December 20, 2024 • 44 mins
Dr. Anna Lembke, bestselling author of "Dopamine Nation," joins Christine MacCarroll to explore the modern challenges of navigating pleasure and addiction in a world designed to hijack our brain's reward systems. The conversation delves into the fundamental role of dopamine as a neurotransmitter that influences our motivation, pleasure, and ultimately, our behaviors. Lembke explains how our ancient brains are misaligned with today's environment of overwhelming abundance, leading to compulsive overconsumption and addiction. They discuss practical strategies such as self-binding and the importance of creating structure in our lives to combat these issues. As they unpack these concepts, listeners are encouraged to reflect on their own relationships with pleasure-seeking behaviors and consider the benefits of taking a break from their "drug of choice."
Takeaways:
- Dopamine plays a crucial role in both pleasure and motivation, impacting our behaviors significantly.
- Our ancient brains are misaligned with the modern world, leading to compulsive behaviors.
- Digital devices and social media have drug-like effects, making moderation challenging for many.
- Self-binding strategies can help individuals manage their 'drug of choice' effectively.
- Abstaining from addictive substances for 30 days can reset the brain's pleasure pathways.
- Creating structures in our lives is essential for managing addiction and promoting well-being.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Here's the truth.
We live in a world where everyswipe, sip and snack has been engineered
to hijack your brain'spleasure circuits.
How do we find balance in aworld that's addicted to more?
Today I'm joined by Dr.
Anna Lemke, bestselling authorof Dopamine Nation, to explore why
our ancient brains struggle ina modern world and what we can do
to reclaim control.
(00:21):
Welcome to ADHD NaturallySmart Solutions for.
Holistic women with Christine McCarroll.
Hi, I'm Christine, and this isthe spot to learn natural strategies
for supporting your ADHD brain.
As a woman with all thehormonal curveballs and unique challenges
that only females.
Face, I've made it my mission to.
Uncover the root causes andlittle known supports for your ADHD
(00:41):
brain that your doctor doesn'tknow and won't tell you.
Learn the truth and find your focus.
No prescription required.
Hey friend.
Welcome back to anotherepisode of ADHD Naturally.
This week is a bonus episodeof an interview I recorded back in
2022 with the phenomenal Dr.
Anna Lemke, New York Timesbest selling author of Dopamine Nation
(01:02):
Finding Balance in the age of indulgence.
Dr.
Lemke has also written aboutthe opioid drug crisis in her book
drug dealer, MD, and appearedas an expert in the Netflix documentary
the Social Dilemma, and morerecently appeared on the Huberman
Labs podcast with Dr.
Andrew Huberman.
Back when I recorded thisepisode, I was just a few months
into my own ADHD diagnosis andI was working towards my certified
(01:24):
Brain health professional certification.
Listening to the episode withfresh ears two years later with everything
that I've learned andexperienced again was eye opening
all over again.
And even though I read herbook twice at the time, I was actually
sent back to her amazing book.
So on this episode, Dr.
Lemke and I discuss how ourbrains are wired for the pursuit
(01:45):
of pleasure, how this wiringcan get us hijacked in a modern era
of abundance, and howeverything from romance novels to
heroin can be fodder foraddictive behavior, even if we don't
think of ourselves as addicts.
While Dr.
Lemke and I didn'tspecifically get into ADHD, dopamine
happens to be the primaryneurotransmitter involved in the
symptoms of ADHD, and Dr.
(02:05):
Lemke discusses the use andabuse of stimulants like Adderall
in her book.
Per her formal bio, Anna Lemkeis Professor of Psychiatry at Stanford
University School of Medicineand Chief of the Stanford Addiction
Medicine Dual DiagnosisClinic, a Clinician scholar.
She has published more than100 peer reviewed papers, book chapters
and commentaries.
She sits on the board ofseveral state and national addiction
focused organizations, hastestified before various committees
(02:27):
in the United States House ofRepresentatives and Senate, keeps
an active speaking calendarand maintains a thriving clinical
practice.
Well, Dr.
Anna Lemke, welcome to the podcast.
Thank you for having me.
I'm excited to be here.
I have to say.
I am.
I'm just thrilled to have youjoining me.
I have actually read your book twice.
(02:48):
So we're going to be talkingabout your book, Dopamine Nation.
You've written more than one,but that's the one that inspired
me to reach out.
I was actually rereading itlast week kind of in preparation
for this conversation and Iwas highlighting it and my daughter,
who's 15, is like, she's justlearning about highlighting books
in high school right now.
(03:09):
She's like, oh, mom, is this like.
What do you highlight?
And I said, well, I'mhighlighting the things that are
important.
And she's like, well, what ifeverything is important?
I was like, yeah, but actuallythat was my feeling in this book
is like, everything is important.
So it was hard to highlight.
Yeah.
(03:29):
Thank you.
So I am definitely going torecommend that everyone reads the
book.
Well, thank you.
So this is a really timely conversation.
I know that people have aquestion already just starting out,
like, what is dopamine?
We're going to talk about dopamine.
I have a lot of secondaryquestions to that.
But just starting out, thewhole title of the book is Finding
(03:51):
Balance.
Dopamine is a kind ofneurotransmitter that isn't necessarily
about balance.
So can you just tell us whatis dopamine and what does it maybe
drive us to do or how does itdrive us to act?
Yeah.
So dopamine is aneurotransmitter in the human brain.
It is.
Neurotransmitters aremolecules that bridge the gap between
(04:12):
neurons.
That gap is called the synapse.
Those neurotransmitters allowfor fine tuning of the electrical
circuits conducted by the neurons.
Dopamine has differentfunctions in the brain, but one of
its most important functionsis for the experience of pleasure,
reward and motivation.
It may be even more importantfor motivation than for pure pleasure.
(04:34):
For example, there was a veryfamous experiment where rats were
engineered to have no dopaminereceptors in their reward circuit,
their brain.
And what the scientistsdiscovered is if they put food in
the rat's mouth, the rat wouldeat the food and seem to get pleasure
from the food.
But if you put the rat, thefood, even a body length away, the
rat would starve to death.
In other words, the absence ofdopamine took away that organism's
(04:57):
motivation to do the work, toget the reward.
So dopamine, you know, it'simportant for pleasure, but again,
it's very, very important for motivation.
The more dopamine that'sreleased in the reward pathway and
the faster it's released, andthis is really, the faster it's released,
the more likely it is to be addictive.
And also, dopamine is aneurotransmitter that's not just
(05:21):
released in response topleasurable stimuli.
It's also released in responseto anything that nature feels like
we need to pay attention to.
So it can be released inresponse to aversive stimuli as well,
or even just anything that'snovel in the environment, anything
that's new.
Dopamine is a neurotransmitterthat says, pay attention to this.
Mm, awesome.
(05:43):
So that's really easy to visualize.
I'm like imagining it like abright red flashing light of like
here is where attention belongs.
And I can imagine thatmillions of years ago when we were
beginning to, to be evolvingon this planet, we had to pay attention
to where to get food.
We had to pay attention to hownot to get eaten by the lion.
(06:03):
We had to remember where therewas water.
There were probably, eventhough there was a whole world full
of, of signals of this is important.
The big differ, the Earth asit was for most of human existence
and the Earth as it has beenfor the last 200 years, is that for
most of human existence, welived in a world of profound scarcity
(06:26):
and ever present danger.
Like we had to work 247 justto live to age 30.
Most of us died in infancy.
We no longer live in that world.
We now live in this world ofoverwhelming abundance, where for
most people living, especiallyin wealthy nations, all of our basic
survival needs have been met.
(06:46):
And further than that, we havenow basically surrounded ourselves
with these highly accessible,highly abundant, highly potent novel
drugs.
We've even drugified thingsthat used to be healthy or good for
you.
And we have drugs that didn'texist before, like social media and
video games and onlinepornography and online shopping.
(07:08):
So the result is that, youknow, our ancient wiring, which was
evolved for this world, worldof scarcity, is really mismatched
for the world that we live in today.
Which is why we're seeinggrowing rates of compulsive overconsumption,
addiction and the Sequelae ofthat, which is despair, essentially.
Anxiety, irritability,insomnia, dysphoria.
(07:30):
So I want to unpack that alittle bit.
Have our brains actuallychanged all that much since millions
of years ago?
Are they essentiallyfunctioning the same way that they
did?
So it depends on what part ofthe brain you're talking about.
But if you're talking aboutthe reward circuit, that has remained
largely unchanged acrossspecies and over millions of years
of evolution, we arereflexively wired to approach pleasure
(07:53):
and avoid pain.
It's what has kept us alive ina very dangerous world.
We don't have to think about it.
We do it reflexively.
In fact, where we do have aheavy cognitive lift is to actually
avoid pleasure and approach pain.
That requires the massive graymatter frontal lobe that we have
added on top of the moreprimitive structures of our brain
(08:14):
over the last period of evolution.
But that reward circuit isessentially identical in a lizard,
which is why it's sometimesreferred to as lizard brain.
Yeah, so we have the samestructures, but we have an amplitude
of millions times more sortsof stimuli now than we did before.
(08:37):
What does that do to ourinteraction with our world when we
have that constantavailability, like just as humans,
not even addicted humans, justlike as a human.
Right.
Well, what it means is thatwe're all more vulnerable to the
pathophysiology of addiction,and we're all engaged in compulsive
(08:58):
over consumption, even ifwe're not crossing that threshold
into addiction.
And the reason for that ishighlighted by neuroscientific findings
in the last 50 to 75 yearsshowing that pleasure and pain are
co located in the brain.
So the same parts of the brainthat process pleasure also process
pain.
And they work like oppositesides of a balance.
When we experience pleasure,it tips one way.
(09:20):
When we experience pain, ittips the other.
But there's an overarchingrule governing this balance.
And that rule is that thebalance wants to remain level.
And with any deviation fromneutrality, our brains are going
to work really hard to restorea level balance.
And they do that by tilting anequal and opposite amount to whatever
the initial stimulus was.
(09:40):
So if the initial stimulus waspleasurable, we're going to pay for
that with a period of painequal in measure right afterwards,
we're going to get a little,you know, bounce into happiness falling
on the heels of pain.
And that's really, reallyrelevant for understanding how our
brains are responding to thisreward overloaded world.
