broken, so ashamed, but you pick yourself up one day at a time and you build a life that's around what can I do right in this moment, that might benefit another
person, and thereby benefit me? - Yeah it's a really important
point, and if you're willing, I'd like to actually stay
on this issue of passion, because I think the dopamine systems, if I understand them correctly, the dopamine systems merge with this work that you're referring to, this immediacy of things calling to us, like taking out the trash, which sounds frankly really
boring, to be honest. I hate taking out the trash, but I do it, 'cause I like a clean home and I like a home that smells good. Or at least doesn't smell bad. So we do these things, and
not that we want to offer some larger carrot as a
consequence of doing those things. But if I understand correctly,
what you're saying is in the act of looking at
one's immediate environment, acting on that immediate environment, we cultivate a relationship
to these circuits in our brain about action and reward
that, at least to my mind, span the range of small
things being rewarding, and then lead us to the
bigger things being rewarding. It's not like all we're
going to do is take out trash and tend to house. We eventually will venture out, and we eventually will find
careers and work on those. But if I understand correctly, you're talking about getting
into a sort of functional or adaptive action step, and it's the action step that
these days we tend to overlook because most of our mindset is in things that are truly outside
of our immediate reality. Do I have that correct? - Yeah, that was beautifully said. And I would just add to that, I see a lot of young
people who, for example, spend most of their waking
hours playing video games, and they come to me and they say I am anxious and depressed. I'm majoring in computer science. I hate it, I thought I would like it. You know, if I could only find that thing that I was really meant to
do, my life would be better. And my first intervention for the many many people like that that I see in clinical care
is, you have it backwards. I don't say it quite like that. You were waiting for that thing to pull you out of the video game world. And you're never going to find it, as long as you're playing video games. 'Cause video games are so
powerfully dopaminergic that you have this distorted sense of really pleasure and pain. And you will not be able to
find that thing that you enjoy. And so of course the intervention is abstain from video games,
reset your reward pathways, start with a level balance. And what invariably happens, and I've just seen it over
20 years so many times I've become really a believer in this, all of a sudden it's like oh wow, my computer science class
is interesting this quarter. It's like okay, you know,
you have a receptivity then to experiencing pleasure and reward in a way you just don't have when you're bombarding
your reward pathways with these high dopamine drugs. - Very interesting. And just to underscore this notion that tending to the immediate things can lead to super performance. I may have mentioned it
earlier this episode, but if I didn't I'll mention it now, which is I have the great privilege of having some close friends
that were in the SEAL teams and doing some work
with those communities. And it's a remarkable community
for reasons that I think most people don't understand. People think, they see the images, carrying logs down the
beach, and all this, blowing stuff up, all the stuff that's fun for guys like that. But all of the guys I know
who were in the SEAL teams have this sense of duty
about immediate things, and not just holding the door and doing, helping with the dishes
and moving things around. They are constantly
scanning their environment for what can be done. - Ah! - They essentially conquer
every environment they're in. They are also some of the
most competitive human beings in the world, and they do it, unless they're in the act of war fighting, which is their real job. They do it in every environment,
in a very benevolent way. And it's a remarkable thing because it, I think it's what is part of
what they're selected for. And, you know, there's a range there. But I think when we hear about tending to the immediate things, or this phrase, you know, how you do one thing
is how you do anything. That's a tricky one for me, because there are certain
things I just don't do well. But should we always be trying? I think that the tending to,
setting the horizon in closely and tending to things in
one's immediate environment, I think is very powerful and translates, - Yes.
- because again, I think the nervous system,
it performs algorithms. It has action steps. The brain doesn't evolve to do one thing, it evolves to be able
to use the same approach to doing lots of different things. - Yes. I just want to add, so even beyond that, 'cause that totally resonates for me, and is very consistent with people in recovery from addiction who learn to take it one day at a time, which is one of the, you know, standard lingo from Alcoholics Anonymous and other 12-step groups. But I think also, as you say, you know, our brain is really wired
for the 24-hour period. We're not very good at sort
of the, you know, 10 year, 20. I mean we have this huge frontal lobes and yes, we're great planners and we can, but if we live too much in that space, we can really get very anxious
and depressed and lost, and either catastrophize or get grandiose. But if you can chunk it down to a day, what people in recovery talk about is how, if I can just do today right, then I will get a chain of days that seem insignificant
in their individual units, but after six months
or a year or two years of those good days, I've got
two very good years, right, and I look back and it's like oh wow, I guess I did all that. But I think that's really,
you know, one of the keys, is really taking it one day at a time, which your SEALs, and also this connecting
with the environment, right? So being awake and alert
to your environment, and connecting with your environment, not trying to escape it. And of course escapism is
what we all want and desire, that experience of non being. And we get it from the
internet or from drugs or whatever it is, but
it's the booby prize. Because ultimately it takes
you further and further away from your immediate environment, which is where we really have to connect to get that sense of
grounded-ness and authenticity, and like of being in our own lives. - Well I think the unit of the day is something that comes
up again and again, in my discussions with colleagues who are extremely successful, and who also have balanced lives. - Right. - This actually came up in the discussion with Karl Deisseroth, who is
also a successful scientist and clinician and, you know,
manages a family, et cetera. So the unit of the day,
I think, is fundamental. And those stack up, as you mentioned. So along those lines, I've heard you say that in order to reset the dopamine system, essentially in order to
break an addictive pattern, to become un-addicted, 30 days of zero interaction
with that substance, that person, et cetera. - Right.
- Is that correct? - Yeah, and 30 days is,
in my clinical experience, the average amount of time it takes for the brain to reset reward pathways for dopamine transmission
to regenerate itself. There's also a little bit of science that suggests that that's true. Some imaging studies showing that our brains are still in
a dopamine-deficit state two weeks after we've been using our drug. And then a study by Schukit and Brown which took a group of depressed men who also were addicted to alcohol, put them in a hospital where they, they received no treatment for depression but they had no access
to alcohol in that time. And after four weeks, 80% of them no longer met
criteria for major depression. So again, this idea that
by depriving ourselves of this high dopamine high
reward substance or behavior, we allow our brains to
regenerate its own dopamine, for the balance to really equilibrate. And then we're in a place where we can sort of enjoy other things. - So that progressive narrowing - Right.
- of what brings one pleasure, eventually expands. So I'd like to dissect out that 30 days a little more finely. And I also want to address how does one stop doing
something for 30 days, if the thing is a thought? So we'll kind of, I'll put that
on the shelf for the moment. So days one through 10, I would imagine will
be very uncomfortable. - [Anna] Yes. - They're going to suck
basically, to be quite honest, because the way you described
this pleasure pain balance, to my mind says that if you remove what little pleasure one is
getting, or a lot of pleasure from engaging in some
behavior, that's gone. The pain system is really ramped up. And nothing is making me feel good. I'll just use myself as an example. I'm not in recovery but, you know, that 10 days is going to be miserable. Anxiety, trouble sleeping,
physical agitation. - Yes.
- To the point where, you know, maybe impulsive, angry. Should one expect all of that? Should the family members of
people expect all of that? - Yeah. So what I say to patients, and it's a really important
piece of this intervention, is that you will feel worse
before you feel better. - For how long, is probably the first question they ask, right?
