Finding Mastery with Dr. Michael Gervais - Pain, Pleasure, and the Addictive Chase for Dopamine | Dr. Anna Lembke

Episode Date: December 22, 2021

This week’s conversation is with Dr. Anna Lembke, a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries. Anna sits on the board of several state and national addiction-focused organizations.In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, which was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic. Anna appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.She's also the author of the recently published, Dopamine Nation: Finding Balance in the Age of Indulgence, which explores how to moderate compulsive overconsumption in a world where feeling good is the highest good._________________Subscribe to our Youtube Channel for more powerful conversations at the intersection of high performance, leadership, and meaning: https://www.youtube.com/c/FindingMasteryGet exclusive discounts and support our amazing sponsors! Go to: https://findingmastery.com/sponsors/Subscribe to the Finding Mastery newsletter for weekly high performance insights: https://www.findingmastery.com/newsletter Download Dr. Mike's Morning Mindset Routine! https://www.findingmastery.com/morningmindsetFollow us on Instagram, LinkedIn, and X.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Okay, this week's conversation is with Dr. Anna Lembke. She is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinical scholar, she has published more than a hundred peer-reviewed papers, books, chapters, and commentaries. Anna sits on the board of several state and national addiction-focused organizations. We are fortunate to have her with us today. In 2016, she published Drug Dealer MD, How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop, which was highlighted

in the New York Times as one of the top five books to read to understand the opioid epidemic. She is also the author of the recently published Dopamine Nation, Finding Balance in the Age of Indulgence, where she explores how to moderate compulsive overconsumption in a world where feeling good is the highest good. It's a great book. I want to encourage you to check that out. This sets the tone for this conversation. With that, let's jump right into this week's conversation with Dr. Anna Lembke. Anna, how are you? I'm good.

Thank you. Yeah. How do you answer that question on the street when people say, how are you? Is it more pleasantry or do you take a beat and actually consider how you are? How do you do that question on the street when people say, how are you? Is it more pleasantry or do you take a beat and actually consider how you are? How do you do that question? I usually just say I'm fine. I'm a pretty private person, so I don't usually go into it. Also, if I were to go into it, it would be a lot for people, way more than they know, I would not have guessed that you are private based on how I experienced your book. Right. And so you are very open about, you know, some who you are relative to two taboo subjects. And so I really appreciate that. So that

must have been either cathartic or hard to do or thrilling and wonderful. What was it to share yourself in the way that you wrote about science and your clients? How was that to talk about yourself? It was terrifying. I think I was in a constant state of panic in the two months just before the book came out. I didn't really want to share myself in that way, but I felt almost obligated to because I had asked my patients to share their stories. And I felt that I would be hypocritical if I didn't also share my own. So I

did share in small ways here and there, but it was really scary for me. Okay. Yeah. I can understand that. And then do you practice vulnerability on a regular daily occurrence or is this something that was way out of the box for you? Gosh, that's a great. And a kind of a hard one to answer, because I'm someone who isn't really all that interested in having casual, superficial conversations. I really like to go deep. I get to do that with my patients, you know, you know, fairly one sided way, but I work in a pretty transparent way where I use humor a lot and I'm pretty transparent with my patients because it feels like a safe space and a space where I'm selective about what I share and only share what I think will be helpful to them. But I would say in my personal life, I'm very private and I'm not very transparent and I'm kind of introverted, although I can be very gregarious and like people. So it's sort of a mixed bag. Okay. Let's do a quick flyover. So folks will have an understanding of your educational

career arc. And so let's start with the's start with the education first, and then career path as a second parallel. Sure. I was a Yale undergrad, humanities major, Stanford Medical School, did a residency in psychiatry, joined the faculty and have been here on the faculty ever since. I have a classic three-legged stool of academic medicine. I see patients I teach and I do research. There's lots of jokes. I was going to say like, where's Stanford or what is that? But it's like your academic prowess and accomplishments are noted. And I want to make sure that that is part of the adventure that you've been on is that you understand what it means to position yourself to

be at two of the best universities in the world on the planet and what it means to be able to contribute at those. So that's important. And that'll be an undercurrent part of the conversation. And then the other part was about, so that's education, some of your career highlights. What are the chapters in your career that are notable? Well, that's a good question. I mean, I would say that I don't really think of my life like that. So give me a second. I guess in terms of academic sort of accomplishments, I did publish a book in 2016 about the opioid epidemic. And I was one of the first people in the side of medicine to talk about that problem and

also the sort of etiologic underpinnings of that problem. I have also been involved as an expert medical witness in federal, state, and county opioid litigation on the plaintiff's side against opioid manufacturers, distributors, and pharmacies. So those are, I guess, my career highlights. But I guess I think of my biggest accomplishments as my children, And those don't exactly go on a CV. So if I'm being totally honest, those are really the highlights for me. Yeah. And I wanted to hear that and feel that, how you said it, because you square up against the giants and you're on the side of people and you understand

from a neural anatomy, from a neurochemistry, from a humanity standpoint, what it means to struggle and what it means to, you know, take on a good fight. And so that's really why I wanted to feel how you answered that. And then it kind of is leading into the early childhood experiences because I want to understand what is, and hold on, does that feel right or accurate? Yeah. Yeah, I think so. Okay. There's hesitation. Let's get it right. Cause I don't, I don't want to move down this path. I'm kind of bracing myself for questions. I don't really want to answer. I mean, okay. So let's, let's start with that. Like, is that how, is that how you work? Like there's a, there's an internal tension, like, Hey, something's coming that's going to require some vulnerability, some exploration,

and I have a fear of how it might go? Well, I mean, I wouldn't have described myself that way, but I guess I have to admit in this moment that it's true. I mean, so, you know, I practice self-disclosure in the book, but I gave a lot of thought to those and I had a lot of, you know, I thought about it a lot and then I put it on paper. And now I feel like you're going to ask me a bunch of questions that I don't know how to answer, that I don't know if I want to answer. So I'm finding I'm getting nervous. Okay. So this is perfect because now we're in the true space. We're in the cone of truth here. And I'll say an axiom with you, I say to most folks I spend time with is that everything you need is already inside you. And so we'll create the space to get to that place.

Okay, that's good. So let's just stay here for a minute. Where do you feel that? Where do you feel nervousness? Oh, that's a nice question. Probably,, I don't know, in my torso mainly. Yeah. And what is it uniquely to you? What does it feel like? Probably like getting ready for battle. So, I mean, if you think about people on the fighter fight spectrum, I'm definitely a fighter. I have a friend who said that, you know, when it comes to end of days, I'm going to be killing people and she's probably right. I would not have guessed that for you. But see, that maps up against like you square up with giants, you know, like in a courtroom.

I didn't really know what you meant by that. Okay. Yeah. Right. I didn't want to admit that I didn't know what you meant by that, but okay. That's so funny. Okay. All right. So then that makes sense to me. And then when you're feeling something, do you pay attention? Is your entry point into internal awareness, is it from emotions or is it from thoughts? What are you more attuned to? Definitely emotions. Yeah. No, I'm like an emotion person. The physiological part of it. so you feel although i will say i i like thoughts to be logical and go in a certain order and it does

bother me when when people like when the thoughts are not coherent like if i'm having a a discussion with a peer let's say and and like i i find that it's not logical or coherent. That does bother me. I don't really want to be admitting this. Two doors down the hall is like, that's why she doesn't talk to me anymore. I know that I can't string together my thoughts. I'm like, yeah, okay, that's good. So, so you, it comes in from emotion. So you're more sensitive to the physiological experiences of happiness to anxiousness to sadness, whatever. And then I don't know, I don't have any idea.

