Huberman Lab - Dr. Anna Lembke: Understanding & Treating Addiction

Welcome to the Huberman Lab Podcast,

where we discuss science

and science-based tools for everyday life.

I’m Andrew Huberman,

and I’m a professor of neurobiology and ophthalmology

at Stanford School of Medicine.

Today, I have the pleasure of introducing Dr. Anna Lemke.

Dr. Lemke is a psychiatrist

and the chief of the Addiction Medicine Dual Diagnosis Clinic

at Stanford University School of Medicine.

She’s a psychiatrist who treats patients

struggling with addiction.

She has successfully treated patients

dealing with drug addiction, alcohol addiction,

and behavioral addictions,

such as gambling and sex addiction,

as well as other types of addiction.

In fact, during our discussion,

I learned that there are a huge range of behaviors

and substances to which people can become addicted to,

and that there is a common biological underpinning

of all those addictions.

I also learned that there’s a common path

to the treatment and recovery

from essentially all addictions.

Dr. Lemke explained that to me

and explained how to think about

and conceptualize our own addictions,

as well as the addictions of other people

who are struggling to get treatment,

move through treatment,

and stay sober from their addictions.

In addition to treating patients,

Dr. Lemke is an author

and was featured in the 2020 Netflix documentary,

‘‘The Social Dilemma.’’

I’m excited to tell you that she has a new book coming out

called ‘‘Dopamine Nation,

Finding Balance in the Age of Indulgence.’’

The book comes out August 24th

and is an absolutely fascinating read into addiction

and ways to treat various types of addiction.

I’ve read the book cover to cover,

and all I’ll tell you is that at the very first chapter

and throughout, you are going to be absolutely blown away.

The stories about her patients are extremely engaging.

It brings forward the real struggle of addiction

and the incredible, I think it’s fair to say heroic battles

that people fight in order to get through addictions

of various kinds.

And all of that is woven through with story,

with science and ways that make it very accessible to anyone

whether or not you have a science background or not.

I can’t recommend it highly enough.

So again, the book is ‘‘Dopamine Nation,

Finding Balance in the Age of Indulgence.’’

It comes out August 24th of this year, 2021.

And you can pre-order that book by going to Amazon.

We will provide a link to that in the show caption.

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Before we begin, I just want to mention

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And now for my discussion with Dr. Anna Lembke.

All right.

Great to have you here.

Thank you for having me.

I’m excited to be here.

Yeah, I have a lot of questions for you.

I and many listeners of this podcast

are obsessed with dopamine.

And what is dopamine?

How does it work?

We all hear that dopamine

is this molecule associated with pleasure.

I think the term dopamine hits,

like I’m getting a dopamine hit from this,

from Instagram or from likes or from praise

or from whatever is now commonly heard.

What is dopamine?

And what are maybe some things about dopamine

that most people don’t know

and probably that I don’t know either?

So dopamine is a neurotransmitter

and neurotransmitters are those molecules

that bridge the gap between two neurons.

So they essentially allow one neuron,

the presynaptic neuron,

to communicate with the postsynaptic neuron.

Dopamine is intimately associated

with the experience of reward,

but also with movement,

which I think is really interesting

because movement and reward are linked, right?

If you think about early humans,

you had to move in order to go seek out the water

or the meat or whatever it was.

And even in the most primitive organisms,

dopamine is released when food is sensed in the environment.

For example, C. elegans, a very primitive worm.

So dopamine is this really powerful,

important molecule in the brain

that helps us experience pleasure.

It’s not the only neurotransmitter involved in pleasure,

but it’s a really, really important one.

And if you wanna think about something

that most people don’t know about dopamine,

which I think is really interesting,

is that we are always releasing dopamine

at a kind of tonic baseline rate.

And it’s really the deviation from that baseline

rather than like hits of dopamine in a vacuum

that make a difference.

So when we experience pleasure,

our dopamine release goes above baseline.

And likewise, dopamine can go below that tonic baseline.

And then we experience a kind of pain.


So is it fair to say that one’s baseline levels of dopamine,

how frequently we are releasing dopamine

in the absence of some, I don’t know,

drug or food or experience, just sitting, being,

is that associated with how happy somebody is,

their kind of baseline of happiness or level of depression?

There is evidence that shows that people who are depressed

may indeed have lower tonic levels of dopamine.

So that’s a really reasonable thought.

And there is some evidence to suggest that that may be true.

The other thing that we know,

and this is really kind of what the book is about,

is that if we expose ourselves chronically

to substances or behaviors that repeatedly release

large amounts of dopamine in our brain’s reward pathway,

that we can change our tonic baseline

and actually lower it over time

as our brain tries to compensate for all of that dopamine,

which is more really than we were designed to experience.


And is it the case that our baseline levels of dopamine

are set by our genetics, by our heredity?

Well, I think, you know, if you think about sort of,

you know, the early stages of development in infancy,

certainly that is true.

You’re kind of, you know,

born with probably whatever is your baseline level,

but obviously your experiences can have a huge impact

on where your dopamine level ultimately settles out.

So if somebody’s disposition

is one of constant excitement and anticipation

or easily excited,

these are, I think, about the kind of people where you say,

hey, do you want to check out this new place for tacos?

And they’re like, yeah, that’d be great.

And other people are a little more cynical,

harder to budge, like my bulldog Costello.

Very, very stable, low levels of dopamine

with big inflections in his case.

Is that, do you think that’s set in terms of our parents

and obviously nature and nurture interact,

but is that, is dopamine at the core of our temperament?

I don’t really think we know the answer to that,

but I will say that people are definitely born

with different temperaments

and those temperaments do affect

their ability to experience joy.

And we’ve known that for a long time

and we describe that in many different ways.

One of the ways that we describe that in the modern era

is to use psychiatric nomenclature,

like this person has a dysthymic temperament,

or this person has chronic major depressive disorder.

In terms of looking specifically

at who’s vulnerable to addiction,

that’s an interesting sort of mixed bag

because when you look at the research

on risk factors for addictions

or what kind of temperament of a person

makes them more vulnerable to addiction,

you see some interesting findings.

First, you see that people who are more impulsive

are more vulnerable to addiction.

So what is impulsivity?

That means having difficulty putting space

between the thought or desire to do something

and actually doing it.

And people who have difficulty putting a space there

who have a thought to do something

and just do it impulsively

are people who are more vulnerable to addiction.


In terms of impulsivity,

is this something that relates literally

to the startle reflex?

Like I, for instance, as a lab director,

I’m familiar with walking around my lab

and when I decide, deciding I’m going to talk to my people,

of course, when they knock on my door,

it’s always like, wait, why am I being bothered right now?

Even though I love to talk to them.

But I walk around my lab from time to time

and some people I notice I’ll say,

do you have a moment?

And they’ll slowly turn around and say, yeah, or no,

in some cases.

And other people will jump the moment I say their name.

They actually have a kind of a heightened startle reflex.

Is that related to impulsivity

or is what you’re referring to an attempt

to withhold behavior that’s very deliberate

under very deliberate conditions?

Yeah, so I don’t think that that startle reflex

is necessarily related to impulsivity.

That can be related to anxiety.

So people who are high anxiety,

people will tend to have more of a startle reflex.

Impulsivity is a little bit different.

And by the way, impulsivity is not always bad, right?

Impulsivity is that thing where

there’s not a lot of self-editing

or worrying about future consequences.

You know, you have the idea to do something and you do it.

And of course we can imagine many scenarios

where that’s absolutely wonderful.

You know, there can be a sort of, let’s say,

intimate interactions between people

where you wouldn’t really wanna be

super inhibited about it, right?

You would wanna be disinhibited and impulsive.

I can also imagine like sort of fight or flight scenarios,

like battle scenarios, right?

Where it would really be good to be impulsive

and just go, rah, you know, just go.

Where hesitation can cost you your life.

Yes, that’s right, that’s right.

But, you know, and I think this brings up a really,

something that I’ve come to believe

after 25 years of practicing psychiatry

is that what we now conceptualize in our current ecosystem

as mental illness are actually traits

that in another ecosystem might be very advantageous.

They’re just not advantageous right now

because of the world that we live in.

And I think, you know, impulsivity

is potentially one of those, right?

Because we live in this world that’s sort of like

you have to constantly be thinking sort of rationally

about the consequences of X, Y, or Z.

And it’s such a sensory rich environment, right?

That we’re being bombarded with all these opportunities,

these sensory opportunities.

And we have to constantly check ourselves.

And so impulsivity is something that right now

can be a difficult trait,

but isn’t in and of itself a bad thing.

I see. Yeah.

Yeah, and I’m beginning to realize

it’s a fine line between spontaneity and impulsivity.

What is pleasure and how does it work

at the biological level and if it feels right

at the psychological level?

And if you don’t mind painting a picture

of sort of the range of things

that you have observed in your clinic or in life

that people can become addicted to.

But just to start off really simply,

what is this thing that we call pleasure?

Well, I think it’s actually really hard to define pleasure

in any kind of succinct way

because certainly there is the seeking out of a high

or a euphoria or I think the kind of experience

that most anybody would associate with the word pleasure.

But also the seeking out of those same substances

and behaviors is often a way to escape pain.

So for example, when I talk to people with addiction,

sometimes their initial foray into using a drug

is to get pleasure.

But very often it’s a way to escape their suffering,

whatever their suffering may be.

And certainly as people become addicted,

even those who initially were seeking out pleasure

are ultimately just trying to avoid the pain of withdrawal

or the pain of the consequences of their drug use.

So I think it’s very hard to actually define it

as this unitary thing.

And it’s certainly not just getting a high.

There are so many ways in which people

sort of want to escape,

which is not the same thing as sort of this hedonic

wanting to feel pleasure.

So someone could decide that they want to go out and dance

or get up and dance because of the pleasure of dancing.

I can imagine that.

And maybe it’s very difficult for them to stay seated

when a particular song comes on, for instance.

But seeking what we would call pleasure

in order to eliminate pain,

that evokes a different picture in my mind.

That evokes a picture of somebody that feels lost

or depressed or underwhelmed.

I definitely want to get into the precise

and general description of addiction and what that is.

But in a previous conversation we had,

you said something that really rung in my mind,

which is that many people who become addicted to things,

let’s call them addicts,

have this feeling that normal life isn’t interesting enough,

that they are seeking a super normal experience

and that the day-to-day routine balance,

which is actually in the title of your book,

“‘Dopamine Nation Finding Balance

in the Age of Indulgence,”

that the word balance itself

can sometimes be a bit of an aversive term for people.

And I’m struck by this idea.

And the reason I want to explore it

is because so much of what I see online

is about generating a lack of balance,

about being tilted forward at all times,

really leaning into life hard, experiencing life,

living a full life.

Even the commencement speech given by Steve Jobs

on this campus was really about finding passion,

digging, you know, that’s so much in the narrative now.

So maybe you could just tell us a little bit

about your experience with this association,

if it really exists, between people’s sense of the normalcy

or maybe even how boring life can be

and their tendency to become addicts of some sort.

Yeah, well, I mean, I think that life for humans

has always been hard,

but I think that now it’s harder in unprecedented ways.

