Habits and Hustle - Episode 162: Dr. Anna Lembke – Psychiatrist, Author, and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic

Episode Date: April 12, 2022

Dr. Anna Lembke is a Psychiatrist, Author, and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Her recent book “Dopamine Nation…” is a look into all things about the modern space of addiction, and how and where we get our dopamine. Dr. Lembke is extremely forward and opens up about her own struggles with certain dopamine addictions and details the ways in which she broke those structures, and how most could do the same. Whether you think you have an unhealthy relationship with your procurement of dopamine or not, you may be shocked to find what Dr. Lembke considers detrimental: phone use, video games, romance novels! Seriously, reading! Reading can be a dopamine addiction! If you feel like you can’t go 5 minutes without your phone, if you’re overwhelmed with the social media and technological landscape that has altered how our brains receive and process joy, or if you know someone else who may be in trouble, this is the episode for you! Dr. Anna’s Lembke – https://www.annalembke.com/ Youtube Link to This Episode ⭐⭐⭐⭐⭐ Did you learn something from tuning in today? Please pay it forward and write us a 5-star review on Apple Podcasts. 📧If you have feedback for the show, please email [e-mail]  📙Get yourself a copy of Jennifer Cohen’s newest book from Habit Nest, Badass Body Goals Journal. ℹ️Habits & Hustle Website 📚Habit Nest Website 📱Follow Jennifer – Instagram – Facebook – Twitter – Jennifer’s Website Learn more about your ad choices. Visit megaphone.fm/adchoices

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what's most amazing is that true nitrogen is backed by 18 clinical trials and has endorsements of two Nobel Prize winning scientists. So go check it out at trueniagin.com. That's T-R-U-N-I-A-G-E-N. And we have a special offer for new customers to receive $20 off orders of $100 or more using the code Hustle20. So definitely run, don't walk, and scoop some up now. Hi guys, it's Tony Robbins. You're listening to Habits in Hustle. Fresh it. Today in the podcast we have Dr. Anna Lemke, who is the chief of the Stanford Addiction Medicine, dual diagnostic clinic at Stanford University School of Medicine. Dr. Lemke is a psychiatrist expert in treating addictions of all kinds, drugs, alcohol, food,

sex, gambling, video games. Dr. Lemke is also an expert in the opiate crisis. We discuss on the podcast today the biology and psychology of why people become addicted to certain substances and behaviors and the cure role that our dopamine balance plays in creating these addictions. We also discussed the science and practice of how to conquer addictions, why people relapse, and how to avoid relapsing. We also talked about topics closely related to addiction, such as shame, lying, community. Her newest book is called Dopamine Nation, which quickly became the number one New York

Times bestseller. She describes very well in layman's terms how all of this happens and how we actually find balance. I really think you're going to enjoy this conversation. This episode is important for anyone struggling with addictions of any kind for their friends and family. And if not, you will really just find a lot of insight. Enjoy. I really like your book.

Oh, thank you. You know, it's interesting. I find it's very timely, too, right? Because it obviously hit a chord since it's, I feel like I see you everywhere. I see the book title everywhere. You obviously know it's great. Yeah, it's great. I think because I think everybody can relate to some level of this, you know. That's right. So that's what I really love about it. I'll just do a quick

little brief intro that we have Dr. Anna Lemke who wrote the book, Dopamine Nation. Here it is. And like I was saying, it's just like obviously I hit a core because we all have, we'll get into it. Why don't we start with the beginning, right? So can you just kind of tell everybody what is Dopamine and why does it get released and why is it so important for us? dopamine and why does it get released and why is it so important for us? Yeah, so dopamine is a chemical made in our brain. It has a number of different functions, but one of its most important functions is to mediate our experience of pleasure, motivation and reward. It's a neurotransmitter, so it's a chemical that's released between neurons.

Neurons are these long spindly cells that conduct these electrical impulses, but they don't actually touch. There's a little gap between them and that gap is called the synapse. And neurotransmitters are the molecules that bridge that gap and dopamine is one of many neurotransmitters. Dopamine is released when we do something pleasurable or rewarding, but it's also really important for motivation. It may be even more important for motivation than pleasure. And dopamine is also important to movement.

I'm sorry, I'm sure you've heard of Parkinson's disease, and that's actually a depletion or lowering of dopamine in a different part of the brain called the substantial Niagara. But it's no coincidence that pleasure motivation and reward and movement are mediated by the same neurotransmitter because of course you know for most of human existence or for that matter, organismal existence, we've had to you know move to get our reward that's no longer true, which is one of the things that makes living in the world today. So challenging, but movement and motivation to your reward are closely linked in the body. You talk a lot about in your book about having that balance between the pain and pleasure. It's like a seesaw in a way, right? You can't have too much, even too much pleasure, can actually lead to a lot of pain or depression. I found that to be extremely interesting to me, personal

answer, other people obviously did too. Now, I guess my first real question with that thing is, number one, how do you balance it? And I guess it's a two-prong question. When you talk about even addiction, let's just go with that actually, is there certain people who are more vulnerable to addiction? And do you find that in our time now, that with social media and all this other you know quick dopamine instant gratification hits that it's spiked and increased over the

last 10 years. Yeah okay so let's start with the second part of your question. It is indeed true that people are differentially vulnerable to the problem of addiction especially to traditional drugs like drugs and alcohol, right? Not everybody is equally susceptible to that problem. And we know that that risk or vulnerability of getting addicted to drugs and alcohol is partially genetic or inborn. If you have a biological parent or a grandparent with addiction to alcohol, for example, you were

at increased risk compared to the general population of becoming an alcoholic, even if you are raised in a totally different home and don't have that behavior modeled for you. So that's a really important thing to realize. There is actually, so people do say that and people always poo-poo it, but that is a thing that people actually are born with that gene. Oh, yeah, for sure. But here's the sort of wrinkle, and the reason, one of the main reasons I wrote, dopamine

nation, there's this concept of drug. So first of all, there's this pleasure pain balance that I talk about in the brain and how pleasure and pain are co-located. They work like opposite sides of a balance. When we experience pleasure, that balance tips one way, when we experience pain, it tips the other, an overriding rule governing the balance is that it wants to stay level. And the way it stays level is first by tilting an equal and opposite amount to whatever the initial stimulus was.

