Big Technology Podcast - This Is Your Brain On iPhone — With Dr. Anna Lembke

Episode Date: August 17, 2022

Dr. Anna Lembke is a professor of psychiatry at Stanford University's School of Medicine and chief of its Addiction Medicine Dual Diagnosis Clinic. She's also the author of Dopamine Nation, a bestseller that uses neuroscience to explain why the pursuit of pleasure so often leads to pain. In this episode, we discuss Dr. Lembke's fascinating thesis about what happens to our brain chemistry each time we pick a device. Stay tuned for the second half, where we discuss whether a more invigorating but less happy life is worth it.

LinkedIn Presents. Hello and welcome to the big technology podcast, a show for cool-headed nuance conversation of the tech world and beyond. And before we introduce our guests today, I just want to say that we are trying to get some more ratings on both Apple podcasts and Spotify. These ratings really help. They make sure that the podcast is seen by more people, which then enables us to get better guests. And guests like our guest today, Professor Anna Lemke.

So if you have a moment and you want to hit that five star on Apple or Spotify, you want to get a quick dopamine hit, feel good about it. We're about to talk about that. I just encourage you to go do that. And I can't even express how grateful we would be here at Big Technology Podcast if you make that happen. Okay, let me introduce our guest today. Our guest today is Anna Lemke. She's the professor of psychiatry at Stanford University, author of Dopamine Nation, finding balance in the age of indulgence.

It's a New York Times bestselling book. And what I love about the book and what I love about hearing Dr. Lemke speak is that we have had a long conversation about phone addiction, companies trying to addict us to our phones. Is it evil? Is it something we can resist? I think the debate has largely been. been unhinged. And the reason is because it's been so far removed from the actual science of the matter. And when you listen to Dr. Lemke speak, I think you're going to start to hear some of that

come through. Not the unhinged part. The science of the matter. Maybe a little bit of the unhinged part. I'll handle that as yesterday will. But I think that we need more voices like the one you're about to hear. And I'm excited to bring this interview to you. So Dr. Lumkey, welcome to the show. Thanks for inviting me. I'm happy to be here. Great to have you. We're living in a very interesting age. We have the most affluent countries in the world as the most depressed, the most interested in suicide, to be frank about it, the most anxious in those that experience the most physical pain you've written about opioids so we can get into that in the second half. It's wild because there's more comfort now than you've ever seen before. So I think we should start. simply by hearing from your point of view, the point of view of someone who works with patients in psychiatry, someone who knows the science. What happens in our brains when we use our phones? So it's very clear, you know, based on imaging studies that screens are lighting up our

brain's reward pathway, which is the circuit in our brain that also responds to addictive. substances like cannabis, cocaine, alcohol, you name it, as well as, you know, potentially addictive behaviors, gambling, sex pornography. So, you know, online content is very reinforcing, very stimulating, leads to the release of dopamine in that very specific brain circuit. And so I think it's very interesting that you point out all these other vices in the beginning. There's a feeling among some that tech is responsible for basically all evil in the world. It's clearly from your opening statement here, not that. However, it does in combination with things like alcohol or like, you know, the other, the other vices that we might have. It's one ingredient in what's making the society, you know, so unhealthy.

And so I think we should, we're going to cover all of it. but we should get into exactly, you know, what happens with tech as an ingredient, and then we can sort of expand a little bit. So let's talk a little bit about our relationship with dopamine and how we get dopamine from the apps that we use on our phone, from messages that we use on our phone, and where that might be leading to some unhealthy situations. Okay, first, let's back up a little bit. I mean, it's interesting that you use the word, vices, this kind of moralizing language about ingesting, you know, certain types of substances are engaging in certain behaviors. On the one hand, you know, I get that. On the other hand,

I think a lot of people are probably react negatively to that kind of moralizing language. Because in a way, these are all just behaviors, right? You know, drinking alcohol. It's really just a behavior going online and betting on a sporting event. It's just a behavior. And I think we're likely to make more progress. If we just conceptualize those behaviors as as behaviors and recognize that for some people who come with an innate vulnerability to the problem of compulsive overuse and who happen to find their lock and key, right? So that specific sort of let's say, I'll just call it a drug, right, for, you know, just kind of keep it down to a catch-all term for all kinds of substances or behaviors that are reinforcing and that we have the

potential to get addicted to. You know, there's a lot of inter-individual variability. So what may be reinforcing for me is not necessarily reinforcing for you and vice versa. But I think one of the ways to maybe move the conversation forward is to just, you know, that these are all behaviors that people do and that in moderation they're not necessarily bad and possibly even good. But it's really a matter really of degree and whether or not that behavior then interferes with our ability to care for ourselves and others as kind of a sort of the starting point because the whole field, you know, is moving toward, you know, using phrases