(10:00):
Essentially what happens iswhen we are exposing our brains to
a reinforcing substance orbehavior, and they're surrounding
all day long.
From the moment we grab ourphones in the morning and see who
texted us to our morning cupof Joe all the way to our Netflix
shows in the evening, we'regetting a surge of dopamine from
those stimuli.
Not just a little bit, a whole lot.
(10:21):
It's coming out really quickly.
And our brain responds bytipping an equal and opposite amount
to the side of pain.
I like to imagine that asthese neuro adaptation gremlins hopping
on the pain side of thebalance to bring it level again so
they stay on until we'retilted and equal and opposite amount
to the side of pain.
That's the come down, thehangover, the after effect, or just
that moment of wanting to, youknow, eat one more sugary muffin
(10:43):
or watch one more Netflix episode.
Now, if we wait long enough,those gremlins hop off and you know,
that craving passes andhomeostasis is restored.
But the urge to continue toconsume once our pleasure pain balance
is still the side of pain isreally overwhelming because we want
to get it back to homeostasisor better yet, back to the side of
(11:07):
pleasure.
And so if we have immediateaccess to our next show.
And of course with Netflix, wedon't even have.
We do, but it just.
It just comes like, we have tostop it.
We have to do work to stop it.
And that's so emblematic ofthe world that we live in today.
We actually have to do work tonot get our reward.
The result of that, if wecontinue to expose our brain days,
(11:29):
weeks, months to continuedpleasures, what happens is that an
initial deviation to pleasuregets weaker and shorter.
That's called tolerance.
But here's a really key piece.
That after response to paingets stronger and longer, in other
words, those gremlins start to multiply.
Pretty soon we have enoughgremlins on the pain side of the
balance to fill this whole room.
And eventually they're campedout there, tents and barbecues in
(11:51):
tow.
And that's the addicted brain.
Right?
Then we're in what we call achronic dopamine deficit state.
Now we need to use, not to gethigh, but just to level the balance.
And when we're not using,we're walking around with a pleasure
pain balance chronicallytilted to the side of pain, experiencing
the universal symptoms ofwithdrawal from any addictive substance
(12:12):
or behavior, which areanxiety, irritability, insomnia,
depression, and craving.
Mm.
So when you're talking aboutpain, like, most people associate
that with, like, I have aphysical pain, and in a way, it is
a physical pain.
Like that craving is like, canbe a physical thing.
Absolutely.
You're not like, okay, pain,like all of a sudden my toe hurts.
It's like, it's the pain I'malmost imagining like heartbreak
(12:35):
or loss.
It's the emotional discomfortand it's the, the space that you
want to fill with the pleasure.
Right.
So there is the thing that'slike, I need that thing back in that
space.
There's an empty hole therethat I don't like.
Is that right?
Yeah.
So when I use the word pain inthis context, I'm really talking
about both physical andpsychological pain.
(12:57):
There are many drugs that so.
And I think withdrawal fromall drugs is psychological.
So it's a hunger, it's ayearning, it's wanting to fill, fill
that space.
But there are also many drugsthat have a physical component to
their withdrawal and somedrugs that have a life threatening
physical component component.
Right.
So for some people, alcohol,benzo and opioid withdrawal can actually
(13:18):
be life threatening.
People can seize and die.
It's the, you know, minorityof people who are at risk of that.
But that's a possibility as well.
So I think one of the thingsyou did really well in the book was
having these case studies thatspanned the spectrum.
So somebody on like the veryextreme, where someone's like, that
is someplace I would never goor I wouldn't understand that kind
(13:39):
of addiction to something thatmay seem a little bit more mundane.
You shared about your personaljourney with romance novels, which
is fascinating because I havespoken to someone recently who is
experiencing that exact same thing.
Yeah, I can recognize that.
But in a way, it's like, youknow, we all have our personal, we
(14:00):
all have our personal pleasureseeking thing that we're doing.
So we all have the capacity ina world where everything is available
all the time to get thoseconstant hits.
And probably we're tryingharder and harder to shrink the space
between the feeling of, gosh,that thing is gone and I have to
get the next hit of that thing.
(14:22):
Right.
I mean, that's precisely theproblem now that we do have nearly
infinite access at the touchof a finger to these, you know, feel
good pleasures, you know, orat least these escapes.
And it does make us all morevulnerable to the problem of addiction
because we've, we've sort ofhacked the motivation circuits.
(14:43):
Whether it's a romance novelor, you know, a cannabis gummy or
a cup of coffee.
You know, we have figured outas a species how to make it its most
potent form.
We've also figured out thatwhen we start to run out of its effects.
If we combine two drugstogether, you know, it'll.
Yeah, it's more potent.
(15:04):
We figured out these ways toget more potency.
So that's why you'll see, forexample, people, what they call double
screening, they're watchingNetflix and on their phones.
At the same time, ourthreshold continues to go up for
what we need to experience pleasure.
And at the same time, oursensitivity to pain is going up because
that pleasure, pain balancegets more and more tilted to the
(15:24):
side of pain.
So it's problematic because Ithink what a lot of us are experiencing
is that our relentless pursuitof pleasure leads to pain.
Right.
It puts us in this.
Not just in a neutral statewhen we're not using now, we're in
a painful state when we don'thave our drug.
Which is why, you know, theunderstanding this is crucial because
the intervention is going tobe very, very different.
(15:46):
Given the reality of thatneuroscience, the intervention is
going to be not, well, makeyourself more comfortable or, you
know, go to a therapist and.
And instead it's going to be,well, you know, our problem is that
we have too much comfort andtoo many intoxicants and that what
we really need to do is makeour lives intentionally.
Harder, which is what we arehardwired not to do.
(16:07):
That's right.
Beginning of the conversation,or hardwired to avoid it.
So even doing the thing likepressing pause on the next Netflix
show that wants to pop up is,in a way, we're triggering that little
bit of.
Of pain because we actuallyhad to stop the pleasure from coming
in.
But we've also reset our baseline.
So.
(16:27):
And.
And I wanted to be actually,like, explicit on some of the things
that you're calling drugs inin your book is it's not just drugs
the way that we typicallythink of them.
And even though lots of peopleare familiar now with, like, the
opioid crisis, certainly thereis a actual drug component.
There are things that peoplehave long recognized as drugs, like
(16:48):
alcohol, even though they are legal.
But then there are also thingslike I would say 90% of everybody
I know has to have a morningcup of coffee, right?
There's social media.
There's even, like, the gameson our phones.
There's constant dinging fromthe work email coming through, which
some people actually, I think,respond, you know, almost a Pavlovian
(17:10):
response to the ding of theemail or the text or whatever coming
through.
So there is no world in whichwe exist unless we just go out and
live in, like, you know, theTundras of Alaska or something where
there isn't something comingin because we all have something.
And then that baseline is justconstantly getting shifted.
Something that I thought wasan interesting.
(17:32):
It's an interesting concept isthat we then have to get more of
that thing to remain neutral.
Right.
So that the baseline is nowadjusted to that stimulus.
And I was immediately justthinking of coffee again, because
that's like everyone I know.
So.
And people say it in a jokingway, like, I have to have my cup
of coffee to be human in the morning.
(17:54):
Like, everybody says that.
But like, truly now we have adifferent baseline because we're
caffeinated.
Yep.
And I think, you know, if itwere just coffee, you know, which
is, you know, a knownstimulant, and we drank it in moderation,
it's probably no big deal.
The problem is that it'scoffee plus our phones, plus our
(18:14):
laptops, plus food, which hasbeen drugified, plus our entertainment,
which is now accessible 24 7.
So that, you know, ultimatelywhat's happening is that we're escaping
reality.
Right.
Where we don't have to befully present for ourselves and other
people in our lives.
And it's our natural instinctto do that.
(18:37):
Yeah.
You know, which makes itreally, really a hard project and
also a collective project.
Because if we're on our owntrying to get back to homeostasis
and normal, healthy dopaminelevels and no one else is coming
with us, it's a pretty lonely place.
You know, I think often now ofparents saying, well, I'd be more
than happy to send my kid outto the back alley to play kick the
(18:58):
can, but there are no otherkids there because inside on their
computers.
And that's absolutely right.
It's a.
It's a collective problem.
And that's why I think thisconversation is so important.
When I say this conversation,I mean this societal problem is really
where we have to essentiallybegin to build a world within a world
where we insulate ourselvesfrom not just our drug of choice,
(19:20):
but also the constant triggersthat also release dopamine that make
us crave our drug of choice.
You talked about self bindingin the book.
So basically, when we are inthis constant exposure, if we go
to the point where werecognize that whatever our drug
of choice is, be it cocaine orromance novels, is impeding with
(19:44):
our lives, and we want tochange our relationship to that thing,
first of all, it has to be conscious.
But there's this tool thatyou're talking about self binding
that goes along with it.
Can you tell us about self binding.
Sure.
Yeah.
So self binding is a way touse both literal and metacognitive
barriers between ourselves andour drug of choice so that we can
(20:08):
press the pause button betweendesire and consumption.
Of course, you know,willpower, we, we have it, but it's
not an unlimited resource.
We wake up with more willpowerin the morning than we have at the
end of the day when we're tired.
It renews itself, typicallyover 24 hours.
But if we just rely on ourwillpower and continue to allow ourselves
to be constantly triggered,we're not going to make progress.
(20:31):
And it's very, very difficult.
You know, once we have thatpleasure, pain balance tipped to
the side of pain to resist thecravings and the general despair
of that, that neurophysiologic state.
So much better that we don'tget into it at all.
And we can do that by againcreating these barriers.
So, for example, for myromance novel addiction, one of the
big instigators was when I gotan E reader.
(20:52):
I had got a Kindle, which madeit possible for essentially me to
be a chain readers.
As soon as I finished onebook, I could go on and read the
next.
I got, you know, cheaper andcheaper samples on Amazon.
You can get free, free romance novels.
I needed more potency overtime to get the same.
In fact, I ended up, you know,reading frank erotica that was not
consistent with my values.
It was interfering with myability to be the parent and the
(21:13):
spouse and the psychiatristthat I want to be.
So one of the first things Idid when I realized I had to abstain
for 30 days, which is what Irecommend to patients in order to
reset reward pathways.