So let me just describe that. I like romance novels. They really stoked me into my brains reward pathway. I get a little tip to the side of pleasure. But then I have these neuro adaptation and gremlins that hop on the pain side of the balance to bring it level again. But they don't get off right when the balance is level.

They like it there. So they stay on until I'm tipped an equal amount to pain and then they get off. And when my balance is tipped to pain, that's the moment of like not being able to put the book down and feeling that urge to read another chapter, right? It's that moment of wanting because I'm in this mini dopamine deficit state, which is what happens when we get a surge of dopamine.

Our brain will compensate by down regulating our own dopamine transmission, not just to baseline, but below baseline. That's those neuro adaptation grind ones. Now, if I wait long enough, they hop off, you know, and balances are stored, but the key thing to keep in mind here is that every pleasure has a price. Every pleasure has a price, okay? And if we deviate our balance aside of pleasure, we are going to have to pay for it with the aftermath. But now getting back to genetics, what tips my balance may not tip your balance, right? So my balance is actually not tipped at all

by alcohol and other drugs, even caffeine doesn't do anything for me. So I thought that I didn't have the addiction gene. I thought I was, like I didn't, I wasn't vulnerable to that problem. But then, lo and behold, the internet was invented, and the Kindle was invented. I discovered teenage vampire romance novels, and I became a chain reader. As I talk about in the book, I really actually got addicted to reading on my Kindle a certain

genre of book that progressed over time to Frank Erotica, essentially, socially sanctioned pornography for women. And that would never have happened, you know, if technology had not invented this infinite access to these types of books that have been engineered, books are also engineered to keep us engaged, right? And so that's a key piece of the message that we're not everybody's equally vulnerable to the problem of addiction. Some people are more vulnerable than others, but what we have now is an infinite quantity of highly reinforcing drugs and behaviors.

The drugification of things that weren't even drugs before, like human attachment and food, those are now drugs or potential drugs, right? And so we've greatly expanded the vulnerability in the population to the problem of addiction. And that's borne out by epidemiology. So for example, if you just look even at alcohol, rates of alcoholism or alcohol use disorder as we say in the field of addiction medicine, in women have gone up 80% in the last 30 years, 80%.

So it used to be that men outnumbered women, 5 to 1 to 2 to 1, in terms of rates of alcohol addiction. Now it's 1 to 1, starting with the millennials. Wow. Yep, rates of alcohol. Why do you think that is, though? Is it big? Yeah, a lot. Yeah. Yep, Rachel, I do think that is, though. Oh, yeah, a lot. Yeah.

No, why? No, I wouldn't. Is that because women are on social media? And I would think it's because you're so much more susceptible because of this whole comparison game. So people try to distract themselves. They try to kind of lose themselves and they're going towards things that are like that.

That's my guess. You tell me why. I mean, I think parents being a mother or being a parent, being a difficult. Right. So I mean, I think it's a lot of different factors. First of all, the population in general is getting more addicted because it's easier to get alcohol and other drugs. We now have drugs that didn't exist before.

Like social media is the drugification of, I mean, we're now getting addicted to social media, right? So I think not getting. Not getting. We are. We are. We are. You're lucky that you're not on it.

You know, that was a very smart move by you because people, it's very, once you're on it, it's very, very hard to get off of it, right? It's like, like, like what you were saying, what this whole, you just said a lot of great things there that I wanted to pick apart. Number one, that drugs, it's not just drugs and alcohol that you can become addicted to, you can become addicted to a plethora of things. One being, which I thought was very shocking, which you were very candid about, like you were saying, reading romance novels, I would never think reading would be an

addiction. Like, can, does that mean anything can be an addiction if you do too much of it? Like, what quantifies something as an addiction? You know, the key message here is that technology has allowed us to drugify things that were not previously addicted, but are now. And the features are quantity. So the more you access you have to a drug, the more likely you are to get addicted because quantity and frequency matter and TikTok never runs out. Right. That's true. We have potency. So like how much dopamine gets released in the reward pathway and

Really this technology has unlocked the code of how to release dopamine They know exactly how to do it you you rank things, you know, you enumerate it with number of likes You include these bright colors beautiful images sounds confetti You know, you link it to a social tribe, but part of what releases dopamine is when we have the same emotion as other people at the same time that they're having it, right? That's a huge release of dopamine. And then you make that tribe not one or two or ten or twenty, but you make it twenty million, you know, that's a huge and potent source of dopamine. And also a huge and potent source of dopamine and also a huge and potent source of potential, a

severe come down if you don't get the response that you are hoping for or that you wanted. Plus, you've got novelty. You've got drugs that didn't exist before. Again, social media, video games didn't exist before. A lot of drugs that now are much more accessible because they're online, pornography, right? Paragraphy, it was like, you had to work to go get the playboy or would I be able to hear middle-aged men talk about how when they were teenagers, now you've got five year olds

swiping right and swiping left, it's really not really scary. So then are we saying those two things? Are you saying that women, it's up 80% for alcohol, is it because more access on, is it the access part? I think the biggest factor is the access. I think another big piece of it is cultural changes. So previously, it was much more stigmatized for women to use substances.