- Yes. And I say usually, in
my clinical experience, you'll feel worse for two weeks, but if you can make it
through those first two weeks, the sun will start to
come out in week three. And by week four, most people are feeling a
whole lot better than they were before they stopped using their substance. So yeah, you have to, it's a hard thing. Like you have to sign up for it. And I will say, obviously there
are people with addictions that are so severe that as
long as they have access to their drug or behavior, they're not able to stop themselves. And that's why we have, you know, higher levels of care, - Sure. - residential treatment. So this is not going to be for
everybody, this intervention, but it's amazing how many people with really severe addictions
to things like heroin, cocaine, you know, very
severe pornography addictions. I posit this, I do it as an experiment. I said you know what,
let's try this experiment. I'm always amazed, number one,
how many of them are willing. And number two, how many of
them are actually able to do it. They are able to do it. And so that little nudge is
sort of just what they need, And the carrot is, you know, there's a better life out there for you and you'll be able to taste it in a month. You really will be able to begin to see that you can feel better,
and that there's another way. - So the way you describe
it seems like it's hard, but it's doable for most people, not everybody.
- Yeah, right. - And we'll return to
that category of people who can't do that on their own. Well, then days 21 through
30, people are feeling better. The sun is starting to
come out, as you mentioned, which translates in the
narrative we've created here, and supported by biology, that dopamine is starting to be released in response to the taste of
a really good cup of coffee, - Yes, exactly.
- for instance. Whereas before it was
only to insert, you know, addictive behavior. - Right, that's right.
- Whichever it happens to be. - Of course, coffee can be addictive too, but we'll leave that aside.
- Sure, yeah. I feel like coffee has a kind of consumption limiting mechanism built-in, where at some point you
just can't ingest anymore. - Yeah.
- But maybe that's wrong. Sorry to give lift to the
caffeine addicts out there. As I clutch my mug. So days 21 through 30. I've seen a lot of people
go through addiction and addiction treatment. I've spent a lot of time
in those places, actually, looking at it, researching. I've got friends in that community. I'm close with that community. One thing I've seen over and over again, sadly often in the same individuals, is they get sober from
whatever, they're doing great. These are people with families. These are people that you discard your normal image of an addict and insert the most normal, typical, whatever, healthy person you can imagine. 'Cause a lot of these people
you wouldn't know were addicts. And then all of a sudden
you get this call, so-and-so's back in jail. So-and-so's wife is going to leave him because he drank two bottles of wine and took a Xanax at 7:00 a.m., crashed his truck into a pole,
has got two beautiful kids. Like how did this happen again? To the point where by the
fourth and fifth time, people are just done. I mean maybe people, you might be able to detect
the frustration in my voice. I'm dealing with this,
with somebody that's like, I don't even know that I
want to help this time. It's been so many times, to the point where I'm starting to wonder is this person just an addict. This is just kind of what
they do and who they are. And you never want to
give up on people but, and I'm hanging in there for them. But I will say that many
people have given up on them. And so what I'd like to
talk about in this context is what sorts of things help other people that we know that are addicted? What really helps? Not what could help,
but what really helps. And are there certain people
for whom it's hopeless? I mean, I don't like to hold
the conversation that way, but I wouldn't be close
to the real life data if I didn't ask. Is it hopeless, are there people who just will not be able to
quit their substance use or their addictive behavior,
despite, I have to assume, really wanting to? - Yeah, so there are people who will die of their disease of addiction, you know, and I think conceptualizing
it as a disease is a helpful frame. There are other frames that
we could use, but I do think, given the brain physiologic
changes that occur with sustained heavy drug use, and what we know happens to the brain, it is really reasonable to
think of it as a brain disease. And for me, the real window of, let's say being able
to access my compassion around people who are repeat relapsers, even when their life is so much better when they're in recovery.
- Oh yeah, yeah. - It's like a no-brainer, right? Is to conceptualize this balance and the dopamine deficit state, and a balance tilted to the side of pain. And to imagine that for some people, after a month or six months,
or maybe even six years, their balance is still
tipped to the side of pain. That on some level that
balance has lost its resilience and its ability to restore homeostasis. - It's almost like the
hinge on that balance - Yes.
- is messed up. - Exactly. And so, I mean, for someone who's never
experienced addiction, like yourself, maybe one
way to conceptualize it is. - Well I didn't say that. - [Anna] Oh okay. - To be clear, I was not
referring to myself, but I, in this example I was giving,
if I were, I would come clean. I would reveal that. But I think that, especially after hearing
some of your lectures and descriptions of the range
of things that are addictive, I think I've been fortunate
I don't have a propensity for drugs or alcohol. - Right, okay. - I'm lucky in that way.
- Right, right. - Frankly, if they remove all
the alcohol from the planet, I'll just be relieved because no one will
offer it to me any more. - [Anna] Right, right. - So don't send me any alcohol. It won't go to me. - [Anna] Right. - But I don't have that, I like to think I have the compassion, but I don't that empathy for, you know, taking a really good situation, and what from the outside looks to be - Right, right.
- throwing it in the trash. - Yeah, so okay, so let me,
and this is really, I think, important because I also had to come to an understanding of
this, and I feel that I have in my 20 years of seeing these patients. And of course addiction
is a spectrum disease, - Sure.
- right, and so you've got the
severe end of things. Imagine that you had an itch
somewhere on your body, okay. And it was, I mean, we've
all had that, like, you know, whatever the source, it
was super, super itchy. You can go for, you know,
if you really focus, you could go for a pretty
good amount of time not scratching it, but the moment you stopped
focusing on not scratching it, you would scratch it. And maybe you'd do it while
you were asleep, right. And that is what happens to
people with severe addiction. That balance is essentially broken. Homeostasis does not get restored, despite sustained abstinence. They're living with that
constant specter of that pull. It never goes away. So let me say, there are
lots of people with addiction for whom that does go away. And it goes away at four
weeks for many of them. But in severe cases, that's
always there and it's lingering, and it's the moment when they're
not focusing on not using, it's like a reflex. They fall back into it. It's not purposeful. It's not because they want to get high. It's not because they value using drugs more than they do their family. None of that. It's that really they cannot not do it when given the opportunity, and that moment when they're
not thinking about it. Does that make sense? - That's a great description and actually in that description I can feel a bit of empathy, because the way you described scratching an itch in your sleep. - Yeah.
- You know, I've done that with mosquito
bites and some of them, - Right.
- you're scratching, you know, like you wake up scratching
that mosquito bite. And I also have to admit
that I've experienced not feeling like I want
to pick up my phone because it's so rewarding, but
just finding myself doing it. - Yes, of course, yes.
- Like I'm not going to use this thing, I'm not
going to use this thing, and then just finding myself doing it, like what am I doing here?
- Yes, right, right. - Sort of the how did I get back here again?
- Yes, right. - And I know enough about
brain function to understand that we have circuits that
generate deliberate behavior. And we have circuits that
generate reflexive behavior. And one of the goals of the nervous system is to make the deliberate stuff reflexive, so you don't have to make the decision, because decision-making is
a very costly thing to do. - Exactly. - Decision-making of any kind. - [Anna] Right, right. - So that does really help. I want to just try and weave
together this dopamine puzzle, however, because if by week, so first phase of this 30 or 40 day detox, it's like a dopamine fast, - Right.
- right, okay. First 10 days are miserable. Middle 10 days, the clouds are out, there may be some shards
of sunlight coming through. And then all of a sudden
sun starts to come out, it gets brighter and brighter. Why is it then that people will relapse, not just after getting fired from a job or their spouse leaving them, but when things are going really well? - Yes.
