Know Thyself - E125 - Dr. Anna Lembke: Addiction To Dopamine Enslaves Us, Reclaim Your Mind & Life

Episode Date: December 3, 2024

In a world of overindulgence, from drugs, food, news, and social media, Dr. Anna Lembke reveals the science that explains why the relentless pursuit of pleasure leads to pain... and what to do about it. She explains how addiction works in the brain and how this plays out on an individual level from the micro decisions we make every single day to the macro. She shares the proven methods to escaping this cycle of suffering and how by intentionally choosing pain through healthy practices like cold plunges, exercise, and meditation, we can reset our dopamine levels in our brain. She explores the concept of delayed gratification as defined by "The Marshmallow Experiment" which discovered a correlation between success in life and ability to delay gratification. This episode is full or practical takeaways for anyone looking to better understand their brain and relationship to dopamine/addiction.André's Book Recommendations: https://www.knowthyself.one/books___________0:00 Intro 2:27 Defining Addiction and Dopamine 8:25 How Pleasure & Pain Work in the Brain14:01 Our Biology Dooms Us in the Modern World16:32 The Plenty Paradox: Convenience is Killing Us22:05 Cold Plunges, Exercise, & Mediation: Healthy 'Pain' that Balances Our Dopamine25:09 Resetting through Vipassana & Darkness Retreats34:58 How She Started Doing This Work37:43 Spectrum of Addiction: From the Intense to the Subtle41:30 Becoming Resilient to Addiction44:23 Breaking the Cycle of Shame and Guilt50:06 Shedding an Addiction to Your Identity54:45 The Pain That’s Good For You56:58 4 Things that Determine Addiction Risk1:00:43 Danger of Social Media Addiction1:08:27 Strategies for Overcoming Compulsive Behaviors1:11:52 How Our Morning Sets Us Up For Success (or failure!)1:13:20 Delayed Gratification: The Marshmallow Experiment1:18:48 Practices to Change Negative Behaviors1:24:54 Your Personal Growth Changes the World1:27:22 The Beauty that Hides in Pain1:30:38 Conclusion___________Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is currently Professor and Medical Director of Addiction Medicine, Stanford University School of Medicine. She is also Program Director of the Stanford Addiction Medicine Fellowship, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and a diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine.Dr. Lembke appeared in the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.Her latest book, "Dopamine Nation: Finding Balance in the Age of Indulgence" (Dutton/Penguin Random House, August 2021) was an instant New York Times and Los Angeles Times bestseller and has been translated into 30 languages. It combines the neuroscience of addiction with the wisdom of recovery to explore the problem of compulsive overconsumption in a dopamine-overloaded world.Website: https://www.annalembke.comBook "Dopamine Nation": https://a.co/d/ccpgrk4Dopamine Nation Workbook: https://a.co/d/6vADILi___________Know ThyselfInstagram: https://www.instagram.com/knowthyself/Website: https://www.knowthyself.oneClips Channel: https://www.youtube.com/channel/UCJ4wglCWTJeWQC0exBalgKgListen to all episodes on Audio: Spotify: https://open.spotify.com/show/4FSiemtvZrWesGtO2MqTZ4?si=d389c8dee8fa4026Apple: https://podcasts.apple.com/us/podcast/know-thyself/id1633725927André DuqumInstagram: https://www.instagram.com/andreduqum/

We are wired to seek out pleasure and avoid pain, and yet now when we do that, we're bound to encounter misery. From the get-go, social media has been engineered to keep our attention for as long as possible. It takes the most reinforcing aspects of human connection, and it distills them down into its most addictive forms. And the more time we spend in that fantasy world, the less salient and desirable the real world becomes. The thing about pleasure and pain is that they're actually co-lover.

located in the brain, and they work like opposite sides of a balance. The problem is you take that ancient wiring and you put it in our modern day ecosystem. That's a perfect storm for all of us getting addicted. The kernel of that is also the answer to our problems, which is that we have to. All we can change really with any kind of exactitude is ourselves. Once we've done that, there's an enormous ripple effect that can improve not just our lives, but other people's lives as well. I think that's really important.

Hey, everyone. Welcome back to Know Thyself. Our guest today is a professor of psychiatry at the Stanford University School of Medicine. She has authored many, many book chapters and articles and really powerful teachings around pain, pleasure, dopamine meaning in life, and very popular book, Dopamine Nation and the new workbook, Dr. Annal-Amkey, thanks for being here. Thanks for inviting me. I'm excited to be here. Yeah.

I like your necklace, by the way. I mentioned that. It's cool. Thank you. What is that? You know, I inherited it, so I don't know the progeny at all, but it's so these two joining hands, the kind of a yin-yang symbol in it. It's also like very on point for your work.

Yeah, and for this podcast. It is. I didn't really even think about, but it just kind of happened. Yeah, nice. You know, I think of so much of your work and how it aligns with ancient wisdom traditions. and the Buddhist understanding of suffering, of our craving for pleasure and avoidance of pain, and the biological understanding of dopamine and how it works neurologically, I think this conversation is going to be so serving, and I'm just so personally curious,

because we live in a very interesting time of indulgence that you speak to, and let's just start baseline with how we define addiction and dopamine. Great. Good place to start. So addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others. Sometimes that's harm that we are aware of and sometimes it's harm that we don't see. Only other people see it. Sometimes it's really subtle, insidious harm that kind of creeps up on us.

There is no brain scan or blood test to diagnose addiction. I always like to emphasize that it's based on phenomenology, which is just a fancy way of saying, patterns of behavior that reliably repeat themselves across individuals, time periods, cultures, demographics. And by the way, every single mental illness is based on phenomenology. If anybody tries to tell you that there's a brain scan or a blood test, a diagnosis, any mental illness, that's not true.

We might be there someday. We're not there yet. So when we think about diagnosing addiction, we have to base it broadly on this pattern of compulsive use despite harm. We have criteria in the Diagnostic and Statistical Manual of Mental Disorders, 11 criteria, which can roughly be summarized as the three C's tolerance and withdrawal. Out of control use, so control is the first C. Compulsive use, that is a level of automaticity. to our use and a kind of obsessionality around it. The third C is continued use to spike consequences.

So we have real-life problems related to our use. Tolerance means that over time, we need more of the drug to get the same effect, and when we're not using, we experience withdrawal. And then withdrawal is whatever that classical pattern of behavior and physiologic reaction that we experience when we're not used. using. And those criteria, you know, it's not like you need this one, but you don't need that one. It's really how many you meet, so two or more of those criteria and you meet threshold for addiction. The more of those criteria you meet, the more severe your addictive disorder.

So as you can see, it's based on judgment, right? We hear somebody's story or we get an account from a family member or we look at their medical record and based on that, we put it all together and we diagnose addiction. Dopamine? Yeah. Okay. So dopamine is a chemical that we make in our brain, has lots of different functions. One of the most important functions is that it's essential for the experience of pleasure,

reward, and motivation. It's not the only neurotransmitter involved in that process, but it is the final common pathway for all reinforcing substances and behaviors. the more dopamine that we release in our reward pathway and the faster that we release it, the more likely that substance or that behavior is to be reinforcing for us. So, for example, in rat studies, we know that chocolate increases dopamine firing 50% above baseline, sex is 100%, nicotine 150%, amphetamine all the way up to 1,000% right? And indeed, a rat will press a lever for amphetamine till exhaustion or death.

So the amount of dopamine released maps pretty well. People are not rats. We're not all that different. But we're not exactly the same. I definitely get the comparative image of the rat and like a human doom scrolling, you know, to our own demise. Yes. And unfortunately, we don't have little smartphones that we can give to rats, but this guy in France actually rigged. Have you heard about this?