And now, it's really not. It's even kind of like a bit of a badge of feminism, right, that we're going to use our, you know, we're going to drink our alcohol the way we want to drink our, we're going to be a boss, we're going to be like a man. Yeah, we're equal to a man, if not more and therefore we can do that. Right. But then getting back to this romance novel then, so then that means your situation. At what point did you feel that that was even

an addiction? Like how much how much is too much when you read? I mean, when you read, is it that it like at what point are you like, ah, this is getting to be a problem? And then do you even have to go cool turkey or have a huge win? And like, you know, a lot of read anybody with Fabio on the cover? Like I don't know. Yeah, great, great question. So, you know, broadly defined addiction, we base a diagnosis of addiction on the four Cs out of control use, compulsive use, cravings and continued use despite consequences. And what happened to me, and also there's also tolerance, tolerance is finding that our drug isn't working at the dose

that we use to work and we need more and more to get the same effect And also withdrawal when we stop and I actually had all of those things So I started to have out of control use where you know I would plan to just read a chapter or maybe just finish the book and it would be like midnight So it was cutting into my sleep and I had to work the next day my husband's asleep next to me and instead of that kindle down, I would like to find myself compulsively scrolling for another book, as soon as I finished one book. I also experienced problems with tolerance, where I found that after I had consumed all of the teenage vampire romance novels, werewolf novels, which romance novels, neckramanswers, susayers, all of the different kinds of fantasy genres, then I

needed, you know, basically Frank Erotica in order to, you know, get my fix. And I got to a point where I wouldn't even finish the books. I would just to get to, you know, three-quarters of the way through, which is like the climactic scene in every single... If you take a romance level and you literally visually open it to three-quarters of the three, you will find the climactic sex scene in there, and I would get to that point, and then I wouldn't read anymore. I just, it was like, I was just like going from my black tar harrow and I wouldn't.

Really? Yeah, and also I was spending less time with my kids, with my husband, I started taking romance novels to work and reading between patients. I mean, I just got totally absorbed in this fantasy world, where I always wanted to be in that world a little bit, like the way people describe a little bit social media, like they're just sort of,

it's always calling them and pulling to them. So, and I did what I, when I finally realized it, which I realized by telling another human being what was going on, I did what I recommend to my patients with jug and alcohol addiction. I tried I abstained for a month and a month is sort of what what happens in the brain if you repeatedly expose your brain to highly reinforcing drugs and behaviors is that in order to compensate you you accumulate more and more neuro adaptation gremlins on the pain side of the vows and ultimately you end up in a dopamine deficit state,

where you've reset your hedonic or joy set point to the side of pain. Now you're in a chronic dopamine deficit state, modest rewards aren't rewarding, and you need to keep using your drug not to get high, but just to level the balance and feel normal. So what happens when you first abstain, obviously, you go into withdrawal,

and that is actually what happened to me. I had a lot of increased anxiety and irritability and insomnia. I really had lost the art of falling asleep without this behavior. So it was really tough for me the first two weeks, but by the time I got two weeks, three and four, I felt a lot better.

And I was at the scraping place, my sort of, you know, I could enjoy other things again, I could look back and say, wow, that was like a nutty interlude in my life. And then I thought, well, I'm good, I'm going to go back to, you know, reading now and then, and I picked up a romance novel, and then I binge the entire weekend. Wow. Yeah, which is what happens to my patients. All right, happens. I find this so, this is what I find so fascinating. Because it's like, you always hear about drugs and alcohol and even social media, right? You don't ever think about these more ancillary things that should fully like anybody can have an addiction that it's not so obvious or socially accept, I mean, or they can be socially

acceptable, you know, reading can, reading is very socially acceptable. So you don't think, well, if it interferes with my life, it's okay because it's just reading. You know, like, that's what I find interesting and like, what, that to your point, then you even start binge reading, binge reading. So are you then, how are you doing it now? Are you not allowed to do it? Yeah, so, so for me, what I decided after that was that I needed to abstain for a year. That clearly a month had was enough to kind of make me be able to recapture, join other things, but was not enough to give me the ability to go back and use in moderation. So I abstained

for an entire year. I was really, you know, pretty good about it. I mean, I would say I made it the whole year. And then something really interesting. I tried to go back, using in moderation, what I found is just it didn't, the drug didn't work at all. Like I had just totally saturated those neurons. Like it was like, it was like this was not going to work, right? If I

was going to have to look for something more than that. And that, that was a really interesting experience. So I was like, wow, okay. And if I really did have sort of this, I would say the disease of addiction in its severe form, I would have found something else. Like I would have, I would have gone it. But because I don't have that, I'm screwed up in a lot of other ways. But I don't have that particular thing. I was able to just reflect and go, okay, there's no end to it. Like there's no end to it. So I'm just not going to go there.

And I was able also to implement, you know, what I think is one of the most important messages of the book, which is that a better way to get your dopamine is actually to do things that are hard up front. Because when we press on the pain side of the balance, those gremlins hop on the pleasure side and reset our pleasure pain pathway to the side of pleasure. So I use a lot of sort of effortful engagement,

like exercise, it's probably my main one, and creative things I try to do, service work, as a way to get my dopamine indirectly. But I do a lot of also just kind of like tempering my expectations and recognizing that life is hard, you know, and it's not just, it's not just going to be necessarily pleasurable when I want it to be pleasurable. My happiest moments are going to come probably when I'm not expecting it and when I can't control it. Control is such a big part of addiction, right? That we can change the way we feel when we want to, how much we want to, you know, in

that very moment. And so kind of this really giving up control and saying, you know, in that very moment. And so kind of this really giving up control and saying, you know, who knows when the next time I'm going to feel, you know, joy, I hope it comes soon. But in the meantime, I just have to sit here and be patient. You know, I'm glad that you mentioned control, right? I think a lot of this has to do with control. And, but I want to say something else, like, because you did the, the, like the romance novels, and then you said this whole thing about doing the hard things first, which I mean, I talk about that quite

often. But if you do exercise, you can transfer that. There's a lot of people who are like exercise addicts. Right? Like, you can become, like, for me, I don't think I'm necessarily, and well, maybe I am actually, like if I don't work out every day, I like get crazy. Like if I become extremely hyper, I can become anxious, I'm irritable, and I'm not right. I'm not right.

Yes. Right. And so you've been to I've been taught or like, oh, that's a positive trait, good for you, that's a great thing, good on you. But the truth is, is it good on me? I mean, I would work out through injury, and that's just not me, it's a lot of people, especially tiny personalities.