like people who use drugs as opposed to addicts, right? Or even, yeah, or actually even people who are addicted. People who use drugs. But the tech community still calls the people that use their products users. So we can talk about that. Yeah, right, right. So, so that kind of language, right, the users, I mean, yeah, we're all users, right, when it comes to technology and digital stuff so um and you know just like most people who who use alcohol don't get addicted to alcohol in truth most people use um online content are not going to get you know addicted according to our clinical criteria which by the way are just criteria we don't have a blood test or a brain scan for any of that it's based on what we call phenomenology or patterns of behavior over time that meet certain criteria

anyway sorry to interject that but i thought that might be worthwhile yeah i think it is and just to like I mean, just to talk about this word vice, I feel like it's worth spending a moment on. You're right. There's definitely like a moralizing element to it. There's also, I think one of the things that I've heard in the past is that everyone kind of needs one. You know, people need outlets. And it doesn't mean to the point of access. But I've never looked at a vice as something that is, you know, a moral failing because I do believe that life is stressful enough.

and you talk about this in your research so we can go deeper into this, but life is stressful enough that sometimes you do need an outlet, you know, whether that's an occasional cigarette or beer once in a while, you know, or an hour on TikTok. And I do think that, yeah, maybe there are folks who look down upon that. I think that when you do get, though, into the addictive area, that's when it's, it becomes problematic for people and you start to want to investigate the root causes. Right. And to even acknowledge that. that, you know, when, when is it that people cross that line from, you know, recreational or even productive, advantageous use of a substance or behavior into sort of maladaptive use? And again,

just emphasizing, it's not like we can scan the brain and say, oh, you know, look at that, look at that when that person's addicted. It's not like that. It's, you know, in many cases, much more subtle. In some cases, it's not subtle. Like people with, you know, addiction is a spectrum disorder or a mild, moderate, in severe cases, some people, everybody could identify that. I mean, people can die of their disease and addiction. But most of us sort of fall somewhere, you know, before that on the spectrum. And, you know, it's not always easy to know when we cross the line. Generally, the overriding definition of addiction is the continued compulsive use of a substance or behavior despite harm to self and or others. And typically, we look for the four Cs, control compulsory.

cravings and consequences, as well as physiologic signs of dependence, like withdrawal, tolerance, needing more and more of time to get the same effect, and, you know, a kind of narrowing of our focus on that drug. Right. And the way to get there is, well, I'm going to throw out the assertion that I have based off of what I've, you know, read of your research, and you can let me know if this is right or wrong. The path to get there is that you start to do these little things, drink up.

a beer, you know, take a hit of a joint. You know, you spend time on social media. And that gives you these dopamine hits. And from my understanding, what your research shows is that your body then gives you a withdrawal or some sort of painful stimulus to help get you back to center. And you just crave more and more. So can you go deep, more deeply into that? Because, and this is where we're going to start setting up the tech conversation, because tech is filled with those little dopamine hits. So can you talk about how those small dopamine hits build up to something bigger? Yeah, happy to do that. So I think this is a really exciting neuroscience of pleasure and pain that, you know, so many wonderful researchers and scientists have worked on in the past 75 to 100 years.

And to me, one of the most exciting findings is that pain and pleasure are co-located in the brains of the same parts of the brain that process pain also process pleasure. And they actually work like opposite sides of a balance. So if you imagine a teeter-totter and a kid's playground, we experience pleasure. It tilts one way, and we experience pain. It tilts the opposite. But there are certain rules governing that balance. And the first rule is that it wants to remain level. And after any deviation from neutrality, our brain, our self-regulating mechanisms will work very hard to restore that level balance or what neuroscientists call homeostasis. So for example, You know, when I, let's say, read a romance novel, which I developed a mild behavioral addiction to reading romance novels about 10 years ago, I get a hit of dopamine, which is a chemical made in our brain. It's a neurotransmitter. It's one of the most important neurotransmitters for pleasure, reward, and motivation. And it's released in a very specific circuit of the brain called the reward circuit. So I read a romance novel. I get a little bit of increased dopamine in my reward pathway. That feels good.

And this metaphorical balance tilts the side of pleasure. But no sooner has that happened, then my brain immediately adapts to the increased levels of dopamine to try to bring it back down to baseline tonic levels of dopamine firing, because we're always firing dopamine at kind of baseline levels. And I like to imagine that as these neuroadaptation gremlins, like these little gremlins that just hop on the pain side of the balance to bring it level again. but the gremlins really like it on the balance so they don't get off as soon as its level, they stay on until it's tilted and equal and opposite amount to the side of pain.

And that's called the opponent process reaction. And we experience that as the hangover, the come down, that moment of wanting to read one more chapter, even though I said when I finish this chapter, I would put the book down and go to sleep. Now, if we wait long enough, those gremlins will hop off the pain side of the balance and homeostasis will be restored, but the key message here for people to realize is that the way the brain restores neutrality is first by tipping an equal and opposite amount to whatever the initial stimulus is. So that means for every pleasure, for every pleasure, we pay a price and that price is the come down. And it may be subtle and it may be outside of our conscious awareness,

but it's always there. Homeostasis is different for everyone. Some people's homeostasis might be a very happy place. And some people's homeostasis might be a very unhappy place. Right. That's right. And I'm curious how you think about that. And this is obviously we're still building up to the tech side.