No, I think you do. I think you just, you felt it in your torso. Okay. I'm imagining that's like stomach and chest. All right. And then, and then I want to know when you have that, do you then go up? And can you, do you have awareness of like how your thoughts work from know when you have that, do you then go up and do you have awareness of how your thoughts work from that? When you feel a bit nervousness, which you were maybe 30 seconds ago, maybe less now, maybe more, I'm not sure. I guess to me, it's just a constant interplay between thoughts and emotions. I don't think, I mean, I would say emotions really matter to me and I think they should matter. And I think they should inform thoughts. And one of the things that I try to live out and also teach is that emotions are good because I see so many patients who come

in and are ashamed of their emotions and think it should all be very cut and dried and logical. And of course that's absurd. So I like, I want to champion emotions, but if I were to talk about how, how it is for me, it's the constant interplay between those two things, probably not waiting one more than another. And I would say, as I progress in my life and age, and I'm perimenopausal now, it might even be less on the emotion front and even more on the cognitive, kind of cerebral. I feel like I'm a lot more numb in some ways than I used to be as a younger person. And that comes as a bit of a relief in all honesty. Yeah. You said that in the book, you talked about that. And I think that that is something that haunts people that are in our shared profession.

And that haunting, if I can just describe it for me, is that it was very early in my career, I said to one of my mentors, I said, hey, I'm not feeling what I used to feel when people are crying and when they're talking about how mad they are or scared they are in life. And it's like, it's real. And it's, and I'm not feeling that the same way. And he goes, Oh, you got there early. I go, what do you mean? He goes, yeah, it happens to us. I appreciate that. I feel like I can be more grounded and less sucked into it. But at the same time, there's something really enjoyable about traveling with them into those places. And so do you miss any of it?

Well, I still feel I do travel with them. I am totally absorbed by my patients and it's a great escape from me and my own ruminations. So I don't feel like I've lost that. And it's still after all these years, never, ever boring. And you know, how many jobs, you know, how many people can really say that about their jobs? So I feel super lucky. But, but you're right. I don't take it home with me the way that I used to when I was younger. You know, I mean, you know, I have patients who die and it's devastating, but I'm not devastated by it. I, you know, I consider it just part of what happens when you treat really sick people, you know, death happens. So, you know, I just think, again, this is sort of the learning cycle and the cycle of repetition plus aging that all kind of comes together.

Some might call it the path of wisdom. Maybe, yeah. Or just maybe the path of getting old. Getting old. Yeah. You know, it's funny you say that because I don't think age solves for mastery or wisdom. You know, I know old people that are, well, I wouldn't, I mean, I don't want to be disparaging in any way, but I know old people that are fools. That's true. They are still chasing the 16-year-old pleasures. And maybe this is a nice jumping off point to talk about one of your main foundational first principles is about pleasure and pain. And I was hoping to maybe link why you wanted to go down the path from a young age.

I intuit that your life has made sense, like the path has made sense. And I wanted to hook back around, was it the dinner table? Was it a crisis in your life? What was it that led you to want to help others who are suffering? And I had this moment in my profession where I was in right before licensure and a supervisor said to me, so what makes you think you can help anybody in this world, Mike? It was an important moment for me. And there was nowhere to go to answer that. And I didn't have a good answer. And the answer or the question was like, actually, Mike, you've got such gumption or not gumption, what's the word?

Hood spot? That's not what he said, but I like it. You think you can actually help somebody. And so anyway, so is there any linking between you being in your life, helping others that are suffering and something that happened in your earlier parts of your life? Yeah. I mean, I mean, I think I was like a chronically unhappy kid and I don't blame my family situation on that. My parents were very unhappily married and did ultimately divorce after 20 years and their unhappy marriage permeated our household. But I think even if they had been blissfully married, I probably would have been an unhappy

kid. I think I'm just chronically dysthymic, but never somehow cross over to a kind of a dysfunctional depression. So that's one thing. The other thing is that my sister had a psychotic manic episode when I was in medical school. And that was when I got to see like form, fruice, mental illness, like, oh, wow, like the brain can get really messed up even without drugs on board. And so that was a very powerful moment, which originally made me run far away from psychiatry because I thought, you know, can't handle it. And then ultimately brought me back to psychiatry in service to wanting to help other people with severe mental illness. So I think kind of a combination of sort of my own longstanding suffering, you know, in the realm of sort of

psychological suffering, plus, you know, a personal family member with a severe mental illness who was helped by medications combined with psychotherapy. Finding Mastery is brought to you by Momentus. When it comes to high performance, whether you're leading a team, raising a family, pushing physical limits, or simply trying to be better today than you were yesterday, what you put in your body matters. And that's why I trust Momentus. From the moment I sat down with Jeff Byers, their co-founder and CEO, I could tell this was not your average supplement company. And I was immediately drawn to their mission, helping people achieve performance for life.

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Again, that's Felix gray. You spell it F E L I X G R a y.com and use the code finding mastery 20 at Felix gray.com for 20% off. Can you take a double beat and explain dysthymia for folks? Sure. So dysthymia, it's, it's, it is a term that I think is no longer in the Diagnostic and Statistical Manual of Mental Disorders. And it was a way to characterize somebody who is sort of like chron this cartoon that was popular when I was a kid called Gulliver's Travels. And there was this one character who no matter what the situation was in the cartoon episode, he would always say, we'll never make it. And I just love that character because on some level I really identified with him. Perfect. I think that's a great description of dyslexia. It's a low level. I shorthand it like it's a low level depressed hum. Yeah. Yeah. But it's insidious to me. It's

a really sneaky one because it's not like I've bottomed out. I need help. Right. And it's not like I'm so anxious. Just help me get grounded. It's just this like, I just feel tired. And it's the first place for me to look at where is there something with the thyroid? Is there something else happening? Yeah. Well, I've never been tired. I mean, in fact, I've always been super high energy. So that's not it. It's just more like a chronic irritability and dissatisfaction. And honestly, I mean, I don't know how different it is from the average person. You know, I mean, I actually think that like life is generally kind of hard. I mean, unless we're trying to, you know, numb ourselves with substances or behaviors and deny that reality. So, you know, again, I say I use this

sort of pathognomonic term, but I don't think I necessarily believe that it's a form of psychopathology. I think it might just be the human condition. It's cool. And it's a good framing that as a first principle, life is hard. And I'm imagining that your position on that would be, that's why people are on this unhealthy pursuit of pleasure. And so does this feel like a stitch into kind of a main treatise that you're presenting about pleasure and pain and some of the neurobiology there, but also the behavioral and psychological components to it? Sure. Absolutely. However you want to do it. Yeah. I think that where do you normally start here? Cause I mean, I could ask probably 200

questions, but where do you normally start to get into this concept of pleasure and pain? Do you normally lead with neurobiology or do you lead with the psychological behavioral component? You know, I can start in either place. I do think it makes sense for people to start with the neurobiology as a sort of, as a lens through which to kind of refract the other ideas. And maybe, maybe in that also talk about like, just ground a couple of terms like dopamine, what is it? Why is it important? The mechanics of dopamine is good, I think, for us to talk about how it's just, it's so slippery, you know, it's such a really slippery neurochemical. And so I think that would be fun to talk about as well.