I got rid of the Kindle.
I got rid of my.
I just simply threw it away.
And that was a, you know, aself finding strategy.
Now if I wanted to romance, Ihad to go to the library or I had
(21:35):
to go to a bookstore.
It's not a big barrier, butit's just enough that it allows me
to, you know, access whateverremaining willpower I may have and
remember why it is that Ididn't want to read romance novels
in that month of abstinence.
So that's an example.
(21:55):
It's a literal geographic barrier.
Other geographic barriers arethings again, like putting our phones
in a different room, turningoff our phones or devices, deleting
certain apps.
Other barriers for likeaddicted gamblers, they could put
them themselves on a no playlist.
So if they go to the casino,they can't actually get in because
they're on a, you Know, a listlike that, other things might be
(22:17):
categorical self bindingstrategies where I realize, okay,
well, I can read maybe acertain type of like for a while
I felt I could read certaininspirational romance novels.
That's a genre of romancenovels that they're quite religious
and they have very little sexin them.
But I told myself I could readthose but not other types of romance
novels.
So that's a categoricalstrategy, right?
(22:38):
Well, I can.
And food, we do this a lot.
Obviously I'm going to eatfood because unless, you know, you
got to eat, but I'm not goingto have cookies or I'm not going
to have processed food becausethat's my drug of choice.
Once I start, I can't stop.
Or maybe it's even just like a trigger.
So one of the things that Inoticed in my effort to abstain from
romance was that certain kindsof romantic songs on the radio, you
(23:00):
know, which most pop music is.
Yeah.
That would then triggercraving for me.
So then I stopped listening tothat music as a way to achieve my
goal.
So that's the thinking on self binding.
So I was thinking about thisin the context of, you know, your
book is Dopamine Nation.
I think you're speaking a lotto just our US audience people.
(23:20):
We do have an abundance ofstimulation in this country.
Just a fact.
And a lot of the things thatare really ridiculously addictive
have come from us like socialmedia and processed foods and all
of these things.
Like we created them.
I'm going to say that wordbinding was reminding me of just
the thought of like containersand structure and framework.
(23:40):
Yeah.
And I'm thinking about how wehad more of these in previous eras
and we have fewer and fewerformal structures to our life.
Our family structures lookreally different.
Our school structure can lookreally different.
And then over the pandemic, it was.
Almost like any structure wehad remaining was completely gone.
And so, so the structures thatused to exist aren't there for us,
(24:05):
so we have to then create them ourselves.
Is that really part of theunderpinning of the self binding
is that we don't have thosestructures to rely on?
Yeah, that's, that's reallywell said because you're, you're
absolutely right.
You know, all humans need structure.
But I can tell you, mypatients struggling with addiction,
structure is a matter of lifeand death.
(24:25):
Death.
And they do much, much betterwith structure.
I do better with structure.
And you're right, our, oursociety and our home life, it's all
gotten looser and looser andLooser, you know, even the sort of
sacred family dinner is nowgone by the wayside because many
kids have their kids in activities.
Yeah.
That are occurring, you know,so, you know, you could do a family
dinner, but only half yourfamily can show up at any, you know,
(24:47):
given time.
There's no consensus time.
So it's really tough, really ahard time to be a parent for all
those reasons.
But I think anything that wecan do as parents, especially when
our kids are little and havemore, let's say, executive control
over what's happening withthem and in the home, really important
to have regular meal times,regular bedtimes, regular wake times,
(25:09):
to have, you know, if not aday of Sabbath, at least a distinction
from the work week when thefamily does different collective
things together.
I mean, what's so amazing isthat a hundred years ago, 200 years
ago, many families not onlyspent their leisure time together,
they also worked together.
They worked in the home makingtextiles, they worked in the farm.
(25:29):
Now not only are we all flyingout in different directions to work
and go to school, but also, ofcourse, our leisure time is separate.
No longer are we even watchingthe same movie at the same time.
We're all on our devices indifferent rooms watching different
things.
So I think just acknowledgingthis and acknowledging that it has
really eroded the family inmany ways and then just being really
(25:52):
intentional about trying tobring that back in and creating a
consistent structure.
I remember my now 19 year oldson who's a sophomore in college
now, but one day he came homewhen he was about five and it was
five o'clock and that was whenwe always had dinner in those days.
And for whatever reason thatday I hadn't set the table, I didn't
(26:13):
have dinner.
And he came in and he had aliteral meltdown.
He's like, where's dinner?
We always have dinner at five.
Right.
What's going on?
And it was just such a greatreminder to me how much kids need
structure, key into structure,how important it is for them to,
you know, to feel safe.
And not just kids, us too.
Which means that, you know, itdoesn't mean you want to be like
rigid about everything, youknow, it doesn't work out.
(26:34):
Right.
Yeah.
And some days, you know, then,but, and then you got to learn to
tolerate that too.
But in general, really, reallyimportant for there to be some kind
of consensus structure.
And it will change over timeas kids age.
Right.
So what kids need in terms ofthe household structure when they're
five is going to be differentthan what they need when they're
15.
So being flexible andappreciating that.
(26:56):
Okay, well, we used to do that.
It was great.
But now we need to do itslightly differently because, you
know, the circumstances havechanged, but still having a structure
around it.
Yeah.
My intention was to follow upwith a question around things like
Alcoholics Anonymous, which Ido want to ask you about.
But it.
This direction of thisconversation reminded me of a book
I recently read called the Artof Gathering.
I believe the author is Priya Parker.
(27:18):
But the entire book is aboutthe necessity of a structure for
any sort of gathering.
So, like, even if it's aparty, right?
Like, people want to know whythey're there and they want to know
how to act.
Yes.
So if it's a costume party,people are happier if you tell them
it's an 80s costume party andyou also should be an 80s rock star.
(27:41):
Right.
And then people can actuallyjust, like, feel calmer because they
know.
Know what they're doing.
Yeah.
They know what their role is.
No, it's really true.
Sometimes patients will saywhen they're seeing me for psychotherapy
or treatment, I don't reallyunderstand how this works.
And I said, yeah, there's noreason that you should understand
it, but one of the reasons itdoes work is because there's a very
(28:02):
defined structure.
I have a role.
You have a role.
Right.
We are here to talk about youand your problems, not me and my
problems.
Right.
What we talk about in herestays in here.
There, it's a safe space.
You'll talk, I'll listen, I'll respond.
Based on what you've said thatmakes people feel so much safer,
I'll have people withterrible, terrible social anxiety
who can't go to any parties orconverse with people in public, but
(28:27):
who have no trouble talking atlength in this setting.
Why?
Because the roles are defined.
So, yeah, finding.
Finding ways to help people with.
With that and to define thestructure and give them roles is
really, really helpful.
I wonder if that's why peopleare seeking more distraction, is
(28:48):
the feeling of unease of nothaving a role to play.
Or like, in a tribe, like,these are the hunters, and these
are the loom weavers, andthese are the cookers or whatever
it is.
Right.
We don't have.
Like, we have.
We're supposed to define theseroles for ourselves, and a lot of
people have a lot of troubledefining those roles for themselves.
(29:09):
But.
Yeah, so I think there is asense that sort of life is so uncertain
and kind of spinning out ofcontrol, and that's what makes the
devices so compelling, right?
Because in that space we havecomplete control.
We can swipe right, we canswipe left, we can delete it, we
can start over again and get anew avatar.
And, you know, it's allcompletely within our control.
(29:31):
And yet paradoxically, youknow, at the same time, we're seeking
kind of to lose ourselves.
So we really, we want to be, Ithink, in many ways subject to something
greater than ourselves.
And yet in pursuit of that,what we do is try to seek more and
more control over our, ourescaping from ourselves.
(29:52):
So it's a really fascinating paradox.
So thinking about how we getourselves out of this box, or maybe
we're not even gonna, we'renot gonna get out of the box because
no one's gonna turn off socialmedia or unmake the lay's potato
chips of no one eat just one, right?
Like that.
We are going to be exposed tothose things.
So first step for someonewould be recognizing if they want
(30:14):
to change and then if they do,probably why.
And then the structures aresometimes self imposed, sometimes
things that are like communitygroup groups.
What, what are things thatpeople can do when they want to?
Well, the first thing Irecommend is to think of a substance
or behavior that, you know, weingest, that we wish we used less
(30:38):
of or not at all or in adifferent way, and then conceptualize
that as our drug of choice,whether it's romance novels or online
chess or cupcakes or alcohol,whatever it is.
And then the first thing is tofast from that drug or behavior for
30 days.
Why 30 days?
Because that's the averageamount of time it takes for those
neuroadaptation gremlins tohop off the pain side of the balance
(31:01):
and for homeostasis or a levelbalance to be restored.
And it's really important torestore that level balance number
one, to just feel better andrecapture our ability to take joy
and more modest rewards.
But also to get insight intohow our drug use, and I use the term
drug broadly, is impacting our lives.
Because when we're in it, wereally can't see it.
(31:22):
And that's just something thatI've seen again and again in myself,
in my patients.
I always warn people thatthey're going to feel worse before
they feel better when theygive up their drug of choice.
But if you can just hang inthere for about two to three weeks,
that's usually the criticalturning point where then in weeks
three and four, people startto really feel a lot better, not
just better than they did inthe first Two weeks when they were
(31:43):
in withdrawal, but actuallybetter than they have in a long time.
So.
So holding that carrot out assort of the motivation, you know,
that you can actually feel alot better and be happier if you
can just do without yourpleasure for a period of time.
And then once we get to thosefour weeks and we feel better, because
(32:03):
most everybody does feelbetter by doing that, then be really
thoughtful.
Okay.
Do I want to continue to abstain?
Is it possible for me tocontinue abstain?
How am I going to reintegratethis substance or behavior back into
my life?
And patients will always saythat, but they'll mostly say they
want to go back to using, butthey want to use differently, they
want to use less, they want tohave more autonomy and control over
(32:24):
how they're using it.
And that's where self bindingcomes in.
You know, that's where we makethese, we put these barriers in place
and then we try to either usein moderation or continue to abstain.
And we see how that goes.
And if it doesn't go well,then we have to rethink our self
binding strategies.
Or, or we have to rethink.