But I think this is important to get into. So let's do it now. And so I'm kind of curious, you know, if, okay, we want to get to homeostasis. Let's say homeostasis is sad. what does that mean? Right. So, yeah, that's such a great, great question because, you know, we all sort of assume that we start out with a level balance, a balance that's sort of equal between pleasure and pain. But the truth is that, you know, some of us, you know, who are, let's say, innately dysphoric or depressed or anxious or who have some kind of chronic physical

pain condition, don't start out with a level balance. We start out with a balance that's tightly, slightly tilted to the side of pain. And that's just, that's homeostasis for us. That's, that's our baseline. And that's important because, you know, that, that means that those individuals are probably, and we have the epidemiologic data to support this, at increased risk of reaching for a drug, you know, it's a manifold variety, you know, to try to feel better. And indeed, you know, the data show that people who have psychiatric disorders like depression, anxiety, schizophrenia, you name it, are at increased risk of getting addicted to drugs and alcohol.

And again, the hypothesis there is that on some level they're trying to self-medicate that underlying, you know, psychiatric disorder. Same thing with people with chronic pain, you know, gosh, you know, physical chronic pain is devastating. stating. And of course, those individuals are looking for something to help them, you know, get out of that kind of painful state. The problem is that these various potent intoxicants that tilt our pleasure pain balance inside of pleasure, unfortunately, the brain still will work very hard to restore homeostasis, whatever that initial homeostasis may be. So, even if, you know, we start out slightly tilted to the side of pain, our brains will work to get us back to that baseline state. And, you know, the problem of addiction comes out of repeatedly exposing

our brains to reinforcing substances and behaviors, ultimately accumulating more and more of these neuroadaptation gremlins on the pain side of the balance, such that that initial response to pleasure gets weaker and shorter, but that after response to pain gets stronger and longer. so that no matter where we start out with repeated exposure to reinforcing drugs and behaviors, we end up in this dopamine deficit state or tilted to the side of pain, even below whatever our initial pain state might have been. You can alter your homeostasis then. Right.

You can start out as a happy person, but if you go too hardcore on dopamine-inducing activities, perhaps your baseline then becomes more sad because you have all these pain gremlins that are saying I shouldn't be here. Yeah, that's exactly right. And, you know, we see this clinically all the time. I have patients who come in. They say I'm depressed. I'm anxious.

I can't sleep. I can't pay attention. You know, and then I discover in the process of my clinical exam that they're smoking pot all day or playing video games all day or on social media all day. So one of my first interventions, you know, 20 years ago, I would have written them for a prescription of an antidepressant anti-anxiety. Now my first intervention is really, I ask them to abstainting. staying for long enough for those neuroadaptation gremlins to hop off the pain

side of balance and for homeostasis to be restored. And in the vast majority of individuals who are willing and able to do that, they will come back a month later and say, I feel so much better. I feel less depressed, less anxious. And they're really surprised. That's the consistent theme, how surprised they are, because they feel like their drug is relieving their underlying psychiatric disorder, but really all it's doing is medicating withdrawal from the last dose. we as a species have worked really hard to build the good life for ourselves. I'm curious, from your perspective, over the course of the last couple hundred years or human evolution, whatever timeline you choose to pick, do we have far more instances available to us where we can

trigger that dopamine release than we did in the past? Like, are we in the all-time leading moment of being able to give ourselves dopamine hits? And what has that evolution looked like? Yeah. Well, I mean, if Mark Zuckerberg has his way with the Metaverse, we're not even at the peak yet of access to highly reinforcing drugs and behaviors. There's yet more potent versions to come. But certainly, you know, the last 200 years is essentially characterized by an unprecedented change in our environment, whereby through technology, which has created more leisure time, you know, more mechanized work. more disposable income, and more access variety and novelty of highly potent reinforcing drugs and behaviors now at the touch of a fingertip, that we've essentially changed the world that we live in. And there's a term for this called the Anthropocene to characterize our age. It's usually used in reference to climate change, but I think it's aptly used to describe the kind of dopamine overload that we experience now where we're insulated from pain.

we have access to almost infinite pleasures without having to work for them. So that's really important because the way that our ancient neural machinery is wired is for us to be the ultimate seekers, to be motivated to work very hard, to get a very modest pleasure. And now the world we're living in, we have access to incredibly potent pleasures, much more potent than our brains can handle or than we ever had before. Fentinell, for example, is an opioid that is 52. 100 times more potent than morphine, which is the opioid, which is derived from a poppy plant and exists in nature. And then that's true for almost every drug, you know, you can look at.