- Is it this unconscious mechanism? 'Cause I've seen this before. They have a great win, I have a friend who's a
really impressive creative. I don't want to reveal any more than that. And relapsed upon getting another really terrific opportunity to
create for the entire world. And I was like how can that happen? But now I'm beginning to wonder, was it the dopamine
associated with that win that opened the spigot
on his dopamine system? Because it happened in a phase of a really great stretch of life. - Yeah, right. Yeah, so you raise that great
point about triggers, right? And triggers are things that make us want to go back to using our drug. And the key thing about
triggers, whatever they are, is they also release a little
bit of dopamine, right? So just thinking about
whatever the trigger is that we associate with drug use, or just thinking about drug use, can already release this
anticipatory dopamine, this new little mini spike. But here's the part that I
think is really fascinating. That mini spike is followed
by a mini deficit state. So it goes up and then it
doesn't go back down to baseline, it goes below baseline tonic levels. And that's craving, right? So that anticipation is
immediately followed by wanting the drug. And it's that dopamine deficit state that drives the motivation
to go and get the drug. So many people talk about dopamine as not really about pleasure, but about wanting and about motivation. And so it is that deficit state that then drives the locomotion to get it. - And earlier your description of dopamine being involved in the desire for more, giving the sense of
reward, but also movement. - Right.
- I have to assume that those things are braided together - Yes, yes.
- in our nervous system, for the specific intention of
when you feel something good, then you feel the pain. - Yes.
- But maybe you don't notice it. And then the next thing you know, you're pursuing more of the thing that- - And I love the way you use
the word braided together, that's beautiful. And let me also just say, something that I find also fascinating in my work with patients,
and I see this all the time. There are people for whom
bad life experiences, loss, you know, in any form, stress,
in many different forms, that's a trigger, but
there are absolutely people for whom the trigger is things going well. And the things going well can be like the reward of the things going well, but very often what it
is is the removal of the hypervigilant state that's required to keep
their use in check. So it's the sense of I want
to celebrate, you know, or I want to, this reward happened, I want to put more reward on there. And it's really really fascinating because when people
come to that realization about themselves, that
they're most vulnerable when things are going well,
that's really a valuable insight because then they can
put some things in place or barriers in place
or go to more meetings or whatever it is that they do, you know, to protect themselves. - Along those lines, I have
a friend 40 years sober, was a severe drug and alcohol
addict from a very young age. Really impressive person, does a lot of important
work in the kind of at-risk youth community out in Hawaii. And he said something to me, he said, as former addicts often do,
they've got these great sayings. But I think it fits very well
with what you're describing. He said, you know, no
matter how far you drive, you're always the same
distance from the ditch. And I said well that's kind
of depressing, and he said no, that's actually what gives me peace. - Yeah. - Because what would happen is for so many years of
relapsing and relapsing, recovering and relapsing, he
felt like it was hopeless. And then somehow conceptualizing that the vigilance can never go away, instead of making him feel burdened, - Yeah.
- it made him feel relieved. So I often think about
that statement, you know, no matter how far you drive, you're always the same
distance from the ditch, because in my mind I
conceptualize that as gosh, that's a tough way to drive down the road. But actually, on a road where
you know where the ditch is and where you know where
the lanes lines are, it's actually a pretty nice drive. It's when you don't know
where the shoulder is, that you constantly have
to be looking around. So there's this, we're
speaking now in analogies and imagery and science. But I, one of the things
I find so incredible about this community of 12-step, and there are a variety of them, are the communities that
they create for themselves, and some of these sayings,
which I do believe link back to really core biological mechanisms. - Yes, yes. - I do want to ask
about those communities. I have a question which might
be a little bit controversial. - Great! - Which is, is it possible that people who were addicted to drugs
or alcohol or gambling, or some other behavior, get addicted to the addiction community? Because one thing that I
think I observe over and over is that there's some circuit
in the brain of human beings that has to tell you about the dream they had the night
before, for whatever reason. There's another circuit that
leads people to wake you up, if they themselves can't sleep. I don't know what circuit it is. I'm being facetious here. But there does seem to also be a circuit in the brain of addicts
to discuss and want to kind of talk about their recovery a lot. And I mention this not to poke at them, but rather the opposite, because I think that one
thing that is challenging, at least for me, and having
friends that have a propensity for drug or alcohol
addiction, not all of them, but certainly some of them, is when they're talking
about their recovery, I feel like it's all they talk about. This meeting, that meeting, that meeting. So what I'm really asking here is that, can we become addicted to sobriety? - Right. So this is a great
question and it links into some of the other things
we've been talking about, having to do with where do
we settle out, you know? What is the way to live
between pleasure and pain? And I implied earlier that ultimately we want a resilient balance that's sensitive to pleasure and pain, but that can easily restore
homeostasis after we indulge, even when we indulge greatly. But the truth of the matter is that people with severe addiction, I believe temperamentally
want those extremes, and they're wired for
that kind of intensity that is more than just
these slight adjustments around the fulcrum, right? It's like they want the
big highs and the big lows. - They'll say great meeting. - Yeah, right, right.
- They're like that was such an amazing meeting. Or they find a group,
- Right, yeah. - They find a group in a location. - Yeah. - This is almost an inside
joke in those communities. Again, I'm not reporting, I'm not talking about a friend in quotes, this isn't me reporting. They'll talk about how
attractive people are at a given meeting, or
how bonded they feel to people at a given meeting.
- Right, right. - That the meetings themselves - Right.
- become their own form of dopamine hit. - Yes, yes, yes. - And again, I'm not
being disparaging, I just, I want to understand this. - Right, so yes, so a lot of
times patients will say to me, oh, you know, I don't want to go to AA. It's a cult. And my response to that is because it's a cult is
exactly why it works, okay. Because yes, it is much better
for you to be addicted to AA and to recovery, than almost any other
addiction I could think of. And we know from Rob Malenka's
work, who's here at Stanford, that oxytocin, you know, is the hormone that's
involved in human pair bonding and relationships and love. And it directly links to dopamine neurons and causes the release of dopamine. So yes, when we connect with other humans, especially in a kind of
transcendent spiritual way, that's a huge dopamine hit. And it does replace the dopamine
that people get from drugs. And for people who have
this addiction temperament, they need it on a more intense level. They're not going to be
generally satisfied with kind of, you know, a sort of
acquaintanceship, right? They want that intensity of
the intimacy that you get with people when you're
cathartically exposing, you know, warts and all. So yes, people can get
addicted to recovery, and good for them. Go for it, you know. And of course this can be disruptive for friendships and relationships, where the one person is not in recovery. Like you're going to so many meetings, you're always talking about
recovery, but you know what, much better than them
being intoxicated, right? I mean, so although you
may tire of your friends talking about their meetings all the time, I'm sure you would
rather have them do that than, you know, be in their addictions. - Absolutely. And this is now the second
time you've done this through this discussion,
but now I have empathy because the way you describe their enthusiasm about meetings, - Yes.
- is probably the way that people feel about me and work.
- Yes, right. - In neuroscience.
- Yes. - I mean, I've been getting
up in front of the class since I was eight years old and talking about things
I read over the weekend. Now I just happen to have
this thing called a podcast. - Right. - I've been doing it since I was a little. And it annoys a lot of people, right. I've learned to suppress it a little bit. Some people like it, but
I'm poking fun at myself just to say that I now can understand that the way I feel
about the reports about yet another amazing meeting or, or for there's a different form of this. But there's some people for which they just love intense experiences. - Yes.
- They're always like trying to pull me off to Bali because they're talking
about how sensual it is all the time, I'm sure Bali's wonderful. But there's this kind of ratcheting up, it's like seeking Burning Man all year long.