Okay, great. Well, I mean, to me, one of the most exciting findings in neuroscience in the past, I don't know, half century or so is that pain and pleasure are co-located, which means the same parts of the brain that process pleasure also process pain and they work like opposite sides of a balance. So if you were to imagine that in your brain, there's a little teeter-totter like in a kid's playground. And that when we experience something pleasurable, that teeter totter tips to the side of pleasure and something painful, it tips to the side of pain. So for example, if I eat a piece of chocolate, I like chocolate, my balance tips slightly to the side

of pleasure. And what happens in my brain's reward pathway is that I get a little release of dopamine. Now dopamine is our brain's reward neurotransmitter. A neurotransmitter is a molecule that allows two neurons to communicate. Neurons are the workhorse cell of the brain. They're the ones that send the electrical impulse to create circuits, to create emotions and thoughts. Those neurons don't touch end to end. There's a little gap between them, and that gap is called the synapse. And neurotransmitters are the molecules that bridge that synaptic gap. The metaphor that I use in the book is imagine that the presynaptic neuron is the pitcher. The postsynaptic neuron is the catcher. The MIT is the receptor. And then the ball going from the pitcher to the catcher

and landing on the MIT, the receptor, the ball is the neurotransmitter, in this case, dopamine. So when we do something pleasurable, dopamine is released in the brain's pleasure circuit, pleasure pathway, which is a phylogenetically highly conserved part of the brain. What that means is that although we've evolved over millions of years, you know, from nematodes, that part of the brain hasn't really changed very much. It stayed the same across species and across evolution, which is, you know, in and of itself, interesting. And that part of the brain is sometimes referred to as the lizard brain. It's the lower areas of the brainstem below our great big gray matter areas. It's also part of what's called the limbic brain

or the emotion brain. This is a very primitive, very powerful, reflexive part of our brain that we can control, but it also has its own instinctual kind of reflexive responses, frankly, to save us in situations of extreme need, extreme scarcity, extreme danger. So anyway, getting back to this teeter-totter, when we do something pleasurable, it tilts to

the side of pleasure. Dopamine is released in the brain's pleasure pathways or reward system. And we feel good. Dopamine makes us feel good. But one of the overriding rules governing that balance is that it wants to remain level. It doesn't want to be tilted for very long to the side of pleasure or pain. And the brain will work very hard to engage its own restorative, re-regulating mechanisms to bring that balance level again. And when that balance is level, that's called homeostasis. And there's a huge biological drive to reassert homeostasis. And the brain will do that by down-regulating our own dopamine receptors. So those little catcher's mitts will actually get resorbed into the postsynaptic neuron and down-regulating our own dopamine production.

And one way to think about that is to imagine these little gremlins hopping on the pain side of the balance to bring it level again. Those gremlins represent what neuroscientists call neuroadaptation, which is this down-regulation in response to this deviation from neutrality. But the thing about the gremlins is that they like it on the balance. So they don't get off as soon as the balance is level. They stay on until it's tipped an equal and opposite amount to the side of pain. And that's the after effect that come down that moment of wanting one more piece of chocolate. Now, if I wait long enough, the gremlins hop off, balance is restored, and that feeling passes. But if I don't wait and I continue to ingest more and more

chocolate, what happens is I eventually accumulate so many gremlins on the pain side of my balance that they could fill this whole room. And now I'm in what's called a dopamine deficit state. And that is what happens to people who become addicted or even on their way to addiction as they develop a kind of compulsive over-consumptive orientation to that substance or behavior driven primarily at this point, not so much by wanting to feel good or to get high, but simply wanting to stop being in pain. Because once that pleasure pain balance is in that dopamine deficit state, then I need to use my drug just to feel normal. And when I'm not using my drug, I'm experiencing the universal symptoms of withdrawal from

any addictive substance, which are irritability, insomnia, dysphoria, anxiety, and intrusive thoughts of wanting to use. Okay. Brilliant. And let me pause here to add one applied texture bit is that dopamine on the reward side of the equation can be triggered from eating chocolate and also thinking that you're about to get chocolate. Right. And so our environment also matters and our psychology also matters. And I love the clarity of your point. So let's kind of keep this balance in place here between pain and pleasure. And I want to go upstream in a minute to talk about like a philosophical position that individuals work from. But there's a society layer that sits in here that says,

yeah, yeah, yeah, don't be in pain. And like, you know, let's avoid pain. Evidence by helicopter parenting, evidence by zamboning parenting, you know, where they just smooth out the ice in front of the kids. And so there is this social bit that does not value the necessary pain to change or, or, um, the necessary experience of pain to have a healthy experience of pleasure. And so we've got, we're like the little rats that are hitting the lever saying more, more, more, and, um, eventually getting fatter, fatter, fatter. And I don't mean that from like a, I don't know, I'm thinking about the obese mice or rats that they just, they don't know when to stop. And so I'll pause there because I know I just leaped over a couple of things and I want

to pause there because environment matters. So thinking about getting something as well as actually experiencing summit, there's a, there's a trigger, but can you talk about your experience about what's happening that we're avoiding pain and the cost of that pain? And, and maybe you can, you can level set a little bit, like what kind of pain are you talking, you guys talking about? Cause I'll, I'll go to extreme and say, no, no, no. It was a chapter in a book that I was working on this, which was making a case for broken bones, meaning, hey, parents, let your kids climb in that tree. Trust, trust, trust that this is going to be a good thing for them because they're going to fall out eventually. And, you know, we don't want broken necks, but a broken wrist?

I don't know. You learned some stuff from it. And I'm taking the example too far, but can you... It didn't make the book for some obvious reasons, but can you talk about the type of pain and then maybe respond to whatever grabbed your attention that I was just talking about as well. Yeah. Okay. Well, let's, let's, let me back up a little bit and first explain, um, Q conditioned responses and triggers. So I think that's, that's important. Um, so if we go back to the metaphor of the balance, right. Um, I mean the, the, the central, um, sort of takeaway from the way that our brains restore homeostasis, which is not just to bring dopamine back to level baseline, because we're always secreting a tonic baseline level of dopamine, but actually to bring it below baseline. So that's really the key sort of neurobiological concept that I want people to grasp. It's not just like you use up the dopamine you have, and then you've run out and you're even again, that the way that the brain

restores homeostasis is to go below baseline and put us in this dopamine deficit state, which is essentially akin to, um, to depression. Now, if you think about this kind of wiring, which by the way, again, has been conserved across evolution and across species for millions of years, this is a highly intelligent and adaptive kind of methodology for restoring homeostasis in a world of scarcity and ever present danger, right? Because it makes us the ultimate seekers. No matter what pleasurable or rewarding substances and activities we find, over time, our pleasure is short-lived.

Because one of the other cardinal features of this balance is with repetition, that initial response gets weaker and shorter, and that after response, the dopamine deficit state gets stronger and longer. That's often called tolerance, needing more of the drug to get the same effect or needing more potent forms over time. This is why those of us who are looking to grow, we could put a nice example like thrill seekers and like those people over there that do kind of crazy feats of thrill, but we are thrill seekers. And so those of us who want to grow and get better, there is this neurochemical thing that's taking place in us where it's a constant satiation for a feeling of aliveness. And if we're not careful, we can overfeed this part of us.