We see increased potency, increased access. I mean, imagine if cocaine were immediately as plentiful as TikTok, right? We would have many more people struggling with cocaine addiction. And the fact that TikTok is infinite really increases its addictive potential because quantity and frequency matter when it comes to addiction. The more we do of our drug and the more often, the more gremlins we accumulate on the pain side of the balance and more likely we are to get into the stokamine deficit state. And once we're there, now we're using not to get high, but just to restore homeostasis and feel like our normal selves. When we're not using, we're experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability,

insomnia, depression, and craving. Right. And so compared to like 200 years ago, where like you'd work the field and, you know, maybe, like, you're, you're a limit, your availability of different dopamine hits was probably limited to, like, I don't know, maybe a romantic relationship and a beer. Now, we have all these forms of drugs. We have Netflix, endless Netflix, endless TikTok. We have really, you know, amazing food. You know, people call it dope food, you know, no joke, right? It's, you know, because it's addicting and everything at our fingertips. I think, you know, right. Yep, I agree. And the thing is that, you know, people have always used intoxicants. And since the beginning of recorded human history, there have always been a subset of people who have not been

able to use in moderation, people we would consider to, you know, have the disease of addiction. But even so, even, you know, the use of intoxicants through the ages, you know, basically people have used relatively mild intoxicants and they were hard to procure and they ran out and they were expensive and people had limited time, you know, in which to indulge in these intoxicants and all that has really been turned on its head. And you can almost, so, so I'm going to posit that, you know, our society now is like even less happy than we were when we didn't have all this amazing stuff before iPhones and MacBooks and, I don't know, Zoom MP3 players even. And you could almost see that as a control variable experiment in our world today where the richest countries

it started leading off with this, like the richest countries, countries with all this technology, the countries with the highest iPhone, you know, per capita are, and I think you've mentioned this, the most depressed, the most anxious,

the most, you know, contemplative of suicide, et cetera, et cetera. It's weird to think, but is there a link to like, you know, the fact that there's all this, all this stuff available at our fingertips

is what's causing, you know, all these issues. And I think, you mentioned that like when our body is out of homeostasis, we are in a mode of stress. And, you know, we always think of stress as the negative, but sometimes the positive can cause stress. I don't throw out a lot of stuff out there, but I'd love to hear your thoughts on this. Yeah. Yeah. No, so I mean, when I was doing the research for my book, one of the most fascinating

things that that I discovered was that on a happiness of nations is directly correlated with wealth of nations. You know, we have Adam Smith's wealth of nations, this idea that capitalism would solve all ills and the invisible hand and the free market. And once people, you know, lived in free and capitalist societies, you know, they would be so happy. And yet what we see is that those countries with the most successful forms of capitalism who've accumulated the most wealth, we're seeing the highest rates of depression, suicide, anxiety, and just general overall misery. And these are based on large-scale population surveys. I will also add that these are also countries

in which we're seeing the highest rate of addiction, not surprisingly. And this is all in just about the last 30 to 50 years that we've seen this major sea change come about, which really suggests a tipping point and which does coincide with the advent of the Internet and these digital devices that have made everything so much more convenient it, you know, for good and for bad.

These are also countries in which people have more access than ever to mental health treatment. More antidepressants are prescribed in these countries than ever before. So, you know, this is not, you know, mental illness is largely destigmatized in these countries. So it's not a function of people not having access to mental health treatment. People are getting a lot of mental health treatment and they're not getting better. And I think that's really important because it suggests that we are misunderstanding the cause of our unhappiness. We are conceptualizing it as due to a mental illness when what I would suggest is that it is due to a mismatch between a healthy but very old brain system and a world that is unlike, you know, the world that we were evolved to live in. And this is essentially the source of our problem.

Pretty amazing. So we build this wealth to effectively buy a good life. People go to war over it, you know, et cetera, et cetera. And in effect, it seems like a fool's errand if I'm hearing you right. Because what it is is leading to all this unhappiness because people keep triggering that dopamine response and it keeps making them unhappier as a result. Yeah, I mean, I think, you know, it's important to acknowledge that like our lives, are really much better in so many ways where we've cured a lot of life-threatening diseases.

You know, people used to live on average to age 30. They now live on average to age 80. I mean, we don't experience the kinds of, you know, nasty, brutish and short lives that characterize, you know, most of human existence. But we have reached some kind of tipping point where these advantages that are, you know, characterized by the scientific progress of our age have this dark side. There's this seedy underbelly. And we have to grapple with that. You know, if we don't, we're going to die of different reasons. So, for example, 70% of global deaths today are due to diseases caused by modifiable risk factors. And the top three are smoking in activity and poor diet. So in other words, we're now at a place where we are

starting to die more often of diseases related to compulsive overconsumption addiction than diseases related to, you know, let's say, what historically have been the cause of death for most of, you know, human existence, things like infectious diseases and cancers. Yeah, and I don't know if I'm allowed to tell this joke, but whatever, I'll do it because I think it was so perceptive that, you know, Louis C.K. before he had his whole situation, and did this bit that everything is amazing and no one's happy. He's talking about how someone's like throwing a fit on an airplane because he can't connect to Wi-Fi.