Oh, this is amazing. This guy in France created this whole rig so that rats could take little rat selfies of them, you know, take pictures of themselves. And first he paired it with sugar water to get them to press the lever because rats will do that for sugar water because sugar is addictive too. But after a while, when he took the sugar water away, they just kept pressing the lever because it turns out rats also like to see themselves. And although we don't have ways to measure absolute amounts of dopamine in the human brain, we can measure relative amounts but not absolutely. absolute amounts, we're pretty certain that digital media and digital devices activate the same reward pathway as drugs and alcohol, which is why they're so reinforcing and potentially addictive. So just one last thing.

Want to emphasize the concept of drug of choice, which is really important, which is to say what, so most things that we think of as intoxicants release a lot of dopamine for most people, but not everybody, right? For some people, traditional drugs, whatever they may be, let's say alcohol, just doesn't do it for them. But pornography might be just their thing. Okay. So everybody's a little bit different in terms of what is very reinforcing for them. And from an evolutionary point of view, that probably makes sense in the idea that we want, like, the tribe to have everything it needs.

So it's good if some people are really interested in some things and other people are interested in other things. and between all of us will get everything that we need, or at least that's a theory. So this notion that addiction kind of lies on a spectrum in a sense where a lot of people are familiar of like, oh, someone's an alcohol addict or a drug addict and overlook the addictive, compulsive habits that we have in our own life, whether it's something more subtle as, you know, social media or romantic novels. Yes. Which was a guilty pastime of yours.

I suppose. And so this seesaw of pleasure and pain, I want to dive deeper into examining this, because if we want to really live our life, we're at odds with this kind of compulsive numbing, this dopaminergic kind of enslavement that is so widely available right now. And coming right into balance of that is like a unique challenge, maybe unlike any other generation in time because of how much access we have to it. So before we get to, ahead of ourselves, that pleasure and pain seesaw. Can you talk about how there are two sides of the same coin or necklace in your case? Yes, yes. Yes, I can do that. Okay, so in order to understand what's happening in the brain as we go from healthy recreational use of an intoxicant

or really any behavior that's reinforcing, I mean learning is reinforcing, right? Playing the piano is reinforcing. We first have to understand the concept of home. homostasis. And homeostasis is essentially our baseline level. So wherever we are at baseline in all living organisms, we kind of want to get back to that. And we can adapt to our environment to a certain degree that's called allostasis. But at the end of the day, there's only a certain range of affordances that the organism can operate in. Like, for example, if you just take temperature in humans, you know, we have sort of our baseline temperature.

We can get hotter and we can get colder, but if we get too hot or too cold, we'll die. Okay, so that's the concept of homeostasis. And the thing about pleasure and pain and how we process pleasure and pain is that they're actually co-located in the brain, so the same parts of the brain that process pleasure also process pain, and they work like opposite sides of a balance. So imagine there's like a beam on a central fulcrum, like a teeter-totter in a kid's playground. And when that beam is at rest, it's level with the ground. So in that sense, a little bit different than a teeter-totter, right, which is normally rested. But just imagine sort of a scale of some sort that's level.

An equanimous teeter-totter. Yeah, there you go. There you go. Some kind of teeter-totter that's like very zen. It knows itself. It has a mind-on-lose practice. A teetotter. with a mindfulness, perfect. I love it. Okay. And that's called homeostasis, right, when it's level with the ground. So when we do something pleasurable, our pleasure pain balance, let's call it, let's call it tips one way. And when we do something painful, it tips the other. There are certain rules governing this balance. And the first and most important rule is that it wants to remain level with the ground. And our brains will work very hard with any deviation from that neutral position to get it back into that neutral position. So, for example, let's say I read a

romance novel, my drug of choice, or it used to be, I'm in long-term recovery. Thank you. And that releases dopamine, my pleasure neurotransmitter and my reward pathway, and my pleasure pain balance tilts to the side of pleasure. No sooner has that happened. Then my brain says, ding, ding, ding, got to bring that back into balance. It adapts to that increased dopamine by, for example, down-regulating dopamine transmission by invaluting post-synaptic dopamine receptors. That's called neuroadaptation. And I like to imagine that as these little neuroadaptation gremlins. Let's personify them, hopping on the pain side of my balance to bring it level again.

But the gremlins like it on the balance so they don't get off as soon as its level. They stay on until I'm tilted and equal and opposite amount to the side of pain. That's the come down, the hangover, the blue Monday, or that moment of craving wanting to read. more chapter in my romance novel, even though I swore when this chapter ended, I would put it down, turn off the light, and go to bed. Okay. Now, if we wait long enough in that state of craving, right, when we're in the come-down part, those gremlins get the message their job is done. They hop off and a level balance or homeostasis is restored. And that's the way it's supposed to work for the most part. The problem is, in this world of overwhelming overabundance, where we can

reach out and get more of our drug of choice at the touch of a fingertip, swipe right, swipe left, whatever it is, then the faster way back to homeostasis is to just have more of my drug, right, which we're very inclined to do. Because when we're in this state, we're in a state essentially of craving, we're tipped to the pain side, we're uncomfortable, we're dysphoric, we're irritable, we're anxious, get some more of that good stuff, put it on the pleasure side and restore homeostasis. The problem is that if we continue to do that over days to months, to weeks, to years, those gremlins start to multiply on the pain side of the balance. They get bigger, stronger. Pretty soon they're camped out there. And now we've entered addicted brain, right?

We've changed our hedonic or joy set point. We need more of our drug, not to get high and feel good, but just to level the balance and feel normal. And we're not using, we're walking around with a balance, tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and craving. And that's what drives reuse when we're addicted, even though we can objectively see that our life is going to pot. So let's examine a little bit more of that wiring of searching for pleasure, avoiding pain. evolutionarily, like obviously that served a very important purpose in a world of scarcity like you speak to so much. And then now there's this disjunct of the world we live in currently,

but we still have the same wiring. And so can you, yeah, share a little bit about the purpose that function that's innate within us all serves and now the world we live in, how it's not exactly. Yeah. Yeah, great questions. So, I mean, yeah, I mean, what we know about the brain is what goes up must come down. So any intense pleasure is going to be followed by pain before going back to the level position. And as you ask, why on earth would Mother Nature do that? Why doesn't Mother Nature just let us get the intense pleasure and then come back down to the level position? Like, that would be so much better, right? Or just for, or for that matter, stay up at pleasure. That'd be really good, wouldn't it? Well, a couple problems with that. In a world of scarcity and ever-present

danger where we've got lions behind, you know, every rock wanting to eat us too, and we go and eat that berry bush and are just sort of like, you know, in a state of bliss for the foreseeable future, that's not too good, right? Because then we're not paying attention to our surroundings and we're bound to be eaten by that lion. But even if we just come back down to the level position and don't go to the pain side, we're not all that motivated to keep searching for that next berry bush. but in a world of scarcity we got to spend every waking moment looking for the natural rewards of food, clothing, shelter, finding a mate, or we're going to die. So from the perspective of Mother Nature, this pleasure pain balance and this what we call this opponent process mechanism is absolute genius to make us the ultimate seekers, never satisfied with what we have, always wanting more, and that way we're going to stay alive, right? The problem is you take that ancient wiring and you put it in our modern day ecosystem where really our survival needs are basically taken care of.

We've got all this leisure time. Even the poorest of the poor have more leisure time and more disposable income than ever before in the history of humankind. And we have access to all these amazing, highly potent reinforcing substances and behaviors. that's a, you know, a perfect storm for all of us getting addicted. Do you see the polarity or dance of those two forces kind of what is, in a way, really driving humanity and driving the evolution of a species? I even think from like a macro level, if you think of like contraction and expansion, the inhale and the exhale, the end and the young, the pleasure and the pain and are those centers within us very much so.

are the means in which we kind of like go on this roller coaster of life in a lot of ways. And of course it can go out of balance, but just any thoughts you have there? I mean, yeah. I mean, I do think that it is this dialectic that is sort of the essence of everything. And it then becomes, so striving and going to the margins of whatever the dialectic is is part of what keeps us alive. but at the same time it's also, I think often the source of our suffering. So having to come back and find that middle is, you know, the dance that we have to keep doing.