And I think that the way that life is really hard now

is that it actually is really boring.

And the reason that it’s boring

is because all of our survival needs are met, right?

I mean, we don’t even have to leave our homes

to meet every single physical need.

You know, as long as you’re of a certain level

of financial wellbeing, which frankly,

you know, we talk so much about the income gap

and certainly there is this enormous gap

between rich and poor,

but that gap is smaller than it’s ever been

in like the history of humans.

Even the poorest of the poor

have more excess income to spend on leisure goods

than they ever have before in human history.

If you look at leisure time, for example,

so people without a high school education

have 42% more leisure time than people with a college degree.

So my point here is that life is hard now

in this really weird way

in that we don’t really have anything that we have to do.

So we’re all forced to make stuff up, you know,

whether it’s being a scientist or being a doctor

or being an Olympic athlete or, you know,

climbing Mount Everest.

And people really vary in their need for friction.

And some people need a lot more than others.

And if they don’t have it, they’re really, really unhappy.

And I do think that a lot of the people that I see

with addiction and other forms of mental illness

are people who need more friction.

Like they’re unhappy, not necessarily

because there’s something wrong with their brain,

but because their brain is not suited to this world.

And do you think they have that sense?

My brain isn’t suited to this world

or they simply feel a restlessness

and they’re constantly seeking stimulation?

I think that’s right.

Yeah, I think it’s not really knowing what’s wrong with me.

Why am I unhappy?

How can I be happier?

And of course, as you talk about what’s so pervasive

in our narrative now is like, find your passion, you know,

find your, you know, whatever it is to save the world.

And in a way that’s good because it has people

out in the world and seeking.

But in a way it can also be misleading in the sense that

I think people aren’t entirely aware

that the world is a hard place and that life is hard

and that, you know, like we’re all kind of making it up.

Do you know what I mean?

Yeah, well, there’s a book by Cal Newport.

I don’t know if you know Cal Newport’s work,

but you guys are very symbiotic in your messages.

He’s a professor of computer science at Georgetown.

Yes, at Georgetown.

And wrote a book some years ago,

really ahead of its time called

So Good They Can’t Ignore You,

which is about not meditating or doing much work

to try and figure out what one’s passion is by thinking,

but rather go out and acquire skills

and develop a sense of passion for something

by your experience of hard work and getting better

and feedback, a little bit of the growth mindset thing

of our colleague, Carol Dweck.

But he’s gone on to write books, Deep Work,

and which is all about removing yourself from technology

and doing deep work.

And he’s been a big proponent of the evils of context

switching too often throughout the day

for sake of productivity, mostly.

His new book is called A World Without Email.

I’m beginning to realize as I cite off these books

and your book, Dopamine Nation,

Finding Balance in the Age of Indulgence,

that maybe the reason why you two don’t know

about one another is because neither of you

are on social media.

That’s it, that’s it.

And yet you’re two of the most productive people

that I know, including productive authors.

So that’s a discussion unto itself.

But I find this fascinating.

So let’s talk about the pleasure-pain balance and addiction.

And I’ve heard you use this seesaw or balance scale

analogy before.

And I think it’s a wonderful one that really, for me,

clarified what addiction is,

at least at the mechanistic level.

Yeah, so to me, one of the most significant findings

in neuroscience in the last 75 years

is that pleasure and pain are co-located,

which means the same parts of the brain

that process pleasure also process pain.

And they work like a balance.

So when we feel pleasure, our balance tips one way.

When we feel pain, it tips in the opposite direction.

And one of the overriding rules governing this balance

is that it wants to stay level.

So it doesn’t want to remain tipped very long

to pleasure or to pain.

And with any deviation from neutrality,

the brain will work very hard to restore a level balance

or what scientists call homeostasis.

And the way the brain does that

is with any stimulus to one side,

there will be a tip in equal and opposite amount

to the other side.

It’s like you have principle laws of physics.

Yes, right, right.

So I like to watch YouTube videos.

When I watch YouTube videos of American Idol,

it tips to the side of pleasure.

And then when I stop watching it, I have a comedown,

which is a tip to the equal and opposite amount

on the other side.

And that’s that moment of wanting to watch

one more YouTube video, right?

Yeah, and I just want to interject there.

So this moment of wanting to watch another

that is associated with pain, I think,

is are we always aware of that happening?

Because you just described in a very conscious way.

But when I indulge in something I enjoy,

I’m usually thinking about just wanting more of that thing.

I don’t think about the pain.

I just think about more.

Right, so really excellent point,

because we’re mostly not aware of it.

And it’s also reflexive.

So it’s not something that consciously happens

or that we’re aware of

unless we really begin to pay attention.

And when we begin to pay attention,

we really can become very aware of it in the moment.

Again, it’s like a falling away,

like that moment you’re on social media,

and you get a good tweet of something.

And then you can’t stop yourself

because there’s this awareness, a latent awareness,

that as soon as I disengage from this behavior,

I’m going to experience a kind of a pain, right?

A falling away, a missing that feeling,

a wanting more of it.

And of course, one way to combat that is to do it more,

right, and more and more and more.

So I think that is really what I want people to tune into

and get an awareness around.

Because once you tune into it, you can see it a lot.

And then when you begin to see it, you have,

and if you keep the model of the balance in mind,

I think it gives people kind of a way to imagine

what they’re experiencing on a neurobiological level

and understand it.

And in that understanding, get some mastery over it,

which is really what this is all about.

Because ultimately, we do need to disengage, right?

We can’t live in that space all the time, right?

We have other things we need to do.

And there are also serious consequences

that come with trying to repeat

and continue that experience or that feeling.

Yeah, so if I understand this correctly,

when we find something, or when something finds us,

that we enjoy, that feels pleasurable,

social media, food, sex, gambling, whatever happens to be,

we will explore the full range of these.

There’s some dopamine release

when we engage in that behavior.

And then what you’re telling me is that very quickly,

and beneath my conscious awareness,

there’s a tilting back of the scale

where pleasure is reduced by way of increasing pain.

And I’ve heard you say before that the pain mechanism

has some competitive advantages

over the pleasure mechanism,

such that it doesn’t just bring the scale back to level,

it actually brings pain higher than pleasure.

Could you tell us a little bit more about that?

Yeah, yeah, so what happens, again,

so the hallmark of any addictive substance or behavior

is that it releases a lot of dopamine

in our brain’s reward pathway, right?

Like broccoli just doesn’t release a lot of dopamine,

just doesn’t, right?

I’m trying to imagine, I was about to say,

and I stopped myself because, no, broccoli’s good,

it can be really good, but broccoli is never amazing.

Right, broccoli’s never amazing.

I mean, honestly, we can probably find somebody

on the planet for whom broccoli is amazing.

And of course, if I’m starving, broccoli is amazing.

Rich Roll, Rich Roll is big on plants

and he has a good relationship to plants.

Rich, tell us how to make broccoli amazing.

If anyone could do it, it’d be Rich.

But what happens right after I do something

that is really pleasurable and releases a lot of dopamine

is, again, my brain is going to immediately compensate

by down-regulating my own dopamine receptors,

my own dopamine transmission to compensate for that, okay?

And that’s that comedown or the hangover,

that after effect, that moment of wanting to do it more.

Now, if I just wait for that feeling to pass,

then my dopamine will re-regulate itself

and I’ll go back to whatever my chronic baseline is.

But if I don’t wait, and here’s really the key,

if I keep indulging again and again and again,

ultimately, I have so much on the pain side, right,

that I’ve essentially reset my brain

to what we call like an anhedonic

or lacking in joy type of state,

which is a dopamine deficit state.

So that’s really the way in which pain

can become the main driver

is because I’ve indulged so much

in these high reward behaviors or substances

that my brain has had to compensate

by way down-regulating my own dopamine

such that even when I’m not doing that drug,

I’m in a dopamine deficit state,

which is akin to a clinical depression.

I have anxiety, irritability, insomnia, dysphoria,

and a lot of mental preoccupation

with using again or getting the drug.

And so that’s the piece there.

There’s the single use, which easily passes,

but it’s the chronic use that can then reset

really our dopamine thresholds,

and then nothing is enjoyable, right?

Then everything sort of pales in comparison

to this one drug that I want to keep doing.

And that one drug could be a person, right?

I mean, I know people in my life

that are still talking about this one relationship,

this one person that was just so great

despite all the challenges of that thing

that it’s almost like they’re addicted to the narrative,

they were maybe or still are addicted to the person.

So it could be to any number of things,

video games, sex, gambling, a person, a narrative.

To me, and because of the way you described this mechanism,

this pleasure-pain balance,

that all speaks to the kind of generalizability

of our brain circuitry.

And this is something that fascinates me,

and I know it fascinates you as well,

which is that nature did not evolve

20 different mechanisms for 20 different types of addiction.

Just like anxiety is a couple of core sets of hormones

and neurotransmitters and pathways,

and one person is triggered by social interactions,

another person is triggered by spiders,

but the underlying response is identical.

It sounds like with addiction as well,

there may be some nuance,

but that they’re sort of a core set of processes.

So it doesn’t really matter

if it’s gambling or video games or sex

or a narrative about a previous lover or partner or whatever,

it’s the same addictive process underneath that.

Is that correct?

Yes, exactly.

And that’s where this whole idea of cross addiction comes in.

So once you’ve been addicted to a substance,

severely addicted,

that makes you more vulnerable to addiction

to any substance.

And when you say substance,

does the same, is what you just said also true for behavior?

Yes, so when I use the word drug,

I’m talking about substances and behaviors, really.

And I’m talking about behaviors like gambling, sex,

gaming, porn, absolutely, shopping, work.

You’ve accused me, I’ll just for the record,

Anna, Dr. Lemke has accused me,

not accused me, has diagnosed me outside the clinic

in a playful way of being work addicted.

You’re probably right.

The first thoughts I have when I wake up

are typically about work,

certainly within 50 milliseconds or so of waking.

And probably the last thoughts I have,

I would hope, are not about work,

but yeah, I work constantly.

I don’t, I do other things,

but I have to actively turn that off.

Yes, that’s exactly right.

And you’re certainly not alone in that.

And of course-

At Stanford, no, no, no, no.

I mean, here in Silicon Valley, right?

It’s highly rewarded, right?

So that kind of addiction-

It’s embedded in the culture.

Oh yeah, absolutely, yeah, yeah.

And there’s this other city,

I think it’s called New York,

where they also work a lot out here,

and it’s heavily rewarded.

I once said, and I’m sure

that I’m not the first person to say it,

but I was thinking about addiction,

and I was thinking about the underlying circuits,

and I posted something to social media,

which said that addiction is a progressive narrowing

of the things that bring you pleasure.

That was the way that I kind of crystallized

the literature in my mind.

And then we met, and you, of course,

came and gave these amazing lectures

in the neuroanatomy course for the medical students,

and the rest is history.

But I tossed out a kind of mirroring statement

for that as well, which was a bit overstepping, I admit,

which I said, addiction is a progressive narrowing

of the things that bring you pleasure.

And I said, dare I say,

enlightenment is a progressive expansion

of the things that bring you pleasure.