- Right. - I've never been to Burning Man, no desire to go to Burning Man. But inside of academia I mean if I were to just
turn the mirror at myself, inside of academia, or
here in Silicon Valley, work, and the
- Right. - pursuit of more success, even if money is kind
of divorced from that, sometimes it is sometimes it isn't. Academic work is, you know, for sake of pursuit of knowledge. It sounds to me like the same mechanism. In fact, it feels to me very
much like the same mechanism. - So Andrew, here's what I love about you. First of all, you're willing
to bring your own flaws and foibles to this conversation. - Well they're everywhere. - Well, you know what, it's wonderful. And then you're really open and curious and wanting to understand, 'cause I can't tell you
how many people I have met who really see addiction
as some kind of otherness. But the truth is we're
all wired for addiction. And if you're not addicted yet it's just, it's right around the corner. Do you know what I mean? Especially with the incredible
panoply of new drugs and behaviors that are out there. So I love that you're
willing to take a moment and really try to understand
this, because it is, we can all relate, and
you're relating it to your, essentially your work
addiction is right and apt. You just happen to be
addicted to something that is really socially rewarded. You know, you figured
that out at an early age. Oh, when I do X, Y and
Z, all these people go look at that smart kid, or
whatever it is, you know. - Well for me, it made me feel safe. - Okay. - I felt like. Yeah, I just felt like this, and I pause there 'cause
it's like, it's like peace. I'm like ah, I can relax for a moment. - When you're talking about neuroscience? - Or just when I feel like
I'm on the right path. - Yeah, okay.
- And I'm onto something. Or if I see something
that I'm excited about, - Right. - I'm like, I feel filled
with, it must be dopamine. - Yes.
- I feel flooded with pleasure, literally from head to toe.
- Right, yeah. - And then my next thought is more. [laughing] - So true, you're a true addict. - Okay, thank you.
- You are. You are. But you just got really,
- I think thank you. - you really got lucky with the fact that what you're drawn to is
adaptive, essentially, you know. And then your challenge
is going to be that your life doesn't get too out of balance in the sense that you're 24/7 working, you don't stop and do some
other things or think of- - And my life, admittedly,
is somewhat asymmetric. I mean it has other
components of physical health, et cetera, but it is somewhat asymmetric. Which is why I got a dog. Although I talk about
him an awful lot, so. - But the dog is good because
that draws you out of yourself and a little bit away from the work. But again, you know, I
think the key here is for people who feel like they don't, they've never experienced addiction or they don't know anybody with addiction, or if they do, they don't get it, just think of that one thing that is the most important
thing in your life that you do, that gives you pleasure
and meaning and purpose. And then imagine if you couldn't do it. - Oh yeah, let's not talk about that. - [Anna] Right. - Well I appreciate the feedback and you can send me a bill at the end. What is the most ridiculous
sounding addiction that you've ever witnessed, that was actually a real
addiction, along these lines. Because I think we all know
the standard heroin, pill. You've been very, I should mention, because it's important,
your previous book, and we will provide a
link to that as well, focused on the opioid crisis and what we thought was medication. It turned out to be just
as bad, if not worse, than a lot of so-called street drugs. So we understand those,
you know, gambling, sex addiction, porn addiction. Now video games. We'll talk about social media
a little bit more in depth. But what's the most like, wow, I didn't realize people
could get addicted to that? - Water. - Really? - Really. So I had a very lovely patient who was, had a severe alcohol addiction, and she got into recovery
from her alcohol addiction for many years. But she kind of had a
sort of a polydipsia, or an urge to be drinking something a lot. And so she drank a lot of
water and slowly, over time, she realized that if
she drank enough water, she could become
hyponatremic and delirious and be out of herself. - You can die from it, right? - Right, which is, she just wanted to be out of her own head. And so she would
periodically intentionally overdose on water, in order, you know, to, I know, it was so sad, so sad. - What happened to her? - She eventually took her own life. - Wow.
- Yeah, it was really. - That's rough.
- She was a lovely woman. She was so bright. She had so many interests and passions, and of course it was very sad
when, you know, when she died. But that was a wow to me, it was like wow, if you have this disease of addiction, you can even get addicted to water. - Wow. And I think it just underscores
the generalizability of the circuits. - Right. - There isn't a brain circuit
for addiction to water that she happened to have. There's a brain circuit for
pleasure and pain and addiction, and water plugged into that circuit.
- Right, right. - Wow. That's intense. In your book, "Dopamine Nation", you also describe some
amazing paths to recovery. People that, you know,
from reading it I would, I won't say which ones and who 'cause there are some great
surprises in the book too, both tragic and triumphant, as they say. You've often described your
patients as your heroes. - Yeah.
- Yeah, tell us a little bit more about that. - You know, when you
think about how hard it is to give up a drug or a behavior
that you're addicted to, how much courage that takes
and fortitude and discipline, and stick to it-ness, these people are really amazing people. I mean that's, I don't
know that I could do it, what they do, you know. And like, you know, we
talked a little bit about just the constant
ever-present urge to use, even after sustained periods
of abstinence for some people. That's really really hard. And of course then you double down on the shame that they
feel, because of that urge, even when their lives are so much better. I mean these people are
really, really remarkable. And you take their
remarkable accomplishment and then you imagine the
world that we live in now, where we are constantly
invited and tempted and really bombarded with opportunities to become addicted- - It's like feeling an itch everywhere. - Oh yeah, I mean you can't escape it. You know, you cannot escape it. That you'll get an email in your inbox inviting you to do X, Y, or Z. And if you're addicted
to that thing, you know, you try to like delete all
your apps and not go here. All of a sudden your work inbox, you know, you're getting those images, let's say. Really, really, really hard. And yet these people find a way to do it. I think it's absolutely amazing. And they're really wise people. They have so much wisdom to offer. They've taught me a lot. You know, as I talk about in my book I have my own addictions, and I really just like took
a page right out of their, I was okay, what do I do now? All right, what did this
patient do, what did that, okay, I'm going to try that. - It is an amazing community - Yeah.
