Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | Why We Are All Addicts | Dr Anna Lembke #345

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Starting point is 00:00:51 10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. Welcome to Feel Better Live More Bite Size, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 222 of the podcast with Dr. Anna Lembke, a professor of psychiatry at Stanford University's School of Medicine and author of the book, Dopamine Nation. In this clip, Anna explains why we're living in a world that's turned us all into addicts, and she shares some practical tips to help us find the right balance. We're living in a dopamine overloaded world where everything has become drugified. Everything has been made more accessible, more abundant, more potent, more reinforcing,

Starting point is 00:02:07 more potent, more reinforcing, more novel. And so we're really living in a world that has turned us all into addicts, essentially. 70% of the global deaths today are caused by modifiable risk factors. The top three are diet, lack of exercise, and smoking. So we really have reached a tipping point when we are dying because of our behaviors. And I really do think that the problem of compulsive overconsumption or addiction is the modern plague that we will be dealing with for the next hundreds of years. Given how important dopamine is, well, one of its functions, as you say, is our pursuit of pleasure. You say it's intimately linked with addiction. So where is that sweet spot where we can use it to gain pleasure, you know, gain those rewards that we all want without it sort of tipping over into addiction. And I think that really, I think, underpins a lot of your book, doesn't it? This balance and this sweet spot,

Starting point is 00:03:14 because we find it hard. Yeah. Yeah. No, you're right. It's really important to understand that pleasure and pain work like a balance in the brain and that the same parts of the brain that process pleasure also process pain. So if you imagine that in your brain, there's a balance like a teeter-totter in a kid's playground, okay? And when we experience pleasure, it tips one way. And when we experience pain, it tips the opposite way. And one of the overarching rules governing that balance is that it wants to remain level. It doesn't want to be tipped for very long to the side of pleasure or pain. And our brains will work very hard to restore a level balance or what neuroscientists call homeostasis. So when we do something pleasurable, okay, so in my case, that might be reading a romance novel

Starting point is 00:04:06 or eating a piece of chocolate or my morning cup of coffee. What happens is that I get a little release of dopamine in a part of our brain called the reward pathway and my balance tips to the side of pleasure. But no sooner has it done that, then my brain will try to restore a level balance by down-regulating dopamine production and dopamine transmission, not just to baseline levels, but below baseline levels. And I imagine that as these little gremlins hopping on the pain side of the balance that bring it level again, but they like it on the balance. So they stay on until it's tipped an equal and opposite amount to the side of pain. That's the come down, the after effect, the hangover, or that moment of wanting one more cup of coffee or wanting that novel not to end or wanting to watch one more

Starting point is 00:04:55 episode. Now, if we wait long enough, those neuroadaptation gremlins hop off and baseline dopamine levels are restored. But if we don't wait, if we continue to consume our drug of choice repeatedly over days to weeks to months to years, we end up with enough gremlins on the pain side of the balance to fill this whole room. In other words, we end up with a pleasure pain balance that has a new hedonic or joy set point. It's now chronically tilted to the side of pain because those gremlins are camped out there and we are in a dopamine deficit state. In other words, to compensate for the increase in dopamine

Starting point is 00:05:39 in our brain's reward pathway, beyond what our brain has evolved to deal with, we essentially go into this chronic dopamine deficit state. And once we're in that state, we are struggling with the addicted brain. And then we need our drug not to feel good, but just to restore our level of balance and feel normal. Yeah, that sort of idea of a seesaw and we move to the side, we have our drug of choice. And, you know, as we're going to talk about, this doesn't necessarily need to be alcohol or, you know, cocaine. This can be sugar, this can be coffee, this can be Instagram. And so we press on pleasure on the seesaw. And you're saying that actually the body then responds by the seesaw goes in the other direction to move us to try

Starting point is 00:06:36 and recreate balance. But if we keep doing this day in day out, the seesaw gets stuck. And actually, we're just left craving all the time. We want, we take any dopamine hit just to get back to normal. That's right. So in the world in which we live, what are some of the things that you find people are probably addicted to? But because they're normalized in society, often people don't actually think of them as addictions. At the one that's top of my head, I think a lot of the world is addicted to caffeine in a big, big way. Caffeine is certainly way up there.

Starting point is 00:07:17 Alcohol is so ubiquitous and so normalized. And I think many, many people use in ways that are not healthy, but are able to tell themselves that their use is okay. I would also put really high up on that list, a lot of digital products and devices, and I would put up their work, you know, addiction to work. It's so socially rewarded, right? That sort of 24 seven, I I'm on it, I'm reachable wherever you want to find me, high stress. And when we add a shot of adrenaline to something that also releases dopamine, it makes it even more reinforcing. There's a fascinating study looking at rats. If you inject a rat with cocaine, slice open its brain, what you'll see is this incredible

Starting point is 00:08:05 arborization of dopamine-releasing neurons in the reward pathway. If you take a rat and subject it to an intense, painful foot shock, you will see the identical arborization of dopamine-releasing neurons in the reward pathway. In other words, we can actually probably get addicted to highly painful stimulus too in the form of work or, you know, news. That's why doom scrolling kind of comes in. So there are lots of things that I think are socially sanctioned. You know, again, I think work is probably, I would put at the top of the list that we kind of don't acknowledge. Even my own attachment to my email. So I'm not on social media,

Starting point is 00:08:47 but I have to really watch myself with my email, which is sort of my work sanctioned social media. You know, I try to take a digital Sabbath once a week and it's really hard. But by the end of that day, I don't even want to go back to using because what I'll notice when I go back to my email is I'll answer the emails that need answering and then I'll linger. I don't want to leave it. I'm sort of waiting for something good or reinforcing to come in. read before, you know, as a way of kind of making myself feel like, okay, I still need to be here in this space, but really I don't. I should just get out of my email and move on to the next thing.