Right, okay, so a couple of things there. I mean, we are evolved over millions of years of evolution to walk tens of kilometers a day. And our lives today are incredibly sedentary. So in fact, we were meant to be very, very active, much more active than we are now. So it's pretty hard to get to a point

where you're actually entering the addicted to exercise realm. It definitely happens. And I've had patients who've gotten addicted to exercise realm. It definitely happens. And I've had patients who've gotten addicted to it. How do you know you're addicted again? Compulsion, craving, and most importantly, continue to use despite consequences. So you're injured, but you're still pounding it

just like before. You're not allowing your body to rest when it really needs to rest. But another key piece to understanding this is that, and so what I'm talking about is mild to moderate exposure to noxious stimuli or pain is healthy, but extreme exposure is not healthy, like cutting on yourself.

That'll definitely release opioids, but that's not healthy, right? We're talking about tempered exposure, but I will also add that the world has also drugified it, exercise. Right? So, and how has it done that? Well, social media is one of the most important ways. Now, on Strava, you can see how your time's rank, leaderboards, even high school athletes now, like they have YouTube channels that are all followingup, I know this because I've got kids who are high school athletes. You know, it's not just like, oh yeah, I won the race that my, you know, local dual meet,

it's like, how do my times compare to, you know, Katie living in Louisiana? It's like, you know, that's so kind of a craziness, right? But that's what's happened, this constant comparison. And then also, I talk about my book, how literally, like the technology of exercise has made exercise more addictive. In my book, I talk about how we used to think in neuroscience, in the field of neuroscience, that running wheels were a way to measure healthy exercise in rats and a cage.

But it turns out that for rats, running wheels can be addictive. If you put a running wheel in nature, you will have rodents who will run on that running wheel, even though they're in nature, right? It's got intrinsic appeal to them. You can have rats that run so much on the running wheel, they permanently torque their tails to the shape of the running wheel, the smaller the running wheel, the more their tails meant. You have rats that will run to death, right? That's amazing. Yeah, right. So, and like, what is it about the running wheel? It's something about the way that that running wheelch doesn't exist in nature defies gravity in a way that's just highly reinforcing for the mammalian brain, somehow going vertically

or horizontally, defying gravity is just like, it's a major adrenaline rush. I mean, I guess you can say, like, the running wheel would be like a treadmill in a way. Yeah. Well, there you go. Exactly, right? And so that's, I mean, the treadmill, in mild to moderate, doses is better than not exercising at all, but can you overdo it? Absolutely.

And is there an intrinsic quality to all this, like, technology and equipment and like the way we compare? You know, that all fuels the potential addictive. Oh, I could not agree with you more. I mean, even with Apple watches and, you know, like, even now you're monitoring your sleep, I mean with Apple Watches and, you know, like even now you're monitoring your sleep, I mean, all this health optimization, you know, I joke around always with my friends. Like, that's actually all these things to kind of like all this extra knowledge that we never

had before is actually stressing us all out. Like all these sleep apps, I couldn't wear it anymore because I was like looking at them all the time. I'm like, I couldn't sleep because of my sleep apps. You know what I mean? Like, yeah, counterintuitive to the purpose. I mean, and you're right. So that even before social media, like look at the internet, like you kind of touched upon how I'm very curious of how all of our mental health and our dopamine and all our issues spiked even before, you know, Instagram, but just on that, we had more availability on screens and information

and watching porn or whatever that is, right? Oh, yeah. For sure. Yeah. I remember about 2010, all of a sudden, all these middle-aged men started coming in for porn addiction. And it makes sense, you know, because the smartphone came out in about 2001. And these were all folks that, you know, had a, like, used porn on, you know, through their adult lives. But it was basically manageable till the smartphone.

And then all of a sudden, you know, five, ten years after the smartphone, these men came in with absolutely ruined lives. They could not stop themselves. Now, yeah, I guess two things. I mean, is there a personality type, even though with all of these accoutrements now, that is more vulnerable, like, is there characteristics of people, of traits that make people more vulnerable to addiction?

And then, do you have a recipe for people to self-monitor themselves, or self-maintain themselves to be more cognizant? So they don't get into that trap. Mm-hmm. Yeah, so there more cognizant. So they don't get into that trap. Yeah, so there are lots of sort of validated characteristics that make somebody more vulnerable to addiction. We used to call it the addictive personality We don't really call it that anymore. We just call it you know the disease of addiction But the disease of addiction takes the vulnerability plus the drug, right?

So it's like finding your drug plus your vulnerability, but really we're all vulnerable in a way today because we all have the same motivational neuro-neural networks that make us inherently approach pleasure and avoid pain. That's how we're wired. But the traits, you know, so core-curring mental illness of any kind make somebody more vulnerable to addiction of any kind makes somebody more vulnerable to addiction, impulsivity, so the inability to sort of put the pause button between wanting to do something and doing it makes people more vulnerable. Cognitive, frontal lobe, kind of, attentional problems make people more vulnerable to addiction, emotion, dysregulation, people who get really dysregulated and then stay in that place

and can't bring themselves down. Those folks are more vulnerable to the problem of addiction. So yeah, definitely there's this innate vulnerability. In terms of what to do about it, my book please out pretty clearly what that would look like. The first thing to do is number one, identify what is your drug of choice and to really be honest with yourself and preferably another human being

or just with yourself in a journal if you're not comfortable sharing with another human being. But writing it down or verbalizing exactly what you're doing how much how often because that really makes it real in a way that it's not when it's just sort of like, you know, in the back of our minds. And that was true with my romance novel addiction, that it wasn't until I really said to someone, I thought, oh, I think I've got a little reading problem. It's like, oh, I think I do have a problem with that. Right, right, right. It's funny, it's funny how that happens.