And he's like, you are on a steel tube, you know, flying at incredible speeds, taking you to your destination and you're going to land and you're mad about the Wi-Fi. And we never really understood why, but I think the science really goes a long way towards explaining what's happening. Right. Like that pleasure pain balance and the hedonic set point and the fact that if we constantly press on the pleasure side of the balance, our brains are trying to accommodate that and will recalibrate to the side of pain until we get to this point where we need a whole lot of pleasure

to feel anything at all that's pleasurable. And even the merest pain is painful. And I think anybody, any of us who does sort of a gut check on our own lives or the culture today can really, you know, that really resonates as just plain old true, right? The types of things that people experience now as difficult or traumatic or painful are just orders of magnitude less than what people have endured with resilience in prior generations. And it's not to say that we're wimpy now. I really contend it's physiologic. It's like it's because we are constantly bombarded with dopamine that we have physiologically, literally changed our ability to tolerate pain. Professor Anna Lemke is with us.

She's the professor of psychiatry at Stanford University and author of the best selling book, Dopamine Nation. Finding balance in the age of indulgence, I'm sure you've already got out and bought it already. But in case you haven't, you have some time to do so. During the break, we'll be back right after this. Hey, everyone, let me tell you about the Hustle Daily Show, a podcast filled with business, tech news,

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And we're back here with Professor Anna Lemke, Professor of Psychiatry at Stanford University, author of Dopamine Nation, Finding Balance in the Age of Indulgence. Well, why don't we talk about tech? Because we've spent the whole first half setting the stage. No regrets about that. It's August. You're probably hanging out, having time to hear a little bit more about how your brain works.

Now we're going to get into some of the industry stuff. It seems to me, Professor, that there we talk about different ways to get dopamine hits. You know, maybe watching a nice movie via a DVD, you know, was that, 15 years ago. But now we have the iPhone or an Android phone in our hands or maybe a Windows phone if you're still in a bunker somewhere in Redmond, Redmond, anyway, in Seattle. And so how has the introduction of the phone changed the amount of dopamine that we've introduced into our daily lives? Is it like the exponential force multiplier that sent all this stuff into overdrive and really hit it hit us with a shock to our systems and and before for you answer I just

want to point out I love talking about it through this lens a because I think it's right and B because it actually comes to show you that this is not you know an evil plot by the tech industry to hijack our brains and it's just kind of how the thing works it's not like where you know being taken over it's just like okay we have this at our you know our our access and it's naturally addictive. It's not designed in an addictive way, even though some of, there might be some game, you know, theory that goes on in Silicon Valley development houses. But they almost don't have to work that hard because our brains are doing it for us anyway. Well, I would say it's a combination. I mean, I think these things are intentionally made to be addictive. But, you know, so is every product.

Right. You know, that is made. That's the point people want to make it so that we will buy more of it, consume more of it, and come back again. But there is something, I mean, I think there is something invidious about the digital products that we didn't anticipate. You know, the extent to which we are compulsively engaged with our smartphones is really impressive. I mean, it's, it's astonishing. You know, I have interacted with many, many teens for whom even the thought of putting their phone away for 24 hours is enough to incite a panic attack. That's really, that's really spectacular. It's, it's not something I think that anybody would have predicted in 2001 when the first smartphones came out. In my clinical practice, after the advent of the smartphone, for the first time,

I started seeing more and more people come in wanting help for behavioral addictions to things like online pornography and online gambling. And these were primarily middle-aged men who had gambled or used pornography, you know, in a manageable way through most of their lives. But then once they got, you know, the internet and the smartphone in particular just found they were no longer able to control their use and their use was out of control and with really significant consequences. So, you know, although that's not a large end, you know, that's just my clinical practice, It certainly stood out, and it allowed me to sort of be on the front lines of observing very early on the potential dark side for some vulnerable individuals in particular, the nature of this sort of 24-7 access to this digital content. And hence, I've likened the smartphone to the hypodermic syringe.

The hyperdermic syringe was invented in the 1850s. It was the first way to administer fluid and chemicals, right? into our bloodstream. Morphine, which was available in the early 1800s, and then quickly led to severe morphine addiction by the middle of the 1800s, 1850s. Interestingly, the hypodermic syringe was going to be the invention that solved the morphine addiction problem. The hypothesis was, well, if you inject morphine directly into the bloodstream, people won't get addicted. Obviously, that was a failure. But it was the advent of that. It was the advent of the bloodstream. that technology that, you know, really accelerated addiction to morphine. And today, of course,

we all know that intravenous drug use is one of the most addictive ways to use drug because it goes drugs because they go right to the bloodstream. And I think the smartphone is like that. You know, because we can take it anywhere we go, we have more access. And remember, quantity and frequency matter when it comes to the potential for developing addiction. If you recall this pleasure pain balance and those gremlins, the gremlins will always hop on the pain side to counteract pleasure. But if we wait long enough in between, they'll hop off and that craving to reuse will pass and homeostasis will be restored. But if when the gremlins are already on the pain side of the balance, we reach for more and more