So now we're in this paradoxical, strange, adverse relationship between affluence and anxiety and where we have so much comfort and convenience and to any, you know, relative degree of wealth, you know, where you can Uber eats your food and swipe for your mate and, you know, work from home on your laptop. It's like we can just kind of sit in a chair and live life that way. It's an offer in this day and age. And that positions us uniquely with obviously those amazing capacities for connection and convenience. But at the same time, I feel like in many ways when we have access to that lifestyle,

if we don't actively seek out discomfort and consciously choose it, then it'll unconsciously choose us in many ways. And we feel the lethargy that comes from that and so many things. And so what is this plenty paradox? Yeah, so precisely what you said, you know, we are wired reflexively to seek out pleasure and avoid pain. And yet now when we do that, we're bound to encounter misery. So, and this isn't just at the individual level,

it's probably at the level of nations. So when you look at, for example, happiness surveys, what you see is that people have become less and less happy over the past 20 to 30 years, and that decrease in happiness is most striking in the wealthiest nations in the world. Conversely, when you look at rates of depression and anxiety, they're going up all over the world,

but they're going up fastest in the wealthiest nations of the world. suicide. You know, here in the United States, we're seeing record suicides among young people. A complete paradox when you think that we have so many privileges in this country. And we also have access to the best mental health care treatment that there is, right? The most antidepressants and mood stabilizers and psychotherapists. I mean, not everybody has access, but compared to other countries, we have more access. And yet, we must be getting something fundamentally wrong about the way to pursue the good life or to thrive because we are just seeing record rates of anxiety, depression, and self-harm. And I think that what's happening or what we're not recognizing

is the ways in which overwhelming overabundance is actually a stressor. And because our brains were not wired for abundance, we were wired for pain. We were wired to face adversity. We're wired for friction, right? But because we don't have that in this world that we've created, our brains are reeling to know what to do with all of these stimuli, all of the things that we do and ingest that release dopamine in our reward pathway. And I think as a result, our brains are compensating by down-regulating our own endogenous dopamine transmission, dopamine production, probably our own endogenous opioids, or endogenous cannabines. All those feel-good, you know, hormones and neurotransmitters are probably downregulated in us to try to offset all the comfort that we have and also all the

ways that we're insulated from pain, right? I mean, not only are we insulated from physical pain, but we also are insulated in many cases from emotional pain, all of the kinds of psychotropics that we take and other drugs that we use. We're even insulated from movement, right? Our lives have become incredibly sedentary, disembodied from our bodies. I think that's really confusing for our mammalian brain and leading to a lot of misery. So, of course, therein, if that really is what's going on, we have, you know, in the kernel of that is also the answer to our problems, which is that we have to actually intentionally seek out pain in all its guises. And we have to eschew some of these pleasures. Not that we can never indulge, but we have to really downregulate our consumption.

Yeah, and the exponential rise of the dopaminergic activities that are on menu at any given moment. Yes. Seeking out some more of those aromatic activities. And so what is, yeah, in the balance and the bringing back balance to whether it's through the exercise and the son and the cold plunge and these things, What have you found are like the healthiest ways to be able to structure healthy stress into our life? Well, even before getting there, you know, I think we need to recognize that simply not ingesting our drug of choice for a period of time, like trying to fast from it is painful. Like we don't even have to do anything else to experience the pain of what it is not to reach for the cell phone or in my case the romance novel. or cannabis or alcohol or nicotine or whatever it is that we use to numb ourselves.

And then notice how when we do that and we take that weight off the pleasure side of the balance, those gremlins crash down on the paint side and we're in withdrawal. And that's very uncomfortable. But being able to sort of sit with that, to tolerate it, ride it out, that is very important to learn how to do that and not try to change it or run away from it. And then beyond that, paradoxically, we can intentionally seek out things that are hard. Going back to this balance, we know that when we press on the pleasure side, the gremlins hop on the pain side, but the opposite is also true. When we intentionally do things that are difficult or painful in moderation, the gremlins will actually hop on the pleasure side and we'll get our dopamine indirectly by paying for it up front.

And what's probably happening there is that by, for example, exercising, which is the classic, you know, example of this, exercise is actually immediately toxic to cells. But we know exercise is good for us. So why is that? Our body senses injury with exercise and then upregulates feel good neurotransmitters like dopamine, serotonin, norophenephrine, endogenous opioids, endogenous cannabinoids. So we get the runners high after we put in the effort. And that's really, you know, how we were evolved to have to do hard things first and move our bodies in order to get the reward, a little bit of reward. So that's generally what I recommend, you know, abstaining for periods of time from highly potent reinforcers and then intentionally doing challenges. physical and mental activities to try to have the body sense injury and upregulate, feel good neurotransmitters. So beyond exercise, there's things like ice cold water plunges, intermittent fasting,

or even just anything that requires effortful, sustained attention. That can be meditation, that can be prayer, that can be reading a challenging text or engaging in a challenging, at times frustrating creative activity. You know, all of that, where in the moment it does. doesn't feel so good. Maybe we procrastinate around it, don't want to do it, but after we're done, we feel better. When you look at the staggering statistics of anxiety and depression and suicide right now, it's just, it's so sad. And I also think of like a lot of the low grade suffering, if you want to call it that, where it's kind of like just a numb, dull, colorblind kind of

experience of life. And, you know, how sad it is that so many of us are missing out fundamentally on the joy of being alive, like the gift that is this life. And Young, I believe, is quoted saying that pleasure is tension reduction. And I'm curious your thoughts on that because this constant urge for a pleasant experience of life. Like so few of us really examine it internally. And I've been on my own journey of navigating this. And that's brought me to doing things like a six-day darkness retreat. Oh, cool. Like, salt long periods of silence. And I really feel the calibration of my nervous system and perception on life. It's like you really can be overwhelmed with joy and awe and wonder at the most subtle experience of a butterfly or the sound of a bird. And like to experience that

level of euphoria from something so simple is amazing. And I think so many of us just have, haven't had that reference point, which is why I love that you're inviting the dopamine detox and the ways to really, like, refrain from those things. And that's just as empowering as the hormotic things as well. So, yeah, just curious on your thoughts around that and how we can, in discovering the true joy that's innate in our being, these like the compulsive urge for bodily pleasures kind of it weakens, it dampens. Yes, yeah. Wow, I'm so curious. Like what was the, I mean, do you mind talking a little bit about the dark room retreat or like, what was that like?

What was it like when you first went in and then like the middle and then when you came out? You're quite literally jumping into the void, you know? Oh, yeah. So it's like kind of like a bunker underground. And so I had my candle lit, which is the last source of light that I had before I blew it out. And it was like, okay, I'm going to do six days in complete darkness. You also can't really hear anything because it's underground. Is there somebody sort of watching over you, presumably? Okay. You're not just sort of like out on your own. Okay. Yeah. So, yeah, there's a center up in Oregon in which I went and they have different things. And there's like a double-sided door where they come once a day to bring you food. So they don't let light in. Right. And of course. And you're not locked in there. So you can like leave at any point. Yeah, right. It's voluntary. Yeah. Yes, of course. You're walking in there. It's actually funny because I feel like so much of the difference between

joy and suffering in life is like the willingness we bring to things. So true. The frame of reference. And like willingly walking into solitary confinement in many ways is much different than somebody putting you there. Exactly. And you know exactly when you're going to get out. Right.

So the amount of control you have over it too. Yeah. Yeah. So I personally love exploring that is of my consciousness. And so I was just kind of jumping into the unknown. And didn't really have many expectations for a starting. And time kind of just designed. It's like everything just kind of blends into one experience.

It's just you and your consciousness bouncing around in the endless void. I would be terrified of my conscience. I mean, like, I think, you know, like there might be a whole lot of nothing going on up there. You know, or the same phrase repeating itself again and again. Did you have that at all? You know, there's a lot of space for reflection in general, you know, so I actually had a lot of things that I was like, felt a lot of compassion and gratitude for. And then things that I want to actually had a journal and wrote very muchily. Yeah, there was a method to the madness.