Not that anybody knows what enlightenment is,

but it was my attempt to take a little bit of a jab

at the fact that nobody knows.

And so why not, why wouldn’t I throw

a neurobiological explanation

just to kind of sample the waters?

And people had varying levels of response.

But the reason I bring that up is that I would imagine

that being able to derive pleasure from many things

would be a wonderful attribute.

We know people like this that can experience pleasure

in little things and in big events,

not just the big milestones of life,

but also the subtle, as like the yogis would say,

the subtle ripples of life.

If such an ability exists,

do you think that that reflects

a healthily tuned dopamine system?

One that can engage and enjoy, but then disengage?

Is that what we should be seeking?

And to underscore,

I know nothing about enlightenment meditation or any of it.

I use these as opportunities to explore.

Yeah, so it’s a great question.

And I understand the question as,

so what should we be striving for, right?

Where should we settle out?

And in my book, I really hold out people in recovery

from severe addiction as sort of modern day prophets

for the rest of us.

Because I do think that people who have been addicted

and then go get into recovery,

do have a hard one wisdom that we can all benefit from.

And the wisdom, I guess, to distill it down,

I mean, it’s many things.

But in terms of dopamine,

the wisdom is there are adaptive ways to get your dopamine

and there are less than adaptive ways.

And in general, you could describe the adaptive ways

as not too potent.

So not tipping that balance too hard or too fast

to the side of pleasure.

So does that mean never allowing myself

to be absolutely in complete bliss?

Or does it mean not allowing myself

to stay in that state too long?

The latter, I think the latter.

So, and then that gets to temperament.

So I’m going to get that to a second.

So in general, what we want is some kind of flexibility

in that balance and the ability

to easily reassert homeostasis.

We don’t want to break our balance,

which is possible if we overindulge

for enough period of time

and end up with a balanced tip to the side of pain,

this dopamine deficit state we’ve been talking about.

We want a flexible, resilient balance, right?

Which can be sensitive to things going on in the environment,

which can experience pleasure and approach,

which can experience pain and recoil, right?

This is all adaptive and healthy and necessary and good.

We would never want a balance that doesn’t tilt.

That would be a disaster.

We wouldn’t be human.

And we wouldn’t want that.

It’d be really, really boring.

On the other hand, what people in recovery

from addiction talk about is to some extent

having to learn to live with things being a little boring

a lot of the time, right?

So trying to avoid some of this intensity

and thrill-seeking and escapism

that really is at the core of addictive tendencies.

Sorry to interrupt, but when you say boring,

can we add stressful and boring?


Because there are days where I’m not,

I’m one of these people who have to remind myself

to have fun because I sort of forgot what the term means.

Because I like to think that I experience

a lot of pleasure in little things,

but I’m a pretty hard-driving guy.

I like goals and big milestones, all that stuff.

Anyway, the point being that many days I’m not bored

thinking, oh, there’s nothing to do,

but I am kind of overwhelmed by the number of things

that are really not pleasureful that I have to do.

I won’t mention what they are

because I don’t want my colleagues to be like,

so that’s why you don’t respond to emails.

No, just your emails.

Not yours, Anna, but theirs.

In any event, so anxiety and boredom

can hang out together, right?

Am I correct?

Oh, for sure.

I mean, actually boredom is highly anxiety-provoking.

Okay, that’s good to know

because I think people hear boredom

and they think like, oh, there’s nothing to do here.

Right, right.

I feel like we have a ton to do,

we just don’t really want to do it,

as opposed to something that we’re excited to do.

Right, okay, so this gets to sort of

some of the core things also we were talking about earlier

about finding your passion.

So I’m going to try to link it all together.

But basically, boredom,

first of all, boredom is a rare experience for modern humans

because we’re constantly distracting ourselves

from the present moment

and we have an infinite number of ways to do that, right?

But boredom is really, I think,

an important and necessary experience.

But it is scary because when you allow yourself to be bored,

and let’s say you had that list

of all the things you hate to do,

but you actually got them all done.

Imagine that, and you got your forthcoming book done,

and you did all your interviews.

And then-

It could happen.

Lightning could strike.

Right, and you walked your dog,

and you cleaned your house,

and you went shopping.

Imagine that for a moment.

You would be sitting in your house,

and my guess is you would be terrified

because, wow, what am I supposed to do now, right?

There’s nothing I really have to do.

And that is really, really scary.

That can feel like free fall.

And yet, that’s really an important

and good experience to have.

And I think that is an experience

out of which we can have a lot of creative initiative,

but also really consider our priorities and values.

Okay, here I am on planet Earth.

What the hee-haw am I gonna do with my life?

What do I really care about?

How do I really wanna spend my time

when I’m not distracting myself in order to spend it?

And then this gets back to our conversation

a little bit earlier about finding your passion.

So I think that one of the big problems now

that’s very misguided about this idea

of finding your passion,

it’s almost as if people are looking to fit the key

into the lock of the thing that was meant for them to do.

Right, and then everything will feel

like a natural progression.

Right, and then everything will be wonderful.

I can attest to the fact that is not how it works

in any endeavor.

Right, and then you’ll have all this great success.

And here’s where I really think the answer lies,

and I really, really believe this.

Stop looking for your passion,

and instead look around right where you are.

Stop distracting yourself,

look around right where you are,

and see what needs to be done.

So not what do I want to do,

but what is the work that needs to be done?

And more importantly,

it doesn’t have to be some grandiose work.

Like, does the garbage need to be taken out, right?

Is there some garbage on your neighbor’s lawn

that someone threw there

that you could actually bend over and pick up

and put into the garbage can?

Look around you.

There is so much work that needs to be done

that nobody wants to do

that is really, really important.

And if we all did that,

I really think the world would be a much better place.

And this is what people who have severe addiction

who get into recovery realize.

They’re like, it’s not about me and my will

and what I’m going to will in my life or in the world.

It’s about looking around what needs to be done.

What is the work that I am called to do in this moment?

Which also is incredibly freeing

because I don’t have to search for the perfect thing.

There’s a lot of burden now on young people

that they have to find that perfect thing,

and until they’ve found that perfect thing,

they’re going to be miserable.

You don’t have to do that.

Look at the life you were given.

Look at the people around you.

Look at the jobs that present themselves to you

and do that job simply and honorably one day at a time

with a kind of humility.

I think this is really what’s so striking to me

about the wisdom of people in recovery.

There’s this incredible humility

that comes out of that experience.

You feel so broken, so ashamed,

but you pick yourself up one day at a time

and you build a life that’s around,

what can I do right in this moment

that might benefit another person and thereby benefit me?

Yeah, it’s a really important point,

and if you’re willing,

I’d like to actually stay on this issue of passion

because I think the dopamine systems,

if I understand them correctly,

the dopamine systems merge with this work

that you’re referring to,

this immediacy of things calling to us

like taking out the trash,

which sounds frankly really boring, to be honest.

I hate taking out the trash, but I do it

because I like a clean home

and I like a home that smells good,

or at least doesn’t smell bad.

So we do these things,

and not that we want to offer some larger carrot

as a consequence of doing those things,

but if I understand correctly,

what you’re saying is in the act

of looking at one’s immediate environment,

acting on that immediate environment,

we cultivate a relationship to these circuits in our brain

about action and reward that, at least to my mind,

span the range of small things being rewarding

and then lead us to bigger things being rewarding.

It’s not like all we’re going to do

is take out trash and tend to house.

We eventually will venture out

and we eventually will find careers and work on those.

But if I understand correctly,

you’re talking about getting into a sort of functional

or adaptive action step.

And it’s the action step that these days

we tend to overlook because most of our mindset

is in things that are truly outside

of our immediate reality.

Do I have that correct?

Yeah, that was beautifully said.

And I would just add to that.

I see a lot of young people who, for example,

spend most of their waking hours playing video games.

And they come to me and they say,

I’m anxious and depressed.

I’m majoring in computer science.

I hate it.

I thought I would like it.

If I could only find that thing

that I was really meant to do, my life would be better.

And my first intervention for the many, many people

like that that I see in clinical care is,

you have it backwards.

I don’t say it quite like that.

You were waiting for that thing to pull you out

of the video game world.

And you’re never gonna find it

as long as you’re playing video games.

Because video games are so powerfully dopaminergic

that you have this distorted sense

of really pleasure and pain.

And you will not be able to find that thing that you enjoy.

And so, of course, the intervention is,

abstain from video games, reset your reward pathways,

start with a level balance.

And what invariably happens,

and I’ve just seen it over 20 years so many times,

I’ve become really a believer in this.

All of a sudden it’s like,

oh, wow, my computer science class

is interesting this quarter.

It’s like, okay, you have a receptivity then

to experiencing pleasure and reward

in a way you just don’t have

when you’re bombarding your reward pathways

with these high dopamine drugs.

Very interesting.

And just to underscore this notion

that tending to the immediate things

can lead to super performance.

I may have mentioned it earlier this episode,

but if I didn’t, I’ll mention now,

which is I have the great privilege

of having some close friends that were in the SEAL teams

and doing some work with those communities.

And it’s a remarkable community

for reasons that I think most people don’t understand.

People think they see the images

carrying logs down the beach

and all the blowing stuff on,

all the stuff that’s fun for guys like that.

But all of the guys I know who were in the SEAL teams

have this sense of duty about immediate things.

And not just holding the door

and helping with the dishes and moving things around.

They are constantly scanning their environment

for what can be done.

They essentially conquer every environment they’re in.

They are also some of the most competitive human beings

that they do in the world.

And they do it unless they’re in the act of war fighting,

which is their real job.

They do it in every environment in a very benevolent way.

And it’s a remarkable thing

because I think it’s what is part

of what they’re selected for.

And there’s a range there.

But I think when we hear about

tending to the immediate things,

or this phrase, how you do one thing is how you do anything.

That’s a tricky one for me

because there are certain things I just don’t do well.

But should we always be trying?

I think that the tending to,

setting the horizon in closely

and tending to things in one’s immediate environment,

I think it is very powerful and translates.

Because again, I think the nervous system,

it performs algorithms, it has action steps.

The brain doesn’t evolve to do one thing.

It evolves to be able to use the same approach

to doing lots of different things.

I just want to add, so even beyond that,

because that totally resonates for me

and is very consistent with people in recovery

from addiction who learn to take it one day at a time,

which is one of the standard lingo

from Alcoholics Anonymous and other 12-step groups.

But I think also, as you say,

our brain is really wired for the 24-hour period.

We’re not very good at sort of the 10-year, 20.

I mean, we have these huge frontal lobes,

and yes, we’re great planners.

But if we live too much in that space,

we can really get very anxious and depressed and lost

and either catastrophize or get grandiose.

But if you can chunk it down to a day,

what people in recovery talk about

is how if I can just do today right,

then I will get a chain of days

that seem insignificant in their individual units.

But after six months or a year

or two years of those good days,

I’ve got two very good years, right?

And I look back and it’s like, oh, wow,

well, I guess I did all that.

But I think that’s really one of the keys,

is really taking it one day at a time,

which you’re sealed.

And also this connecting with the environment, right?