Maybe moderation is impossiblefor me when it comes to this drug.
Maybe I really need to abstainfrom the long haul.
(32:47):
Yeah.
So that's kind of the strategy.
Doing it collectively as afamily or with friends is a really
good idea.
You know, setting it togetherand then you have that support.
And again importantly, knowingthat you'll feel worse before you
feel better, but just get totwo weeks, you'll really notice a
big improvement.
Start to change.
Yeah, I always do a dry January.
I've heard people doSobertober, which I think is October,
(33:09):
but I think there is the powerof the collective in those moments.
So, like, it's not a problembecause everybody is all doing this
one thing together and itfeels more comfortable.
So you're not the one persondoing the weird thing outside of
everybody normalizes it.
Yeah.
So even before neuroscienceconfirmed it to be the case, people
(33:30):
have instinctively known thata dopamine fast from, you know, some
kind of reinforcing substanceis really important for resetting
brain pathways.
I think what we're only justrealizing now is that, that we can
get addicted to behaviors aswell, including digital drugs.
And so abstinence from thosebehaviors is really important to
(33:51):
reset reward pathways.
I did a digital detox at theend of the year last year where I
just said.
And it was actually like thisinteresting thing for me was the.
There is an aspect kind oflike this Kind of like when people
do like a.
Some sort of food change.
Like you still have to eatwith my phone.
(34:11):
I was like, okay, my phone.
But if I want to get togetherwith someone in person, I actually
still have to use the phone tocall them.
Or like if I need directionsto somewhere that I'm meeting someone,
like I still, I'm gonna pullup my Google Maps.
I don't have a map in my car.
Ride share or what?
You know, there are manythings that.
Yeah, yeah.
So then it's a matter ofdeleting the apps that you don't
(34:31):
want to use.
Being intentional.
Sometimes I recommend writingdown what you're going to do on the
phone or the device before youactually go on it.
Create that intentionality.
Things like that.
I have been noticing latelyhow often I go to do something in
particular and then I getconnected on whatever thing was the
last thing I had up on my phone.
Doesn't even matter what it was.
And then I'm like, what was Ihere for?
(34:52):
Why did I even open this device?
To capture attention.
So how did your digital detox go?
It was kind of like what youdescribed in the book.
Like you just start to noticeyour own response.
I mean, I probably should havekept track of how many times I reached
for my phone with no reason.
It was just a knee jerk reaction.
I kept reaching for it to getmy mind off.
I was bored sitting at arestaurant for 10 minutes for a table,
(35:14):
like, let me go play a game onmy phone.
So realizing how many timesthat I was mindlessly reaching for
it and then for sure there wasalmost like that painful like, like,
well, what am I supposed to do now?
Like, right, okay, I gottafill this up with some.
And it really did feel likesomething was leaving my.
Like I had been possessed.
(35:35):
Yeah, my body.
And I was kind of sad.
Like it, I mean it wasn'tquite two weeks, but like around
that two week mark is when Iwas like, okay, well I got it.
Like lots of things have tohappen again in my life because,
you know, end of the year Iwas able to.
Holidays, the people weren'tonline anyway.
Right.
But it was, it was a differentexperience when I came back and I
was definitely much more awareand methodical.
(35:56):
But now nine months later, I'mprobably back to where I was.
So like, I'm really lookingforward to the digital detox again
this December.
And I think that's true to life.
With these devices and thesedigital drugs, it's more normal than
not to gradually slip over time.
But at Least we're slippingnow with the awareness of what's
happening, why it's happening,and the importance of resetting reward
(36:19):
pathways, of doing thedopamine fast again and kind of resetting
those pathways, but some kindof pulsed interval that's right for
us in our lives in order tokind of just remind ourselves and
have a healthier relationshipwith these devices.
It's not that the genie isgoing back into the bottle, but we've
got to figure out how to havehealthier relationships with this
technology.
Yeah, I appreciated how muchyou went to the gray zone there.
(36:42):
Like, I feel like that's thesticky place of most conversations.
Like, people can usually agreeon the outer edges of something where
nobody's going, but where theline is of what's okay and what's
not okay and what's too much.
And that's the sticky part, Ithink, personally.
And in these largerconversations, I don't know if we
have time to fully go intothis conversation.
(37:03):
I'll ask for a quick bit ofopinion here, but I live in Colorado,
and on the ballot in a fewweeks is psilocybin.
Right.
And we were the first state tolegalize marijuana a few years ago.
And there is this growinginterest in microdosing, which I
think is people's attempt tofind a smaller spot, like, oh, I'm
(37:25):
not gonna go just go do aweekend of mushrooms.
But like, I mean, I wasresearching it recently, I was seeing
that there was this wholegroup here, it's called moms who
microdose.
Like it's a social group.
And I was like, this is fascinating.
So maybe your thoughts, if youhave them quickly on, like, microdosing.
Yeah.
(37:46):
So, you know, psilocybin,these are psychedelics.
They release an enormousamount of serotonin in the brain
and also dopamine.
They are addictive.
Contrary to what you will readin the general lay press or even
what some scientists will say,these are absolutely addictive.
People get addicted to them,use them repeatedly in harmful ways.
(38:08):
Yeah, the science is at.
Really at.
At the very beginnings.
So there's no, there's notcurrently robust evidence that they
are effective treatment forany psychiatric disorder.
There's.
There's some preliminaryevidence suggesting that in certain
contexts they may be helpful,but I can tell you it's not really
robust.
(38:28):
So if you.
One head to head studypublished in the New England Journal,
comparing psilocybin with anssri, which is an antidepressant
approved by the FDA for thetreatment of depression, basically
they came psilocybin was no better.
But psilocybin has many moreserious adverse events, including,
you know, persistentperceptual disturbances.
(38:49):
So, you know, like the meltingwalls thing.
People can sound scary therest of their lives.
Right.
Wow.
People can get psychotic whenthey take these molecules.
So although I have, I'vetalked to people who said that it
was transformative in apositive way.
You know, I hear that and I'mtrying to remain open.
But I also think it's reallyimportant that the media and the
(39:11):
online chatter doesn't getahead of the evidence because that's.
That happens so often and.
And people are harmed as a result.
So, yeah, I would just say theevidence isn't there yet.
We know about real harms.
It is addictive.
It is pressing hard and faston the pleasure side of the balance,
which means come downs are real.
Blue Monday is a real thing.
(39:32):
And also there are other, youknow, potentially permanent mind
altering effects even withvery limited exposure.
So I'm not sure it's worth that.
You know, people talk aboutwanting a spiritual awakening.
I would think that there areother ways to get that spiritual
awakening that take longer,but probably lead to more lasting
(39:53):
and more permanent brainchanges because you had to work for
them over a long period of time.
Yeah, well, and there is thiswhole area of study of these kind
of endogenously produced feelgood chemicals of a variety of sorts.
Right.
But that we actually have thecapacity for our own bodies to create
these things in the right circumstances.
(40:13):
You were mentioning a patientwho was doing the cold dips in your
book.
That's something I actually practice.
Ice cold water showers, icecold water baths.
And there is that painpleasure piece that I know you were
talking about.
But it is like the I'm my own pharmacy.
Right.
And this is the whole scienceof hormesis.
Hormesis is Greek for to setin motion.
(40:35):
And essentially when we exposeour body to mild to moderate noxious
stimuli like exercise, icecold water, intermittent fasting,
or even just challengingpsychological and intellectual endeavors,
we're essentially telling ourbody to upregulate its own healing
hormones and neurotransmitters.
We're telling our dopaminefactories to make more dopamine,
(40:57):
which means we can get thatdopamine, we can get that high, but
we do it by paying for it up front.
And that way we avoid gettinginto this dopamine deficit state
which is the hallmark of addiction.
Of course, in some rare cases,people can get addicted to pain.
Right.
And for example, get addictedto exercise.
But it's very rare.
I Like that idea, actually,that you just said of like, we're
(41:18):
paying for it up front insteadof later.
Like there is no escaping thatyou're going to pay for it.
No free lunch.
There's no free lunch much.
It's really true.
But you could choose to payfor it up front instead of putting
it on layaway.
Yes.
Yes, that's right.
Then your reward.
Yeah.
Is on the other side.
And then you don't have those.
Those potential addictive.
Or a much lower chance ofthose addictive pieces.
(41:44):
Exactly.
This has been A greatinterview, Dr.
Lemke.
I wish we had more time.
I always like to end with my fast.
Four that are just fun questions.
So nothing to do with yourcurrent work?
It might actually.
Yeah.
First one is.
And maybe this is my personaldopamine thing.
I love music.
I love live music.
So I always ask what yourfirst concert was, if you remember.
(42:07):
Wow.
I think my first concert.
I'm trying to remember.
I'm blanking on her name.
She was.
I love folk music.
And she's like an acousticfolk guitarist.
And she was sort of famous forabout five minutes and then she disappeared.
I can't remember her name, but folk.
It would have been a folkmusic concert.
Awesome.
I love that.
Do you have a morning routine?
(42:28):
And if so, what does it look like?
Yes, I do.
I get up early, usually around5 or 6 in the morning.
And I either go for a walk, gofor a swim.
Cold waters, you know.
I'm not a cold water person.
I can't do that.
I.
I was in Iceland recently withmy family and they have these alternating.
Ice cold.
I actually can't do that.
(42:51):
What's on your nightstand?
Books.
A good reader.
Yeah, me too.
No romance novels?
Not anymore.
I gave that up.
Gave that up for the long haul.
Cool.
And last question.
Any unusual talents or funthings that nobody knows about you?
Ah, well, I don't know.
Not nobody, but many peopledon't know that I speak Mandarin
Chinese.
(43:11):
I lived in China for a whileafter I graduated college and I lived
there, taught English there,came home, was a bilingual teacher
for a while, and stilloccasionally get to use it in my
practice.
Awesome.
Well, I am so glad we got tohave this conversation.
I will be linking in the shownotes to your book, your website,
any other places that peoplecan find you.
(43:33):
I know you're on social media.
That's it.
And I appreciate it.
Awesome.
Well, everyone should go buyyour book.
Thank you so much for this view.
And I have a great rest ofyour day.
Yeah, you too.
Thanks for inviting me.
I've enjoyed the conversation.
Awesome.