Little ridges, so I got some still on the line. Okay. It was legible afterwards. And yeah, a lot of amazing insights came up. But, yeah, again, the most profound thing for me was coming out, taking my blindfold off as I walked out, and just being so sensitive, you know, to the very subtle pleasures of life. and that reference point, I think, was worth the whole thing. Yeah. So, so, yeah.

Just realizing how little it actually takes to experience joy once you've been in a cave for seven days, right? Right? Yeah. Yeah. It's like, we're so disconnected from how we just spoke to, how we've evolved. And, like, not that we used to maybe do that to that extent. Right. But, you know, maybe some extreme measures for extreme times.

Yeah. just to reset the balance. So how about the, how long, what's the longest you've gone without speaking, the silent thing? Yeah, I've done a couple of opasanas, so it's like 10 days of silence. I'm going again in a couple weeks, which I'm excited. And what's that like? It's different because darkness is like there's no schedule or routine. The vipasana, you're meditating for eight plus hours a day. So there is a structure to it. You're sitting down. It's a lot on the body. It can be quite intense. But you also have an even deeper deepening of that sensitivity because of how much. you're observing the sensations that arise in your body. And so it's a lot harder, in my opinion, even than the darkness. Interesting. Yeah.

I think the darkness would be challenging for a lot of people. I think it would be very challenging for me. I mean, I could see myself getting kind of panicky, but that didn't happen to you? I'm really comfortable being alone. Okay. Yeah. So I don't know if it's just me and my own wiring. I'm pretty comfortable just existing, I guess.

Nice. That's good. Yeah, but the viphasinas are definitely a bit. They're a lot more challenging on the body physiologically. Interesting. And when you're done with that and you start speaking again, is it like hard? Do you find you don't want to come back and come back? Or are you eager to be speaking again? No, I think you realize how loud humans are after God, that experience. I'm just thinking now I've been screaming the whole time. Okay. Okay. Yeah, it just, yeah, it just comes. Coming out of that, you're just, it's just like so much more sensitive. It's like right when you wake up, someone just blasting bright lights in your eyes. It's like that, but with every sense, you know, with your sight and your hearing and your taste also, you know, and all of it. So anyways.

Okay, I know you're supposed to be interviewing me, but I really, I genuine on it. Because I hear, I hear about these things, but I, you know, don't get to talk to many people who do them. after you've been in the dark cave or after your meditation retreat, does it last? Not if you don't have some sort of practice to continue with it. It'll trail off. Like in my experience, if you just like, for example, don't meditate after doing something that intense, you'll trail off, you'll feel like you're floating, at least I did, after day 10.

But if you don't have a practice to kind of carry that, it's almost like going and getting a deep detail for your car. Yeah. And then just like never getting washing it. Okay. They're never taking a shower again, you know. So that's kind of the practice is the upkeep for me. Yeah.

But it is a really nice reference point recalibration. Nice. Deep car wash. And how, what was the practice required? Is it like an hour a day, two hours a day, 10 minutes? Right. So it obviously depends on the system with DOMA, which is the Vipasana. It's kind of like the OG one.

Okay. They, yeah, it's like an hour or two hours a day if you're doing an hour in the morning and at night. Okay. So it's a lot. It's a big commitment. It is. Yeah. But I've experimented with many different types of contemplative practices and fun ones that, in my opinion, I've been just as beneficial with a lot less time.

Oh, interesting. Okay. But still you're doing this one. Now I'm doing more of that because I'm about to go back into it. Okay. I kind of oscillate between different. Got it, got it. Yeah.

Thanks for sharing. I'm happy to share. I just think that it's just that that possibility is not experienced by a lot of people. And I'm curious for you, like in your own discovery of mindfulness practices or, you know, going to those places where you have the mindful teeter-totter that we spoke to earlier, you know, and you feel that kind of homeostasis. Yeah, right. What has been your experience of, like, cultivating that equanimity? Yeah, so I think I have probably three major sources where I cultivate that. One is exercise. So that's sort of, you know, I don't listen to music or anything.

And it's not really intense, but it's, you know, can be like an hour or two of meditative walking or half an hour of swimming. So it's sort of like a moving meditation. And then writing is a really happy place for me, or at least when I have. have time and I'm not in a rush and I don't have anything else going on and the house is quiet, you know, and I can really just be really quiet and just let my mind drift. That's very pleasurable and it feels like a kind of a coming home. And then I would say at work. So like seeing patience is, it's, it feels like a practice, you know, in the sense that I just, I'm like fully present, you know, at least the best version of myself, I'm fully present. And, and, and, you know, and the best version of myself,

I'm fully present. And we're exploring, you know, the world of their psyche and consciousness. And so that's, that's, you know, really rewarding for me. And again, it feels like sort of a coming home. Was there a primary drive that led you to your practice in your work initially? Like, what I'm curious, what was the origin of your deep fascination with studying this, making your life's work so much about this all? Oh, yeah.

Well, I mean, in medical school, I, I pretty quickly realized I was more interested in quality than quantity in terms of helping people. You know, wanting to make lives better, not just longer. And I realized pretty quickly, too, that I wanted the relationship through time with patients, which is hard to get in medicine now because there's just so much churn. So psychiatry was kind of a natural, you know, when I finally made my way there. And then in terms of addiction, that was not something I was looking for. It's something that I actually happened on because I had a patient who was in a car accident.

I'd been seeing her for about a year doing weekly psychotherapy, talking about, you know, everything I noticed on. But I never once asked her about drugs and alcohol because I hadn't gotten any training in that. I kind of didn't, like, I don't, you know, addiction. I don't want to deal with that. but then her brother called and said that she'd been in a roll over a car accident because she'd been using again. I said, well, using, using what? And he said, using heroin, isn't that what you've been treating her for? And I was at this moment of like, no, you know, and a lot of shame there, obviously.

Because it's not her responsibility to tell me about that. You know, it's my responsibility as a skilled physician to sort of ask the questions and get at that information. and I hadn't done that. And so this was sort of a realization, oh, wow, I'm actually harming people out of ignorance. So I really changed my focus at that point and decided to ask, begin to ask patients to start to research it, educate myself, talk to colleagues in this space. And what I learned was, number one, when you ask the questions, patients are very eager to talk about it. They're not withholding. It's easy to draw it out.

And number two, when you treat the addiction, everything else gets better without you having to do anything else. And I was so shocked by that. Like here I'd been, you know, prescribing mood stabilizers and antidepressants and this and that and another thing. And patients weren't getting better. And then I focused on the addiction. And in many cases, you didn't even need the medication anymore.

That's how much better their lives got. So I'm not that everybody got better, but for folks who got better and it's a good, I mean, people, there's, it's evidence-based treatment. People respond pretty well to the treatment when they engage. It was just really gratifying work and they're an amazing population. Because you share what's like a couple of the most both intense and subtle cases you've worked with? Because we spoke earlier how if addiction lies on a spectrum, you know, I would presume that the majority of people listening right now are not addicted to math into this podcast. But like you spoke to, depending on our temperament and our makeup, we all have our own things, whatever it is.

like you said, whether it's more sexually oriented, psychologically, you know, so many different ways. And so, yeah, I would love to hear one or two. Sure. Well, I mean, one of the patients I write about in the book with his permission is a patient of mine who had a very severe sex addiction to the point that he had built. He was an engineer and he built his own masturbation machine, which was originally like a modified record player, that went round and around. He had its attachment that went on his penis and he could modify it.

But over time, once the Internet was invented, he rigged up a whole speaker stereo system that allowed strangers remotely to actually manipulate the electricity that was potentially life-threatening, right? I mean, it was a very dangerous apparatus and he could easily have died and he knew that

and yet couldn't get himself to stop using. So that was a very extreme case, but also a case where I sort of saw myself, you know, because I had developed this addiction to romance novels and erotica and my Kindle facilitated, you know, me becoming a chain reader. And I was to escape into that even like the 10 minutes between patient. Chain reader. A lot of chain reader. I know, right? Chain reader.