And then it feels more real when you say it out loud or you write it down or, right? Yeah, you kind of come out, you sort of come out of your waking dream, you know, you can't sleep, walk your way through that anymore. Right. And then the thing that I recommend is a month of abstinence from our drug of choice. So, you know, deleting that app or in my case, getting rid of my kindle and not reading romance or for people with sex addiction, no pornography, and no orgasms with themselves or others or no alcohol or no cannabis or

whatever it is. Obviously, people who might go into life threatening withdrawal, wouldn't do this for people who would repeatedly try to stop and weren't able to stop on their own. But for those with more mild to moderate forms of this problem, who are able to stop on their own, that's what I recommend, with the caveat that you will feel worse before you will feel better. Why will you feel worse? Because you're going to take the weight off the pleasure side,

those neurotic patient gremlins are going to slam your balance down to the pain side and you will experience the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and craving. But if you wait long enough, the gremlins hop off and homeostasis is restored and you feel people generally feel much better and are less craving and may be able to engage their frontal lobes to make more realistic determinations of what kind of relationship they want to have with their drug of choice. And then from there you decide do you want to continue to abstain? Can you continue to abstain if not?

Then how are you going to use it? And the specificity is here is key here. You know how much are you going to use on any given day? Exactly. What are you going to use under what circumstances are you going to use? What are the red flags you're going to look for for when your use is getting out of control? How are you going to track it? I talk a lot about self-finding strategies, which is a way of pressing the pause button between the desire to use and actually having access to your drug. So you're going to get the drug out of the house.

So you're going to make sure you only have access on certain occasions. So access is really, really important. When access is there, it's actually a strain on our minds because we're always going, I could check it now, I could check it now, I could check it now. It's like resisting scratching an inch. Whereas if we don't have access, well, you know, that kind of goes away. So that's really key. I recommend doing this with a friend or loved one or as a family. If you can't do a month, do less than that. For some people just not using their phone for 24 hours is a hardship, which is really almost alarming for me to see that. That is the, you know, things have progressed over the last 20 years. You know, really highly years, you know, really highly sort of successful people couldn't imagine not having access to their phone for even 24 hours. That's crazy. You know what's amazing. I remember even like 15 years ago,

right? I never I had my cell phone and I barely used it like I only use it for an emergency. Right. Right. And it's funny how that's evolved to such a point where now you can't even imagine not picking it up every minute. But you said something to that I think is very important. There's things that I think people that work for example, or food for access reasons. Right? Like people who are food addicts who you have to eat three times a day,

or food or intermittent fasting at least once a day. How do you moderate that and work? Because the, I think work people really, that's not only is it socially acceptable, it's like revered in a lot of places like New York, San Francisco, even LA, where they worked such a hard worker. That also is very, that would take your foresees and you would take it through the roof. Yeah, so you're right. Workaholism is a huge modern problem, especially in certain professions. Again, I really recommend starting with the dopamine fast because the salience that we attribute to these behaviors when we're caught up in them really goes away when we stop them for

long enough for our brains to reset reward pathways. And you may be able to relate to this experience where you have the opportunity to go on a vacation, you leave your devices, and you work at home and all of those fears of missing out that you're indispensable, that things are going to go, hey, wire, if you don't immediately respond to them, you have those in the first part of your vacation, right? But by the time you get to maybe two weeks, day four or five or whatever it is, you realize, you know what, that was crazy. Like, I don't need to be that available. Yeah, exactly. And I'm not that, I'm not indispensable.

And these things will either sort themselves out or they don't matter, right? And you come to this place where you have this realization. And then, of course, you come back and you're like, you don't even want to restart. You know, you don't want to check your email. Because you know, you're, so, but that's the key to kind of reset things.

And then when you go back, put in those self-winding strategies. Say, you know what, I in those self-winding strategies. Say, you know what? I'm not gonna bring that device home, or I'm gonna turn it off at 5 p.m. I mean, turn it all the way off, power that sucker down, and put it in my bag. And I'm not gonna go get it.

And I'm gonna do that together with a partner, right? Where we're gonna make this tech-freeze. I mean, these are all really hard. Don't get me wrong. I go home every night and I'm like, I'm not gonna watch YouTube while I'm brushing my teeth. I'm really not gonna watch. And every night I'm like, you do, you do.

Exactly. I feel like you're a psychiatrist. And because there's something, it's so true. And this is what I think is what I think. The more you focus on something, I feel the worse it gets. Like, for example, if I say I'm not gonna have that piece of chocolate cake, I'm not gonna have that piece of chocolate cake, I'm not gonna

have that piece of chocolate cake. I'll not only eat that piece of chocolate cake, I'll eat the entire cake. Right? Like, it's because I'm psyched. I'm so preoccupied with it, right? Right. Right. So like how do people like, how do people like handle that?

Like it's all in theory. It sounds like great. Like I'm not gonna, I'm gonna stay in for a month and like to what you talk a lot about this, you know, the first two weeks or half or third week, fourth week, it gets much better. But when even in the middle or whenever you're doing it and you really, you know, you have a problem, you're self-aware enough, but you really have like you're so addicted that you don't have You don't you're so impulsive or you you cannot get that thought it won't you cannot stop That thought unless you actually do it

Yeah, like with your romance knowledge or my topic right or whatever it is right? Yes, so what that is I mean you're getting to the essence of what we mean when we talk about craving. Craving are these intrusive thoughts or images that come into our minds. And we feel in that moment, overwhelming dysphoria and anxiety, the only solution to which is to consume that thing. And that's craving. But the truth is that if we just sit with that feeling and do not act on it, it will pass.

We have this subjective experience that it will go on forever unless we give into it, but really it will pass. So what is the key to affording ourselves time to let it pass? Self-binding, we cannot have the chocolate cake in the house. If you put the chocolate cake in front of me, I will eat the chocolate cake when I'm craving the chocolate. There's just no way that that's like 2 plus 2 equals 4. Right. But it's the chocolate cake in front of me, I will eat the chocolate cake when I'm craving the chocolate. There's just no way that that's like two plus two equals four. Right.