- of people, they are very sage. I wanted to just touch on
something that you mentioned, which is the shame. - Yeah. - You know you can't go to a
meeting, or talk to addicts, without detecting or hearing about like lies, shame, et cetera. I heard you say in an interview
with somebody else recently that truth-telling and secrets are sort of at the core of recovery. And yeah, tell us more about that. - Yeah. So one of the things that I
found really fascinating about working with people in recovery,
was how telling the truth, even about the merest
detail of their lives, was central to their recovery. And I became really curious about that. Like why would truth-telling
be so important? And of course there is
the obvious thing that when people are in their addiction, they're lying about using, you know. So part of getting into recovery is to stop lying to the
people they care about, about their use. But it's really more than that because what people in recovery
have taught me is that it's not even just not
lying about using drugs. I have to not lie about anything. I can't lie about why I was
late to work this morning, which we all do all. Oh I hit traffic, no I didn't hit traffic, I wanted to spend two more
minutes reading the paper and drinking my coffee, right. Or just lying about, you know, I don't know where I had dinner. Like, so people with addiction
will get into, you know, the lying habit where they're
lying about random stuff, 'cause they're sort of
in the habit of lying. And how recovery is really
about telling the truth, you know, in all ways. And so one of the things that I, I had a lot of fun with
in writing the book, is sort of exploring
the neuroscience around why truth-telling is important
to leading a balanced life. And we know like every religion, since the beginning of time,
is all about telling the truth. Well why, right? And there's really interesting
neuroscience behind it that suggests that when we tell the truth, we actually potentially strengthen our prefrontal cortical circuits, and their connections to our limbic brain and our reward brain. And of course, these are the
circuits that get disconnected when we're in our addiction, right? Our balance, in our reward
pathway, our limbic brain, our emotion brain, is doing one thing, and our cortical circuits are completely disengaged from that, ignoring what's happening, which is easy to do
because it's reflexive. We don't need to think about that balance for the balance to be happening. But we have to re-engage those circuits, anticipate future consequences, think through the drink, you know, not just how am I going
to feel now if I use, but how am I going to feel
tomorrow or six months from now? And that telling the truth
is in fact a way to do that, to make these connections stronger. And there I talk about
some studies in my book that kind of indirectly show that. So I find that really fascinating, plus just that like being
open and honest with people really does create very
intimate connections, and those intimate
connections create dopamine. So we were talking a little bit about how you know a bunch of people who need like intensity in their lives. For me, I need a lot of intensity
in my human connections. Like I'm really not interested in, and bored by and made anxious
by, casual interactions. But you know, like having this
kind of discussion with you, that's very intense and also
intimate and self-disclosing, is very rewarding for me. So that's an important source of dopamine. Thank God I became a psychiatrist. - Yeah, absolutely. - Like I can't disclose all my stuff, but I am quite transparent
with my patients, which is a slightly unorthodox. But, you know, when I think it's right, I'm also transparent with them. So that's, you know, that's
a source of dopamine too, when we're honest and we disclose. You think people are going
to run away from you, if you tell them about all
like your weird neuroses, but really they don't. What they're like is oh thank God, I'm not the only one, right. - What I love about, I love
many things about your book. I read it in one sweep. - Oh thank you. - And I was like wow. I was pleasantly surprised,
but I was like wow, she's really opening up in this book, from the very beginning. And I don't want to give
it away, but it's yeah, you're very open where it's appropriate. And also I think that this
question about truth-telling, I always think about like tell the truth, be a hundred percent about the truth, but there's also this element about do you report previous lies, right? What about prior behavior? And I'm fascinated by this
'cause to me telling the truth has many facets, but the
three sides of this thing in my mind, are one is
reporting everything accurately. The other is what do you withhold, what do you not withhold, right? Because some people say tell the truth, or at least don't lie. That's sort of a- - Lies of omission, right. - Yeah, so lies of omission. Lies of omission. And then there's the, what I
have to assume for most people, is a small to enormous batch of things that they lied about in the past, that still thread into the future. - Right. - So how important is it for the addict, or every person really, to, 'cause it sounds like
cultivating the circuitry between prefrontal cortex
and the dopamine system would be great for anybody. Since we're all addicts, - Right.
- everyone should do it. But in all seriousness, it sounds like a good
thing for everybody to do. How much work needs to be
done on all the priors, all the stuff we've hidden? I mean not me, but all the stuff that everybody else has hidden. - Yeah, so the, you know, the steps of the 12-steps
of Alcoholics Anonymous, a good number of those steps
are about that very thing. The past, the ways that we've
harmed people in the past. And the fourth step is
about making amends, you know, by admitting the ways in which that we've contributed to harming others. And it is a really big piece of recovery. So, you know, how important,
so for people with addiction, it's really, really important
to go back and make amends. And, you know, the key idea there is you just go back and
you apologize, you know, and you don't have to get any
particular kind of response, or you don't need to be forgiven. It's the act itself of apologizing about the ways in which we've harmed or lied to people in the past, that is cathartic and renewing, and allows us to kind of shed this skin and be new in our lives and begin again. Sort of absolved, you know,
of past sins, so to speak. So it is really important. You know, are there situations when it's maybe not a good idea, because of that person or the nature? Sure, you know, there
are always going to be, it doesn't have to be like, it's not, we're talking about not
like Kant's idea about I'd never lie, robbers in your house. You're a stowaway. You can't lie even about that. It's like no, there are
probably situations where, - Absolutely.
- you know. - For sake of other people's safety, - Right, and-
- children's safety, sure. - Right, I mean there are, you can think of a million scenarios. But in general, you know,
when we're taking stock, because I don't know about you, but I have a lot of regrets and guilt about a lot of things in my life. And they kind of haunt me, you know. It means I'll have nightmares, right. And I think that's true for most people. I mean I occasionally will
meet somebody who's like I don't have any regrets
in my life, I'm like wow. Like I cannot relate to that at all. So, you know, this idea of
like catharsis and, well, I mean, in the 12-steps it's telling God, or your higher power,
telling another human being, the ways in which you've wronged others. Considering your own character defects and how those have contributed. To me, that's a really important piece and something that we don't do enough in our current culture. Especially in psychiatry, frankly, where there's like a lot of eternally empathizing with patients, but not a whole lot of
likes going well, you know, actually you kind of messed that up. Or like that was really
bad on you, you know. And in my work, I don't
necessarily use that language, but, you know, patients might say like I really feel badly about,
you know, this thing. I'll be like yeah, I get it. I understand that you feel. - Well guilt is a- - [Anna] Right. - There's a circuit for that too. - Right, and it's important, right, and it's also important to recovery and to not becoming addicted. Experiencing a certain
amount of appropriate shame for things that we have
done and, you know, feeling the pain that comes with shame, which is an incredibly
painful emotion, right. And I think that may be the
one that we all try to avoid more than any other, is like that shame of not being
liked or not being accepted or not being celebrated.
- Or the thing that we did is really despicable. - Right, it's really,
yeah, like oh my God, I did that horrible thing, right, right. So, I mean, I've done horrible things that I haven't gone back and
said I did this horrible thing, but I'm, maybe I've
tried to pay it forward. Like I've told my kids, you know, when I was younger I
did this horrible thing and it still haunts me. So if you're ever tempted to
do something like what I did, you might think about my situation. So, you know, some kind of way. But I think wrestling
with that is important. - I think it's a really
important element to all this, and there's not, I love that
there's neuroscience being done on truth-telling, - Yeah.
- and the value of truth-telling. - Yeah.
- I think, if I were to predict a new
and truly exciting area that people are going to
be really curious about, in this huge sphere we call neuroscience, I hope they'll continue to do more work. Also, I'm so glad to hear that's
happening here at Stanford. - No that's, the literature that I look at isn't Stanford work, but there's work. - Great.
- It might be people at Stanford.
- Great, regardless of where it's happening. More of that and all the rest please. I want to ask you about using
drugs to treat drug addiction. These days there's a growing interest, or at least discussion about ibogaine. People going down, going out of country, because I think it's still
illegal here, or is illegal here, going out of country to, I dunno, either inject it or smoke
it or whatever it is. Or people going and doing
Ayahuasca journeys or MDMA, which is still an illegal
drug in this country, but there are clinical trials. There are people on this campus
doing experimental studies. I don't know of clinical trials, but at Johns Hopkins there are
clinical trials, et cetera. So this is a vast area, right? Different chemistries for different drugs and different purposes. But the rationale, as I understand it, is take people who are in
a pattern of addiction, launch them into a experience that's also chemical and extreme, often of the extreme serotonin
and or extreme dopamine type. So MDMA,
- Right. - ecstasy for instance. Tons of serotonin dumped,
tons of dopamine dumped. How neurotoxic, if neurotoxic, debatable, et cetera, et cetera. Not a topic for now. But a lot. And then somehow that extreme experience wrapped inside of a
supported network in there, whether or not there's just someone there or whether or not they're
actively working through something with the patient, is
supposed to eject the person into a life where drug use
isn't as much of interest. This violates, at a purely rational level, this violates everything
we've talked about in terms of dopamine biology. It would, if this arrangement
is the way I described it, cause more addiction, is
anything but a dopamine fast, it's a dopamine feast. So we hear about successful
transitions through this, at least anecdotally, and
maybe some clinical studies. What is going on? What is going on? It doesn't make any sense to me. Yeah. - Yeah, so I think it's
good that you're skeptical. I think we all should be skeptical. Having said that, there are
clinical studies showing, you know, and these are small studies and they're short duration,
small number of subjects, but, you know, taking people for example, who are addicted to alcohol,
and then having them have this, let's say a psychedelic experience in a very controlled setting. - So either, typically it's
a high dose psilocybin, or three dose, as I saw
it for the MAP study of MDMA. - Right.