and more of our drug. Again, that is what gets us into this dopamine deficit state where we change our hedonic set point. And that's exactly, you know, what's happening with digital content, where because we've now got we're mainlining it, we don't give our brains any opportunity to recover in between and that, you know, accelerates and puts us all at greater risk for addiction to digital drugs. Yeah. And so going back to the characterization of what's looking about, I'm not making excuses for people who are trying to build addictive products, but it's almost a feature of the form where if you're in a world where you're using DVDs, okay, you put the DVD in, you got to go buy another one and you put another, you're going to sit there for an hour

and a half. With a TikTok, you know, you're looking at a minute video and then the next one and the next one. Yeah. I mean, right. I mean, I think the way, you know, more addictive. Yeah. What I think about, go ahead. I'm sorry, you go ahead. You finish. I was just going to say it's inherently more addictive because the videos are coming much more frequently. It's the nature of the form. Yes. Yes, it's the nature of the form. I think the key piece here when we think about the culpability of the corporations who make in profit from these digital drugs is to really analogize it to cigarette makers. You know, I think early on, the cigarette makers were the first to know that their product was

harmful, but they hit it for a very long time and they also weren't willing to do anything about it. So I think that's an important analogy because I think it's not, it's, it's accurate to analogize cigarettes to, you know, smartphones or to the digital content and admit that these are, you know, addictive products. They're legal addictive products, but we really do have to treat them as addictive products, which means that they shouldn't be marketed to children. There should be age restrictions. People should have warnings. You know, they should be taxed and disincentivized, all of those kinds of barriers, we as individuals need to take responsibility for our choices and actions around our consumption. But when you're dealing with a highly addictive product

that's aggressively marketed and pushed out there, you know, just it can't be left just up to the individual corporations, federal government, everybody needs to get on board with trying to help solve this problem. At least that's my opinion. Yeah. So from your perspective, it's companies, but it's almost like the companies would have to shut down in order to stop this. Like, yes, some of the reforms that you mentioned are common sense. However, like, it's still going to be Instagram. It's still going to be TikTok at the end of the day, even if you don't market the stuff to kids. And I don't think, you know, is there a way?

Again, going back to this is the form. And maybe, you know, I don't know, not saying this to make excuse for the industry. Maybe this is what we need to do. You know, is there a way to then have this stuff and not create all these negative effects? Because at the end of the day, a feed of like one-minute videos tailored to your interests are, is a feed of one-minute videos tailored to your interests. It's not romance novels. What do you mean? I mean, to me, it's not that different from romance novels.

If your drug of choice is romance novels and you'll get hooked on that. If it's one-minute videos, you'll get hooked on that. You know what I mean? But the availability. So I would say isn't the availability and the time that you can spend with romance novels very different from the availability. and time that you can spend with tech apps. I mean, they're on your phone. Your phone's with you all the time.

Whether you're at your desk online to, you know, buy something at the supermarket, at home on your couch, about to go to bed, waking up in the bathroom, they're with you all the time. Whereas like romance novel, like it's just not going to be in this same set of availability, which is why I think that like, you know, speaking about your research, we don't have, we didn't have a rise of anxiety and depression when we had the introduction of romance novels. but we do have this rise with the iPhone and the Android. Well, you know, as somebody who got addicted to romance novels, primarily... I don't mean to minimize that, yeah. Yeah, primarily propelled by acquiring a Kindle and fueled by a romance novel industry, writing these novels according to a formula that they know will hook you. And the sheer volume of romance novels available today,

romance novels for free, sold on Amazon to get you hooked and keep you coming back, I really don't think there's a difference. You know, I was at a point where I was reading romance novels at work between patients. You know, you can read romance novels on your smartphone, right? So it's really, my matter, to me, it's all the same. These are all, you know, the, what makes something addictive? It needs to release dopamine in the reward pathway. There's inter-individual variability.

What releases dopamine in your brain may not release dopamine in mind and vice versa. And then we have modern supply chain and innovation and technology that allows for four things. Increased quantity of our drugs. Increase potency of our drugs. Increase novelty of drugs, meaning that there are drugs that didn't even exist before. And increased access to our drugs, meaning that we can access them 24-7, really wherever we are. So quantity, potency, novelty, and access, those things apply to almost any reinforcing drug and behavior. And I would contend that almost all human consumptive behaviors have become drugified

in a modern capitalist society and that there's really not a big distinction between TikTok, cocaine, and romance novels. The distinction is how ubiquitous are they? Are they legal? How socially normalized, are they? And what is your particular drug of choice? Okay. I hadn't thought about it that way, and I appreciate you bringing it to light. I appreciate that. My mind's changed. So I'm going to come back to the question, then, what do you do about it? I mean, it's one thing again to like have kids, you know, not market to kids, but there are a lot of, you mentioned middle-aged adults that were suffering a lot of the impacts here. I mean, here's a stat that I read that I wanted to bring up that Um, I mean, friendship declines and loneliness is, is clear across the board. Um, I'm seeing that in men in