But it's a chocolate. Yeah, going to party, right? For a while, maybe you can't go to those parties, right? You can't go because that party, you know, but if you have enough abstinence, I promise you with sustained abstinence, it gets easier. You re-engage your frontal lobe. You're not immune, but You re-engage your frontal lobe, you're not immune, but you re-engage your frontal lobe,

your physiology changes, and you're not in that vortex. The other thing that's just really, really helpful for a lot of different reasons is to connect with people on a regular basis, struggling with the same problem. Of course, this is the genius of alcoholics and anonymous, but it really, really works. And there's food addicts and anonymous, there's a reader's anonymous. You know, there's the genius of alcohol is anonymous. But it really, really works. And there's food addicts anonymous,

there's a reader's anonymous. You know, there's a lot of anonymous. Oh, there's probably a reader's anonymous. I don't know, but there probably is. There probably, there's a sex and love addiction anonymous, there's a love addiction anonymous. That's kind of similar bucket. Well, you know what, I've also find that a lot of times

that people are doing great, right? They like, they kind of are like on that path. Why do people like self sabotage themselves when they're doing so well? Well, because of the grub winds, because they kind of creep up again. Yeah, well, what happens is this is about triggers and triggers can be external things,

people places, and things that remind us of our drug or even our own euphoric recall of the drug where we remember only the good things and none of the bad things, which is what we all tend to do. Romanticize it basically. Right. And what what neuroscience has shown and this is to me really fascinating that when when we are triggered for our drug or even just remember our drug, we actually get a release of dopamine. So that alone gets us a little bit high, but then that's followed immediately by the dopamine deficit state. So then we go into craving. So already this cycle of elevated dopamine and then below baseline levels of dopamine occurs with the reminder of the drug. And of course, once we're in that dopamine deficit state,

then that's craving. And then we're driven to do the work to go get the drug. So protecting ourselves from the triggers is really important. And also doing what's called thinking through the drink. When we have euphoric recall, trying to remind ourselves, wait a minute, my brain is telling me all the great things.

But I have to force myself to remember all of the bad things that came afterward because we will remember how good it felt, but we don't remember all the crap. And then we go for the drug and we try it and it doesn't even feel that good, right? Because our brain has now already been recalibrated for that substance and it doesn't work. And then we're frustrated because then we relapsed anyway, but then it's like, well, now I might as well eat the whole cake because it's just, it's just, it's such a vicious cycle. But we can, we can get a hold of it.

I also really think that this pressing on the pain side is key. And I also talk about radical honesty telling the truth and making intimate human connections. I want to talk about that. Yeah. Yeah. Mornings are coming on strong with dark and bold from community coffee Get it on up! Get it on up! Bustin' loose when you're born or say Bustin' loose baby do ya thing Talk about bustin' loose Dark and bold from Community Coffee Look for it at your local grocery or communitycafy.com

At Weaver, people are our formula We believe relationships should be stronger than your internet connection which is why we're committed to understanding your goals and helping you achieve them. Learn more at weaver.com. Well, you talk about endopaminia. It's like each letter stands for something else, and people can read the book, but to get all of it.

But you do talk about the M is for mindfulness, and you get that you hear about that a lot. But the way you say it is actually, I really enjoy the way you talk about it. It's not so, so like calm in as everyone else mentions. But like you said, like it's kind of reminds me

when you have that chocolate cake craving. I'm just using that as an example. But like when you have any type of thing, if you actually like sit with it long enough, it will dissipate. But in the moment, you don't think it will, right? So you can remind yourself in that moment, you know, there's two shall pass, right? But you do talk about the truth telling, and I do want, well, you let me just mention it, so let's talk about that.

And then I wanted to ask you something differently. Yeah. Yeah, so the other thing that I prescribed to patients in this 30-day period, but also for recovery in general, which is just something I learned from patients in recovery, which is that we need to tell the truth about things large and small. And once we start lying, even about little things,

we're vulnerable to relapse. And that's sort of interesting. Like, yeah, why is that? Yeah, why is that, right? Yeah. And I write in the book about how it works on a number of different levels. But one of the important ways that it works is that when we're radically honest with other people that we love and care about, we think that they're going to go running screaming

from us because we're exposing, you know, words and all. But instead, what it actually does is make people feel closer to us. So it promotes intimacy and true intimacy is a great and healthy source of dopamine. And when we feel that hit of intimacy, boy, that's one of the rare moments in life,

at least for me, where I feel truly happy, you know, for a while, right, before I happy, you know, for a while, right, before I'm, you know, not again. So that's really important. The other thing is that, you know, the stories that we, the autobiographical narratives or stories that we tell about our lives are really, really important. And there are healing narratives, and then there are destructive narratives. And I've learned over the years that healing narratives are the ones that adhere closest

to true reality. That is to say the ones that if you were to get every single person who saw the car crash at the intersection and put all their versions of it together, you would get closest to what it is. But instead what we often want to do is write a story where we're the heroes or the victims or where we're not really being totally honest about how we contributed to the problem. It's really important that we do that, that our stories that we tell about our lives, really honestly look at the ways that we've messed up.

And that's uncomfortable to do that. It's not sort of our natural reflex. We're generally wanting to cover that stuff up. But I found that's really important. Why? Because these narratives are not just a way to organize the past. They're really also a roadmap for the future. So we're telling stories that aren't true. We're not going to have access to the information that we need going forward to make good decisions. But true stories allow us to really pinpoint what's really happening, you know, and then enlist the evidence to make better decisions going forward. So that's why I feel like friends of mine who've been in like AA and all

this, that's like a big thing, right? They all about radical. And it's like if you do, if you'd say a little lie, that can lead, it's a gateway to a big lie. That's right. Yeah, that's right. So like, yeah, if you smoke a little bit of pot, that could be a gateway to heroin. Or by the way, like pot can be, like people are over OD-ing on pot

because they think as you talk with us in your book with one of your heroes, patients, right, like that they, people think, oh, I haven't, I have anxiety. I'm going to, I'm going to mask it with this will help. But that ends up becoming the problem. Right. When does somebody, like, when do people, can you give, can you give a couple of examples or tell people when that, like, how they know when that is an issue, like let's just use the pod example, right? Like you have anxiety, so you end up like smoking every day.