- Of ecstasy. Those are sort of the,
seem to be the kind of, - Yes, the typical, right.
- the kind of bread and butter of this kind of work.
- Right, right. But the thing to really
keep in mind is that this is completely interwoven
with regular psychotherapy, and that these are highly
selected individuals. - In clinical trials. - Right, right. And these are clinical-
- we're referring to legal clinical trials. - Right, right. And so, you know, I think the metaphor that helps me think about this is there are many ways to
the top of the mountain, and these are sort of
like taking the gondola instead of walking up. It sort of, instead of doing like a year of psychoanalysis where you're sitting
on the couch every week reflecting on your life, it's a condensed version of
psychoanalysis or psychotherapy, plus, you know, MDMA, which
gets you there faster. - And creates the intimacy,
presumably, because of the- - Well I think the main thing that happens when it's beneficial, is
it just allows the person to get outside of their own
head and look at their lives on a much broader sweep,
and to consider themselves not mired in the quotidian
sort of details of their life, but rather as a human on
the large planet Earth, in the vast universe. So I think it takes,
it's like when it works, it's a transformational experience because it gives the person another lens through which to view their lives, which I think for some people
is positive and powerful, because they can come
back from that and be like oh my gosh, I care about my family, and I don't, I want X, Y, or Z for them. And I realize that my continuing to drink is not going to, you know, achieve that. So it's almost like a
spiritual or values-based. So I think it can be very
powerful, but having said that, I truly am quite skeptical
because, you know, addiction is a chronic
relapsing and remitting problem. It's hard for me to imagine that there's something that
works very quickly short-term, that's going to work for a disease
that's really long-lasting. - Yeah, the two addicts I know that did MDMA-assisted psychotherapy
as part of this thing, both got worse. - Yeah. - But the people I know who
had severe trauma who did this, who took this approach,
seem to be doing better. - Okay, interesting.
- And so I, I think that the discussion,
as we hear it now, is just sort of psychedelics,
which is a huge category that includes many different
drugs and compounds with different effects. And we hear about trauma and
addiction lumped together. And I think that I'm a
splitter, not a lumper, as we say in science. And I think it's going to be
important for people to know that this is definitely
not a one-size fits all kind of thing. But it sounds like it
may have some utility under certain conditions. - Yeah, I think so. I'm trying to be very open-minded about its potential utility
for certain individuals. But I can tell you in my clinical work, what is a very concerning
unintended consequence of this narrative, is I have a lot of people who
are looking for some kind of spiritual awakening who on their own, not in the context of
any kind of therapeutic, psychological work, you know, microdose or want to try
psilocybin or MDMA with a friend or wherever, so they can have
this spiritual experience that they can figure out their lives. That's a disaster and
almost never works out well. And I've then had people who literally, supposedly you can't get
addicted to psychedelics because, you know, something with the biochemistry which I don't fully understand, 'cause it doesn't make any sense to me. But I have patients clinically who definitely are addicted to, you know, MDMA, to micro-dosing. So that's very concerning
to me 'cause like, you know, Pollan's "How to Change Your Mind", I respect that work, but on
the other hand, it's penetrated the culture-
- Michael Pollan's book. - [Anna] Yeah, yeah. - And I don't know him and
so I don't have a problem taking a stance. So I'll just say my stance on that is the narrative of popular authors can expand and wick out so fast, - Yes. - that pretty soon people are essentially taking their mental health
into their own hands. And I actually, I have great
optimism for this business of clinical use of
psychedelics, including MDMA. Matthew Johnson at Johns Hopkins is doing fabulous work on this. And there are others too, of course. But those are controlled settings. - Right. - And the pharmacology is being tuned up. And one thing that I think is coming. There are several papers
published recently in great journals like nature
and science, et cetera, where there are scientists
who are removing the hallucinogenic
components of these drugs and finding that they still
have the antidepressant effects. - Interesting.
- And so the experience of a psychedelic, and the long-term effects
of the psychedelic, might actually be dissociable. And so, again I, and I'm
always careful to say I'm neither for something or against it. I just think that treading
carefully is what's important. - I agree with you, and
I can just tell you that the downstream effect
for the average person, many of whom present in our clinic, is that they've misconstrued the data on the use of psychedelics
for mental health conditions, to this idea that they're safe, or that anybody can take
them in any circumstance and have this kind of awakening. And that's not what the data show, right? The data are these highly
controlled settings, you know, carefully selected patients. So that's my worry, you know. - Sure. And I'm going to be sitting
down with Matthew Johnson at some point, and we'll discuss this. And I think that, ah,
that care and that cocoon of real clinical care, does seem to be an important component.
- Yes. - Well I'm glad we could
touch on it and, you know, I'm sure I'll get a bunch of comments telling me that, you know. But I think it is
important to explore things from all sides, and that's what we do, as scientists.
- Yes. - And if Michael Pollan wants
to chat, we can do that too. That's fine. I very much enjoyed the book actually.
- Yes, yes. - But I think that people run with ideas. - That's right. - They don't walk with them, they sprint.
- That's right, right. Yeah. - There are a couple other
things I just want to touch on, but they all relate to social media. - [Anna] Okay. - You were featured in
"The Social Dilemma". It was a powerful movie. I think many people
avoided seeing that movie because it reflects back on us
just how addicted we all are and how manipulated we all are. - [Anna] Yes. - But it doesn't seem to
have changed behavior much. I have to say that the movie changed my understanding
and my perception, but not my behavior too much. If we look at addiction
as a maladaptive thing, something that's making our lives worse or us less functional at
work and in relationships, I could imagine a version of social media where it's making me more connected. I mean this is a podcast after all. - Yes, yes.
- I post videos. This will show up on YouTube and elements of it on Instagram as well. So much like sugar or other things, I have to imagine that
we need to regulate, not necessarily eliminate, this behavior. So I want to talk about
what that looks like. And I want to talk about
what you've referred to as this narcissistic preoccupation that social media is creating. That we are all far more
keenly aware of how we look and how we sound and how
we are being perceived, than we were 10 years ago. - [Anna] Right. - So first of all, social media,
how addicting is it really? And what is healthy social media behavior? - So the first message I
would want to get across about social media, is
that it really is a drug and it's engineered to be a drug. And it's based on, you know,
potency, quantity, variety, the bottomless polls, the likes, the way that it's enumerated, all of that. Which doesn't mean that we can't use it, but we need to be very thoughtful
about the way we use it, just like we need to be thoughtful about the way we use any drug. And so that means with
intention and in advance, planning our use, right. And trying to use it as
a really awesome tool to potentially connect with other people, and not to be used by
it or get lost in it. And of course, you know, people are going to come
with different propensities for addiction to any drug, and that's true for social media too. Some people will have no
problem using it in moderation or using it in a way that's adaptive. And other people will
immediately get sucked in. And the key thing about
getting addicted is when it's happening, nobody
who's getting addicted thinks they're getting addicted, right. Let's face it, it's only after
the fact that we go woops, you know, what was that about? - Remember texting and driving, there are all these books
about texting and driving, how terrible it was. - Yeah. - Even the governments
have largely given up. You see these billboards - Terrifying.