And so that's where I was hoping you're going, because there's tolerance, which is a problem, evidence like by cocaine and, you know, as a common stimulator of dopamine. But there's a tolerance issue that we can think about. A little bit of cocaine leads to eventually a lot of cocaine and a lot of cocaine eventually is no longer a high. It's to have some sort of baseline. And that's where in your world and the world, you know, I know plenty of clients that have struggled with drugs that they say, I'm not partying anymore. There's no party happening here. I'm just trying to level. I'm just trying to stay level. And it's like, well, how much drugs are you doing? Aren't you full? Like, you know, is it whether it's alcohol or cocaine or whatever? Like, aren't you full from all that? And so anyways, I say all that because

can maybe you take us down that path a little bit too? Sure. Yeah. So, I mean, one thing though, I always like to say about this pleasure pain balance is that it seems like nature's cruel joke to require that for every pleasurable experience, we will experience pain. But if you, again, think about the way that humans have survived on this planet over most of human existence, it's absolutely genius because no sooner have we found some kind of rewarding substance or behavior, then our brain plummets us into this dopamine deficit state, which has got us going looking for that next thing. And another reframe that I think that I really value is that people are variably vulnerable to the proclivities, let's say, of the pleasure-pain balance. And that people who are innately more vulnerable to addiction probably are people who

are willing to work harder to get that reward, right? To experience more friction in order to get it, which again, in a world of scarcity and ever-present danger would be incredibly valuable to the tribe. Like those are people like, please be in my tribe, you know, because you're going to be the ones that are going to find this stuff that's going to allow us to survive. But the fundamental problem that we have now is that we're no longer living in that world of scarcity and ever-present danger. We're now living in a world of overwhelming abundance where everything, all of our basic survival needs are met. And then on top of that, we have almost universal access to these highly potent rewards and behaviors, which means that the people that had that sort of drive to seek out reward, i.e. people vulnerable to addiction, are now incredibly vulnerable. But even beyond that, people who maybe are relatively immune to that problem are also vulnerable because there are so many drugs

and they're so potent and access is so easy. So that's really the thesis of Dopamine Nation is this idea that our primitive brains are mismatched for our modern ecosystem. And it, you know, it doesn't, and if you reframe addiction to think about, well, what is the addicted person? That's a person who's got incredible tenacity and perseverance, right? They're really, you know, Once they decide what their drug of choice is, they're willing to go to the end of the earth to get it. I like that reframe and I think it's important because I think it speaks to a truism across the board when we're thinking about psychopathology and how we diagnose it. It's not really in the person. It's not something wrong necessarily with their brain. It's very often a mismatch between their unique characteristics and their environment, which brings us back to your point about the environment and the importance of the environment, which brings us back finally to your question about triggers or your comments about triggers, which again is to say not only are we filled with, you know, in a world of overwhelming abundance, but we're constantly being tempted by these triggers, by these reminders, by ads, by alerts. And what we know

about these triggers is based on rats, experiments in rats, where they stuck a probe in the rat's brain to measure dopamine levels. And they found out that, for example, when a rat presses the lever for cocaine and gets an influx of intravenous cocaine, there's a huge burst of dopamine in that rat's reward pathway. Then when rats were trained to know that that cocaine would be available with a lever press after they heard a bell or saw a light, what the scientists have seen is that even when they just see the light, there's a slight increase in dopamine level. So it's like we get a little mini reward with the reminder of the reward that's coming. Now, here's what I think is really fascinating and important. After that

little mini spike of dopamine with a trigger, a light, or a cue, again, what we get is dopamine levels going not just back down to baseline, but actually below baseline. That is then creating the motivation or the craving that gets us to go over to the lever and press that thing as many times as we need to in order to get the reward, which then releases a whole huge bolus of cocaine. Furthermore, if we've been conditioned to believe that after a reminder, we're going to get the reward, and then we don't actually get that reward that we were expecting, dopamine levels go way below baseline. So not just a little bit, but way below. So I think this speaks to a lot of aspects of modern human suffering. The fact that we're constantly

ingesting these high dopamine rewards and behaviors, we're bombarding our reward pathway. This is not what our primitive brains were designed for. We've had to adapt by down-regulating our own dopamine receptors and transmission, putting us in this chronic dopamine deficit state, which I think is the main contributor to increasing rates of depression and anxiety, especially in rich nations, which is what survey studies show. But also these constant triggers, tweets, and reminders also cause these kinds of dopamine fluctuations that put us in these states of reward, mini reward, and then mini craving. And then when we don't get the reward or we build up tolerance to the reward,

we don't just go back to baseline levels up tolerance to the reward, we don't just go back to baseline levels of dopamine. We actually go well below. So I think it's these fluctuations in dopamine, which I think can help inform a lot of modern suffering. Finding Mastery is brought to you by Cozy Earth. Over the years, I've learned that recovery doesn't just happen when we sleep. It starts with how we transition and wind down. And that's why I've built intentional routines into the way that I close my day. And Cozy Earth has become a new part of that. Their bedding, it's incredibly soft, like next level soft. And what surprised me the most is how much it actually helps regulate temperature. I tend to run warm at night and these sheets have

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You added a complexity here, which is you want this person in the tribe because those that will work really hard, let's call it addiction for a moment. Those that will work really hard for dopamine and also have a high threshold for pain. Those are the ones that are really hard to work with because they can deal with too much pain and they'll work really hard to get the dopamine. Healing for them is really tricky, but at some level you're like, Hey, some of those folks are really good in this tribe because they're going to work really hard. They can deal with pain. They are self-reinforcing. So this is where dopamine is also part of the motivation system as well as

the reward system. So we've got this virtuous cycle. And I want to add that this is where the hustle hard mentality that has, I think it's being found out is not healthy, but this hustle hard mentality, like be a grinder and you'll have success, falls short. And it falls short because there's more complexity here than, um, than just working hard and be right. Because there's, there's something maybe more intelligent. How do you make this hustle hard work and it'll work out? That's the way to do life. How do you uniquely address that with your science, your understanding of your science? Yeah.

Well, I mean, so anything that releases dopamine has the potential to be addictive. And that includes things like work. That includes things like, you know, external accomplishments, awards. That includes athletic endeavors. You know, those are typically, I mean, I think of those as healthier sources of dopamine because they require an enormous amount of effort to get there. Doing something. Yeah. You've done something to get it. Right. I mean, as opposed to like cocaine or heroin or alcohol, which can also require effort to, to get, but, but nowadays really don't require all that much effort, um, and release a whole lot of dopamine, you know, an abnormally

huge amounts of dopamine in our reward pathway. Whereas, you know, sort of work and athletic accomplishments and stuff like that, you know, it's effortful over many days to weeks, but even so, um, I think, you know, this concept of developing a tolerance to that, you know, what's initially rewarding, you know, oh, wow, I won, I won states, or I won the county division. Oh, I won states. Oh, I'm, I'm, I'm, I'm the national leader. You know, then it's like, oh, I won an Olympic gold medal. And then all of a sudden, you know, there's that kind of that letdown that can happen. And again, I think it's all related to this pleasure pain balance and the ways in which we are evolved to be constant seekers so that no matter what it is, when we eventually get it,

it's often not what we had hoped for, or it's not quite as fulfilling. Or even if it is fulfilling, then we need to continue to get, you know, more and more. Also what I would say that I've, you know, experienced myself, but also, I mean, many of my patients have talked about this, that even if those accomplishments are really fulfilling and rewarding and they get that big hit of dopamine, there's a come down. So there's a price to pay. You're out and you're performing and it's all wonderful and you're getting that rush, but then you come home and you go into a dopamine deficit state, you experience anxiety, you're worrying about,

will I ever be able to replicate that? Feeling depressed, again, just that comedown. So I think it's really important to notice these fluctuations, to appreciate that they're essentially normal because they're driven by this pleasure pain balance, which again is evolutionarily designed to keep us seeking in a world of scarcity, but which is now made much more complex by this sort of hyper-convenient world that we live in now. And it's the receiving this big hit of dopamine without work is, I think, one of the ills that we're facing. That's part of it. But I think it's just also the problem. I mean, I think the orientation that has to shift around this is like the dopamine for its own sake is sort of the problem. So just the reward is not really ultimately going to pan out. And really what we need to do is look for meaning