And, you know, when I met him, like there was a part of me that was really kind of horrified and like, oh my gosh, how could anybody do that? And then there was another part of me, it was like, oh, yeah, I see you. You know, that could have been me. So that was one case. And then I guess, I mean, a milder, more subtle case on the other end. Yeah, like maybe even just like a variety of subtle ones that you've seen that people might not overtly think. Right. Yeah, yeah, yeah. Well, I mean, I think my case is a case of a mild case, right? You don't think of getting addicted to reading. But really, we have so many ways of escaping into this fantasy world, whether it's through movies or books or video games.

And the more time we spend in that fantasy world, the less salient and desirable the real world becomes, and the more we just want to be in that fantasy world, whether our medium is, again, is books or a visual medium or what have you. So I think we need to be much more conscious of that. You know, another really powerful, I think, form of escapism or subtle addiction is engagement in sports, you know, and kind of being consumed by sports and sports teams. And, of course, now with gamblification, you know, betting on the sports, like it adds a whole other layer of addictive potential. And again, it's hard because these things can bring us a lot of joy in our lives and in moderation, you know, aren't necessarily bad. But there are so many ways now to 24-7 consume things like sports that it can really begin to interfere with our primary relationships, with our sleep, with our own exercise.

you know, every single form of digital media, social media, the internet in general, the amount of time that now, you know, we're just spending, chasing down these rabbit holes is really insidious and very, very addictive, you know, where we're just like can't stop scrolling on our phones, for example. What do you think are that, like, a couple key main things in someone's life that would make them really resilient to addiction? You know, I think of certain individuals that really live in like a purpose. purpose-driven life, and they're like, they're getting a lot of pleasure out of the service of

others or something like that. What would you say are a few of those things and qualities in someone's life that would protect them against that? I mean, probably top of the list is human connection. So intimate connections with other people, I would venture to say in real life. You know, I mean, I think that we can get, we can make deep and meaningful intimate connections online, but I think if that's all we have without being in the physical presence of people that we're intimate with, I think that that doesn't go well in the long run. So like people in our lives that we spend time with in real life is a crazy concept. Yeah, totally crazy, right? Can you imagine? You're really going on the fringe here. Yeah, really like, talk about a

wild idea. I know, right? So nuts. So I think that that's a really big piece of it. Movement. so people who are connected with their bodies, attach their bodies. And it doesn't necessarily, you don't need to be doing like marathons, right, for this to apply. Just being connected to your body, eating right when you're hungry,

sleeping when you're tired, having a regular sleep wake cycle that's in tune with the circadian rhythms of nature, so you feel embedded and connected to nature. I think those are really important protective factors. Meaning in purpose are huge. but you can kind of get addicted to that now, right? So, I mean, we've sort of drugified everything,

and now, you know, you can start to be like, you know, get all, who knows, a lot of attention and positive regard, and then all of a sudden you're like checking, you know, this or that, and you're checking, oh, you know, what number of podcasts are we, and how are we doing today? And all of a sudden, what started out is, know thyself is now its own hamster wheel. Yep.

So it happens really quickly. I think with the rise of anyone's career, you know, the addiction to achievement. Yes. and things that society celebrates. It's like those are even some of the more dangerous ones because they're more insidious in it in some ways, right? So true.

I remember when Dopamine Nation first came out and all of a sudden it was on the New York Times bestseller list and then it was like Amazon and then it was in the top 10 and I was like I started checking the Amazon and where it was. And I was like, oh, that's so cool. Of course it felt really good. And then the next day I checked it like two or three times. I mean by day seven, I was checking that thing 10 times a day.

What's happened? You know, if I'd gone down on there, oh, no, what's going on? You know, I was like, I mean, it just happens so quickly. I was like, oh, that needs to stop. So I don't, I immediately saw it and then I stopped checking. But it is amazing how quickly it can happen. And we get caught up in that. I have some, like, artist friends and individuals who, you know,

maybe have achieved a lot in the external world and how much they were celebrated for this unrelenting, not healthy balance for them. or a lot of people around them of hard work and pushing themselves because there is that hamster wheel of like in the fear of what would happen if I stop, right? And yeah, it's just something that isn't really thought of as an addiction. Right. Yes, exactly. But there are so many things we're addicted to that are more subtle in our own identity. Yes.

And so one of those things that's tied to it, like the emotions of shame and guilt, I think are very interesting, drivers, and I know you talk to in your book, Dopamination, in regards to the guy who created the masturbating machine. What do you see as the possibility? Because it's really easy to say, like, oh, meth. I'm addicted to meth. Meth's the problem, right? When there is, but in regards to anything and even, especially the more subtle ones, like

the energies and the emotions that are tied to the things is in like very real ways pharmacologically, internally what we're familiar with. Yes. And so can you speak to how it's not. just the thing, but also the shame and the guilt of doing the thing that we're addicted to. Yes. Well, I mean, so I talk about destructive shame. Some of my colleagues have referred to it as malignant shame, which I think is a great phraseology too. And it's this idea that, okay, I'm doing this behavior that I'm not proud of. And I think of other people found out, you know, they would

judge me for it. And so I feel shame about it, you know, which. you know, is a very, they might need not verbalize that they feel shame, but shame is almost something like we want to avoid feeling. You know, it's an emotion we actually don't want to feel. So we put a lot of work into avoiding feeling shame. And so one of the things we do is then we lie, right? We start to have the double life. We're over here on this person, and then over here, I'm doing this behavior that no one else knows about, or I hope they don't know about it. Right. But then the lying about the behavior can actually contribute to the shame, which then contributes to doing the behavior to try to get rid of feeling the shame, and then you get

in this very destructive shame cycle. So the way to break from that cycle is what I call radical honesty, right, which is this idea that the place to intervene in that shame cycle is the lying part. Because it's very tangible, right? It's a thing that I can do. I can lie or I cannot lie. And when we, you know, muster the courage to tell another human being what we're doing, at least in part, it serves many different functions. Number one, we become aware of it. Because when we're lying to other people, we're also lying to ourselves, and the behavior can stay hidden in the dark recesses of our minds. But once we use language as a tool to tell another person, oh, I've been doing this, and I've been staying up late doing that, and this has. And this

happened, we can't unsee it. And that's a really powerful moment. Because even if we continue the behavior, we're now watching ourselves do it in a very new way, which is fascinating. And then with awareness often comes the desire to change the behavior. Plus, we all kind of have inculcated this idea and feeling that when we tell other people these shameful things that we're doing, they're going to run screaming like, ew, you're gross. You know, I'm done with you. the opposite happens, right? When we open up like that and reveal our own brokenness, people come closer because they have their things too, right? And nobody actually feels like they can approximate perfection. So in general, people who seem perfect usually don't have many friends because like who can be that,

you know, who can relate to that. So it's amazing when we're honest and we're open, it fosters intimacy. and that intimacy is itself a bulwark against addiction, right? Because now you're beginning to make a stronger human connection, which eventually can help to try to displace some of these addictive behaviors. So on many different levels, that's the way to begin to break that destructive shame cycle and get into what I call a pro-social shame cycle. Because the truth is we need some degree of shame in order to be motivated to change our behaviors.

If we didn't feel any shame at all, we wouldn't be motivated. And I wonder, I know for me in my practices, my, you know, meditation practices, such as they are, a lot of times what comes up is stuff that I would call related to my conscience, right, or related to things that I really feel I should do or I could do to be the best version of myself, that I would really drown out if I'm constantly distracting myself with all of these. distractors that we have. But in my meditation practice, it keeps coming up. Oh, I should call that person. Oh, I should reach out. I should reach out to that person. And then I get to the end of my, you know, practice. And I go and I reach out to everybody. Because I'm just so tired of hearing it. Right. Just to be done with that.