So being awake and alert to your environment

and connecting with your environment,

not trying to escape it.

And of course, escapism is what we all want and desire,

that experience of non-being.

And we get it from the internet or from drugs

or whatever it is, but it’s the booby prize.

Because ultimately, it takes you further and further away

from your immediate environment,

which is where we really have to connect

to get that sense of groundedness and authenticity

and like of being in our own lives.

Well, I think the unit of the day

is something that comes up again and again

in my discussions with colleagues

who are extremely successful

and who also have balanced lives.

This actually came up in the discussion

with Karl Deisseroth,

who is also a successful scientist and clinician

and manages a family, et cetera.

So the unit of the day I think is fundamental

and those stack up, as you mentioned.

So along those lines, I’ve heard you say

that in order to reset the dopamine system,

essentially in order to break an addictive pattern,

to become unaddicted,

30 days of zero interaction with that substance,

that person, et cetera.

Is that correct?

Yeah, and 30 days is in my clinical experience,

the average amount of time it takes

for the brain to reset reward pathways,

for dopamine transmission to regenerate itself.

There’s also a little bit of science

that suggests that that’s true.

Some imaging studies showing that

our brains are still in a dopamine deficit state

two weeks after we’ve been using our drug.

And then a study by Shuckett and Brown,

which took a group of depressed men

who also were addicted to alcohol,

put them in a hospital

where they had received no treatment for depression,

but they had no access to alcohol in that time.

And after four weeks, 80% of them no longer met criteria

for major depression.

So again, this idea that by depriving ourselves

of this high dopamine, high reward substance or behavior,

we allow our brains to regenerate its own dopamine

for the balance to really equilibrate.

And then we’re in a place

where we can sort of enjoy other things.

So that progressive narrowing

of what brings one pleasure eventually expands.

So I’d like to dissect out that 30 days a little more,


And I also want to address

how does one stop doing something for 30 days

if the thing is a thought?

So we’ll kind of put that on the shelf for a moment.

So days one through 10,

I would imagine will be very uncomfortable.

They’re going to suck, basically, to be quite honest,

because the way you describe this pleasure-pain balance,

to my mind says that if you remove what little pleasure

one is getting or a lot of pleasure

from engaging in some behavior,

the pain system is really ramped up

and nothing is making me feel good.

I’ll just use myself as an example.

I’m not in recovery,

but that 10 days is going to be miserable.

Anxiety, trouble sleeping,

physical agitation to the point where

maybe impulsive, angry.

Should one expect all of that?

Should the family members of people expect all of that?

Yeah, so what I say to patients,

and it’s a really important piece of this intervention,

is that you will feel worse before you feel better.

For how long?


This is probably the first question they ask, right?

And I say, usually, in my clinical experience,

you’ll feel worse for two weeks.

But if you can make it through those first two weeks,

the sun will start to come out in week three.

And by week four,

most people are feeling a whole lot better than they were

before they stopped using their substance.

So yeah, you have to, it’s a hard thing.

You have to sign up for it.

And I will say, obviously,

there are people with addictions that are so severe

that as long as they have access to their drug or behavior,

they’re not able to stop themselves.

And that’s why we have higher levels of care

or residential treatment.

So this is not going to be for everybody, this intervention,

but it’s amazing how many people

with really severe addictions to things like heroin,

cocaine, very severe pornography addictions,

I posit this, and I do it as an experiment.

I said, let’s try this experiment.

I’m always amazed, number one,

how many of them are willing,

and number two, how many of them are actually able to do it.

They are able to do it.

And so that little nudge is sort of just what they need.

And the carrot is,

there’s a better life out there for you,

and you’ll be able to taste it in a month.

You really will be able to begin to see

that you can feel better and that there’s another way.

So the way you describe it seems like it’s hard,

but it’s doable for most people, not everybody.

And we’ll return to that category of people

who can’t do that on their own.

Well, then days 21 through 30,

people are feeling better.

The sun is starting to come out, as you mentioned.

Which translates in the narrative we’ve created here

and support by biology,

that dopamine is starting to be released

in response to the taste of a really good cup of coffee.

Yes, exactly.

Whereas before it was only to insert addictive behavior.

Right, that’s right.


Of course, coffee can be addictive too,

but we’ll leave that aside.

Yeah, I feel like coffee has a kind of

consumption limiting mechanism built in,

where at some point you just can’t ingest anymore.

But maybe that’s wrong.

Sorry to give lift to the caffeine addicts out there,

as I clutch my mug.

So days 21 through 30,

I’ve seen a lot of people go through addiction

and addiction treatment.

I’ve spent a lot of time in those places,

actually looking at it, researching.

I’ve got friends in that community.

I’m close with that community.

One thing I’ve seen over and over again,

sadly, often in the same individuals,

is they get sober from whatever.

They’re doing great.

These are people with families.

These are people that you discard

your normal image of an addict

and insert the most normal, typical,

whatever, healthy person you can imagine,

because a lot of these people you wouldn’t know were addicts.

And then all of a sudden you get this call.

So-and-so’s back in jail.

So-and-so’s wife is going to leave him

because he drank two bottles of wine

and took a Xanax at 7 a.m.,

crashed his truck into a pole.

It’s got two beautiful kids.

How did this happen again?

To the point where by the fourth and fifth time,

people are just done.

I mean, you might be able to detect

the frustration in my voice.

I’m dealing with this with somebody that’s like,

I don’t even know that I want to help this time.

It’s been so many times.

To the point where I’m starting to wonder,

is this person just an addict?

This is just kind of what they do and who they are.

And you never want to give up on people,

but, and I’m hanging in there for them,

but I will say that many people have given up on them.

And so what I’d like to talk about in this context

is what sorts of things help other people

that we know that are addicted?

What really helps?

Not what could help, but what really helps?

And are there certain people for whom it’s hopeless?

I mean, I don’t like to hold the conversation that way,

but I wouldn’t be close to the real life data

if I didn’t ask, is it hopeless?

Are there people who just will not be able

to quit their substance use or their addictive behavior,

despite, I have to assume, really wanting to?


Yeah, so there are people who will die

of their disease of addiction.

And I think conceptualizing it as a disease

is a helpful frame.

There are other frames that we could use,

but I do think given the brain physiologic changes

that occur with sustained heavy drug use

and what we know happens to the brain,

it is really reasonable to think of it as a brain disease.

And for me, the real window of, let’s say,

being able to access my compassion

around people who are repeat relapsers,

even when their life is so much better,

when they’re in recovery.

Yeah, it’s like a no-brainer, right?

Is to conceptualize this balance

and the dopamine deficit state

and a balance tilted to the side of pain.

And to imagine that for some people,

after a month or six months or maybe even six years,

their balance is still tipped to the side of pain,

that on some level, that balance has lost its resilience

and its ability to restore homeostasis.

It’s almost like the hinge on that balance is messed up.

Yes, exactly.

And so, I mean, for someone who’s never experienced

addiction like yourself,

maybe one way to conceptualize it is-

Well, I didn’t say that.

Oh, okay.

No, to be clear, I was not referring to myself,

but in this example I was given,

if I were, I would come clean.

I would reveal that.

But I think that, especially after hearing

some of your lectures and descriptions

of the range of things that are addictive,

I think I’ve been fortunate

that I don’t have a propensity for drugs or alcohol.

Right, okay.

I’m lucky in that way, that frankly,

if they remove all the alcohol from the planet,

I’ll just be relieved because no one will offer it to me.

Right, right.

So don’t send me any alcohol.

It won’t go to me.


But I don’t have that,

I like to think I have the compassion,

but I don’t have that empathy for

taking a really good situation

and what from the outside looks to be

throwing it in the trash.

Yeah, so okay, so is that what that means?

And this is really, I think, important

because I also had to come to an understanding of this,

and I feel that I have in my 20 years

of seeing these patients.

And of course, addiction is a spectrum disease, right?

And so you’ve got the severe end of things.

Imagine that you had an itch somewhere on your body, okay?

And it was, I mean, we’ve all had that,

like, you know, whatever the source.

It was super, super itchy.

You can go for, you know, if you really focus,

you could go for a pretty good amount of time

not scratching it.

But the moment you stopped focusing on not scratching it,

you would scratch it.

And maybe you would do it while you were asleep, right?

And that is what happens to people with severe addiction.

That balance is essentially broken.

Homeostasis does not get restored

despite sustained abstinence.

They’re living with that constant specter of that pull.

It never goes away.

So let me say there are lots of people with addiction

for whom that does go away.

And it goes away at four weeks for many of them.

But in severe cases, that’s always there and it’s lingering.

And it’s the moment when they’re not focusing on not using.

It’s like a reflex.

They fall back into it.

It’s not purposeful.

It’s not because they want to get high.

It’s not because they value using drugs

more than they do their family.

None of that.

It’s that really they cannot not do it

when given the opportunity and that moment

when they’re not thinking about it.

Does that make sense?

That’s a great description.

And actually in that description,

I can feel a bit of empathy

because the way you described scratching an itch

in your sleep, I’ve done that with mosquito bites

and someone scratching and you’re like,

oh, you wake up scratching that mosquito bite.

And I also have to admit that I’ve experienced

not feeling like I want to pick up my phone

because it’s so rewarding, but just finding myself doing it.

Yes, of course.

Like I’m not going to use this thing.

I’m not going to use this thing.

And then just finding myself doing it.

Like, what am I doing here?

Sort of the, how did I get back here again?

And I know enough about brain function

to understand that we have circuits

that generate deliberate behavior

and we have circuits that generate reflexive behavior.

And one of the goals of the nervous system

is to make the deliberate stuff reflexive

so you don’t have to make the decision

because decision-making is a very costly thing to do.

Decision-making of any kind.

So that does really help.

I want to just try and weave together this dopamine puzzle,

however, because if by week,

so first phase of this 30 or 40 day detox,

it’s like a dopamine fast, right?

Okay, first 10 days are miserable.

Middle 10 days, the clouds are out.

There may be some shards of sunlight coming through

and then all of a sudden, sun starts to come out,

it gets brighter and brighter.

Why is it then that people will relapse

not just after getting fired from a job

or their spouse leaving them,

but when things are going really well?

Is it this unconscious mechanism?

Because I’ve seen this before is they have a great win.

I have a friend who’s a really impressive creative.

I don’t want to reveal any more than that.

But, and relapsed upon getting another

really terrific opportunity to create for the entire world.

And I was like, how can that happen?

But now I’m beginning to wonder,

was it the dopamine associated with that win

that opened the spigot on this dopamine system?

Because it happened in a phase

of a really great stretch of life.

Yeah, right.

Yeah, so you raised that great point about triggers, right?

And triggers are things that make us want to go back

to using our drug.

And the key thing about triggers, whatever they are,

is they also release a little bit of dopamine, right?

So just thinking about whatever the trigger is

that we associate with drug use,

or just thinking about drug use,

can already release this anticipatory dopamine,

this little mini spike.

But here’s the part that I think is really fascinating.

That mini spike is followed by a mini deficit state.

So it goes up, and then it doesn’t go back down

to baseline, it goes below baseline tonic levels.

And that’s craving, right?