Starting point is 00:09:31 And I've developed some tricks for coping with that, but it's really hard. Yeah. I mean, what you're speaking to as well is ease of access. How easy it is to access clearly makes a huge difference. And I guess work, again, going back 20, 30 years ago, when we didn't have email or the ability to have email in our pockets, you know, when you left the office, you were probably barring an emergency where someone phoned your landline, you were probably kind of done, right? You would naturally be able to switch off. And I think there's been this insidious creep. I think with technology, for me, it's about intentionality. We've not really asked ourselves, or many of us, what do we want this smartphone for? We take it with, like it's the sweet shop with all the

Starting point is 00:10:18 goodies on it. And it's kind of like, well, why don't you think about what do you want from it? Okay, I want to be able to make calls. Okay calls okay great you want to be able to make text messages okay great right what else you might want to listen to music okay you know and and actually introduce the apps that you want right that are going to enhance your life rather than make you a slave and I guess that email piece is if you don't have email on your phone it's just a hell of a lot easier to not be checking your work emails at the weekend. Yeah. Which gets to one of the, you know, so dopamine nation is not just about the problem. It's also about what we can do about it. And one of the recommendations in addition to the dopamine fast is the self-binding strategies, which is essentially creating literal and metacognitive

Starting point is 00:11:05 barriers between ourselves and our drug of choice, exactly what you describe, that if we make it harder to access our drug of choice, that little bit of a pause is often just enough to make us, to allow us to decide not to use in that moment. And that's really, really important. decide not to use in that moment. And that's really, really important. The first intervention when I have patients come in with depression, anxiety, insomnia, inattention, I say, let's eliminate your drug of choice, whatever it is, whether it's social media, video games, cannabis, we're going to take it away for a whole month. Why a month? Because a month is typically the minimum amount of time it takes for the brain to restore dopamine levels back to healthy baseline. I also warn them that in the first two weeks of abstention or the dopamine fast, they're going to feel worse before they feel

Starting point is 00:11:57 better. Why? Because those gremlins are camped out on the side of pain and they're in a dopamine deficit state, which means when they're not using their drug, they're in withdrawal. So I tell them, you're going to be more anxious, more depressed, restless. You're going to have intrusive thoughts of wanting to use your phone, play video games, use cannabis. But if you can just get through those first two weeks, by weeks three and four, the light really does come out and you will notice yourself feeling better. And almost universally, that is what happens. And I've been doing this for 25 years. So I really believe that this works because I have a huge sample.

Starting point is 00:12:35 Now, Rangan, you know that abruptly stopping your drug of choice is not something you would recommend in somebody who's at risk for life-threatening alcohol withdrawal, benzodiazepine withdrawal, or opioid withdrawal. Those individuals may indeed need medically monitored detoxification in order to get into a dopamine fast, which means that they might need a slow taper or another medicine to prevent life-threatening withdrawal. But for the vast majority of us, stopping cold turkey is perfectly fine. Patients will say it's hard, but they definitely have reduced anxiety, depression, insomnia, all of it at a month. Not only that, they have insight because now they're able to really look back and see the true impact of their use on their lives, which is really hard to do

Starting point is 00:13:23 when we're in it. It's only by changing something in that biological system, forcing our brains to start to regenerate our own dopamine, that we can look back and say, oh my goodness, that's surreal. I can't believe I was so invested in that. And that I think is a second critical point because that's empowering for an individual, isn't it? That gives them a sense of control, a sense of agency that, oh, I get it. When I engage in these behaviors, my mood goes down. I get depressed, I get anxious. When I come off it, I feel better. When I restart again, I get worse. And it doesn't mean you're going to get, certainly through what I've seen, it doesn't mean the first time you're going to get it right. You're going to

Starting point is 00:14:09 stop and then you're all good. No, but it's a process of education each time. And every time you go back, you keep reminding yourself, oh, do you know what? I feel better when I'm actually not on this stuff. That's right. And I always frame it to patients as an experiment. I said, you know what? You're the scientist. This is the experiment called your life. Let's gather data. The best way to know how a system is working is to change a period of time and see what happens. And my hypothesis is that you will feel initially much worse because you will be in withdrawal and craving. But if you can make it a long enough period to restore homeostasis, you will feel better. And when patients see that for themselves and experience that for themselves, I no longer have to convince them that it's a worthy project. I think many people will have resonated with so many elements of this. It would have heard little bits and thought, man, maybe I've got an unhealthy relationship with

Starting point is 00:15:15 X, Y, or Z. For those people who are now questioning their relationship with certain things and maybe recalibrating it. I wonder if you could give some sort of final words of wisdom for them. Yeah. First of all, don't be hard on yourself. Self-compassion is key, but do continue. Don't give up. I think that's probably the bottom line. We can make our lives better, especially when we understand the source of our suffering. And the real point of dopamine nation is that paradoxically, a major source of our suffering may be the very things that give us so much instantaneous pleasure. So by eliminating those things to the extent that we're able for long enough for our brains to recalibrate,

Starting point is 00:16:05 I really do believe that that will be an aha moment for a lot of people. Hope you enjoyed that bite-sized clip. Hope you have a wonderful weekend. And I'll be back next week with my long-form conversational Wednesday and the latest episode of Bite Science next Friday.

Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | Why We Are All Addicts | Dr Anna Lembke #345

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