And then you think if you don't smoke, you're gonna keep on having terrible anxiety. When really, that's the end of opinion. The end of opinion is actually the problem that you're trying to mask it with is the problem. Yeah, so this gets to the whole concept of self-medication and this idea that that in toxicants like cannabis are self-medication for an underlying psychiatric disorder like depression. And it is very true that, you know, with initial use immediately, we get relief from those

psychiatric symptoms. But with continued use, we basically change our dopamine set point. So, so, we're walking around with our balance tilt at the side of pain. And now, essentially, the pot is driving the depression and anxiety. And I know this from, you know, the neuroscience, but also my clinical experience. I have so many patients come in. They want help with depression, anxiety, they're smoking pot every day. They want me to prescribe them an antidepressant 20 years ago I would have.

Now I say, you know what, you got to cut out the pot for a month and that alone make your depression. And of course, they don't ever think that could be true because they say, but wait a minute, I feel better when I smoke. It's the only thing that helps my depression. I say, well, it may feel in the moment that it's helping your depression, but really all it's doing is getting you to equilibrium, right? It's just restoring, hoping a stasis temporarily while more gremlins hop on the pain side. And then those who are willing and able to do the experiment, about 80 percent of them will come back and say, I haven't felt this good in years.

I hadn't realized that the pod itself was making me feel bad. How many people, or what's the percentage if you have it of people who actually are able to do that? Like, just like, basically not do anything for the month or and like, wait it out. Do people usually just give up because they can't take it or like what's the ratio? I would say yeah, so in my clinical practice, I would say roughly between about 50% let's say

are both willing and able to do it, about 50 of folks some people just aren't willing they don't like just won't buy into even doing the experiment Some people some people will plan to do it and then are unable to And that's also useful information, right? It's like well, maybe this is actually not within your willful control Like we set that goal you agree to go but you couldn't do it. Maybe you need a higher level of care, a more extreme intervention, like maybe a residential treatment facility. And then also importantly, although most people feel much better

if they do it and they're successful, there's a percentage of folks who don't, probably about 20% of folks come back and say, you know, I abstain for the whole month, I don't feel any better, what you predicted didn't happen for me. And that's again, it's always sad, but also really useful information because it's like, okay, whatever's going on with you is not then primarily being driven by your drug use. Can you tell, what's the most, like obscure addiction that you've seen in your office. You've been doing this for 25 years, right?

You've been a psych... You still practice, right? Yeah. Oh yeah. I know most of my professional work is seeing patients and teaching other people. Do you do virtual? Not because for me, I'm just asking you to do virtual.

I'm sure you're so inundated with people who just want to work with you now, right? But with you, yeah. So I'm not personally taking new patients just to put that out there. You'll be flooded with more, right? Yeah, I'm primarily, you know, counseling other people now to see patients and, you know, supporting them in that endeavor. And yeah, about 95% of our care now is virtual since the pandemic used to be all in person. And now it's a present virtual. And we can only see people in California because that's where we have medical license.

So it's all the most unusual addiction probably was a woman who had been addicted to alcohol and was in sustained recovery from her alcohol use, but then got addicted to water. And what happened there was that she had figured out that if she drank very large volumes of water, she could cause herself to become hyponatremic and altered because of that. So that was really sad, yeah. Where is she now? She ended her life, yeah, so she died of her disease. Very, very sad, oh my gosh.

Yeah. How much water would you need to drink for that to happen? Leaders and leaders. Wow. So that's the most unusual one that you've seen, basically. Yeah, I mean, then there's like a whole host of just new behavioral addictions, behavioral addictions are addictions to a behavior of and a drug, you know, all manner of, as you know, for my book, sex and pornography addiction, but also all kinds of addictions of digital drugs.

Then have you seen people who are insensitive to dopamine, like who are unable to get that, like what would that be called if you're not able to get that dopamine? That's almost, you could almost call that depression, that would be depression, right? That would be great. And sometimes that theory is that that's why people with severe depression are at higher risk for addiction because they're reaching for something to get them out of that.

But the irony, the terrible paradox there is that addictive substances ultimately make the depression worse, right? So even if you start out here with a pleasure pain balanced on the side of pain, if you use an intoxicant, those gramolins will just push you further down on the pain side. So is there like to get it back to the baseline with the pleasure pain, is would you have to do what you the completely go cool turkey for the month basically to kind of level yourself back up to baseline? Yeah, so a lot of times patients will say, well, can I just cut back?

And in my clinical experience, that doesn't work. Why? Because you never restore baseline homeostasis. You just kind of inch yourself a little bit here, but you never get the reward of being at baseline and feeling what it's like to be out of that vortex of compulsive overconsumption and be able to enjoy other things. It really takes three to four weeks minimum of abstinence. But what about things like the working or the eating? Because you need to be doing those. So what are you supposed to do? Well, for food addiction, what means to have more work addictions?

Right. Because you people are working and they need to sustain like an attorney or an investment banker or, you know, me, you know, anybody who works a lot. Like how are you so, I'm like, you're an entrepreneur, right? Because it's like, you eat what you kill, right? Yeah, right. How can you moderate that?

Well, very hard. I mean, I'm not pretending like that's easy. I do think, again, quantity and frequency really matter with any addiction. So making sure that you take a day of Sabbath and rest one day a week, making sure that you get enough sleep and exercise and structure, trying to even limit the number of hours that you work on any given day. People are very embracing the intermittent fasting. How about

intermittent working? Yeah. You know, that might be the thing. And then I think also qualitatively, just being aware of what aspects of your work bring you a kind of deeper joy in what aspects leave you feeling sort of frustrated and angry and irritable. And then if you have the ability sort of parse away those things that are ultimately don't give you a sense of meaning and purpose and trying to keep the things that do. Yeah. Wow. I mean, your book is very, very good. It's called Doe Pamy Nation. I will let you off because it's all in here. You've been doing so many podcasts and I mean, you must be getting tired of answering the same questions probably over and over and over again.