Hey love, thanks for making itthis far.
If you're hearing this, you'reone of.
The magical statistical fewthat listened all the way to the
(43:54):
end and I.
So appreciate your engagement.
I hope that means the message today.
Resonated with you and you'retaking away a tool trick or action
step that will help you haveyour best feeling brain.
If that's you, I have a favorto ask.
So many more women need tohear this Message and your 30 seconds
to leave a rating or reviewwill help them hear it.
Just.
Just go to the show in your.
Podcast player and scroll downuntil you see the stars to leave
(44:15):
a quick rating.
And make my day while you'reat it.
Thank you so much.
Here's the truth.
We live in a world where everyswipe, sip and snack has been engineered
to hijack your brain'spleasure circuits.
How do we find balance in aworld that's addicted to more?
Today I'm joined by Dr.
Anna Lemke, bestselling authorof Dopamine Nation, to explore why
our ancient brains struggle ina modern world and what we can do
to reclaim control.
(00:21):
Welcome to ADHD NaturallySmart Solutions for.
Holistic women with Christine McCarroll.
Hi, I'm Christine, and this isthe spot to learn natural strategies
for supporting your ADHD brain.
As a woman with all thehormonal curveballs and unique challenges
that only females.
Face, I've made it my mission to.
Uncover the root causes andlittle known supports for your ADHD
(00:41):
brain that your doctor doesn'tknow and won't tell you.
Learn the truth and find your focus.
No prescription required.
Hey friend.
Welcome back to anotherepisode of ADHD Naturally.
This week is a bonus episodeof an interview I recorded back in
2022 with the phenomenal Dr.
Anna Lemke, New York Timesbest selling author of Dopamine Nation
(01:02):
Finding Balance in the age of indulgence.
Dr.
Lemke has also written aboutthe opioid drug crisis in her book
drug dealer, MD, and appearedas an expert in the Netflix documentary
the Social Dilemma, and morerecently appeared on the Huberman
Labs podcast with Dr.
Andrew Huberman.
Back when I recorded thisepisode, I was just a few months
into my own ADHD diagnosis andI was working towards my certified
(01:24):
Brain health professional certification.
Listening to the episode withfresh ears two years later with everything
that I've learned andexperienced again was eye opening
all over again.
And even though I read herbook twice at the time, I was actually
sent back to her amazing book.
So on this episode, Dr.
Lemke and I discuss how ourbrains are wired for the pursuit
(01:45):
of pleasure, how this wiringcan get us hijacked in a modern era
of abundance, and howeverything from romance novels to
heroin can be fodder foraddictive behavior, even if we don't
think of ourselves as addicts.
While Dr.
Lemke and I didn'tspecifically get into ADHD, dopamine
happens to be the primaryneurotransmitter involved in the
symptoms of ADHD, and Dr.
(02:05):
Lemke discusses the use andabuse of stimulants like Adderall
in her book.
Per her formal bio, Anna Lemkeis Professor of Psychiatry at Stanford
University School of Medicineand Chief of the Stanford Addiction
Medicine Dual DiagnosisClinic, a Clinician scholar.
She has published more than100 peer reviewed papers, book chapters
and commentaries.
She sits on the board ofseveral state and national addiction
focused organizations, hastestified before various committees
(02:27):
in the United States House ofRepresentatives and Senate, keeps
an active speaking calendarand maintains a thriving clinical
practice.
Well, Dr.
Anna Lemke, welcome to the podcast.
Thank you for having me.
I'm excited to be here.
I have to say.
I am.
I'm just thrilled to have youjoining me.
I have actually read your book twice.
(02:48):
So we're going to be talkingabout your book, Dopamine Nation.
You've written more than one,but that's the one that inspired
me to reach out.
I was actually rereading itlast week kind of in preparation
for this conversation and Iwas highlighting it and my daughter,
who's 15, is like, she's justlearning about highlighting books
in high school right now.
(03:09):
She's like, oh, mom, is this like.
What do you highlight?
And I said, well, I'mhighlighting the things that are
important.
And she's like, well, what ifeverything is important?
I was like, yeah, but actuallythat was my feeling in this book
is like, everything is important.
So it was hard to highlight.
Yeah.
(03:29):
Thank you.
So I am definitely going torecommend that everyone reads the
book.
Well, thank you.
So this is a really timely conversation.
I know that people have aquestion already just starting out,
like, what is dopamine?
We're going to talk about dopamine.
I have a lot of secondaryquestions to that.
But just starting out, thewhole title of the book is Finding
(03:51):
Balance.
Dopamine is a kind ofneurotransmitter that isn't necessarily
about balance.
So can you just tell us whatis dopamine and what does it maybe
drive us to do or how does itdrive us to act?
Yeah.
So dopamine is aneurotransmitter in the human brain.
It is.
Neurotransmitters aremolecules that bridge the gap between
(04:12):
neurons.
That gap is called the synapse.
Those neurotransmitters allowfor fine tuning of the electrical
circuits conducted by the neurons.
Dopamine has differentfunctions in the brain, but one of
its most important functionsis for the experience of pleasure,
reward and motivation.
It may be even more importantfor motivation than for pure pleasure.
(04:34):
For example, there was a veryfamous experiment where rats were
engineered to have no dopaminereceptors in their reward circuit,
their brain.
And what the scientistsdiscovered is if they put food in
the rat's mouth, the rat wouldeat the food and seem to get pleasure
from the food.
But if you put the rat, thefood, even a body length away, the
rat would starve to death.
In other words, the absence ofdopamine took away that organism's
(04:57):
motivation to do the work, toget the reward.
So dopamine, you know, it'simportant for pleasure, but again,
it's very, very important for motivation.
The more dopamine that'sreleased in the reward pathway and
the faster it's released, andthis is really, the faster it's released,
the more likely it is to be addictive.
And also, dopamine is aneurotransmitter that's not just
(05:21):
released in response topleasurable stimuli.
It's also released in responseto anything that nature feels like
we need to pay attention to.
So it can be released inresponse to aversive stimuli as well,
or even just anything that'snovel in the environment, anything
that's new.
Dopamine is a neurotransmitterthat says, pay attention to this.
Mm, awesome.
(05:43):
So that's really easy to visualize.
I'm like imagining it like abright red flashing light of like
here is where attention belongs.
And I can imagine thatmillions of years ago when we were
beginning to, to be evolvingon this planet, we had to pay attention
to where to get food.
We had to pay attention to hownot to get eaten by the lion.
(06:03):
We had to remember where therewas water.
There were probably, eventhough there was a whole world full
of, of signals of this is important.
The big differ, the Earth asit was for most of human existence
and the Earth as it has beenfor the last 200 years, is that for
most of human existence, welived in a world of profound scarcity
(06:26):
and ever present danger.
Like we had to work 247 justto live to age 30.
Most of us died in infancy.
We no longer live in that world.
We now live in this world ofoverwhelming abundance, where for
most people living, especiallyin wealthy nations, all of our basic
survival needs have been met.
(06:46):
And further than that, we havenow basically surrounded ourselves
with these highly accessible,highly abundant, highly potent novel
drugs.
We've even drugified thingsthat used to be healthy or good for
you.
And we have drugs that didn'texist before, like social media and
video games and onlinepornography and online shopping.
(07:08):
So the result is that, youknow, our ancient wiring, which was
evolved for this world, worldof scarcity, is really mismatched
for the world that we live in today.
Which is why we're seeinggrowing rates of compulsive overconsumption,
addiction and the Sequelae ofthat, which is despair, essentially.
Anxiety, irritability,insomnia, dysphoria.
(07:30):
So I want to unpack that alittle bit.
Have our brains actuallychanged all that much since millions
of years ago?
Are they essentiallyfunctioning the same way that they
did?
So it depends on what part ofthe brain you're talking about.
But if you're talking aboutthe reward circuit, that has remained
largely unchanged acrossspecies and over millions of years
of evolution, we arereflexively wired to approach pleasure
(07:53):
and avoid pain.
It's what has kept us alive ina very dangerous world.
We don't have to think about it.
We do it reflexively.
In fact, where we do have aheavy cognitive lift is to actually
avoid pleasure and approach pain.
That requires the massive graymatter frontal lobe that we have
added on top of the moreprimitive structures of our brain
(08:14):
over the last period of evolution.
But that reward circuit isessentially identical in a lizard,
which is why it's sometimesreferred to as lizard brain.
Yeah, so we have the samestructures, but we have an amplitude
of millions times more sortsof stimuli now than we did before.
(08:37):
What does that do to ourinteraction with our world when we
have that constantavailability, like just as humans,
not even addicted humans, justlike as a human.
Right.
Well, what it means is thatwe're all more vulnerable to the
pathophysiology of addiction,and we're all engaged in compulsive
(08:58):
over consumption, even ifwe're not crossing that threshold
into addiction.
And the reason for that ishighlighted by neuroscientific findings
in the last 50 to 75 yearsshowing that pleasure and pain are
co located in the brain.
So the same parts of the brainthat process pleasure also process
pain.
And they work like oppositesides of a balance.
When we experience pleasure,it tips one way.
(09:20):
When we experience pain, ittips the other.
But there's an overarchingrule governing this balance.
And that rule is that thebalance wants to remain level.
And with any deviation fromneutrality, our brains are going
to work really hard to restorea level balance.
And they do that by tilting anequal and opposite amount to whatever
the initial stimulus was.
(09:40):
So if the initial stimulus waspleasurable, we're going to pay for
that with a period of painequal in measure right afterwards,
we're going to get a little,you know, bounce into happiness falling
on the heels of pain.
And that's really, reallyrelevant for understanding how our
brains are responding to thisreward overloaded world.
(10:00):
Essentially what happens iswhen we are exposing our brains to
a reinforcing substance orbehavior, and they're surrounding
all day long.
From the moment we grab ourphones in the morning and see who
texted us to our morning cupof Joe all the way to our Netflix
shows in the evening, we'regetting a surge of dopamine from
those stimuli.
Not just a little bit, a whole lot.
(10:21):
It's coming out really quickly.
And our brain responds bytipping an equal and opposite amount
to the side of pain.
I like to imagine that asthese neuro adaptation gremlins hopping
on the pain side of thebalance to bring it level again so
they stay on until we'retilted and equal and opposite amount
to the side of pain.