particular, you know, the people who have no close friends in 1990, it was three percent. Now it's 15 percent of men. When people have one friend, three percent, up to six percent. I mean, two friends, eight percent, up to 12 percent. So, um, what, what do you do? Yeah. Yeah, I mean, you know, what we often talk about how addiction breeds isolation, and isolation in turn puts people at risk for addiction. So it's a vicious sort of two-way cycle. And I think you're right to sort of question the voices or the chorus around saying, you know, get rid of Facebook. Because if we were to get rid of Facebook tomorrow, we would have five other social media companies rising up in its place. But that doesn't mean that we can let the corporations off the hook, right? I think this is a hard problem to

solve. We don't have the answer, but we need to start looking for it. We need to do that collectively as individuals and also as school systems and as governments and as parents and its corporations. I mean, it's interesting to look at, for example, what a country like China has done, where they have, you know, set regulations, nationwide regulations. that minors cannot play video games except for two days a week, two hours a day. And they have held the corporations responsible for creating software that limits minors having access, including using facial recognition software. Now, of course, you know, teenagers and younger children even are going to figure out ways around that.

But it's nonetheless an important message. And for most minors who use, it's going to be a deterrent. And for parents in China, I can only imagine they're ecstatic because they now collectively can say when their kids are saying, well, you know, I can remember my kids. There's not like, well, you're not playing me playing video games. All my friends are playing video games. You know, I'm not going to have any friends if I can't go on and play video games. In China, kids can't say that. It's like, nope, nobody else is on, you know, except for on Friday and Saturday for two hours a day.

So I think, you know, we really do have to think of it like a global. sociological as well as a psychological and biochemical problem. And that these kinds of top-down measures as well as bottom-up measures are going to be really important, just like with climate change. Right. I mean, we all need to drive less and not use plastic bags and plastic bottles and do whatever we can on an individual basis. But that's not going to, that's not going to alone save our planet. We need the government to implement, you know, regulations around gas emissions, around waste emissions, around cleaning up our waterways, etc. Right, yeah.

And I was going to ask about the individual responsibility. Because like the other side of this, so we have like two groups who talk about this. We've both had them on, we've had both of them on the show, Tristan Harris. We talks about the company's responsibility. Nira Yal talks about individual personal responsibility here. How much of this is on people to actually, you know, I guess NIR's perspective is, you know, you, as soon as you say people are addicted to technology, you know, you're inherently insulting them and calling them weak and everybody has the ability to unaddict themselves to

these technologies. So we need to stop giving the company so much credit. So what's your perspective on that? Yeah. I mean, I know near A.L's work, he and I actually debated this in an online form called pair, a graph, spelled P-A-I-R like a pair too. And, you know, I mean, we, we, fundamentally disagree because basically I consider addiction to be a brain disease, at least in its severest form. And it's a brain disease that's characterized by loss of agency. It doesn't mean you have no agency, but it's very mitigated autonomy and agency. It's really an inability to choose what you want. And instead, you're really sucked into this black hole compulsible reuse such that you can't stop even when you want to.

And, you know, I've spent 25 plus years treating patients with severe addiction. And trust me, they want to stop and they are not able to. And I think the same thing can happen with these, you know, with this digital content. Most people, and this is an important point, just like most people who consume alcohol will not get addicted to alcohol, most people online are not going to develop the severe forms of addiction to online content. They're going to see themselves going down a rabbit hole. and they're going to be able to kind of self-correct. But there is a subset of the population, which is probably going to be about 10% prevalence, because that's what it is for drugs and alcohol.

And I'm not saying it's the same 10%. So that's the other interesting thing is that even people who are immune to addiction to drugs and alcohol, because of their chemical makeup, can get addicted to digital drugs, which means that we're extending, you know, the risk overall in the population because we have these drugs that didn't exist before, which will appeal to certain brains that are otherwise, you know, not vulnerable to the problem addiction. But I have certainly seen tragic cases of people who are suicidal because of their online gambling, because of their online gaming, because of their online pornography use, because

of their online social media use, depressed, anxious, addicted, suicidal, who are unable without help to stop. Yeah. And I think the amazing thing, is you don't even need to be, and by the way, I tend, I'm on, I fall more on your side than on near side. I appreciate what near is doing. I happen to think there's some flaws there. If you're interested in a new listener, you can go check out my interview with him. Yeah.

From some time last year. But I just want to, you know, ask about this because it's not just the addicts, right? It's the people who may never show up in your office for a session of therapy, but are just totally rocked by constant checking of Twitter, constant checking. Yeah, constant checking of email. I mean, every, I feel like everyone, I mean, I have a part of a generation that grew up, you know, as like the first group of users of Facebook. I know people who are like in the first couple dozen to log on. Everybody in this generation is messed up some way by these phones. You can't sit at dinner with most of them without having, you know, about half of it taken

over by phone checking. And when you look at what people are doing, it's nothing. Right. So it's not just the addictive part. It's not the addict, clinical. It's those, it's the sort of the middle. That's the sad part. Yeah, I absolutely agree with you. It's sort of like the subthreshold functioning of people who aren't going to end up in my office, but are nonetheless have impoverished lives as a result of their attachment to the technology.