So that anticipation is immediately followed

by wanting the drug.

And it’s that dopamine deficit state

that drives the motivation to go and get the drug.

So many people talk about dopamine

is not really about pleasure,

but about wanting and about motivation.

And so it is that deficit state

that then drives the locomotion to get it.

And earlier, your description of dopamine being involved

in the desire for more, giving the sense of reward,

but also movement.

I have to assume that those things are braided together

in our nervous system for the specific intention

of when you feel something good,

then you feel the pain, but maybe you don’t notice it.

And then the next thing you know,

you’re pursuing more of the thing that could deliver.

And I love the way you use the word braided together.

That’s beautiful.

And let me also just say something

that I find also fascinating in my work with patients,

and I see this all the time.

There are people for whom bad life experiences,

loss, you know, in any form,

stress in many different forms, that’s a trigger.

But there are absolutely people

for whom the trigger is things going well.

And the things going well can be like the reward

of the things going well,

but very often what it is,

is the removal of the hypervigilant state

that’s required to keep their use in check.

So it’s this sense of, I wanna celebrate, you know,

or I wanna, this reward happened,

I wanna put more reward on there.

And it’s really, really fascinating

because when people come to that realization

about themselves, that they’re most vulnerable

when things are going well,

that’s really a valuable insight

because then they can put some, you know,

things in place or barriers in place,

or go to more meetings or whatever it is that they do,

you know, to protect themselves.

Along those lines, I have a friend, 40 years sober,

who was a severe drug and alcohol addict

from a very young age, really impressive person,

does a lot of important work

in the kind of at-risk youth community out in Hawaii.

And he said something to me, he said,

as former addicts often do, they’ve got these great sayings,

but I think it fits very well with what you’re describing.

He said, you know, no matter how far you drive,

you’re always the same distance from the ditch.

And I said, well, that’s kind of depressing.

And he said, no, that’s actually what gives me peace

because what would happen is for so many years

of relapsing and relapsing, getting,

recovering and relapsing, he felt like it was hopeless.

And then somehow conceptualizing

that the vigilance can never go away.

Instead of making him feel burdened,

it made him feel relieved.

So I often think about that statement, you know,

no matter how far you drive,

you’re always the same distance from the ditch

because in my mind, I conceptualize that as, gosh,

that’s a tough way to drive down the road,

but actually on a road where you know where the ditch is

and where you know where the lane lines are,

it’s actually a pretty nice drive.

It’s when you don’t know where the shoulder is

that you constantly have to be looking around.

So there’s this, we’re speaking now in analogies

and imagery and science.

But one of the things I find so incredible

about this community of 12-step,

and there are a variety of them,

are the communities that they create for themselves.

And some of these sayings, which I do believe link back

to really core biological mechanisms.

Yes, yes.

I do want to ask about those communities.

I have a question which might be a little bit controversial.


Which is, is it possible

that people who were addicted to drugs or alcohol

or some gambling or some other behavior

get addicted to the addiction community?

Because one thing that I think I observe over and over

is that there’s some circuit in the brain of human beings

that has to tell you about the dream

they had the night before, for whatever reason.

There’s another circuit that leads people to wake you up

if they themselves can’t sleep.

I don’t know what the circuit is.

I’m being facetious here.

But there does seem to also be a circuit

in the brain of addicts to discuss

and want to kind of talk about their recovery a lot.

And I mentioned this not to poke at them,

but rather the opposite,

because I think that one thing that is challenging,

at least for me and having friends

that have a propensity for drug or alcohol addiction,

not all of them, but certainly some of them,

is when they’re talking about their recovery,

I feel like it’s all they talk about.

This meeting, that meeting, that meeting.

So what I’m really asking here is,

can we become addicted to sobriety?

Right, so this is a great question,

and it links into some of the other things

we’ve been talking about having to do with

where do we settle out?

What is the way to live between pleasure and pain?

And I implied earlier that ultimately

we want a resilient balance

that’s sensitive to pleasure and pain,

but that can easily restore homeostasis after we indulge,

even when we indulge greatly.

But the truth of the matter is that

people with severe addiction,

I believe temperamentally want those extremes

and they’re wired for that kind of intensity

that is more than just these slight adjustments

around the fulcrum, right?

It’s like, they want the big highs and the big lows.

They’ll say, great meeting.

Yeah, right.

They’re like, that was such an amazing meeting,

or they find a group.

They find a group in a location.

This is almost an inside joke in those communities.

Again, I’m not reporting,

I’m not talking about a friend in quotes,

this isn’t me reporting,

where they’ll talk about how attractive people are

at a given meeting,

or how bonded they feel to people at a given meeting,

that the meetings themselves

become their own form of dopamine hit.

Yes, yes.

And again, I’m not being disparaging,

I just, I want to understand this.

Right, so yes, so a lot of times patients will say to me,

oh, you know, I don’t want to go to AA, it’s a cult.

And my response to that is,

because it’s a cult is exactly why it works, okay?

Because yes, it is much better for you

to be addicted to AA and to recovery

than almost any other addiction I could think of.

And we know from Rob Malenka’s work,

who’s here at Stanford,

that oxytocin is the hormone that’s involved

in human pair bonding and relationships and love.

And it directly links to dopamine neurons

and causes the release of dopamine.

So yes, when we connect with other humans,

especially in a kind of transcendent spiritual way,

that’s a huge dopamine hit.

And it does replace the dopamine that people get from drugs.

And for people who have this addiction temperament,

they need it on a more intense level.

They’re not gonna be generally satisfied

with kind of, you know, sort of acquaintanceship, right?

They want that intensity of the intimacy

that you get with people

when you’re cathartically exposing, you know, warts and all.

So yes, people can get addicted to recovery

and good for them, go for it, you know?

And of course, this can be disruptive for friendships

and relationships where the one person is not in recovery,

like you’re going to so many meetings,

you’re always talking about recovery, but you know what?

Much better than them being intoxicated, right?

I mean, so although you may tire of your friends

talking about their, you know, meetings all the time,

I’m sure you would rather have them do that

than, you know, be in their addiction, so.

Absolutely, and this is now the second time

you’ve done this during this discussion,

but now I have empathy because the way you describe

their enthusiasm about meetings

is probably the way that people feel about me and work.

And in neuroscience, I mean,

I’ve been getting up in front of the class

since I was eight years old

and talking about things I read over the weekend.

Now I just happen to have this thing called a podcast.

I’ve been doing it since I was little

and it annoys a lot of people, right?

I’ve learned to suppress it a little bit.

Some people like it, but I’m poking fun at myself

just to say that I now can understand

that the way I feel about their reports

about yet another amazing meeting

or for, there’s a different form of this,

but there’s some people for which

they just love intense experiences.

They’re always like trying to pull me off to Bali

because they’re talking about how sensual it is.

Although I’m sure Bali is wonderful,

but there’s this kind of ratcheting up.

It’s like seeking Burning Man all year long.

I’ve never been to Burning Man,

no desire to go to Burning Man.

But inside of academia, I mean,

if I were to just turn the mirror at myself,

inside of academia or here in Silicon Valley,

work and the pursuit of more success,

even if money is kind of divorced from that,

sometimes it is, sometimes it isn’t,

academic work is for sake of pursuit of knowledge.

It sounds to me like the same mechanism.

In fact, it feels to me very much like the same mechanism.

So Andrew, here’s what I love about you.

First of all, you’re willing to bring your own flaws

and foibles to this conversation.

Well, they’re everywhere.

Well, you know what?

It’s wonderful.

And then you’re really open and curious

and wanting to understand,

because I can’t tell you how many people I have met

who really see addiction as some kind of otherness.

But the truth is we’re all wired for addiction.

And if you’re not addicted yet,

it’s just, it’s right around the corner.

Do you know what I mean?

Especially with the incredible panoply of new drugs

and behaviors that are out there.

So I love that you’re willing to take a moment

and really try to understand this,

because it is, we can all relate.

And you’re relating it to your,

essentially your work addiction is right and apt.

You just happen to be addicted to something

that is really socially rewarded.

You know, you figured that out at an early age.

Oh, when I do X, Y, and Z,

all these people go, look at that smart kid

or whatever it is, you know.

For me, it made me feel safe.


I felt like, yeah, I just felt like this.

And I paused there because it’s like peace.

I’m like, ah, I can relax for a moment.

When you’re talking about neuroscience.

Or just when I feel like I’m on the right path

and I’m on to something,

or if I see something that I’m excited about,

I’m like, I feel filled with, it must be dopamine.

I feel flooded with pleasure, literally from head to toe.

And then my next thought is more.

So true, you’re really, you’re a true addict.

You are.

Thank you.

You are, but you just got really,

you really got lucky with the fact

that what you’re drawn to is adaptive, essentially.

And then your challenge is going to be

that your life doesn’t get too out of balance

in the sense that you’re 24 seven work

and you don’t stop and do some other things

or think about it.

And my life admittedly is somewhat asymmetric.

I mean, it has other components of physical health,

et cetera, but it is somewhat asymmetric,

which is why I got a dog.

Although I talk about him an awful lot.

But the dog is good because that draws you out of yourself

and a little bit away from the work.

But again, I think the key here is for people

who feel like they’ve never experienced addiction

or they don’t know anybody with addiction,

or if they do, they don’t get it.

Just think of that one thing

that is the most important thing in your life that you do

that gives you pleasure and meaning and purpose.

And then imagine if you couldn’t do it.

Oh yeah, let’s not talk about that.

Well, I appreciate the feedback

and you can send me a bill at the end.

What is the most ridiculous sounding addiction

that you’ve ever witnessed

that was actually a real addiction along these lines?

Because I think we all know the standard heroin pill.

You’ve been very, I should mention,

because it’s important, your previous book,

and we will probably link to that as well,

focused on the opioid crisis

and what we thought was medication

and turned out to be just as bad,

if not worse, than a lot of so-called street drugs.

So we understand those gambling,

sex addiction, porn addiction, now video games.

We’ll talk about social media a little bit more in depth,

but what’s the most like, wow,

I didn’t realize people could get addicted to that?




So I had a very lovely patient

who had a severe alcohol addiction

and she got into recovery from her alcohol addiction

for many years,

but she kind of had a sort of a polydipsia

or an urge to be drinking something a lot.

And so she drank a lot of water

and slowly over time,

she realized that if she drank enough water,

she could become hyponatremic and delirious

and be out of herself.

You can die from it, right?

Right, which is,

she just wanted to be out of her own head.

And so she would periodically,

intentionally overdose on water

in order to,

I know it was so sad, so sad.

What happened to her?

She eventually took her own life.


Yeah, it was really.

That’s rough.

She was a lovely woman.

She was so bright.

She had so many interests and passions.

And of course it was very sad when she died.

But that was a wow to me.

It was like, wow,

if you have this disease of addiction,

you can even get addicted to water.


And I think it just underscores

the generalizability of these circuits.


There isn’t a brain circuit for addiction to water

that she happened to have.

There’s a brain circuit for pleasure and pain

and addiction and water plugged into that circuit.

Right, right.

Wow, that’s intense.

In your book, Dopamine Nation,

you also describe some amazing paths to recovery.