That's the come down, thehangover, the after effect, or just
that moment of wanting to, youknow, eat one more sugary muffin
(10:43):
or watch one more Netflix episode.
Now, if we wait long enough,those gremlins hop off and you know,
that craving passes andhomeostasis is restored.
But the urge to continue toconsume once our pleasure pain balance
is still the side of pain isreally overwhelming because we want
to get it back to homeostasisor better yet, back to the side of
(11:07):
pleasure.
And so if we have immediateaccess to our next show.
And of course with Netflix, wedon't even have.
We do, but it just.
It just comes like, we have tostop it.
We have to do work to stop it.
And that's so emblematic ofthe world that we live in today.
We actually have to do work tonot get our reward.
The result of that, if wecontinue to expose our brain days,
(11:29):
weeks, months to continuedpleasures, what happens is that an
initial deviation to pleasuregets weaker and shorter.
That's called tolerance.
But here's a really key piece.
That after response to paingets stronger and longer, in other
words, those gremlins start to multiply.
Pretty soon we have enoughgremlins on the pain side of the
balance to fill this whole room.
And eventually they're campedout there, tents and barbecues in
(11:51):
tow.
And that's the addicted brain.
Right?
Then we're in what we call achronic dopamine deficit state.
Now we need to use, not to gethigh, but just to level the balance.
And when we're not using,we're walking around with a pleasure
pain balance chronicallytilted to the side of pain, experiencing
the universal symptoms ofwithdrawal from any addictive substance
(12:12):
or behavior, which areanxiety, irritability, insomnia,
depression, and craving.
Mm.
So when you're talking aboutpain, like, most people associate
that with, like, I have aphysical pain, and in a way, it is
a physical pain.
Like that craving is like, canbe a physical thing.
Absolutely.
You're not like, okay, pain,like all of a sudden my toe hurts.
It's like, it's the pain I'malmost imagining like heartbreak
(12:35):
or loss.
It's the emotional discomfortand it's the, the space that you
want to fill with the pleasure.
Right.
So there is the thing that'slike, I need that thing back in that
space.
There's an empty hole therethat I don't like.
Is that right?
Yeah.
So when I use the word pain inthis context, I'm really talking
about both physical andpsychological pain.
(12:57):
There are many drugs that so.
And I think withdrawal fromall drugs is psychological.
So it's a hunger, it's ayearning, it's wanting to fill, fill
that space.
But there are also many drugsthat have a physical component to
their withdrawal and somedrugs that have a life threatening
physical component component.
Right.
So for some people, alcohol,benzo and opioid withdrawal can actually
(13:18):
be life threatening.
People can seize and die.
It's the, you know, minorityof people who are at risk of that.
But that's a possibility as well.
So I think one of the thingsyou did really well in the book was
having these case studies thatspanned the spectrum.
So somebody on like the veryextreme, where someone's like, that
is someplace I would never goor I wouldn't understand that kind
(13:39):
of addiction to something thatmay seem a little bit more mundane.
You shared about your personaljourney with romance novels, which
is fascinating because I havespoken to someone recently who is
experiencing that exact same thing.
Yeah, I can recognize that.
But in a way, it's like, youknow, we all have our personal, we
(14:00):
all have our personal pleasureseeking thing that we're doing.
So we all have the capacity ina world where everything is available
all the time to get thoseconstant hits.
And probably we're tryingharder and harder to shrink the space
between the feeling of, gosh,that thing is gone and I have to
get the next hit of that thing.
(14:22):
Right.
I mean, that's precisely theproblem now that we do have nearly
infinite access at the touchof a finger to these, you know, feel
good pleasures, you know, orat least these escapes.
And it does make us all morevulnerable to the problem of addiction
because we've, we've sort ofhacked the motivation circuits.
(14:43):
Whether it's a romance novelor, you know, a cannabis gummy or
a cup of coffee.
You know, we have figured outas a species how to make it its most
potent form.
We've also figured out thatwhen we start to run out of its effects.
If we combine two drugstogether, you know, it'll.
Yeah, it's more potent.
(15:04):
We figured out these ways toget more potency.
So that's why you'll see, forexample, people, what they call double
screening, they're watchingNetflix and on their phones.
At the same time, ourthreshold continues to go up for
what we need to experience pleasure.
And at the same time, oursensitivity to pain is going up because
that pleasure, pain balancegets more and more tilted to the
(15:24):
side of pain.
So it's problematic because Ithink what a lot of us are experiencing
is that our relentless pursuitof pleasure leads to pain.
Right.
It puts us in this.
Not just in a neutral statewhen we're not using now, we're in
a painful state when we don'thave our drug.
Which is why, you know, theunderstanding this is crucial because
the intervention is going tobe very, very different.
(15:46):
Given the reality of thatneuroscience, the intervention is
going to be not, well, makeyourself more comfortable or, you
know, go to a therapist and.
And instead it's going to be,well, you know, our problem is that
we have too much comfort andtoo many intoxicants and that what
we really need to do is makeour lives intentionally.
Harder, which is what we arehardwired not to do.
(16:07):
That's right.
Beginning of the conversation,or hardwired to avoid it.
So even doing the thing likepressing pause on the next Netflix
show that wants to pop up is,in a way, we're triggering that little
bit of.
Of pain because we actuallyhad to stop the pleasure from coming
in.
But we've also reset our baseline.
So.
(16:27):
And.
And I wanted to be actually,like, explicit on some of the things
that you're calling drugs inin your book is it's not just drugs
the way that we typicallythink of them.
And even though lots of peopleare familiar now with, like, the
opioid crisis, certainly thereis a actual drug component.
There are things that peoplehave long recognized as drugs, like
(16:48):
alcohol, even though they are legal.
But then there are also thingslike I would say 90% of everybody
I know has to have a morningcup of coffee, right?
There's social media.
There's even, like, the gameson our phones.
There's constant dinging fromthe work email coming through, which
some people actually, I think,respond, you know, almost a Pavlovian
(17:10):
response to the ding of theemail or the text or whatever coming
through.
So there is no world in whichwe exist unless we just go out and
live in, like, you know, theTundras of Alaska or something where
there isn't something comingin because we all have something.
And then that baseline is justconstantly getting shifted.
Something that I thought wasan interesting.
(17:32):
It's an interesting concept isthat we then have to get more of
that thing to remain neutral.
Right.
So that the baseline is nowadjusted to that stimulus.
And I was immediately justthinking of coffee again, because
that's like everyone I know.
So.
And people say it in a jokingway, like, I have to have my cup
of coffee to be human in the morning.
(17:54):
Like, everybody says that.
But like, truly now we have adifferent baseline because we're
caffeinated.
Yep.
And I think, you know, if itwere just coffee, you know, which
is, you know, a knownstimulant, and we drank it in moderation,
it's probably no big deal.
The problem is that it'scoffee plus our phones, plus our
(18:14):
laptops, plus food, which hasbeen drugified, plus our entertainment,
which is now accessible 24 7.
So that, you know, ultimatelywhat's happening is that we're escaping
reality.
Right.
Where we don't have to befully present for ourselves and other
people in our lives.
And it's our natural instinctto do that.
(18:37):
Yeah.
You know, which makes itreally, really a hard project and
also a collective project.
Because if we're on our owntrying to get back to homeostasis
and normal, healthy dopaminelevels and no one else is coming
with us, it's a pretty lonely place.
You know, I think often now ofparents saying, well, I'd be more
than happy to send my kid outto the back alley to play kick the
(18:58):
can, but there are no otherkids there because inside on their
computers.
And that's absolutely right.
It's a.
It's a collective problem.
And that's why I think thisconversation is so important.
When I say this conversation,I mean this societal problem is really
where we have to essentiallybegin to build a world within a world
where we insulate ourselvesfrom not just our drug of choice,
(19:20):
but also the constant triggersthat also release dopamine that make
us crave our drug of choice.
You talked about self bindingin the book.
So basically, when we are inthis constant exposure, if we go
to the point where werecognize that whatever our drug
of choice is, be it cocaine orromance novels, is impeding with
(19:44):
our lives, and we want tochange our relationship to that thing,
first of all, it has to be conscious.
But there's this tool thatyou're talking about self binding
that goes along with it.
Can you tell us about self binding.
Sure.
Yeah.
So self binding is a way touse both literal and metacognitive
barriers between ourselves andour drug of choice so that we can
(20:08):
press the pause button betweendesire and consumption.
Of course, you know,willpower, we, we have it, but it's
not an unlimited resource.
We wake up with more willpowerin the morning than we have at the
end of the day when we're tired.
It renews itself, typicallyover 24 hours.
But if we just rely on ourwillpower and continue to allow ourselves
to be constantly triggered,we're not going to make progress.
(20:31):
And it's very, very difficult.
You know, once we have thatpleasure, pain balance tipped to
the side of pain to resist thecravings and the general despair
of that, that neurophysiologic state.
So much better that we don'tget into it at all.
And we can do that by againcreating these barriers.
So, for example, for myromance novel addiction, one of the
big instigators was when I gotan E reader.
(20:52):
I had got a Kindle, which madeit possible for essentially me to
be a chain readers.
As soon as I finished onebook, I could go on and read the
next.
I got, you know, cheaper andcheaper samples on Amazon.
You can get free, free romance novels.
I needed more potency overtime to get the same.
In fact, I ended up, you know,reading frank erotica that was not
consistent with my values.
It was interfering with myability to be the parent and the
(21:13):
spouse and the psychiatristthat I want to be.
So one of the first things Idid when I realized I had to abstain
for 30 days, which is what Irecommend to patients in order to
reset reward pathways.
I got rid of the Kindle.
I got rid of my.
I just simply threw it away.
And that was a, you know, aself finding strategy.
Now if I wanted to romance, Ihad to go to the library or I had
(21:35):
to go to a bookstore.
It's not a big barrier, butit's just enough that it allows me
to, you know, access whateverremaining willpower I may have and
remember why it is that Ididn't want to read romance novels
in that month of abstinence.
So that's an example.
(21:55):
It's a literal geographic barrier.
Other geographic barriers arethings again, like putting our phones
in a different room, turningoff our phones or devices, deleting
certain apps.