- like don't text and drive, or any text can wait, or whatever. Not worth dying for. - Right, right.
- But everybody's texting and driving. - Right and if you look at
young people today, teenagers, I mean they're basically
cybernetically enhanced, that the phone is there. You know, it's like they're talking to you and texting 12 friends at the same time, and there's no stopping it. I mean the genie is out of
the bottle where, you know, we're not going back. - [Andrew] Right. - So we do need to figure out, you know, how to make this tool
something that's, you know, going to be good for us
and not ultimately harmful. And I don't have all the answers by any stretch of the imagination,
but I do think, you know, some of the wisdom that we have learned from using other drugs, also
applies to social media. Which is to say that we have to, again, put barriers in place that allow us to remain in control of our
use, which means not too much, you know, not too often, not too potent. - Do you think in, going
back to this idea of the unit of the day being
a good attractable unit, a manageable unit of time for most people, so you're saying in advance,
so allocating two hours in which you're going to
allow yourself to have free reign use of the phone and all its apps and all its things, or even more restricted
than that, meaning okay, I'm only going to allow
myself 30 minutes a day to post and comment, and then
that's a closeout completely. - Yeah, so I think it's,
it depends on the person and sort of a combination. We talked earlier about, you know, having an itch and
scratching yourself at night. We've gotten to a point with smartphones, people are pulling them out and they are utterly
unconscious of doing so, pulling them out, you know,
a couple of texts, a couple. They don't know they're doing it!
- I have a friend who works in, delivers babies, and many pregnant mothers won't actually deliver
without their phone in hand. And this used to be the hand that was connected to their spouse. This may be a comment on
spouses more than on phones. But it sounds like it's a
kind of a security blanket of sorts.
- Right, like a transitional object, yeah. - Actually that reminds me,
you've referred to the phone, I think it's the phone, but maybe it's our online
persona or ourselves, as we've become sort of
infantile in our need for, it's like a baby and a bottle. - Right, right. - And so I do wonder if we have regressed, and I do think we've
regressed a bit in terms of our online behavior. Our inability to act like. I always thought an adult was somebody that can
control their behavior. - Yeah.
- That's the difference between a baby and an adult. You don't have to be a
developmental neurobiologist for very long to understand that a young organism
can't control its behavior, an older one can. So to me, a mature organism,
mature in years organism that can't control its
behavior, is a baby. It's an immature version of itself. And there's neuroscience
to support that statement. I look at my own behavior
with the phone sometimes and I think, I'm a grown man. Like what is the problem here, right? You know, I don't eat baby food, but I'm acting like a baby
with the phone, all right, in the sense that I'm
reflexively picking it up, I'm not being intentioned
and deliberate with it. Do I need a full 30 days, Anna? - So yes, so- - 30 days away from my phone? - As you know, that's my recommend, the full 30 days to reset. If you're severely addicted,
I recommend the 30 days. But if you're just a little
bit addicted, like most of us, you probably don't need 30 days. In fact, a single day, not
only would be challenging, but probably may be sufficient. - My phone is off for
substantial segments of the day. - Okay, that's great. - And it drives other people crazy. People expect me to respond. But I don't care. - Yeah, right, right.
- I really don't. And I actually take a
little bit of pleasure in the fact that, well, because I think the
point I'm trying to make is the right one, which is that
it's not just right for me, but like why, I don't see
a clause on text messages or emails that say must
be responded to within X amount of time or else, or else. So I take the liberty of
replying when I'm able to. - Yeah, that's right.
- Or want to. - Right, which touches on
one of the big challenges about social media, is
that as more and more of us are spending more and
more time on social media, we're divesting our libidinous
energies, et cetera, from real-life interactions. So that means even when we want to choose to not be online connecting, we go outside and there's
no there there, right. There's nobody else there. So I think our collective challenge, and it should be our mission, is to make sure that we are preserving and maintaining offline ways
to connect with each other. 'Cause if we don't do that then
we'll be very lonely, right, if we were not online. But if you have a tribe of
folks that you can be with, none of whom are on their phones while you're together for
that discreet amount of time, then it's wonderful and liberating
and nobody's distracted. And I think that's really the key. And I think young people are
figuring that out, you know. They're trying to create these
spaces or try to, let's say, instead of doing a
dopamine fast by yourself, do it with your friends, right. Then there's the FOMO is
less, the fear of missing out because, oh you're all doing
the dopamine fast together. So these are some of the tricks
that we can come up with. - I like that.
- Yeah, okay good.
- I like that. I don't allow, I have a home
gym and I love working out. I just enjoy it and always have. And I don't allow my
phone in my gym anymore. - Right. - And I live in an area where
I don't get any reception, like two meters outside my door. So all my dog walks now are just, and they were boring as hell. - Yes.
- I also have a bulldog, he doesn't like to walk. It's really slow. And it was so boring for a while - Yes.
- because I was so used to taking calls while I walk,
- Right. - and it's super efficient when I do that. The walks now are some of
my favorite part of the day, - Yeah, right.
- because, and if the phone, if I were to get a call on one of those or they brought reception of the areas, I would be very dismayed.
- Yeah, right. - So I can attest to this, and I don't think I'm a phone addict, but I do put work into
regulating my phone behavior. - Yeah, so this is the key. You have to, with intention, prior to being in that
situation, think of literal, physical and metacognitive barriers that you can put between
yourself and your phone, or whatever your drug is, to create these intentional spaces where you're not constantly
interrupting yourself, essentially, and distracting yourself, because I really do think,
you know, I think we talked just before we started with
the interview, you know, we're losing the ability to
have a sustained thought, right? I mean we get so far and then, then you get to that point in the thought where it's a little bit hard
to know what's coming next. And it's very easy to check
your phone or check your email, or look something up on the internet. And then you never get that opportunity to finish that thought, which is really the
source of creative energy and an original thought, right. You're not just reacting to what's coming at you.
- Right, and something that could contribute to the world. - That's right. - I'm a big believer that
you're either consuming or you are creating. And there is, I should
mention, it's important, I do believe in neutral time. I think sleep is great. I'm a big proponent of sleep and I've talked a lot
about it on the podcast, I care a lot about sleep. And not just for sake of performance. I actually just really like sleep. I think that being a constant consumer of visual information and
information of all kinds, can be a problem. But there's some really
great sources of information on the internet.
- Yes. - And I certainly benefit
from the fact that those channels exist. Narcissistic pre-occupation. Am I a narcissist? - You know, first of all, there's healthy- - Or is the fact that I asked,
does that take me out of, would a narcissist
never ask that question? - Oh yes, a highly
sophisticated narcissist - Oh I see.
- would know to do that. - Well I'm not very sophisticated. - So there's healthy narcissism, which means that we all
invest our personal energies into things that we care about. And if our competence in
that arena is threatened, we would all experience
a narcissistic injury, and that's normal and healthy. But we are living in a
narcissistic culture, I mean that's not news, this preoccupation with
individual achievement and individual self-worth and
individual self-confidence. And I think all of that is
just fueled by social media, where we're not just seeing ourselves, but we're seeing people's
reactions to ourselves, and every single, you know,
thing we say or do, you know, we get likes and this and that. It's really insidious and
it contributes, I think, ultimately to a lot of personal shame, because we're not really
meant to be individuals bouncing around in the universe. We're social animals. And we're probably generally happiest, even for natural contrarians among us, when we're part of a tribe, right. And if we do too much to
kind of separate ourselves from that tribe, I think that the brain's natural and instinctive corrective
mechanism against that is self-loathing and shame. So, you know, it's so ironic because the culture tells
us if we just achieve more, we'll like ourselves more. But the truth is actually the opposite. That I think when people
get these pinnacles of personal achievement, you know, you have things
like the imposter syndrome or whatever, you know. - Or you just, you know, we're at Stanford after a lot of high achievers. - Right.