and purpose, pretty much independent of that reward. But it's very hard to get away from because we do have a culture that is steeped in this idea of bookending our days through rewarding ourselves. And rewarding ourselves has really almost become the primary way we organize time. And so it's a huge shift to think about doing it any differently. What does that mean that it's the primary way that we organize our time? Right. So I suggest a good Duncan experiment, which I sometimes do on myself, which I think is really interesting. Go through an entire day without doing anything that gives you pleasure, you know, beyond like eating the food that you need to get through the day, but not anything really tasty

or good. So no listening to music, no eating, you know, sweets, you know, no Netflix, you know, binges, absolutely nothing, just the whole day without any reward. First of all, I think it's noteworthy that that would be really different for most of us, because usually we're thinking, okay, I'm going to do my work. And then when I get home, I'm going to have a okay, I'm going to do my work. And then when I get home, I'm going to have a cocktail or I'm going to smoke a joint, or I'm going to watch a movie, or I'm going to read a book or whatever it is. So if you take that away, what I find happens, which I think is really interesting is it totally changes the shape of the day because when I stop looking forward to the reward that I'm going to get at a later moment in time,

all I can do then is be here in the moment now. And it just changes the experience of time. And so it can be interesting to do that because I think it does reveal how much we use rewards to create space and time in our everyday lives. Here's where that gets complicated for me. I love the experiment. I think that that would be a fun, almost like dopamine cleanse, but a good experiment. Maybe the Finding Mastery community, we could do it together and talk about it. But there's even a one-off experiment of it.

But here's where it becomes problematic for me is I think, and I'd love to hear your take on it, that when I check email, that I get a dopamine hit. I don't want more emails. Okay. But like emails that come through are pretty exciting usually for me. And, and I also like the way it feels and there's some satisfaction of accomplishing, you know, some clearing of the stack of requests. So it's like twofold. So I'm not sure like I could actually, this is scary, but manage my day without my work day, without some sort of email experience because I do, I I'm getting dopamine from it. So can you coach there? Yeah. I mean, so I think that's very fair. I mean, email is really just another form of

social media and many of us are compulsively checking our email, myself included, looking, you know, it totally engages our treasure hunting, you know, brain reward functions, looking for that next positive or exciting or new thing. And novelty is a huge trigger for dopamine. So you're absolutely right. So, I mean, dopamine is fundamental to survival, to reward, to noticing novelty, to surviving in our environment. I guess what I'm talking about is I think at the end of the day, though, for most people, email is work. But if you notice that it really is sort of rewarding and enhancing and distracting, that it would be something like, well, when I get to the end of my workday at 5 p.m., I'm not going to check email again for the rest of the day. So again, that would be a way of experimenting with not bookending your day with the checking of the email. Got it. Okay. Very cool.

Very cool. And then I want to come back to that list and I can prime you because I have the advantage of looking at what you reported. And I don't know if it's on the top of your mind, but when we study dopamine in rats and we give them a bit of chocolate, there's an increase. Do you know that? Yeah. Okay. Yeah. So this is an experiment done by sticking a probe into a rat's brain and measuring,

actually measuring how much dopamine levels increased above tonic baseline levels with exposure to a variety of substances. So chocolate increases dopamine levels levels 50 units above baseline. Food is about 100 units. I think nicotine is about 150. Cocaine is about 250. And amphetamine is about 1,000 units above baseline. But a couple sort of, I think that requires a little bit of an explanation. First of all, one of the reasons that amphetamines are so high is because the mechanism of action of amphetamines is to release dopamine directly into the synapse, whereas other drugs are mediated through other endo-opioid, endo-cannabinoid, and other endogenous systems.

The final common pathway for all rewarding drugs and behaviors is dopamine, but not all of them work directly on dopamine. So that's one caveat. The other thing too, is that rats are not people. So, you know, we are using that analogously, but we're not exactly the same as rats. And then finally, I think this concept of drug of choice is really important, which is to say what tips your pleasure-pain balance hard to the side of pleasure may not tip my pleasure-pain balance hard to the side of pleasure. And that people are really different in that regard. I mean, usually intoxicants are intoxicating for most people, but sometimes people can have a really strong positive reaction to alcohol, but

not methamphetamines or not cannabis. So there is enormous individual variability. And I would just add that one of the reasons that I claim that we're all more vulnerable to addiction today is because we have drugs that didn't even exist before, things like video games and social media, and even traditional drugs are so much more accessible that it's inevitable that each one of us is going to find that key that fits perfectly into our dopamine lock and turns it making us all more vulnerable to the problem of addiction. Because you categorize social media as a drug because you're looking at the what it does to the brain and you're seeing a big flood of dopamine when you're scrolling.

Yeah, absolutely. And again, it's not to say that social media is a bad thing in all instances. And for some people, it won't be a drug of choice at all. So it won't be a problem. I think it's probably more a problem for people for whom human connection is essentially their drug. Also, I think it's important to define what social media is. I'm not, when I think about social media as a drug, I am not talking about all of the ways in which people exchange images, texts, and ideas online. And much of that can be really good and foster amazing, true, and intimate and adaptive connections. I'm really talking about the ways in which the media portion of social media has turned human connection into performance and into posturing and has engineered it to follow people around and essentially

constantly amend what they're already looking at for increased novelty, which then triggers dopamine. Because again, if we look at the four aspects that make a drug more addictive, it's access, quantity, potency, and novelty. And when social media conspires to increase all of those four functions, you really do end up with a drug. Finding Mastery is brought to you by iRestore. When it comes to my health, I try to approach things with a proactive mindset. It's not about avoiding poor health. This is about creating the conditions for growth. Now, hair health is one of those areas that often gets overlooked until your hair starts to change.

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$50 off when you use the code finding mastery at checkout. That's Lisa L E E S a.com. The promo code is finding mastery for 25% off and then plus an extra $50 on us because quality sleep is just too important to leave to chance. And then, so let's go back to the list just for clarity. Chocolate is around 50 food is around a hundred percent increase in dopamine. So is sex. Nicotine was 150. Cocaine was around 250. Amphetamine is about a thousand. On that stack, where do you put the mindless scrolling? Well, a couple of things. So you use the word mindless. That's interesting. I mean, I would... Let me clarify. Yeah. Right. Is I'm just floating around on, let's call it one of the platforms looking for like something interesting. Right. But I'm not really kind of mapping it to work or business or something. I'm just kind of

looking for the, oh my God, look at this. Oh my God, look at that. And so like, there's that kind of loop where people talk about, where did those last 30 minutes of my life go? And so that's what I mean by that. Yeah, no, I mean, I actually liked the use of the word mindless. It triggers a couple different thoughts, but just to get back to your original question, first of all, those studies were done in rats. We really don't have a way to measure that in humans and it hasn't been done with social media. So we really don't know, but my guess is that it would be somewhere around where sex is, because again, I think that social media is really about human connection. It's, it's, you know, we are evolved over millions of years to connect with other people.

We are social creatures. Human connection has allowed us to find healthy mates, protect ourselves from predators. You know, a shepherd scares resources. We release oxytocin when we make human connections. My colleague, Rob Malenka, recently showed that oxytocin binds to dopaminergic neurons in the reward pathway and releases dopamine. So we know that's reward pathway and releases dopamine. So we know that's all mediated by dopamine. So my guess is it's sort of on par with sex, not quite as potent, but it's around, it's in that human connection category. But getting back to your

mindless scrolling bit, I mean, one thing that I think is interesting is the ways in which there's both the intentional sort of seeking out or treasure hunting that happens online that is related to dopamine. And then there is this scrolling that really is a kind of a mindless resting state, which I think is really fascinating because we do have what are called resting neural states. And these were discovered sort of by accident when people were put in fMRI machines to look at their brain activity, engaging in certain specific tasks. And originally, researchers were very interested in what nuclei were stimulated during these specific tasks and ignored what the brain was doing in between tasks. But at some point, somebody realized, well, actually, there's some really interesting stuff occurring in this resting state, the mental resting network.