People that, from reading it,

I won’t say which ones and who,

because there’s some great surprises in the book too,

both tragic and triumphant, as they say.

You’ve often described your patients as your heroes.


Yeah, tell us a little bit more about that.

You know, when you think about how hard it is

to give up a drug or a behavior that you’re addicted to,

and how much courage that takes and fortitude

and discipline and stick-to-itiveness,

these people are really amazing people.

I mean, that’s, I don’t know that I could do it,

what they do, you know.

It’s, and like, you know, we talked a little bit about,

you know, just the constant, ever-present urge to use,

even after sustained periods of abstinence for some people.

That’s really, really hard.

And of course, then you double down on the shame

that they feel because of that urge,

even when their lives are so much better.

I mean, these people are really, really remarkable.

And you take their remarkable accomplishment,

and then you imagine the world that we live in now,

where we are constantly invited and tempted,

and really bombarded with opportunities

to become addicted at every turn.

It’s like feeling an itch everywhere.

Oh yeah, I mean, you can’t escape it.

You know, you cannot escape it,

that you’ll get an email in your inbox

inviting you to do X, Y, or Z,

and if you’re addicted to that thing,

you know, you tried to like delete all your apps

and not go here, all of a sudden, your work inbox,

you’re getting those images, let’s say,

really, really, really hard.

And yet these people find a way to do it.

I think it’s absolutely amazing.

And they’re really wise people.

They have so much wisdom to offer.

They’ve taught me a lot.

You know, as I talk about in my book,

I have my own addictions,

and I really just like took a page right out of there,

but I was like, okay, what do I do now?

All right, what did this patient do?

What about, okay, I’m gonna try that.

It is an amazing community of people

that they are very sage.

I wanted to just touch on something that you mentioned,

which is the shame.

You know, you can’t go to a meeting

or talk to addicts without detecting

or hearing about like lies, shame, et cetera.

I heard you say in an interview

with somebody else recently

that truth-telling and secrets

are sort of at the core of recovery.

And yeah, tell us more about that.

Yeah, so one of the things that I found really fascinating

about working with people in recovery

was how telling the truth,

even about the merest detail of their lives,

was central to their recovery.

And I became really curious about that.

Like, why would truth-telling be so important?

And of course, there is the obvious thing

that when people are in their addiction,

they’re lying about using.

So part of getting into recovery

is to stop lying to the people they care about

about their use.

But it’s really more than that,

because what people in recovery have taught me

is that it’s not even just not lying about using drugs.

I have to not lie about anything.

I can’t lie about why I was late to work this morning,

which we all do.

Oh, I hit traffic.

No, I didn’t hit traffic.

I wanted to spend two more minutes reading the paper

or drinking my coffee, right?

Or just lying about, I don’t know, where I had dinner.

So people with addiction will get into the lying habit

where they’re lying about random stuff

because they’re sort of in the habit of lying.

And how recovery is really about telling the truth

in all ways.

And so one of the things that I had a lot of fun with

in writing the book is sort of exploring

the neuroscience around why truth-telling is important

to leading a balanced life.

And we know like every religion since the beginning of time

is all about telling the truth.

Well, why, right?

And there’s really interesting neuroscience behind it

that suggests that when we tell the truth,

we actually potentially strengthen

our prefrontal cortical circuits

and their connections to our limbic brain

and our reward brain.

And of course, these are the circuits that get disconnected

when we’re in our addiction, right?

Our balance in our reward pathway, our limbic brain,

our emotion brain is doing one thing

and our cortical circuits are completely disengaged

from that, ignoring what’s happening,

which is easy to do because it’s reflexive.

We don’t need to think about that balance

for the balance to be happening.

But we have to re-engage those circuits,

anticipate future consequences, think through the drink,

not just how am I gonna feel now if I use,

but how am I gonna feel tomorrow or six months from now?

And that telling the truth is in fact a way to do that,

to make these connections stronger.

And there, I talk about some studies in my book

that kind of indirectly show that.

So I find that really fascinating,

plus just that being open and honest with people

really does create very intimate connections.

And those intimate connections create dopamine.

So we were talking a little bit about how you know

a bunch of people who need intensity in their lives.

For me, I need a lot of intensity in my human connections.

Like I’m really not interested in

and bored by and made anxious by casual interactions.

But like having this kind of discussion with you

that’s very intense and also intimate and self-disclosing

is very rewarding for me.

So that’s an important source of dopamine.

Thank God I became a psychiatrist.


Like I can’t disclose all my stuff,

but I am quite transparent with my patients,

which is a slightly unorthodox.

But when I think it’s right, I’m also transparent with them.

So that’s a source of dopamine too,

when we’re honest and we disclose.

And that you think people are going to run away from you

if you tell them about all like your weird neuroses,

but really they don’t.

What they’re like is, oh, thank God,

I’m not the only one.


Well, what I love about,

I love many things about your book.

I read it in one sweep.

Oh, thank you.

And I was like, wow.

I was pleasantly surprised, but I was like, wow,

she’s really opening up in this book from the very beginning.

And I don’t want to give it away,

but it’s, yeah, you’re very open where it’s appropriate.

And also I think that this question about truth-telling,

I always think about like, tell the truth,

be 100% about the truth,

but there’s also this element about,

do you report previous lies?


Like what about prior behavior?

And I’m fascinated by this,

because to me, telling the truth has many facets,

but the three sides of this thing in my mind are,

one is reporting everything accurately.

The other is, what do you withhold?

What do you not withhold?


Because some people will say, tell the truth

or at least don’t lie.

That’s sort of a-

Lies of omission.

That’s a lies of omission, lies of omission.

And then there’s the,

what I have to assume for most people is a small

to enormous batch of things that they lied about

in the past that still thread into the future.

So how important is it for the addict

or the every person really to,

because it sounds like cultivating the circuitry

between prefrontal cortex and the dopamine system

would be great for anybody,

since we’re all addicts, everyone should do it.

But in all seriousness,

it sounds like a good thing for everybody to do.

How much work needs to be done on all the priors,

all the stuff we’ve hidden and,

I mean, not me, but all the stuff

that everybody else has hidden.


So the steps of the 12 steps of Alcoholics Anonymous,

a good number of those steps are about that very thing,

the past, the ways that we’ve harmed people in the past.

And the fourth step is about making amends,

you know, by admitting the ways in which

that we’ve contributed to harming others.

And it is a really big piece of recovery.

So, you know, how important,

so for people with addiction,

it’s really, really important to go back and make amends.

And, you know, the key idea there is

you just go back and you apologize, you know,

and you don’t have to get any particular kind of response

or you don’t need to be forgiven.

It’s the act itself of apologizing about

the ways in which we’ve harmed or lied to people

in the past that is cathartic and renewing

and allows us to kind of shed this skin

and be new in our lives and begin again,

sort of absolved, you know, of past sins, so to speak.

So it is really important.

You know, are there situations

when it’s maybe not a good idea

because of that person or the nature?

Sure, you know, there are always gonna be,

it doesn’t have to be like,

it’s not, we’re talking about not like Kant’s idea

about like never lie, but you know,

robbers in your house and you’re stowaway.

You can’t lie even about that.

It’s like, no, there are probably situations where,

you know.

For sake of other people’s safety.


Children’s safety.

Right, right, right.

I mean, there, you can think of a million scenarios,

but in general, you know, when we’re taking stock,

because I don’t know about you,

but I have a lot of regrets and guilt

about a lot of things in my life.

And they kind of haunt me.

You know, and sometimes I’ll have nightmares, right?

And I think that’s true for most people.

I mean, I occasionally will meet somebody who’s like,

I don’t have any regrets in my life.

I’m like, wow.

Like, I cannot relate to that at all.

So, you know, this idea of like catharsis and well,

I mean, in the 12 steps,

it’s telling God or your higher power,

telling another human being the ways

in which you’ve wronged others,

considering your own character defects

and how those have contributed.

To me, that’s a really important piece

and something that we don’t do enough in our current culture,

especially in psychiatry, frankly,

where there’s a lot of eternally empathizing with patients,

but not a whole lot of like going, well, you know,

actually you kind of messed that up.

Or like, that was really bad on you.

You know, and in my work,

I don’t necessarily use that language,

but, you know, patients may say like,

I really feel badly about, you know, this thing.

I’ll be like, yeah, I get it.

I understand that you feel.

Well, guilt is a, there’s a circuit for that too.

Right, and it’s important, right?

And it’s also important to recovery

and to not becoming addicted,

you know, experiencing a certain amount of appropriate shame

for things that we have done.

And, you know, feeling the pain that comes with shame,

which is an incredibly painful emotion, right?

And I think that may be the one

that we all try to avoid more than any other,

is like that shame of not being liked

or not being accepted or not being celebrated.

Or that the thing that we did is really despicable.

Right, it’s really, yeah.

Like, oh my God, I did that horrible thing.

Right, right.

And then, so, I mean, I’ve done horrible things

that I haven’t gone back and said,

I did this horrible thing,

but maybe I’ve tried to pay it forward.

Like I’ve told my kids, you know, when I was younger,

I did this horrible thing and it still haunts me.

So if you’re ever tempted to do something like what I did,

you might think about my situation.

So, you know, some kind of way,

but I think wrestling with that is important.

All right, I think it’s a really important element

to all of this.

And there’s not, I love that there’s neuroscience

being done on truth-telling and the value of truth-telling.

I think if I were to predict a new and truly exciting area

that people are going to be really curious about,

in this huge sphere we call neuroscience,

I hope they’ll continue to do more work.

Also speaks to, I’m so glad to hear

that’s happening here at Stanford.

No, that’s, well, the literature that I look at

isn’t Stanford work, but there’s work.

There might be people that say,

Regardless of where it’s happening,

more of that and all the rest, please.

I want to ask you about using drugs to treat drug addiction.

These days, there’s a growing interest

or at least discussion about Ibogaine.

People going out of country,

because I think it’s still illegal here,

or is illegal here, going out of country to,

I don’t know, either inject it or smoke it

or whatever it is,

or people going and doing ayahuasca journeys or MDMA,

which is still an illegal drug in this country,

but there are clinical trials.

There are people on this campus doing experimental studies.

I don’t know of clinical trials,

but at Johns Hopkins, there are clinical trials.

Et cetera.

So this is a vast area, right?

Different chemistries for different drugs

and different purposes,

but the rationale as I understand it

is take people who are in a pattern of addiction,

launch them into a experience

that’s also chemical and extreme,

often of the extreme serotonin and or extreme dopamine type.

So MDMA, ecstasy, for instance,

tons of serotonin dumped,

tons of dopamine dumped,

how neurotoxic, if neurotoxic, debatable, et cetera,

et cetera, not a topic for now, but a lot.

And then somehow that extreme experience

wrapped inside of a supported network in there,

whether or not there’s just someone there

or whether or not they’re actively working through something

with the patient is supposed to eject the person

into a life where drug use isn’t as much of interest.

This violates, at a purely rational level,

this violates everything that we’ve talked about

in terms of dopamine biology.

It would, if this arrangement is the way I described it,

cause more addiction.

It is anything but a dopamine fast.