Other barriers for likeaddicted gamblers, they could put
them themselves on a no playlist.
So if they go to the casino,they can't actually get in because
they're on a, you Know, a listlike that, other things might be
(22:17):
categorical self bindingstrategies where I realize, okay,
well, I can read maybe acertain type of like for a while
I felt I could read certaininspirational romance novels.
That's a genre of romancenovels that they're quite religious
and they have very little sexin them.
But I told myself I could readthose but not other types of romance
novels.
So that's a categoricalstrategy, right?
(22:38):
Well, I can.
And food, we do this a lot.
Obviously I'm going to eatfood because unless, you know, you
got to eat, but I'm not goingto have cookies or I'm not going
to have processed food becausethat's my drug of choice.
Once I start, I can't stop.
Or maybe it's even just like a trigger.
So one of the things that Inoticed in my effort to abstain from
romance was that certain kindsof romantic songs on the radio, you
(23:00):
know, which most pop music is.
Yeah.
That would then triggercraving for me.
So then I stopped listening tothat music as a way to achieve my
goal.
So that's the thinking on self binding.
So I was thinking about thisin the context of, you know, your
book is Dopamine Nation.
I think you're speaking a lotto just our US audience people.
(23:20):
We do have an abundance ofstimulation in this country.
Just a fact.
And a lot of the things thatare really ridiculously addictive
have come from us like socialmedia and processed foods and all
of these things.
Like we created them.
I'm going to say that wordbinding was reminding me of just
the thought of like containersand structure and framework.
(23:40):
Yeah.
And I'm thinking about how wehad more of these in previous eras
and we have fewer and fewerformal structures to our life.
Our family structures lookreally different.
Our school structure can lookreally different.
And then over the pandemic, it was.
Almost like any structure wehad remaining was completely gone.
And so, so the structures thatused to exist aren't there for us,
(24:05):
so we have to then create them ourselves.
Is that really part of theunderpinning of the self binding
is that we don't have thosestructures to rely on?
Yeah, that's, that's reallywell said because you're, you're
absolutely right.
You know, all humans need structure.
But I can tell you, mypatients struggling with addiction,
structure is a matter of lifeand death.
(24:25):
Death.
And they do much, much betterwith structure.
I do better with structure.
And you're right, our, oursociety and our home life, it's all
gotten looser and looser andLooser, you know, even the sort of
sacred family dinner is nowgone by the wayside because many
kids have their kids in activities.
Yeah.
That are occurring, you know,so, you know, you could do a family
dinner, but only half yourfamily can show up at any, you know,
(24:47):
given time.
There's no consensus time.
So it's really tough, really ahard time to be a parent for all
those reasons.
But I think anything that wecan do as parents, especially when
our kids are little and havemore, let's say, executive control
over what's happening withthem and in the home, really important
to have regular meal times,regular bedtimes, regular wake times,
(25:09):
to have, you know, if not aday of Sabbath, at least a distinction
from the work week when thefamily does different collective
things together.
I mean, what's so amazing isthat a hundred years ago, 200 years
ago, many families not onlyspent their leisure time together,
they also worked together.
They worked in the home makingtextiles, they worked in the farm.
(25:29):
Now not only are we all flyingout in different directions to work
and go to school, but also, ofcourse, our leisure time is separate.
No longer are we even watchingthe same movie at the same time.
We're all on our devices indifferent rooms watching different
things.
So I think just acknowledgingthis and acknowledging that it has
really eroded the family inmany ways and then just being really
(25:52):
intentional about trying tobring that back in and creating a
consistent structure.
I remember my now 19 year oldson who's a sophomore in college
now, but one day he came homewhen he was about five and it was
five o'clock and that was whenwe always had dinner in those days.
And for whatever reason thatday I hadn't set the table, I didn't
(26:13):
have dinner.
And he came in and he had aliteral meltdown.
He's like, where's dinner?
We always have dinner at five.
Right.
What's going on?
And it was just such a greatreminder to me how much kids need
structure, key into structure,how important it is for them to,
you know, to feel safe.
And not just kids, us too.
Which means that, you know, itdoesn't mean you want to be like
rigid about everything, youknow, it doesn't work out.
(26:34):
Right.
Yeah.
And some days, you know, then,but, and then you got to learn to
tolerate that too.
But in general, really, reallyimportant for there to be some kind
of consensus structure.
And it will change over timeas kids age.
Right.
So what kids need in terms ofthe household structure when they're
five is going to be differentthan what they need when they're
15.
So being flexible andappreciating that.
(26:56):
Okay, well, we used to do that.
It was great.
But now we need to do itslightly differently because, you
know, the circumstances havechanged, but still having a structure
around it.
Yeah.
My intention was to follow upwith a question around things like
Alcoholics Anonymous, which Ido want to ask you about.
But it.
This direction of thisconversation reminded me of a book
I recently read called the Artof Gathering.
I believe the author is Priya Parker.
(27:18):
But the entire book is aboutthe necessity of a structure for
any sort of gathering.
So, like, even if it's aparty, right?
Like, people want to know whythey're there and they want to know
how to act.
Yes.
So if it's a costume party,people are happier if you tell them
it's an 80s costume party andyou also should be an 80s rock star.
(27:41):
Right.
And then people can actuallyjust, like, feel calmer because they
know.
Know what they're doing.
Yeah.
They know what their role is.
No, it's really true.
Sometimes patients will saywhen they're seeing me for psychotherapy
or treatment, I don't reallyunderstand how this works.
And I said, yeah, there's noreason that you should understand
it, but one of the reasons itdoes work is because there's a very
(28:02):
defined structure.
I have a role.
You have a role.
Right.
We are here to talk about youand your problems, not me and my
problems.
Right.
What we talk about in herestays in here.
There, it's a safe space.
You'll talk, I'll listen, I'll respond.
Based on what you've said thatmakes people feel so much safer,
I'll have people withterrible, terrible social anxiety
who can't go to any parties orconverse with people in public, but
(28:27):
who have no trouble talking atlength in this setting.
Why?
Because the roles are defined.
So, yeah, finding.
Finding ways to help people with.
With that and to define thestructure and give them roles is
really, really helpful.
I wonder if that's why peopleare seeking more distraction, is
(28:48):
the feeling of unease of nothaving a role to play.
Or like, in a tribe, like,these are the hunters, and these
are the loom weavers, andthese are the cookers or whatever
it is.
Right.
We don't have.
Like, we have.
We're supposed to define theseroles for ourselves, and a lot of
people have a lot of troubledefining those roles for themselves.
(29:09):
But.
Yeah, so I think there is asense that sort of life is so uncertain
and kind of spinning out ofcontrol, and that's what makes the
devices so compelling, right?
Because in that space we havecomplete control.
We can swipe right, we canswipe left, we can delete it, we
can start over again and get anew avatar.
And, you know, it's allcompletely within our control.
(29:31):
And yet paradoxically, youknow, at the same time, we're seeking
kind of to lose ourselves.
So we really, we want to be, Ithink, in many ways subject to something
greater than ourselves.
And yet in pursuit of that,what we do is try to seek more and
more control over our, ourescaping from ourselves.
(29:52):
So it's a really fascinating paradox.
So thinking about how we getourselves out of this box, or maybe
we're not even gonna, we'renot gonna get out of the box because
no one's gonna turn off socialmedia or unmake the lay's potato
chips of no one eat just one, right?
Like that.
We are going to be exposed tothose things.
So first step for someonewould be recognizing if they want
(30:14):
to change and then if they do,probably why.
And then the structures aresometimes self imposed, sometimes
things that are like communitygroup groups.
What, what are things thatpeople can do when they want to?
Well, the first thing Irecommend is to think of a substance
or behavior that, you know, weingest, that we wish we used less
(30:38):
of or not at all or in adifferent way, and then conceptualize
that as our drug of choice,whether it's romance novels or online
chess or cupcakes or alcohol,whatever it is.
And then the first thing is tofast from that drug or behavior for
30 days.
Why 30 days?
Because that's the averageamount of time it takes for those
neuroadaptation gremlins tohop off the pain side of the balance
(31:01):
and for homeostasis or a levelbalance to be restored.
And it's really important torestore that level balance number
one, to just feel better andrecapture our ability to take joy
and more modest rewards.
But also to get insight intohow our drug use, and I use the term
drug broadly, is impacting our lives.
Because when we're in it, wereally can't see it.
(31:22):
And that's just something thatI've seen again and again in myself,
in my patients.
I always warn people thatthey're going to feel worse before
they feel better when theygive up their drug of choice.
But if you can just hang inthere for about two to three weeks,
that's usually the criticalturning point where then in weeks
three and four, people startto really feel a lot better, not
just better than they did inthe first Two weeks when they were
(31:43):
in withdrawal, but actuallybetter than they have in a long time.
So.
So holding that carrot out assort of the motivation, you know,
that you can actually feel alot better and be happier if you
can just do without yourpleasure for a period of time.
And then once we get to thosefour weeks and we feel better, because
(32:03):
most everybody does feelbetter by doing that, then be really
thoughtful.
Okay.
Do I want to continue to abstain?
Is it possible for me tocontinue abstain?
How am I going to reintegratethis substance or behavior back into
my life?
And patients will always saythat, but they'll mostly say they
want to go back to using, butthey want to use differently, they
want to use less, they want tohave more autonomy and control over
(32:24):
how they're using it.
And that's where self bindingcomes in.
You know, that's where we makethese, we put these barriers in place
and then we try to either usein moderation or continue to abstain.
And we see how that goes.
And if it doesn't go well,then we have to rethink our self
binding strategies.
Or, or we have to rethink.
Maybe moderation is impossiblefor me when it comes to this drug.
Maybe I really need to abstainfrom the long haul.
(32:47):
Yeah.
So that's kind of the strategy.
Doing it collectively as afamily or with friends is a really
good idea.
You know, setting it togetherand then you have that support.
And again importantly, knowingthat you'll feel worse before you
feel better, but just get totwo weeks, you'll really notice a
big improvement.
Start to change.
Yeah, I always do a dry January.
I've heard people doSobertober, which I think is October,
(33:09):
but I think there is the powerof the collective in those moments.
So, like, it's not a problembecause everybody is all doing this
one thing together and itfeels more comfortable.