Because what they found was that specific activities that required focus concentration lit up specific nuclei, but these resting mental networks were a kind of a cross dialogue of a diffuse set of nuclei all across the brain integrating together in a kind of symphony, which is really fascinating because it suggests that this is a kind of a, like the brain's heartbeat or a resting consolidation integration period. Are we talking about the default mode network? Yes, that's right. Okay. So the default mode network, there's a hum of activity across multiple part regions

and nuclei across the brain. And okay. So I just want to make sure I'm grokking on the right place with you and, or, or mapping on the right place. So yeah. Okay. So, so what I, what I get to bring it back to your mindless thing, you know, mindless scrolling. So what, what, so these, you know, this, this default resting mental network, these in-between times, what we have learned is that they're really central for learning and consolidation of what we've been doing. These periods of rest are not just passive periods. They're periods where there's integration and consolidation of what came before. But what I am observing happening now is that people are not really, they're scrolling during these resting mental, that they're resting by scrolling. And I just wonder about what the implication of that will be. Yeah, because resting while triggering external noise at some level with some added dopamine and a bit of that dopamine deficit that, you know, is the parlay there that, yeah, that's a really good thought.

And where I get interested in the default mode network is that there's a self-reference component to the default mode network. Like, am I okay? Is this okay? Is this okay? There's like that self-referencing bit. Does she think I'm okay? Does he think I'm okay? Is this okay? That is quite exhausting when the default mode network is online. And one of the ways to dampen that or to, it's not quite an extinguish, but to work with that is something that requires full attention. And like a meditation or climbing a cliff or, you know, playing an instrument, playing sport, writing a document, whatever. And there's a relief that comes with that deep focus from that self-referencing checking, am I okay? And so I like where you're taking it,

which is like, wait, what are we doing? We've got a generation that's changing the way the default mode network is operating, but maybe it's more the same of the self-referencing. Yeah, the self-comparison. Yeah, that's right. I mean, you've understood my point exactly, is that that default network, that resting state can be uncomfortable, but it's very important for integrating opportunity to consolidate our experiences and to grow and change and create the new neural networks that we need to in order to move forward? In my book, I give the example of a young woman who came in, a young South Korean woman

who came in with complaints of anxiety and depression, a Stanford student. One of the things I discovered in talking to her was that she was always plugged into something, whether she was walking to class, waking up, falling asleep. This is a good story. So I suggested to her that maybe as an experiment, I always like to pose these things as experiments. I'm not sitting in judgment. I'm just like, hey, you know, try this, try that. This is all about the way that our physiology interacts with our environment. I said, why don't you try walking to class without listening to anything? She just looked at me in absolute horror. Why would I do that?

It would be so boring. And I said to her, well, yeah, it probably would be really boring. And the truth is that being bored is not just boring. It's also scary because when we are bored, it brings up all those questions like, what am I supposed to do right now? What am I supposed to do in the big picture? Why am I here? What am I ever supposed to do? But being bored is fundamental to having an original idea. You cannot have an original idea unless you have a period of being bored. So what I loved is that she was willing to try this experiment. She came back next time.

She goes, well, I did it. And I said to her, well, how was it? She said, well, it was boring. But she said, after I did it for a while, I started to kind of notice things. And I said, well, what did you notice? She said, well, I started to notice the trees. And I thought that's great. You know? So, so those are things to think about, you know, the ways in which we're really constantly distracting ourselves from the present moment, all of the tools that we have to do that

now. And they're not, they're so alluring. I mean, it's hard not to be, you know, drawn in by them because the flashing lights, the bottomless bowls, the beautiful faces, you know, the, the sort of intrinsic rewarding potential, the way that they're engineered to keep us clicking. So this is, you know, not an easy thing, but I do think that this is something that's worth doing. I do. I think it's a great challenge experiment. And then, so can we, can we bounce over to marijuana and so, or go back maybe to kind of the dopamine circuitry? Where do you think dope marijuana is on that hierarchy of dopamine release

if cocaine is 250? You know, it really depends on the person. I mean, I think that's just got to be an enduring message for some people. It's highly reinforcing for other people. It's aversive. They would do it once and never do it again. But even for a person for whom it's reinforcing in my experience with repetitive use tolerance develops, the initial response gets weaker and shorter in duration, that dopamine deficit state gets longer and stronger. And there's hardly a person I've seen in my clinical practice for whom eventually cannabis doesn't turn on them.

So that's another way of saying that it eventually turns on everybody. So whether you're using it to have fun or to solve a problem, it just stops working and can make that original problem worse. So people who use it for insomnia, and then it keeps them awake. People who use it for anxiety, it makes them anxious. I've just seen that again and again. And again, that's the brain adapting to the presence of that drug in a way that seems cruel and insidious, but is actually highly adaptive in a world of scarcity. And many people smoke because of an underlying anxiety. And actually, you articulate it well,

and it's been my experience with people is that it can actually be a cause of anxiety. The rebound effect of it is one of it. And the second is when people are high and they have THC on board, they don't practice anxiety. They don't practice being anxious. So there's like two parts, right? We've become atrophied in practicing being uncomfortable. And then the second is that tolerance bit, which is, you know, we're just, we're, or not, not the tolerance. That's the third bit, but the, the piece where we are no longer relieved from it, but it's actually triggering more. So can you just talk about that? Because there is a casualness in sport about marijuana. Oh, sure. I mean, you know, in my clinical practice, cannabis addiction is one of the most common reasons that people come in.

And again, these are often people who have been able to use cannabis in moderation or even daily for very long periods of time, in some cases decades, but eventually it sort of runs out for them. It just stops working or even makes the very thing they're searching for. It creates the opposite for them. And again, the way to understand that is just to go back to this pleasure pain balance that, you know, with repeated pressing on that pleasure side, the brain is going to adapt by down-regulating dopamine transmission, dopamine receptors by down-regulating our transmission, dopamine receptors by down-regulating our own endocannabinoid system. So remember, most addictive substances and behaviors mimic some chemical that our brain makes. We have anandamide receptors. Anandamide is Sanskrit for joy or peace or bliss. And we make our own sort of endogenous version of cannabis. When you ingest, uh, cannabis,

you're essentially usurping our own endogenous cannabinoid system with an incredibly potent form of the same. Um, and you're telling your body, Hey, you know, that cannabis stuff, you don't need to make that. And by the way, with all that cannabis on board, just let's resorb some of those endocannabinoid receptors because we got to get back to balance and homeostasis. Remember, that's the sort of the ulterior motive of many, if not most physiologic and natural biological systems. So the result is that you need more and more to get the same effect, stops working over time. Each time you use it, it feels good or it can continue to feel good short-term, but that's not because it's doing what it did before. That's because you're walking

around with a balance tip to the side of pain and you need to smoke just to feel normal, which is why one of my main interventions in my clinical practice is to suggest a 30-day dopamine fast, or in the case of cannabis suggests that folks not, not use cannabis at all for 30 days. And oftentimes, you know, patients will say to me, but why would I do that? It's the only thing that helps with my anxiety. And I said, and I always say, I'm sure it feels like it's helping with your anxiety, but my hypothesis is, is actually creating your anxiety by putting you in this dopamine deficit state.