It’s a dopamine feast.

So we hear about successful transitions through this,

at least anecdotally,

and maybe some clinic will say,

what is going on?

What is going on?

Doesn’t make any sense to me.


Yeah, so I think it’s good that you’re skeptical.

I think we all should be skeptical.

Having said that, there are clinical studies showing,

you know, and these are small studies

and they’re short duration, small number of subjects,

but, you know, taking people, for example,

who are addicted to alcohol,

and then having them have this,

let’s say psychedelic experience

in a very controlled setting.

So either, typically it’s a high dose psilocybin

or three dose, as I saw it for the MAP study of MDMA,

of ecstasy.

Those are sort of the, seem to be the kind of bread

and butter of this kind of work.

But the thing to really keep in mind

is that this is completely interwoven

with regular psychotherapy.

And that these are highly selected individuals.

And clinical trials.

Right, right.

And these are clinical trials.

We’re referring to legal clinical trials.

Right, right.

And so, you know, I think the metaphor

that helps me think about this is,

there are many ways to the top of the mountain,

and these are sort of like taking the gondola

instead of walking up.

It’s sort of, instead of doing like a year of psychoanalysis

where you’re sitting on the couch every week,

reflecting on your life,

it’s a condensed version of psychoanalysis or psychotherapy

plus, you know, MDMA, which gets you there faster.

Creates the intimacy, presumably, because of this.

Well, I think the main thing that happens

when it’s beneficial is it just allows the person

to get outside of their own head

and look at their lives on a much broader sweep.

And to consider themselves not mired

in the, you know, quotidian sort of details of their life,

but rather as a human on the large planet Earth

in the vast universe.

So I think it takes, it’s like, when it works,

it’s a transformational experience

because it gives the person another lens

through which to view their life, their lives,

which I think, for some people, is positive and powerful

because they can come back from that and be like,

oh my gosh, I care about my family

and I don’t, I want X, Y, or Z for them.

And I realize that my continuing to drink

is not going to, you know, achieve that.

So it’s almost like a spiritual or values-based.

So I think it can be very powerful.

But having said that, I truly am quite skeptical

because, you know, addiction is a chronic relapsing

and remitting problem.

It’s hard for me to imagine that there’s something

that works very quickly short-term

that’s going to work for a disease

that’s really long-lasting.

Yeah, the two addicts I know

that did MDMA-assisted psychotherapy

as part of this thing, both got worse.


But the people I know who had severe trauma,

who did this, who took this approach,

seem to be doing better.

Okay, interesting.

And so I think that the discussion as we hear it now

is just sort of psychedelics, which is a huge category

that includes many different drugs

and compounds with different effects.

And we hear about trauma and addiction lumped together.

And I think that I’m a splitter, not a lumper,

as we say in science.

And I think it’s going to be important for people

to know that this is definitely not

a one-size-fits-all kind of thing.

But it sounds like it may have some utility

under certain conditions.

Yeah, I think so.

I think I’m trying to be very open-minded

about its potential utility for certain individuals.

But I can tell you in my clinical work,

what is a very concerning unintended consequence

of this narrative is I have a lot of people

who are looking for some kind of spiritual awakening

who on their own, not in the context

of any kind of therapeutic psychological work,

you know, microdose or wanna try psilocybin

or MDMA with a friend or wherever

so they can have this spiritual experience

that they can figure out their lives.

That’s a disaster and almost never works out well.

And I’ve then had people who literally,

supposedly you can’t get addicted to psychedelics

because something with the biochemistry,

which I don’t fully understand

because it doesn’t make any sense to me.

But I have patients clinically who definitely are addicted

to, you know, MDMA, to microdosing.

So that’s very concerning to me

because like, you know, Pollen’s How to Change Your Mind,

that, you know, I respect that work,

but on the other hand, it’s penetrated the culture.

Michael Pollan’s book.

Yeah, yeah.

Well, and I don’t know him

and so I don’t have a problem taking a stance.

So I’ll just say my stance on that is the narrative

of popular authors can expand and wick out so fast

that pretty soon people are essentially

taking their mental health into their own hands.

And I actually, I have great optimism

for this business of clinical use of psychedelics,

including MDMA.

Matthew Johnson at Johns Hopkins

is doing fabulous work on this

and there are others too, of course,

but those are controlled settings.

And the pharmacology is being tuned up.

And one thing that I think is coming,

there are several papers published recently

in great journals like Nature and Science, et cetera,

where there are scientists

who are removing the hallucinogenic components

of these drugs and finding that they still have

the antidepressant effects.

And so the experience of a psychedelic

and the long-term effects of the psychedelic

might actually be dissociable.

And so I, again, and I’m always careful to say

I’m neither for something or against it.

I just think that treading carefully is what’s important.

I agree with you.

And I can just tell you that the downstream effect

for the average person,

many of whom present in our clinic,

is that they’ve misconstrued the data

on the use of psychedelics for mental health conditions

to this idea that they’re safe

or that anybody can take them in any circumstance

and have this kind of awakening.

And that’s not what the data show, right?

The data are these highly controlled settings,

carefully selected patients.

So that’s my worry.


And I’m going to be sitting down with Matthew Johnson

at some point and we’ll discuss this.

And I think that that care

and that cocoon of real clinical care

does seem to be an important component.

Well, I’m glad we could touch on it.

And I’m sure I’ll get a bunch of comments telling me.

But I think it is important to explore things

from all sides.

And that’s what we do as scientists.

And if Michael Pollan wants to chat, we can do that too.

That’s fine.

I very much enjoyed the book, actually.

But I think that people run with ideas.

That’s right.

They don’t walk with them, they sprint.

Right, yeah.

There are a couple other things I just want to touch on,

but they all relate to social media.


You were featured in the Social Dilemma.

It was a powerful movie.

I think many people avoided seeing that movie

because it reflects back on us just how addicted we all are

and how manipulated we all are.


But it doesn’t seem to have changed behavior much.

I have to say that the movie changed my understanding

and my perception, but not my behavior too much.

If we look at addiction as a maladaptive thing,

something that’s making our lives worse

or us less functional at work and in relationships,

I could imagine a version of social media

where it’s making me more connected.

I mean, this is a podcast after all.

I post videos.

This will show up on YouTube

and elements of it on Instagram as well.

Much like sugar or other things,

I have to imagine that we need to regulate,

not necessarily eliminate this behavior.

So I want to talk about what that looks like.

And I want to talk about what you’ve referred to

as this narcissistic preoccupation

that social media is creating,

that we are all far more keenly aware of how we look

and how we sound and how we are being perceived

than we were 10 years ago.

So first of all, social media,

how addicting is it really?

And what is healthy social media behavior?

So the first message I would want to get across

about social media is that it really is a drug

and it’s engineered to be a drug.

And it’s based on potency, quantity, variety,

the bottomless bowls, the likes,

the way that it’s enumerated, all of that,

which doesn’t mean that we can’t use it,

but we need to be very thoughtful about the way we use it,

just like we need to be thoughtful

about the way we use any drug.

And so that means with intention

and in advance planning our use, right?

And trying to use it as a really awesome tool

to potentially connect with other people

and not to be used by it or get lost in it.

And of course, people are gonna come

with different propensities for addiction to any drug,

and that’s true for social media too.

Some people will have no problem using it in moderation

or using it in a way that’s adaptive

and other people will immediately get sucked in.

And the key thing about getting addicted

is when it’s happening, nobody who’s getting addicted

thinks they’re getting addicted, right?

Let’s face it.

It’s only after the fact that we go,

whoops, what was that about?

Well, remember texting and driving?

There were all these books about texting and driving,

how terrible it was.

Even the governments have largely given up.

You see these billboards, like don’t text and drive

or any text can wait or not worth dying for,

but everybody’s texting and driving.

Right, and if you look at young people today, teenagers,

I mean, they’re basically cybernetically enhanced

that the phone is there.

It’s like they’re talking to you

and texting 12 friends at the same time,

and there’s no stopping it.

I mean, the genie is out of the bottle.

We’re not going back.

So we do need to figure out how to make this tool

something that’s gonna be good for us

and not ultimately harmful.

And I don’t have all the answers

by any stretch of the imagination,

but I do think some of the wisdom that we have learned

from using other drugs also applies to social media,

which is to say that we have to, again,

put barriers in place that allow us

to remain in control of our use,

which means not too much, not too often, not too potent.

Do you think in going back to this idea

of the unit of the day being a good tractable unit,

a manageable unit of time for most people,

so you’re saying in advance,

so allocating two hours in which you’re going to allow

yourself to have free reign use of the phone

and all its apps and all its things,

or even more restricted than that,

meaning, okay, I’m only gonna allow myself 30 minutes a day

to post and comment,

and then that’s a closeout completely?

Yeah, so I think it depends on the person,

and it’s sort of a combination.

We talked earlier about having an itch

and scratching yourself at night.

We’ve gotten to a point with smartphones,

people are pulling them out,

and they are utterly unconscious of doing so,

pulling them out, a couple texts, a couple,

they don’t know they’re doing it.

I have a friend who works and delivers babies,

and many pregnant mothers

won’t actually deliver without their phone in hand,

and this used to be the hand

that was connected to their spouse.

This may be a comment on spouses more than on phones,

but it sounds like it’s a kind of a security blanket.

Right, like a transitional object, yeah.

Actually, that reminds me, you’ve referred to the phone,

I think it’s the phone,

but maybe it’s our online persona or ourselves

as we’ve become sort of infantile in our need for,

it’s like a baby in a bottle,

and so I do wonder if we have regressed,

and I do think we’ve regressed a bit

in terms of our online behavior,

our inability to act like,

I always thought an adult

was somebody that can control their behavior.

That’s the difference between a baby and an adult.

You don’t have to be a developmental neurobiologist

for very long to understand that a young organism

can’t control its behavior and an older one can.

So to me, a mature organism, mature in years organism

that can’t control its behavior is a baby.

It’s an immature version of itself,

and there’s neuroscience to support that statement.

I look at my own behavior with the phone sometimes,

and I think, I’m a grown man.

Like, what is the problem here, right?

You know, I don’t eat baby food,

but I’m acting like a baby with the phone, all right?

In the sense that I’m reflexively picking it up.

I’m not being intentioned and deliberate with it.

Do I need a full 30 days, Anna?

30 days away from my phone?

No, that’s my recommendation, the full 30 days to reset.

If you’re severely addicted, I recommend the 30 days,

but if you’re just a little bit addicted like most of us,

you probably don’t need 30 days.

In fact, a single day not only would be challenging,

but probably maybe sufficient.

My phone is off for substantial segments of the day.

Okay, that’s great.

And it drives other people crazy.

People expect me to respond, but I don’t care.

I really don’t.

And I actually take a little bit of pleasure

in the fact that, well, because I think the point

I’m trying to make is the right one,

which is that it’s not just right for me,

but like why, I don’t see a clause on text messages

or emails that say, must be responded to

within X amount of time or else, or else.

So I take the liberty of replying when I’m able to.

Yeah, that’s right.

Or want to.