- Right. Some phenomenal, amazing
people like yourself and other colleagues of mine
that just, I'm always in awe. Like it's just amazing, like
the mean is shifted so high. And also people who have
amazing paths to get here, coming from very little
and accomplishing so much. But it's also the pressure, - Yeah.
- right. You know, the way that this
career was described to me the day I got my job, was
one colleague of mine, the late Ben Barres said,
welcome to schizophrenia 'cause you're never going to
be able to complete anything without getting interrupted. That was partially true,
although I've created buffers. And the other one, very
successful scientist, member of the National
Academy, et cetera, said to me, you know, just remember, it's pinball. You never win. The best you can do is just keep playing. - Yes, right.
- And I thought wow, okay. Okay. And then you just go. - Right.
- But I think that as we achieve more, not
just academics of course, but as anyone achieves more, there's the relishing
in the accomplishment. There's often the desire for more, but there's also the pressure of, well now I have to do this
for the next 30 years, even though I love it. It's the pressure of, well,
if the mountain is this high, then how do I get here and here and here, and then you start shoveling more dirt on so you can keep climbing. And it's a lot of work. - [Anna] Yes. - And I think that the
perception of success is that there's a roar of the
crowd and you cruise. You don't cruise. They just give you more to do. - Right.
- Or you give yourself more to do. - Well what I think is, at
least in my life experience, and I've heard this from other
people as well, you know, it's that prize that we're going for, that if we get it is so unsatisfying. And it's the prize that we never imagined that we kind of go, well,
how did that happen, but gee, you know, that feels good. And so I'm very, what's the- - It's like a mirage - Yeah.
- in the one case. - Yeah. - It's almost like dopamine
can create these mirages. - Yes. - That there's some place there.
- That's right. And if I just, it's that pot of gold. If I just-
- Constant dopamine. - Right, right, that's right.
- Constant dopamine. - And I think, you know,
this really, I think, is related to our discussion earlier about this taking it one day at time, or paying attention to that, you know, 24-hour period in your environment. I am absolutely fascinated by the ways in which we accumulate
success, when we do that, totally independent of
the desire for success. It's really process-oriented. It's like, where am I today? How can I make today a
good and meaningful day, a little bit better, or as good as some other days I've had? Constantly tweaking and experimenting with this experiment that
we call our human existence. And when we do that in
a way that's authentic and paying attention and value-driven, whatever our, you know,
values are informed by, it is very, very interesting how those days again
accumulate, and you find, well, I guess I contributed
something of value there, but I wasn't trying to do that. You know, I think that's really, I mean, what I'm so amazed
by is like, you know, 20 years ago when I went
to Stanford Medical School, or 25 years ago, you know, I just, I was happy to just be a good doctor. I was like, I guess I'm just
going to try to figure out how to be a good doctor,
I'm here to learn that. And now I see these medical
students, and they're wonderful. They're brilliant and they're
- They are. - well-intentioned, all that. But they're like how can I, you know, write the great American novel,
do my startup, go to Africa, apply for that grant? You know, it's like, really, I was just trying to
learn how to be a doctor. And it's, as you say, it's
a lot of pressure on them. And it's also kind of a weird leapfrogging of the real way to accomplish something. - Right.
- Which isn't about like oh how can I accomplish something. It's like, what can I do today
that would be of service. Right? And then finding that of trying
to be of service, you know, and not really going for recognition, can sometimes lead to
what people call success, although that wasn't
what you were aiming for. - And it's all the more beautiful when it's not what you're aiming for. - Oh so much better, so much better. - Yeah, I'm a big
believer that when one can align their compulsion
with some greater good. - Yes, right.
- A service to humanity or the planet or animals, whatever it is, that's where the really
good stuff emerges. Because there's a lot
of reciprocity there. The world starts to,
you're supporting the world and then it starts to support you in a way that feels very fluid.
- And it comes back. Right, and I mean that speaks to you like your generosity to
me, vis-a-vis my book. And I have to say- - Well, I love the book. - I know, it's- - There's like, we're not
in a business deal folks. It's just purely that I heard
Anna lecture in my course, I wanted to learn more about dopamine. She taught me, I asked her if she would
come on the podcast. Turned out she wrote this amazing book. She sent me an advanced copy of the book. I read it in one sweep, it's incredible. And I love it. So just like the eight
year old version of me, now the 45 version of myself, I can't stop blabbing
about the things I love. - Well it's awesome, but I have to say, I have been surprised by your generosity. It's not something I've
encountered frequently at Stanford, which is a wonderful place. But there is a general
sense that if I give away to somebody else, I've lost something, which is not the right
way to think about it. Not how you are, and also
not how the world works, 'cause when we give away to other people, we get back so much more. But it takes a long time and it might not come through that path. - I never think about reciprocity. But I was weaned by good advisers. - That's very nice, - Yeah.
- yeah. - I think it just sort
of got drilled into me that the more you give, the
better your immediate life is. - Yes, yeah. - And I also don't have a
long-term vision, you know. I just, I'm just excited about the book. I'm excited that people are learning about the brain and dopamine. I have to admit, having grown up in
neuroscience essentially, I did not understand
that pleasure and pain were orchestrated the way that they are. I'm very mindful of it now. - Oh good. - And it's changed a
number of my behaviors. I know a number of people
are going to have questions and want to get in contact with you. You are not on social media. - That's correct, yes. - You are true to your ideology. That's great. - And the reason for that is just, I wouldn't be able to control myself. I mean, that really would be my drug. People are my drug, intimacy is my drug, and I wouldn't be able to manage it. And so just, it was just easier
for me to not do it at all, rather than try to moderate it. - Well the book, as you mentioned before, and as I can attest to, is
it has a certain intimacy. People get to know you through the book. So definitely check out the book. If you have questions
about the book, et cetera, you're welcome to send them my way. I will buffer you from
all those questions. I'll filter them. Anna, Dr. Lembke, I should
be formal, forgive me, I've been referring to you - No no, that's fine.
- as Anna the whole way through,
'cause we're colleagues, but thank you so much for
sharing this information. And I know I learned a ton. and I know everyone else is
going to learn a lot more about addiction and the
good side of dopamine. - That's right. Thank you for having me. It's been really, really
great to talk with you. - Great, thank you. Thank you for joining me for my discussion with Dr. Anna Lembke. I hope you enjoyed it as much as I did. Please be sure to check out her new book, "Dopamine Nation, Finding Balance
in the Age of Indulgence". You can pre-order it on Amazon or any places where books are sold. It's an absolutely
fascinating and engaging read, all about addiction and dopamine. If you're learning from, and
or enjoying this podcast, please follow us on YouTube by subscribing to the
Huberman Lab channel. In addition, you can
subscribe to the podcast on Apple and Spotify, and on Apple you have the
opportunity to leave us up to a five star review. If you have comments or suggestions for topics for future podcasts, please put those in the comments section below this episode on YouTube. In addition, we have a Patreon. That's patreon.com/andrewhuberman. And there you can support us
at any level that you like. Please also check out our sponsors that we mentioned at the
beginning of the episode. That's a terrific way
to support our podcast and our ability to continue to bring you zero cost to consumer
information about science and science-related tools. And last but not least, thank you for your interest in science. [upbeat guitar music]