So you're not the one persondoing the weird thing outside of
everybody normalizes it.
Yeah.
So even before neuroscienceconfirmed it to be the case, people
(33:30):
have instinctively known thata dopamine fast from, you know, some
kind of reinforcing substanceis really important for resetting
brain pathways.
I think what we're only justrealizing now is that, that we can
get addicted to behaviors aswell, including digital drugs.
And so abstinence from thosebehaviors is really important to
(33:51):
reset reward pathways.
I did a digital detox at theend of the year last year where I
just said.
And it was actually like thisinteresting thing for me was the.
There is an aspect kind oflike this Kind of like when people
do like a.
Some sort of food change.
Like you still have to eatwith my phone.
(34:11):
I was like, okay, my phone.
But if I want to get togetherwith someone in person, I actually
still have to use the phone tocall them.
Or like if I need directionsto somewhere that I'm meeting someone,
like I still, I'm gonna pullup my Google Maps.
I don't have a map in my car.
Ride share or what?
You know, there are manythings that.
Yeah, yeah.
So then it's a matter ofdeleting the apps that you don't
(34:31):
want to use.
Being intentional.
Sometimes I recommend writingdown what you're going to do on the
phone or the device before youactually go on it.
Create that intentionality.
Things like that.
I have been noticing latelyhow often I go to do something in
particular and then I getconnected on whatever thing was the
last thing I had up on my phone.
Doesn't even matter what it was.
And then I'm like, what was Ihere for?
(34:52):
Why did I even open this device?
To capture attention.
So how did your digital detox go?
It was kind of like what youdescribed in the book.
Like you just start to noticeyour own response.
I mean, I probably should havekept track of how many times I reached
for my phone with no reason.
It was just a knee jerk reaction.
I kept reaching for it to getmy mind off.
I was bored sitting at arestaurant for 10 minutes for a table,
(35:14):
like, let me go play a game onmy phone.
So realizing how many timesthat I was mindlessly reaching for
it and then for sure there wasalmost like that painful like, like,
well, what am I supposed to do now?
Like, right, okay, I gottafill this up with some.
And it really did feel likesomething was leaving my.
Like I had been possessed.
(35:35):
Yeah, my body.
And I was kind of sad.
Like it, I mean it wasn'tquite two weeks, but like around
that two week mark is when Iwas like, okay, well I got it.
Like lots of things have tohappen again in my life because,
you know, end of the year Iwas able to.
Holidays, the people weren'tonline anyway.
Right.
But it was, it was a differentexperience when I came back and I
was definitely much more awareand methodical.
(35:56):
But now nine months later, I'mprobably back to where I was.
So like, I'm really lookingforward to the digital detox again
this December.
And I think that's true to life.
With these devices and thesedigital drugs, it's more normal than
not to gradually slip over time.
But at Least we're slippingnow with the awareness of what's
happening, why it's happening,and the importance of resetting reward
(36:19):
pathways, of doing thedopamine fast again and kind of resetting
those pathways, but some kindof pulsed interval that's right for
us in our lives in order tokind of just remind ourselves and
have a healthier relationshipwith these devices.
It's not that the genie isgoing back into the bottle, but we've
got to figure out how to havehealthier relationships with this
technology.
Yeah, I appreciated how muchyou went to the gray zone there.
(36:42):
Like, I feel like that's thesticky place of most conversations.
Like, people can usually agreeon the outer edges of something where
nobody's going, but where theline is of what's okay and what's
not okay and what's too much.
And that's the sticky part, Ithink, personally.
And in these largerconversations, I don't know if we
have time to fully go intothis conversation.
(37:03):
I'll ask for a quick bit ofopinion here, but I live in Colorado,
and on the ballot in a fewweeks is psilocybin.
Right.
And we were the first state tolegalize marijuana a few years ago.
And there is this growinginterest in microdosing, which I
think is people's attempt tofind a smaller spot, like, oh, I'm
(37:25):
not gonna go just go do aweekend of mushrooms.
But like, I mean, I wasresearching it recently, I was seeing
that there was this wholegroup here, it's called moms who
microdose.
Like it's a social group.
And I was like, this is fascinating.
So maybe your thoughts, if youhave them quickly on, like, microdosing.
Yeah.
(37:46):
So, you know, psilocybin,these are psychedelics.
They release an enormousamount of serotonin in the brain
and also dopamine.
They are addictive.
Contrary to what you will readin the general lay press or even
what some scientists will say,these are absolutely addictive.
People get addicted to them,use them repeatedly in harmful ways.
(38:08):
Yeah, the science is at.
Really at.
At the very beginnings.
So there's no, there's notcurrently robust evidence that they
are effective treatment forany psychiatric disorder.
There's.
There's some preliminaryevidence suggesting that in certain
contexts they may be helpful,but I can tell you it's not really
robust.
(38:28):
So if you.
One head to head studypublished in the New England Journal,
comparing psilocybin with anssri, which is an antidepressant
approved by the FDA for thetreatment of depression, basically
they came psilocybin was no better.
But psilocybin has many moreserious adverse events, including,
you know, persistentperceptual disturbances.
(38:49):
So, you know, like the meltingwalls thing.
People can sound scary therest of their lives.
Right.
Wow.
People can get psychotic whenthey take these molecules.
So although I have, I'vetalked to people who said that it
was transformative in apositive way.
You know, I hear that and I'mtrying to remain open.
But I also think it's reallyimportant that the media and the
(39:11):
online chatter doesn't getahead of the evidence because that's.
That happens so often and.
And people are harmed as a result.
So, yeah, I would just say theevidence isn't there yet.
We know about real harms.
It is addictive.
It is pressing hard and faston the pleasure side of the balance,
which means come downs are real.
Blue Monday is a real thing.
(39:32):
And also there are other, youknow, potentially permanent mind
altering effects even withvery limited exposure.
So I'm not sure it's worth that.
You know, people talk aboutwanting a spiritual awakening.
I would think that there areother ways to get that spiritual
awakening that take longer,but probably lead to more lasting
(39:53):
and more permanent brainchanges because you had to work for
them over a long period of time.
Yeah, well, and there is thiswhole area of study of these kind
of endogenously produced feelgood chemicals of a variety of sorts.
Right.
But that we actually have thecapacity for our own bodies to create
these things in the right circumstances.
(40:13):
You were mentioning a patientwho was doing the cold dips in your
book.
That's something I actually practice.
Ice cold water showers, icecold water baths.
And there is that painpleasure piece that I know you were
talking about.
But it is like the I'm my own pharmacy.
Right.
And this is the whole scienceof hormesis.
Hormesis is Greek for to setin motion.
(40:35):
And essentially when we exposeour body to mild to moderate noxious
stimuli like exercise, icecold water, intermittent fasting,
or even just challengingpsychological and intellectual endeavors,
we're essentially telling ourbody to upregulate its own healing
hormones and neurotransmitters.
We're telling our dopaminefactories to make more dopamine,
(40:57):
which means we can get thatdopamine, we can get that high, but
we do it by paying for it up front.
And that way we avoid gettinginto this dopamine deficit state
which is the hallmark of addiction.
Of course, in some rare cases,people can get addicted to pain.
Right.
And for example, get addictedto exercise.
But it's very rare.
I Like that idea, actually,that you just said of like, we're
(41:18):
paying for it up front insteadof later.
Like there is no escaping thatyou're going to pay for it.
No free lunch.
There's no free lunch much.
It's really true.
But you could choose to payfor it up front instead of putting
it on layaway.
Yes.
Yes, that's right.
Then your reward.
Yeah.
Is on the other side.
And then you don't have those.
Those potential addictive.
Or a much lower chance ofthose addictive pieces.
(41:44):
Exactly.
This has been A greatinterview, Dr.
Lemke.
I wish we had more time.
I always like to end with my fast.
Four that are just fun questions.
So nothing to do with yourcurrent work?
It might actually.
Yeah.
First one is.
And maybe this is my personaldopamine thing.
I love music.
I love live music.
So I always ask what yourfirst concert was, if you remember.
(42:07):
Wow.
I think my first concert.
I'm trying to remember.
I'm blanking on her name.
She was.
I love folk music.
And she's like an acousticfolk guitarist.
And she was sort of famous forabout five minutes and then she disappeared.
I can't remember her name, but folk.
It would have been a folkmusic concert.
Awesome.
I love that.
Do you have a morning routine?
(42:28):
And if so, what does it look like?
Yes, I do.
I get up early, usually around5 or 6 in the morning.
And I either go for a walk, gofor a swim.
Cold waters, you know.
I'm not a cold water person.
I can't do that.
I.
I was in Iceland recently withmy family and they have these alternating.
Ice cold.
I actually can't do that.
(42:51):
What's on your nightstand?
Books.
A good reader.
Yeah, me too.
No romance novels?
Not anymore.
I gave that up.
Gave that up for the long haul.
Cool.
And last question.
Any unusual talents or funthings that nobody knows about you?
Ah, well, I don't know.
Not nobody, but many peopledon't know that I speak Mandarin
Chinese.
(43:11):
I lived in China for a whileafter I graduated college and I lived
there, taught English there,came home, was a bilingual teacher
for a while, and stilloccasionally get to use it in my
practice.
Awesome.
Well, I am so glad we got tohave this conversation.
I will be linking in the shownotes to your book, your website,
any other places that peoplecan find you.
(43:33):
I know you're on social media.
That's it.
And I appreciate it.
Awesome.
Well, everyone should go buyyour book.
Thank you so much for this view.
And I have a great rest ofyour day.
Yeah, you too.
Thanks for inviting me.
I've enjoyed the conversation.
Awesome.
Hey love, thanks for making itthis far.
If you're hearing this, you'reone of.
The magical statistical fewthat listened all the way to the
(43:54):
end and I.
So appreciate your engagement.
I hope that means the message today.
Resonated with you and you'retaking away a tool trick or action
step that will help you haveyour best feeling brain.
If that's you, I have a favorto ask.
So many more women need tohear this Message and your 30 seconds
to leave a rating or reviewwill help them hear it.
Just.
Just go to the show in your.
Podcast player and scroll downuntil you see the stars to leave
(44:15):
a quick rating.
And make my day while you'reat it.
Thank you so much.
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