Yeah. Close those tabs. Yeah. That's right. Yeah. Does something similar happen to you? Yeah. Depending on, I guess, how busy my week is or whatever is usually invariably the first five times. 10 minutes, things will come up that I've just forgot to close tabs on. Yeah. And sometimes it's helpful just to go and close them. And I'm just like, okay, now that's not right, you know. Right. But yeah, it's interesting.

I also find that we were speaking to this, even the identity of being somebody who meditates or like it's so important to examine where that energy is coming from. Because I think earlier on there was a part of me that was a lot more militant with like a practice. And identifying is like, that's a good. thing to do and you're not a good person if you're not doing the good thing to do it in a way it's like sounds so like silly but it's subtle in the way that it works i feel like yeah and when you're not bringing your genuine sincerity and heart into a practice it's it in many ways stops being the spiritual practice that you want right yeah that's so great i love that and i can really relate um you know

some of the sort of suffering that i've experienced is when my need to solidify an identity about myself gets in the way of my being able to, you know, really be open or to be authentic. And for me, it's like this identity is somebody who's a giving healer, who cares for other people. And the way that will get me into trouble is I'll end up agreeing to do things that I don't really have time for or maybe don't want to do, but I feel I should do them, you know, and then I'm like covertly resentful that I'm actually doing them, or I feel I'm not sufficiently appreciated. And this person, like, that's on me, right?

If I didn't want to do it, I should have just said no. But I think the ways in which we have these identities about ourselves, and then we do these things to kind of maintain that kind of rigid ego structure definitely can be problematic. And in a way we can sort of be, you know, yeah, addicted to that certain way of being or being perceived. It's such an interesting balance because, like, identity and like the roles we play in our life, of course, are very helpful to like be a psychiatrist.

Right. Right. When you're somebody, you're helping somebody. Yeah. Right. And then it's in some ways, I heard someone refer to like the face can eat into the mask or the mask can eat into the face of the wearer where it's like the identities become callous. And it's who we think we are and we lose that fluidity of experience. Yes, exactly.

Yeah. That's beautifully said. Yeah. And I feel like that that creates a more numb experience of life. Like you don't feel pain or pleasure to the same capacity. Yeah. And I see a lot of young people who have this kind of experience, especially in our performative world where really young people are encouraged to, you know, do all these performative

things, to get into the right college so they can, you know, have the right career so they can be a success. I mean, it's really overt now. it's not even subtle. And so I think there is a lot of this sense of feeling that they don't know who they really are or very displaced from themselves or, you know, what J.D. Winnicott, a famous psychoanalyst, has called the false self. So a lot of effort put into kind of this self that's perceived by others,

but that doesn't at all feel connected to the grounded self. And of course, that's where a practice can make a big difference. Number one, even just identifying that mask, number two, letting it fall away and reconnecting with this kind of grounded self. Yeah, I feel like even just experiencing a little bit of distance from it creates a lot of freedom. Like, I know I've been so surprised if it felt like overwhelmed with work or like something in the past, simple state change through like a breathwork practice or something. It's like so funny how our biology can switch just like that when we allow it to, right?

Yeah. Yeah, it is really amazing. And, you know, studies have shown that dopamine is released when we engage in those types of practices. It's a subtle thing. It's, you know, it's typically non-intoxicating. Although I did meet one person who said that he would orgasm when he meditated. So we had to give it up for a while because it was so re-erner. I was like, wow, that's kind of cool.

But, yeah, but short of that. Is this like the evolved version of the masturbating machine man? Maybe it is. Right, yeah. 2.0. It's the Buddha version of the... No, but he was serious. He literally, he's like, I have to give up this matter.

It's too pleasurable for me, which is just sort of interesting. Because I think for most people, there's some distress. So, you know, it's not all pleasurable. And it's not that pleasurable one. It is. It's more that it sort of quiets things down and you feel more centered. Yeah, I don't remember what I was saying. Well, is there a fundamental.

difference what's happening neurologically from, for example, the pain that comes after the immense amount of pleasure from doom scrolling on your phone versus the, like, the hormesis and like a breathwork or a cold plunge, how is the function of dopamine different if it is at all in those examples? I mean, it's just inverse. Yeah. It's kind of like pain just comes first. Yes, it is. I think, you know, I think it gets back to sort of how we evolved. And we really evolved for pain. We did. We have an amazing capacity to tolerate and adapt to pain.

And dopamine is one of, you know, Mother Nature's gifts and our endogenous opioids and our endogenous cannabino. That's why we have those things to give us some relief when we experience pain, which We're essentially supposed to be experiencing like all the time. You know, just really simple physical pain just from going and getting enough food to be able to survive. But now our brains are just so confused, right? Because we really don't have many painful physically painful experience. I mean, really the only natural physically painful experience that I can even think of is childbirth, you know, short of a traumatic injury or something.

So that's why we have to do these exercises and find these other ways to stress our bodies, which, you know, in moderation is probably a good thing for us. So the big difference then, you know, between getting your dopamine, like from an intoxicant, where you do no work and you get a psh, versus you do a lot of upfront work, effortful engagement, and then you get a little bit of dopamine is I think just that the latter is really what we were meant for, what are, what the, the mechanism was designed for. The former is not. So in regards to that, I've heard you speak to the three qualities that make things more addictive. And we now live in a society where we have so many things that really have those three qualities. And social media, obviously, being a big one. So first, what are those three?

And then in what ways is social media particularly damaging in that process? So they are potency, quantity. And access. Sometimes I talk about novelty, too. Yeah, I got quantity, potency novelty. Okay. Access is important. Actually, I actually just talk about four.

So let's see, potency. So potency number one is how much dopamine it releases and how quickly. If we look at traditional drugs over time, we have bioengineered, and when I say traditional drugs, mainly it's plant-based drugs. We've managed to bioengineer those to make them much, much more potent than they ever were, than they ever are in nature. Opioids are a great example. So opium, which has been around for many thousands of years and which people have used,

takes a lot of effort. You've got to, like, grow a whole poppy field, right? And then you've got to harvest and cultivate it. You got to wait for that to happen. And then you have to, you know, do what you do with the resin, and then you got to smoke it or you got to drink it. fast forward to today we have fentanyl it's many many times more potent than opium or morphine it's made in a laboratory you don't need a poppy plant precursor right i mean that just explodes all of that right and and and that kind of trajectory for every single traditional

substance is there for cannabis right the cannabis today is wildly more potent than the cannabis of even 30 years alcohol. We have all of these different beverages. They're much more potent if we choose to drink a potent one. Caffeinated beverages. You know, nicotine products. It's all, vapes are like the, you know, hyper-palatable foods. Right. Food, right. Exactly. The additional salt, fat, sugar, flavorance, it's all of that. So potency. We vastly increase the potency. Number two, quantity. So quantity matters, right? How much we're exposing our brains to, and how often has a big impact on the addiction risk. The more we use and the more frequently we use,

the more likely we are to change our brains in this way that leads us to this dopamine deficit state, which is the sine quaan or the origin of this dysphoria-driven-driven relapse where we're using not to get high, but just to feel normal. And like, you know, quantity, it's everywhere now, right? I mean, TikTok is infinite. It literally never runs out. The cigarette rolling machine that was invented,

I think in the 1800s. You know, we went from being able to manufacture four cigarettes an hour to manufacturing 20, I mean, four cigarettes a minute to manufacturing 20,000 cigarettes a minute. Now we have a supply chain that can transport them all over the world. There's nowhere you can go on planet Earth and not get pretty much any drug you want, right? So the access, the quantity is huge. Novelty, right? How do we overcome tolerance when our drug stops working?

we take two separate drugs, combine them together, make a new drug, and our brain goes, oh, that's cool. I've never seen that before, right? And all of a sudden, we got the dopamine going again. I mean, novelty and is like instantly overcome, or tolerance is instantly overcome on the internet, right? By taking music, which is reinforcing and releases dopamine for many people, and adding it to a narrative, which is a story, stories you're reinforcing, and then turning it into a game. what do you have? You have American Idol right there, right?