And I see that, you know, sadly even in my, you know, my own children, right, the ways in which they're constantly checking. And we're not aware, you know, if we really, got real numbers about how many times we touched our phone and looked at this one, how much time it took and how much time we wasted. I mean, I think all of us would be shocked, you know, to realize the ways in which that behavior is not productive, is making us less happy, is really interfering with our goals and values. So it's, I agree with you. It's a, it's a big problem, not just at the extremes, but all of all of us in between there. Yeah. Okay. I need to ask you this final question. so now I like will reveal I feel like I'm pretty addicted to my phone I don't think that like it's it's clinical level but it's very difficult for me to put it down and oftentimes I like I'll take think of an app like Twitter for instance I know you talk about this a lot on podcast but anyway here we go

I feel like Twitter makes me less happy without a doubt I'm less happy for using Twitter but I think that it makes my life more enriching I mean I definitely feel feel like I learned so much from it and I enjoy the interactions. And I say, I'm less happy, but I'm more enriched. And as of today, I'll take the more enriching life versus the quote unquote happier life. What do you think about that? There's got to be a balance here because all these things that we talked about is bad up until this point. They deliver a lot that people are interested in. And so I'm curious, like, have you thought about the balance between happiness and, you know, enrichment at the tradeoff there.

And what's your perspective on? Yeah, I mean, I think that's a really important question. And that's really the fundamental question, right? Or the genie, we're not going to put the genie back in the bottle. The technology is here to stay. It's embedded into our lives. It's part of our DNA. So how do we live in relation to the technology?

What is the optimal tradeoff? And I think, you know, it's going to be different for every person. And for you, it really may be true that, you know, your life is better off with Twitter than without, even if Twitter makes you a little bit unhappy. However, as a psychiatrist and one who deals with addiction, I wouldn't just take that at face value. I would really want you to break it down from you. Okay, you're saying you're more enriched. In what ways are you more enriched? You know, you're saying it adds to your life, okay, in what ways does it detract from your life?

let's really look carefully at that. Can we talk to other people who know you who might weigh in on ways in which your phone usage detracts from your life in ways you can't see? So one thing that's certainly true is in we're chasing dopamine, we can really become blind to cause and effect and not really see the adverse consequences because those dopamine hits, and this is part of the loss of autonomy, they kind of strip our ability to be objective and truly aware of the true impact on our lives. So I would want to do. like, talk to other people who know you well and see if they think that, you know, your usage of your phone and Twitter is really enriching your lives. And then I would say

almost most importantly, if you're in doubt about about it, my recommendation to you would be to give Twitter up for a whole month. Why a month? Because a month is about a minimum amount of time it takes to reset those reward pathways, to reassert homeostasis, to get your prefrontal cortex back online, talking to your gremlins, and for you to really be able to see. true cause and effect. Because when I have my patients do that, often they'll come back 30 days later and they'll say, I don't even recognize that person who was on Twitter all the time. Like, that just seems crazy to me now, but they can't see it when they're in it. Yeah. No, I mean, I did give up Twitter for, I think, six months while I was writing my book and it was definitely

happier. And, you know, it's interesting. So I say, like, less happy, more enriched. But the question, But you also use another phrase, better off. And that to me is the question. Am I better off being less happy but more enriched, still working through that? And I think it's going to be a question for as long as I have one of these things in my pocket or in my hand at dinner. Well, people are trying to talk to me. Yep. Okay.

Well, this has been such an amazing discussion. And professor, I just want to say, I appreciate you being here. I appreciate the work that you're doing. Again, I think it's bringing a level of science. level-headedness and practical experience to the conversation that's been lacking up to date. So for those who don't have it yet, the book is dopamine nation, finding balance in the age of indulgence. And then when you finish that one, you should read Drug Dealer MD, another book by Professor Lemke. Professor Lemke, thanks so much for joining. Really appreciate it.

Oh, you're very welcome. Thanks for having me. Thanks for being here. Thank you, Nick Watney, for doing the audio. Thank you, LinkedIn, for having me as part of your podcast network. Thanks for all of you. who are going to take the risk and hit five stars to give yourself that reward. Oh, boy, I can't believe I said that after this whole conversation. But you might want to try it. It feels good. We'll be back next week.

I'd love to hear what you think about this conversation. You're drop some comments on my LinkedIn or hit me an email, a big technology podcast at gmail.com. We have another great interview for you next week with a tech insider, outside agitator, but man, it could be hard to stop this one. Thanks again for Professor Lemke for being here. And until next week, take care. Thank you.

Thank you.