It's a real leap of faith for people to believe that that's true. Because again, the subjective experience is that it's relieving anxiety, which it is doing because it's bringing the balance from pain to level. But in fact, the reason that the balance is tipped to the side of pain in the first place is because of those chronic hits of cannabis. So by not smoking, we allow those neuroadaptation gremlins to hop off for homeostasis to be restored. I tell patients in those first two weeks, you're going to feel worse. You're going to have awful, awful, just awful, right? This is the rebound, right? More anxiety, more depression, intrusive craving. Yeah. Just all you got to do is get through that first two weeks.

Get through it. What you'll notice is that it's like a window opens. You're not, you know, here's a really important key piece about addiction. It narrows our focus. Other things become less salient. Things we used to enjoy are no longer enjoyable. We start to blame those other activities as being inherently unenjoyable or those people being not the right people or not the right job or not the right major in college, when in fact it's actually our drug of choice, which is depleting the hedonic valence from those substances and behaviors. And when we take a period of abstinence, we can get that joy back because we're starting to regenerate our own dopamine and endogenous cannabinoids, et cetera. I want to add something and wave me off if I'm, if I'm, if I'm, if you have a reaction to this in a way that, you know, would send me down a different path, but when folks come in and do some work with me and, you know, we're going through basic stuff and what they want to do and who they want to become and all the good things that, you know, are fun of

that fun part of the vision setting. And then we get into basic ways that they organize their life. And when they, when they have something about like, I'm using heroin, it's usually like, well, we probably need to stop that. And, you know, like that's, in my case, it's usually like, well, we probably need to stop that. And you know, like that's in my case, it's extremely rare. Amphetamines extremely, or I'm sorry, cocaine, sometimes amphetamines. Yeah, there's some in there, but not what you're thinking. Like it's still rare. Marijuana, pervasive. And so here's my question. What I say is like, I don't think I know how to help you. Being the person you just described, while you're getting high every day, you know, or you're smoking every day and like, ah, come on, man, get with it. I'm like, no, seriously,

like I understand how this chemistry works. You don't quite know what I know about this. So listen, if you really want to do that work and become the human that you're, we're describing, um, we got to go on a little bit of an experiment and I use the word experiment as well. And they're like, get out of here. It creates some space. And then I go, and then I go, this is where I go with them as I go. That's what I figured you can't do it. And they look at me like, Oh, you're going to challenge me? I go, I'll say it with something like this. Say it's an alpha male athlete. I'll say something like, no, let me not be crass. Because there's some locker room talk I'm about to go to. But so I'll say, you don't have any of what this takes to actually go for 30 days

without smoking. You can't do it. And they're like, I can do it. I go prove it. And they go, no, I don't need to prove it. Like, what are we doing here i it helps me with sleep it helps me just chill out it's part of my social thing and i enjoy it and i'm telling you doc it's not part of the thing i go like i said you can't so listen um i don't know maybe i'll see you down the road sometime let me know and they're like are you serious you're kicking me out and i'm like yeah i don't know how to help you and so am I being too rigid there? Because like the neuroscience that you and I are talking about is material is so clear to me.

And, and also like, there's the Spicoli dude, where's my car? You know, eventually it gets to that, you know, super burnout, low motivation kind of thing where you just lose that spark. And anyway, so wave me off and say, Mike, actually, you can maybe be a little less or a little more in one direction or the other. You know, I'm very glad to hear that you approach it as a first principle. I think that the majority of mental health care providers of whatever ilk basically ignore this problem. They will ask patients about every conversation they ever had with their mother, but they'll never ask them about substance use. And I was in that category

when I started my career. And it was really, you know, when I realized that I was in fact a bad psychiatrist because I wasn't asking about substance use and addictive behaviors, because the science is really pretty convincing that unless you're targeting both the substance use and addictive behaviors and the other mental health problems at the same time, you're not going to make progress with either one. And I want to be really clear. These are some of the most extraordinary performers and doers and sometimes thinkers on the planet. And they have this idea that there's more. So they don't come to me because they're suffering,

right? They come to me, maybe there's a struggle in the gap between consistent excellence and inconsistent excellence. So they're not, so think about like suffering, struggling and thriving, like, you know, that model, but they're the best in the world. And so they're like, get out of here. Like, look, look, I'm doing great. And so, yeah, but to get where you want to go, I'm not sure that what got you here is going to extend that adventure. So I find that when I explain to patients about the pleasure pain balance and really educate them about the neuroscience, there is, there can often be like a sort of aha moment. Cause I think that makes sense to people. The other thing too, is, you know, I think it's key here is we're not asking for a lifetime. We're asking for 30

days in the broad scheme of your life. Can you give me 30 days without using? And by the way, at the end of those 30 days, we can talk about what's next. And maybe what's next is going back to using in moderation because about 80% of my patients who can do the experiment come back, not only feeling better with a pleasure pain balance with homeostasis restored, but also are able for the first time to see true cause and effect, which you cannot see when you're chasing dopamine. They're able to look back and say, wow, I was really using a lot or, well, I can't believe I cared that much about that. Or I can't believe what I was neglecting for my drug. And you can't see it when you're in it. You really cannot.

And then when they come back, what we do as a pros and cons list, what was good, what was bad, almost always at the top of what was bad list is I had more time and I didn't know what to do with it. I was bored. And I was lonely because all my friends use and I couldn't hang out. But there are so many good things that the majority of people, I say, now, do you want to abstain another month or do you want to go back? The vast majority want to go back to using, which is fine, but they almost always want to use differently. And mainly they want to use less and they want to use in a healthier way. They don't want to be attached to it in the same kind of way. And so then it's a matter of, okay, well then what is

that going to look like? When are you going to use? How much are you going to use? Let's get down to the nitty gritty details because I find that's really key for making sure that they stay on task with their new goals of moderation. The other thing I always emphasize to people is that daily use is really what gets you into trouble with those neuroadaptation gremlins. But if you can avoid daily use and leave enough time in between for the gremlins to hop off and for homeostasis to be restored, then you will preserve that resilience in your pleasure pain balance to be able to restore homeostasis after you use, you know, some kind of intoxicant. And there are studies to show that. So there's a really interesting study by Kub and Ahmed, where

if you give a rat unrestricted access to cocaine, methamphetamine, heroin for a period, for six hours a day over many days, they will progressively press that lever more times per unit time, more times every six hours in order to get more drugs. So in other words, they will escalate their use over time. So this idea that, oh, well, you know, if I just had infinite access, then I would know I had it and I wouldn't use as much. It's the opposite. The more access we have, the more we use. So what Kub and Ahmed did said, what happens if we restrict exposure to only one hour a day? And what they found is in that case, the rats pressed the lever for cocaine at a steady rate that didn't increase day to day. So that suggests

that if you leave enough time in between, homeostasis is restored in between and you don't get into that vicious cycle of addiction. And so an analogy might be like if you're leaving your bong fully filled with the lighter next to it, and there's five of them across your home. Right. It's probably going to be really challenging. And then the way I make the switch here in my head is that, okay, listen, we don't train a muscle group every day. Right. Right. Because we'll burn it out.

Right. It will over-train. It will over-use it. And so there's an intelligence about how we think about physicality. And let's think about our brain. Our brain and our body are, it's the same thing, you know, different functions, obviously. So how about a little bit of that intermittent exposure? Right.

And so, yeah. So anyways, I feel refreshed with that. And I also want to make sure that, you know that I'm being very clear to folks that are in my life and folks that might be in my life at some point. I have zero judgment about use. Zero. Like, I just find that there's a gap between the human you want to be and the way that you're engaging in your life.