Infinite novelty. Right. And it's highly potent, highly reinforcing, incredibly accessible 24-7. So I think that's what we're dealing with. So when you look at social media, like how you just, you know, share it, it has those combinations very strongly. Like, we have so much access to it. Our phones are always with us. If we have social media downloaded on our phone, there's just infinite novelty and potent. of new stories and interesting people to look at and things to do. What do you feel like social media uniquely?

How is it detrimental as opposed to other things where, you know, there's the physiological effects of hyper-palatable foods, for example. There's many different things and how the effects cascade down. But with social media, what do you see it does to our brains that is uniquely harmful? Well, I mean, social media. essentially exploits our desire for connection, right? It takes the most reinforcing aspects of human connection, and it distills them down into its most addictive forms. We're wired to connect through hormones like oxytocin, which is our love hormone. Oxytocin binds to dopamine releasing neurons in the

reward pathway and releases dopamine, which is why falling in love feels so good, right? It's because it releases dopamine. Social media takes that and essentially exploits it, right, by giving us access to millions of faces that are now curated, made more beautiful, more visually appealing. Furthermore, we have to do very little upfront work in order to find those people. I mean, you know, to meet people even just 20 years ago, you got had to get off the couch. You had to go where the people were. You had to like make some effort. If they were like not that attractive or not that interesting to you, well, too bad because that's all there was, right? Now you're just like, oh, I don't like them. Swipe right. Or they say something that's not pleasing to me. Bye-bye.

And so for no upfront effort, we have access to these highly amazing, you know, versions of humans in an almost infinite supply with zero need for frustration tolerance. If we don't like what they say, we just go find another one. And all of that just amounts to making human connection addictive, which is what social media has done. It's like we have these fundamental human needs, food being one, connection being another. And it's like in many regards, modern society is giving us empty calories for food.

And also like the mental empty calorie of like fake connection in a way. Because we feel like, oh, we've seen kind of what people are up to, but we haven't really connected with people, you know? Yeah, and that's the key. It creates the illusion of connection, even when there's no real connection happening. Now, I'm not saying that people can't have real connections. I think people can have meaningful, intimate connections online.

I think that social media can bolster and strengthen our in-real-life connections, but the medium itself is so reinforcing that we can very quickly go from something that's a useful tool to something that we're really just using for its drugification, right? The way that it kind of makes us feel good, releases dopamine, soothes us. And at that point, we're now eroding connection because it's not just an individual problem, it's a collective problem. The more time we collectively are spending investing online and in the online world, the less time we're investing in real life.

And now when we try to detach and, like, go back. into the real world. There's nobody there, right? Or they're actually genuinely boring because they haven't done anything except to watch other people online. Do you know what I mean? Yeah, I so agree. I really think that it's just using the tool and not letting the tool use us, you know, because it really can be a powerful tool to be connecting and meeting your tribe and these parissocial relationships. You know, I love listening to podcasts. You know, there's a lot of podcasters. maybe I haven't met that I feel a connection to. Like, likely I'm sure everyone listening right now.

And that's great. You get to find people that align with your values where maybe 20, 30 years ago, you're kind of stuck with whoever's in your community and you're a black sheep. But now you can find your black sheep's out there. Like, I'm not that weird after all, right? Yeah, you get to find your black sheep that are out there, you know? So it's just like a knife is an amazing tool if you hold it at the handle, right? Right.

Yeah, good point. Otherwise, you're just going to cut yourself. Yeah. Yeah. Yeah, that's true. And I think it's good that you emphasize that, you know, there are many ways in which social media has been a real boon, especially for marginalized people, helping people in community, get validated. And that's all great. And, you know, I hope that continues. But we just have to be very alert to the fact, again, that it's been engineered to keep us, you know, tapping and swiping beyond its utility because we're getting this dopamine hit from it. It's the same thing with, probably. food, right? Ultra-processed food. It's not just giving us calories, it's also giving us dopamine hits so that we will continue to eat even after we've gotten the calories that we need for our survival because it's so pleasurable. And I think just keeping that in mind and setting limits,

you know, I say, I'm not going to use before this time in the day. I'm not going to use after that hour in the day. I'm only going to use this platform. I'm only going to connect with these friends, really being very thoughtful about how we engage. Yeah, Tristan Harris and the Social Dilemma has done interesting work here, just how these algorithms created by these large corporations have designed the user experience on social media to be so that there's as least friction as possible and maximum dopamine to keep you going and keep you stay on that platform, contributing to a profitable business for the owners and shareholders.

and I think ignorance is not bliss in this way because really understanding how these things have been set up is really empowering so that you can just come into right relationship with it. And I think we've, you know, we've all been there. And you're somebody who's fairly offline, right? You're not on social. Oh, I've never been on social media because I wouldn't be able to handle it, not for one hour. I'd be going crazy. Yeah.

Yeah. So I'm really glad I never got on it. I just said, no, abstinence for me. But no, you're absolutely right. I mean, that's a key piece that from the get-go, social media, other forms of digital media, has been engineered to keep our attention for as long as possible. Why? Because the advertisements that come up is the way that the companies make their money.

That's how TikTok and Snapchat and Facebook and all. That's how they make their money, right? So the longer we're engaging on the app, the more ads we'll see. And by the way, the ads are also, you know, primers for engaging in more consumptive behavior to buy things. But the bottom line is the more time we spend on a given platform, the more ads we see, the more the companies that pay for those ads will enrich the platforms that show the ad. So that's why it's to their advantage. I just highlight that because sometimes it's not necessarily obvious. Like, oh, how are, you know, how is Facebook making money, right?

Like, how is meta making money? It's through ads. Yeah, it's, again, enacting and taking advantage of the capacity we all have to slip into unconsciousness and compulsive behaviors that are acting on these reward centers that we've been speaking to. And, yeah, that I'm curious how much you've examined both in your practice personally, like the moment a compulsive thing arises. because I feel like breathing a little bit of space into the moment that happens can be a very

powerful, even if you still do the behavior, but like in the moment catching that, I feel like diffuses a little bit of the charge the compulsive unconsciousness has on you. So I'm curious if you have thought so. So we just came out with the official dopamine nation workbook. It's called the official because there are a lot of fake dopamine nation. I wasn't going to really write a workbook. I never, that was another plan. But there were all these fake ones. So I thought I better get an official one. And there's an exercise in there where we ask people to really reflect on what was coming up for them or what were they doing just before they reached for their phones. And often it's like a moment of frustration or boredom or even more powerfully like uncertainty. Like they'll be doing,

get a certain place in their work, let's say, and then they encounter a problem. And then they're not, You know, we're not exactly sure how to solve the problem, but instead of sort of sticking there and sticking with it, much easier to go over here. So tension, tension in some sort, I guess. Yes, yes. Yeah, that's fair. Yeah. So in the workbook, you give numerable examples to support this process of examining the moment where something becomes seemingly overwhelming for us or the tension that arises. Right.

And the easier thing is just to distract yourself. from it. Yeah, exactly. Yeah. And so you've seen that examining that moment where compulsion arises is a powerful. Yeah, very, very powerful. And the other thing that it can, when we identify that chain of events, we can try to put in some alternative behaviors, you know, not using another distractor, but just something like, as you mentioned, kind of like a breathing technique or looking out the window. Because a lot of this, you know, we all have to be on our devices so much of our day. Hard not to want to go look at something else. I mean, I have, you know, I'll just watch a YouTube video for five minutes, you know.

It's such a bad idea because although it makes me feel better immediately, when I get off the YouTube video, of course I feel worse, right? And even less engaged in my work. So just little things like standing up, doing a breathing exercise, you know, letting your attention go out the window. The other thing is what we call self-binding strategies. So these are both literal and metacognitive barriers that we put between. in ourselves and our drug of choice, that forces a bit of a pause between desire and consumption. A really simple one that I highly recommend is to power the phone down and off before putting it in the back. Just knowing it's off and not transmitting and receiving somehow makes it less alive because these devices have a really alive quality that's very beguiling.