Right, which touches on one of the big challenges

about social media is that as more and more of us

are spending more and more time on social media,

we’re divesting our libidinous energies, et cetera,

from real life interactions.

So that means even when we want to choose

to not be online connecting, we go outside

and there’s no there there, right?

There’s nobody else there.

So I think our collective challenge,

and it should be our mission,

is to make sure that we are preserving

and maintaining offline ways to connect with each other.

Because if we don’t do that, then we’ll be very lonely,

right, if we were not online.

But if you have a tribe of folks that you can be with,

none of whom are on their phones while you’re together

for that discrete amount of time,

then it’s wonderful and liberating and nobody’s distracted.

And I think that’s really the key.

And I think young people are figuring that out.

They’re trying to create these spaces or try to,

let’s say, instead of doing a dopamine fast by yourself,

do it with your friends, right?

Then there’s the FOMO is less, the fear of missing out,

because, oh, you’re all doing the dopamine fast together.

So these are some of the tricks that we can come up with,


I like that.

Yeah, okay, good.

I like that.

I don’t allow, I have a home gym and I love working out.

I just enjoy it and I always have.

And I don’t allow my phone in my gym anymore.

And I live in an area where I don’t get any reception,

like two meters outside my door.

So all my dog walks now are just with the dog.

And they were boring as hell.

I also have a bulldog.

He doesn’t like to walk.

It’s really slow.

And it was so boring for a while.

Because I was so used to taking calls while I walk

and it’s super efficient.

Why wouldn’t I do that?

The walks now are some of my favorite part of the day.

Because, and if the phone were,

if I were to get a call on one of those

and they brought reception in the area,

I would be very dismayed.

So I can attest to this.

And I don’t think I’m a phone addict,

but I do put work into regulating my phone behavior.

Yes, so this is the key.

You have to, with intention,

prior to being in that situation,

think of literal physical and metacognitive barriers

that you can put between yourself and your phone

or whatever your drug is,

to create these intentional spaces

where you’re not constantly interrupting yourself,

essentially, and distracting yourself.

Because I really do think,

I think we talked just before we started with the interview,

we’re losing the ability to have a sustained thought, right?

I mean, we get so far,

and then you get to that point in the thought

where it’s a little bit hard to know what’s coming next.

And it’s very easy to check your phone or check your email

or look something up on the internet.

And then you never get that opportunity

to finish that thought,

which is really the source of creative energy

and an original thought, right?

You’re not just reacting to what’s coming at you.

Right, and something that could contribute to the world.

That’s right.

I’m a big believer that you’re either consuming

or you are creating.


And there is, I should mention, it’s important.

I do believe in neutral time.

I think sleep is great.

I’m a big proponent of sleep

and I’ve talked a lot about it on the podcast.

I care a lot about sleep

and not just for sake of performance.

I actually just really like sleep.

I think that being a constant consumer of visual information

and information of all kinds can be a problem.

But there’s some really great sources of information

on the internet.

And I certainly benefit from the fact

that those channels exist.

Narcissistic preoccupation.

Am I a narcissist?

First of all, there’s healthy-

Or is the fact that I asked, does that take me out of,

would a narcissist never ask that question?

Oh yes, a highly sophisticated narcissist

would know to do that.

Well, I’m not very sophisticated.

So there’s healthy narcissism,

which means that we all invest our personal energies

into things that we care about.

And if our competence in that arena is threatened,

we would all experience a narcissistic injury

and that’s normal and healthy.

But we are living in a narcissistic culture.

I mean, that’s not news,

this preoccupation with individual achievement

and individual self-worth and individual self-confidence.

And I think all of that is just fueled by social media

where we’re not just seeing ourselves,

but we’re seeing people’s reactions to ourselves

and every single thing we say or do,

we get likes and this and that.

It’s really insidious.

And it contributes, I think, ultimately

to a lot of personal shame

because we’re not really meant to be individuals

bouncing around in the universe, we’re social animals.

And we’re probably generally happiest,

even for natural contrarians among us,

when we’re part of a tribe, right?

And if we do too much to kind of separate ourselves

from that tribe, I think that the brain’s natural

and instinctive corrective mechanism against that

is self-loathing and shame.

So, it’s so ironic because the culture tells us

if we just achieve more, we’ll like ourselves more.

But the truth is actually the opposite,

that I think when people get these pinnacles

of personal achievement,

you have things like the imposter syndrome or whatever.

You know, we’re at Stanford

after a lot of high achievers here, right?

Some phenomenal, amazing people like yourself

and other colleagues of mine that just, I’m always in awe.

Like, it’s just amazing.

Like, the mean is shifted so high.

And also people who have amazing paths to get here

coming from very little, accomplishing so much.

But it’s also the pressure, right?

You know, the way that this career was described to me

the day I got my job was one colleague of mine,

the late Ben Behrer, said,

“‘Welcome to schizophrenia

“‘cause you’re never going to be able to complete anything

“‘without getting interrupted.’”

That was partially true.

Although I’ve created buffers.

And the other one, very successful scientist

and a member of the National Academy, et cetera,

said to me, you know, just remember it’s pinball.

You never win.

The best you can do is just keep playing.

And I thought, wow, okay, okay.

And then you just go.

But I think that as we achieve more,

not just academics, of course,

but as anyone achieves more,

there’s the relishing in the accomplishment.

There’s often the desire for more,

but there’s also the pressure of,

well, now I have to do this for the next 30 years,

even though I love it.

It’s the pressure of, well, if the mountain is this high,

then how do I get here and here and here?

And then you start shoveling more dirt on

so you can keep climbing.

And it’s a lot of work.

And I think that the perception of success

is that there’s a roar of the crowd and you cruise.

You don’t cruise.

They just give you more to do.

Or you give yourself more to do.

Well, what I think is, at least in my life experience,

and I’ve heard this from other people as well,

you know, it’s that prize that we’re going for

that if we get it, is so unsatisfying.

And it’s the prize that we never imagined

that we kind of go, well, how did that happen?

But gee, you know, that feels good.

And so I’m very, you know, it’s cure.

What’s the cure?

It’s like a mirage in the one case.

And it’s like a, yeah, it’s on the one,

it’s almost like dopamine can create these mirages.

That there’s some place there.

That’s right.

And if I just, it’s that pot of gold, right?

If I just-

Constant dopamine.

Right, right.

That’s right, that’s right.

And I think this, you know, this really, I think,

is related to our discussion earlier

about this taking it one day at a time

or paying attention to that, you know,

24 hour period in your environment.

I am absolutely fascinated by the ways

in which we accumulate success when we do that,

totally independent of the desire for success.

It’s really process oriented.

It’s like, where am I today?

How can I make today a good and meaningful day,

a little bit better or as good as some other days I’ve had?

Constantly tweaking and experimenting with this experiment

that we call, you know, our human existence.

And when we do that in a way that’s authentic

and paying attention and value driven,

whatever our, you know, values are informed by,

it is very, very interesting how those days, again,

accumulate and you find, wow,

I guess I contributed something of value there,

but I wasn’t trying to do that.

You know, I think that’s really,

I mean, what I’m so amazed by is like, you know,

20 years ago when I went to Stanford Medical School,

25 years ago, you know, I just,

I was happy to just be a good doctor.

I was like, I guess I’m just gonna try to figure out

how to be a good doctor and I’m here to learn that.

And now I see these medical students and they’re wonderful.

They’re brilliant and they’re well-intentioned, all that.

But they’re like, how can I, you know,

write the great American novel, do my startup,

go to Africa, apply for that grant?

You know, it’s like, really?

I was just trying to learn how to be a doctor.

And it’s, as you say, it’s a lot of pressure on them.

And it’s also kind of a weird leapfrogging

of the real way to accomplish something.

Which isn’t about like, oh, how can I accomplish something?

It’s like, what can I do today

that would be of service, right?

And then finding that, of trying to be of service,

you know, and not really going for recognition

can sometimes lead to what people call success.

Although that wasn’t what you were aiming for.

And it’s all the more beautiful

when it’s not what you’re aiming for.

Oh, so much better, so much better.

Yeah, I’m a big believer that when one can

align their compulsion with some greater good.


The service to humanity or the planet or animals,

whatever it is, that’s where the really good stuff emerges.

Because there’s a lot of reciprocity there.

The world starts to, you’re supporting the world,

and then it starts to support you

in a way that feels very fluid.

And that comes back, right?

And I mean, that speaks to like your generosity to me,

vis-a-vis my book.

And I have to say-

Well, I love the book.

I know.

There’s like, we’re not in a business deal, folks.

It’s just purely that I heard Anna lecture in my course.

I wanted to learn more about dopamine.

She taught me.

I asked her if she would come on the podcast.

Turned out she wrote this amazing book.

She sent me a copy of the book.

I read it in one sweep.

It’s incredible.

And I love it.

So just like the eight-year-old version of me,

now the 45 version of myself,

I can’t stop blabbing about the things I love.

Well, it’s awesome.

But I have to say I have been surprised by your generosity.

It’s not something I’ve encountered frequently at Stanford,

which is a wonderful place,

but there is a general sense

that if I give away to somebody else,

I’ve lost something,

which is not the right way to think about it,

not how you are, and also not how the world works.

Because when we give away to other people,

we get back so much more, but it takes a long time.

And it might not come through that path.

I never think about reciprocity,

but I was weaned by good advisors.

That’s very nice.

Yeah, I think I just sort of got drilled into me

that the more you give, the better your immediate life is.

Yes, yeah.

But I also don’t have a long-term vision.

I’m just excited about the book.

I’m excited that people are learning

about the brain and dopamine.

I have to admit, having grown up in neuroscience,

essentially, I did not understand

that pleasure and pain were orchestrated

the way that they are.

I’m very mindful of it now.

Oh, good.

And it’s changed a number of my behaviors.

I know a number of people are going to have questions

and want to get in contact with you.

You are not on social media.

That’s correct, yes.

And you are true to your ideology.

That’s great.

And the reason for that is just

I wouldn’t be able to control myself.

I mean, that really would be my drug.

People are my drug.

Intimacy is my drug, and I wouldn’t be able to manage it.

And so it was just easier for me to not do it at all

rather than try to moderate it.

Well, the book, as you mentioned before,

and as I can attest to, it has a certain intimacy.

People get to know you through the book.

So definitely check out the book.

If you have questions about the book, et cetera,

you’re welcome to send them my way.

I will buffer you from all those questions.

I’ll filter them.

Okay, Anna, Dr. Lemke, I should be a formal,

forgive me, I’ve been referring to you

the whole way through-

No, no, that’s fine, that’s fine.

Because we’re colleagues,

but thank you so much for sharing this information.

And I know I learned a ton,

and I know everyone else is going to learn

a lot more about addiction and the good side of dopamine.

That’s right.

Thank you for having me.

It’s been really, really great to talk with you.

Great, thank you.

Thank you for joining me for my discussion

with Dr. Anna Lemke.

I hope you enjoyed it as much as I did.

Please be sure to check out her new book,

Dopamine Nation, Finding Balance in the Age of Indulgence.

You can pre-order it on Amazon

or any places where books are sold.

It’s an absolutely fascinating and engaging read

all about addiction and dopamine.

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