And that's okay. That is perfectly fine. But if you got a little spunk on you, go for 30 days, try it out. So anyways, okay, so all that being said, I wanna honor our time and I wanna round out just a little bit here on social anxiety and this pervasive worry about what others might be thinking of us. And so I want to almost leave it open-ended to see where do you take, where are your insights

around the anxiousness from what others might think of us. And you could kind of plow down social anxiety as a parallel path or just this pervasive, excessive worry about what people might think of us as it relates to, let's call it, neurostructure and neurochemistry. Here's how I think about this. We have a culture that is focused on narcissistic self-aggrandizement. That doesn't mean that we're all narcissists. There's a healthy amount of narcissism that we all have. It's what allows us to invest our creativity, our libido, our energy into anything that we do. And that's a good thing. But when we achieve something that is then recognized as a singular or individual achievement, which by the way, our culture loves, the media seeks that out

rapaciously. School culture, athletic culture is all about this individual and their superhuman accomplishments. So we've got a culture that drives toward that. And what that essentially does is that is in the moment, a huge source of dopamine, but invariably for every price, there's a consequence for every pleasure, there's a pain. And the comedown from narcissistic self-aggrandizement is essentially shame. And shame is an incredibly powerful emotion. And I believe that shame is probably the most powerful pro-social emotion that we have because it's what brings us back into the tribe, right? Because we feel shame naturally when we do something that deviates from social norms. And then shame is what, again, brings us back in. So we have this kind of vicious cycle in our culture where we're encouraged to

seek out this narcissistic achievement. And we do, and we do get a dopamine hit from it, but then the comedown is shame. And that shame is the price that we pay. And often that's the lingering feeling, a kind of lingering, shameful self-loathing, which is the cost of this sort of external accolades. So to me, that's how I think of it. And that means that the answer is to not try to separate yourself from the tribe. Now, I do believe it's possible to seek out excellence and achieve without narcissistic self-aggrandizement. And to do that, we have to take ourselves out of that achievement and just think about what it is we are trying to accomplish. What's the meaning? What's the purpose? What's the message? It's not so much what I did. It's what is being

put into the world through me. And I think through that, we can pursue excellence without getting into this terrible sort of seesaw between the high of narcissism and the come down of self-loathing and shame. So how do we work with this obsession about what people think of us? What essentially do you recommend people do that are hypersensitive in a way that it doesn't allow them the freedom to really go for it in life, to say what they want to say, to laugh they want to laugh, to know that they're okay if they stumble publicly? Like, I mean, to me, to me, you know, I mean, of course, we're, you know, this is a very broad topic, you know, where if people have like social phobia or social anxiety, I really recommend exposure therapy, you know, in graded measure, forcing ourselves to do the thing

that makes us anxious to interact with people in ways that makes us anxious so that we can build up those mental calluses. Again, if you think about the metaphor of the pleasure-pain balance, this is hormesis, pressing on the pain side so that the neuroadaptation gremlins hop on the pleasure side to restore our hedonic set point tilted to the side of pleasure instead of to the side of pain. So the remedy is to do the hard thing. But again, even more broadly, I think, you know, as like a life approach is to not conceptualize these interactions as reflecting on me or really about me, but instead thinking about how I can express myself and find meaning and purpose in a way that channels sort of, you know, energy through me, but it's not really about me. So, for example, one thing that I do is

like on these Zoom calls, I hide self-view. So, I can't see myself now because I don't want to focus on myself because it's not about me, right? It's about something that I'm trying to teach. For these interviews, I never watched them afterwards. I haven't watched or listened to a single interview ever. And that's because I probably wouldn't like what I saw. And then I would start to ruminate and get preoccupied on like the performance aspect rather than just like the message aspect. So I think, and of course, social media is antithetical to that because it's all about my image and my performance and how many likes I got, which I think is really a huge contributor to shame and self-loathing. Awesome. Super. I found such relief taking that selfie off, you know, because I found that it was like, I would look at myself and I'm like,

why am I looking at myself talking? Like I know what I look like. And, you know, and that it was like, I would look at myself and I'm like, why am I looking at myself talking? Like, I, I know what I look like. And, you know, and so it, it was like the head that was moving on the, on the, the squares. And so I was looking at that one rather than looking at my friends. So. Now part of that is hardwired, right? Because our brains are hardwired to watch the mouth that's moving. And so of course we will look at ourselves because when we're talking, but, but I think it's the other piece too. Let's round us home with this one. Thank you. I love the clarity and the depth. The whole thing is just, it's like candy for me, but let's round it out with this. If, if parents, if parents knew what you knew, how would they parent better? If leaders knew what you knew, how would they parent better? If leaders knew what you knew, how would they lead better? And if athletes knew what you knew, how would they perform better?

Can you just walk through a couple of super tight little gems there? Oh my goodness. That's a lot. I mean, I think for parents- You can do it. Can do it. Okay. The key things I would say for parents are share with your kids early on the drugified nature of so many things in our lives today. Talk about dopamine and the importance of not just how you feel when you're using the drug, the video game, the social media, the YouTube, but also how you feel afterwards. Notice that falling away as you have to turn it off, what's happening in our brains. We're plummeting into a dopamine deficit state. And then being very aware of that. And that if we continually try to chase and recreate

that good feeling, we can get into this vicious cycle. I think kids kind of get science and they like it. And I think that's just a useful kind of thing to arm them with. And then the other thing I really advocate is what I call transparent parenting or radical honesty, where we're not just modeling what we want our kids to do, but also truthful with our kids about our own struggles. For business leaders, I don't know. I'm not sure, but I think it's a lot like parenting, you know, modeling what we want our colleagues and others to do. And also, again, what I really have found useful in my work is to practice as much as we're able an egoless selflessness and trying to give it away. I find the more I've tried to give it away in my professional life, I've gotten so much more back

than when I tried to hold on to it. And then for athletes, gosh, you know, I mean, I love athletics and sports. It's such a beautiful expression of sort of the best of what's human. But I think that in many ways, you know, the way that sports has become commodified, the way that the media really encourages this narcissistic self-aggrandizement, instead of the beauty of the human body and what it can accomplish. I think this has made it really difficult for athletes to take joy in their sports and find themselves. Even my children who are quite good athletes, they get interviewed by the intrepid reporter after they win a race, and then they're watching that interview afterwards. And I just

think it sets it up this terrible dopamine cycle where it's not about the joy of the sport, but about chasing those accolades. And so for athletes, I would just, you know, really get them to be thinking about that. So good. And do you have this last question for me? Do you have a habit that has been meaningful to you to help you be the woman that you are? Oh my gosh. One habit. I listen to my husband, whatever he tells me, I do it. He really is a very wise and much kinder person than I am. He helps me. He reminds me to be kind. He's a very good man. And I'm glad that people like him exist in the world. Oh, very cool. I've got a newfound appreciation of just like, my wife is such an anchor in the

human I am, that I think it's so easy to not go to that place and talk about, oh, it's this skill, or that tactic, or this philosophy. No, actually, it's the foundation of the relationship with the most important people in my life, like period, you know, full stop. And so that's refreshing. And so thank you. And Dopamine Nation, you know, in a bookstore near you and all the places that folks can find books. And then also, like, where can we follow? What's the best way to follow your, your thinking? Right. So the best way to follow me is on finding mastery. I'm not actually on social media. So there I'm, I'm nowhere to be found except right here. I just want to say, thank you for sharing your time, your expertise. I want to encourage people to go become gripped with the stories that

you share in your book. Like the clients that you have are like, they're like fascinating, you know, like electricity around male genitalia all the way to like, you know, fill in the blanks. Like it's awesome, you know? And so what a weird way to end our beautiful conversation, but like your clients are fascinating. And so anyways, I want to say thank you for your time and your expertise. And this has been a wonderful conversation. Well, thank you. It was a joy. All right.

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