But well, I believe in the message, so I want to get it out there to as many people. I do feel it's fundamental to flourishing life in the modern world. It's worked for so many of my patients and their recovery. I've stolen so many of their ideas in my own life. It can sometimes be hard to, to do the interviews over and over again, but what I, that's one of the things I've been looking at myself as we're talking about, you know, work and how to optimize it. And one of the things I've concluded is if I feel like I make a real honest human connection with the interviewer, then actually it's very joyful for me and not burdensome.

I feel that way today with you, so thank you. Oh, thank you. It's as we could say. I feel like we made it in an honest connection. But some other times I haven't been able to have that feeling. It's not as joyful. And it's not, I'm not saying it's the other, the interviewers fall, it could just as well be my fault. You know, sometimes you just kind of can't make the connection. Yeah, I just

feel that. And also like, I think that it's always, it could be mind-namingly annoying when people are asking, what is the opening over and over and over again? And you have to sit there and be polite. And it's a difficult thing. I mean, I don't mind that. I don't mind that. Because I'm pretty stupid myself, and I need to hear things over.

I don't think it's stupid at all. I mean, I like to teach to a receptive audience. I love to teach. That's a great joy. Do you teach still, by the way? Oh, yeah. I'm basically a receptive audience, I love to teach. That's a great joy. Do you teach still, by the way? Oh yeah, I'm basically a clinician educator, so I see patients and I teach. I teach all the time.

That's what I do. You do teach all the time. Oh yeah, oh yeah. Well, because your book is so successful, I mean, do you ever get like, are you addicted to what, looking at how many copies are being sold? Oh yeah, once. When it first came out, I was, I was,

because I didn't think it would sell but two copies. And then when it was number two on Amazon, or number one on Audible, I got addicted to checking it. I was checking every hour. I did that for about two weeks. See, here's the thing about life. We keep making the same mistakes over and over again,

but hopefully we make them faster. So this time it didn't take me two years. It just took me two weeks to go, oh, I'm getting addicted to, and so then I stopped. And now I don't, and also I never watched myself being interviewed later, never. Yeah, that's a good one. I mean, how did you, so how did you, how did you even, even the self-awareness of like, okay, I'm, I'm getting addicted to like looking at that happening because I was, I was thinking, how do you not, like you're a human being? I mean, it was also like, it's a New York Times bestseller, too.

Yeah. What number did it get to New York Times? I don't know, I stopped looking. That's one. How do you stop, like, so you kind of caught yourself and then how did you stop it, though? Like, with all your training, you're just like, you kind of just implemented this one month

of abstaining from looking at you, you're better. Yeah, I know it sounds too simple to be true, but I'm telling you, you can get through a month of not using, you get out of the suction of the black hole and then you get to this place where you can enlist your own agency and decide and deciding in a way that's consistent with your values goals, meaning in purpose is then really, really important. So, you know, why did I write the book? I didn't write the book to sell a lot of books or make money and trust me. I'm making a lot of money on the book.

I know how that works and I know how that works. I wrote the book because I wanted to get a message out, you know, that I thought would be helpful to people. And then that's then, okay, what am I doing the things to help get the message out? And then that those are the things I focus on. No, I think it's great. Are you doing a lot of speaking engagements? I get different Univer Colleges and yeah, so I get invited to do those. I do those. I like the podcast better because like it's one-on on one with a human and when

we have a good connection, it's really enjoyable. Right. I'm not as much of like get on the stage and I can do that, but I don't enjoy that. Also, you know, a lot of these virtual events now, you can't see anybody. I know. So you're like a floating head in like in like zoom land and that's very creepy and disorienting. I don't like that at all. No, I totally I hear that. Are you planning on writing like a follow-up book or you haven't even thought that far down there? I haven't even thought about it. I mean, you know, sometimes I have some ideas, but boy, for every, you know, 100 ideas I have, there's maybe half a good one. No, I mean, I don't that, but I feel like this book was so timely because of also COVID, right?

Everybody is like stuck in their lockdown and not doing what they want to be doing, and they're looking for any hit to be. And it's probably such a, it was so increased by, of course, social media and digital porn and food, like any big addiction would be, it's going to be like, it's going to be at its precipice at that point, right? Right. Exactly. Exactly. And it's just going to be like the modern dilemma.

I mean, this is really just opening the conversation of, you know, what we need to continue to talk about for like the foreseeable future. And so disorienting is on the one hand we've got people dying in the Ukraine. I know. The word obsessing about our Instagram. But it is the world we live in. I mean, we can't so do we have to accept that is the world that we live in. So like, how are we going to make the best of it? Absolutely true. Well, I really appreciate your time. Yeah, fantastic. No, seriously, thank you. The book is called Doe Pamy Nation. Here it is. And hopefully, I mean, maybe you can come on again and shed some light again on topics in it, because I know this is going to be, is going to resonate with a lot of people as it has already.

And you're obviously extremely knowledgeable. And like I said, I really appreciate you coming on. Is there, you're not on social media. So how do people find you? Just not they don't. They don't just essentially. They listen to your podcast and read the book. Right. Right. Right. Exactly. And then leave you alone, right? Leave you to teach and do. Yeah., exactly. Let's exactly throw that. It's good, good on you for not getting sucked into that vortex of social media girl. Oh, I wouldn't be able to handle it.

Daring and teed, I wouldn't be able to handle it. That was very, very smart of you. Cause once I said from the beginning, once you start, it's like literally a black hole and you cannot get out. Right. So, but thank you. I appreciate your time. And I'll see you soon.

Sounds good. Bye bye. Thank you. I hope you enjoyed this episode. I'm Heather Monahan, host of Creating Confidence, a part of the YAP Media Network, the number one business and self improvement podcast network. Okay, so I wanna tell you a little bit about my show. We are all about elevating your confidence to its highest level ever and taking your business right there with you. Don't believe me, I'm gonna go ahead

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