But when it's off, it just sort of seems dead. not to mention the fact that if I were going to go look at it, I would have to take the whatever, you know, 30 seconds it takes to turn it on again. So that's just a good example of a self-binding strategy. You know, another common one with the phone is going grayscale or just deleting apps. All of those things can be genuinely helpful if you are someone who really does want to change that behavior. Do you find that when it comes to like your behavior first in the morning that kind of sets your threshold for pain and pleasure? because I think that a lot of people who have just gone on their phone right when waking up. It's like they need a lot more to get stimulated throughout the day versus if you start with something

which is more like a concentrated mind or pain, you know, pain in a way. Yes, yes. Yeah, I mean, I always say I start my day with pain and I mean it. So that morning routine is key, right? It's going to set you up for the whole rest of the day. And when I start my day with pain, I mean I usually get up before the sun comes up. I start punching yourself in the face. Yeah, basically, I do.

I just wake up. The equivalent. My husband punches me in the face. No, no, not really. But he does help me get out of bed because I do not want to get out of bed in the morning. He's just, it's a start. But then the first thing that we do is we, you know, we go swimming or we go on a walk. So it's not super intense, but going outside, moving the body.

You know, then when I come home, again, an urge to check my email because I don't really use a phone very much. But still, the laptop, the email. But I have a checklist of things I have to. do before I allow myself to do that. Self-minded strategies, right? What do I do? I make my bed. I eat breakfast.

I brush my teeth. I take care of whatever I need to take care of to kind of straighten up. And then, and only then, do that. I kind of check my email and see what, you know, what's on for the day. I've heard you speak to the accessibility we have with instinct gratification. We've been speaking to it with social media and so many other things. what were the key findings from the marshmallow experiment around delayed gratification and how that plays in here? Yeah.

Because it's kind of exactly what you're speaking to. Yeah, yeah. So for those of those folks who don't know about the Stanford marshmallow experiment, they essentially wanted to test in kids whether or not if they were put in a room with nothing but a table, a chair, a plate, and a marshmallow on it. Could they go a full 15 minutes without heating the same? the marshmallow if they were promised a second marshmallow. So that was the paradigm. It was like, could kids delay gratification for the potential future reward of an additional marshmallow? And what they found, not that surprisingly, was that in kids like ages three to five, that older

kids were more likely to be able to wait the full 15 minutes than younger kids. So, you know, age plays a factor. Your frontal lobe gets online, starts to connect to your limbic brain. That all makes total sense. But it was interesting because even within a single age cohort, there were differences, like, you know, among, let's say, four-year-olds, some four-year-olds were more likely to wait or could wait longer than other four-year-olds, which is kind of interesting. And then what the experimenters did was they followed those kids prospectively, you know, through middle school, high school, college, later life. And per their results found that kids, little kids who could delay gratification, had better odds of like actually going to college, getting a, you know,

getting a job, having a meaningful career, all the kind of milestones that we associate. One of the things I always like to say, though, about that is that some of the most tenacious, persistent people I have ever met who can really, in a way, delay gratification are people with addiction. So it's not, I mean, although impulsivity tracks is a risk factor for addiction, sometimes the most addicted people are the ones who really can exert this kind of amazing control, either in pursuit of their drug or, you know, what have you in pursuit of other things. What was interesting about that experiment as well, though, was in observing the kids as they were waiting for those 15 minutes,

the kids naturally manifested a whole bunch of self-winding strategies. They called themselves and say. Yeah, like, you know, a kid wouldn't look at the marshmallow, you know, kick the table. I think one girl was like pulling her braids, which is kind of like inflicting a kind of pain, you know, to distract yourself from the marshmallow. You can just imagine all the things. And I mean, that's willpower and action, right, where you're trying to, like, steal yourself to not. ingest this thing that you wanted to want to ingest. So that was really interesting to sort of see

sort of self-binding writ large in these kids. The other really interesting wrinkle on that experiment, a modification, was they divided the kids into two separate groups in a different experiment. And in addition to the plate and the marshmallow, there was also a little bell, like the kind of bell you can ring at the deli. And they told one group of kids, hey, we're going to go out and come back 15 minutes later and if you can wait the full 15 minutes, like we said, you'll get a second marshmallow. They held that to both of the groups.

And in one of the groups, when the kids did that and like hit the bell, they went back in. The other group, when the kids hit the bell, they didn't go back in. They let the kid just kind of hang out there. And so in other words, they lied to one of the groups. And not surprisingly, in the group that they lied to, those kids were much more likely to eat that first marshmallow

and much less likely to be able to wait until, you know, the full 15 minutes. I think that's super fascinating, right? Because it speaks to the ways in which, first of all, lying begets a kind of scarcity mindset where you go into survival mode and feel like, okay, I cannot trust and rely on these people to provide for me or do what they said they were going to do. So I'm going to eat this marshmallow because, who knows, when they come back in 15 minutes, there might not be a second marshmallow coming, right? And I think, you know, when I treat people with addiction,

oftentimes they have grown up in households where there's the caregivers are addicted. But even if there's not addiction, there's lying there. There's a sense that you can't trust people, that they're not going to do what they said they were going to do. And that then I think really breeds, again, this kind of scarcity mindset and this idea that, shoot, I better take care of myself. And one of the ways I can take care of myself is by, you know, self-soothing with drugs and alcohol. And I think the opposite is also true. When people in our lives tell the truth and we feel we can rely on them in some uncertain future, well, then it's much easier to deny myself this instant pleasure, partially because

I have a kind of higher pleasure I'm looking toward in these trustworthy other people, but also because I feel like I can rely on the future, like it's less uncertain. I think to help kind of tie a bow on a lot of this, because we all have our things where it'd be important to examine what would those bindings, self-binding processes be, or even just creating systems in our life that work for us and work well for us, one of which for me is like my phone, I charge it in a separate room that when I wake up is not on the way to my meditation room. So I'm like not seeing it. I'm not as tempted. And sometimes I see it. I'm still go check my phone, you know? So not perfect here. But creating like systems like that.

Yes. And, you know, I would just love for you to highlight what have you seen the most efficacious protocols and practices for coming to right balance with this all. Yeah. I mean, I love the word systems. I think we all need systems because systems essentially reduce the cognitive load, right? I mean, habits essentially are a way of neurological systems, right, for repetitive things that we've done a lot that we don't now have to think about anymore because we have a neurological system to help us do it without heavy cognitive load. So in trying to change behaviors, we have to come up with different systems, right, to help us along the way. And I love your example. That's exactly right. Keep the smart phone out of the room, charge it somewhere else. You have your own, as one of my patients called it.

He called his morning routine the whole jamboree. He said if as long as I do the whole jamboree that I've set up well for the rest of the day, which I thought was a great way to describe it. So, yeah, those kinds of systems are really important. Again, it's like, you know, literal barriers between ourselves. And if you're asking specifically about, you know, devices, I think that having a time when we wake up and a list of things that we do before the very first time we touch any devices really,

is really important. Because once we've touched the device, we really have changed our brain waves. I mean, I really think that, like, we're in a different neurological space. And maybe we need to be in a different neurological space to do what we need to do online. But it pretty much derails anything else we are planning to,

but we literally forget. The other thing I think can be very helpful is to make a list what we're going to do on the device before we open the device. Because, again, very quickly, once we've opened it, we're easily distracted by something incoming. Making the device overall less potent, again, by doing something like grayscale,

so we're not seeing those colors, but a big one is turning off notifications. That's huge. You know, every time we get a notification, it's like a cue-induced craving, right? We get a little hit of dopamine that then sets us up for wanting to get more of the same. So that's really important. And then I think, importantly, you know, thinking when we're using it, okay, this is a tool. I'm not going to use it for entertainment or to change the way I feel. And that's kind of the bottom line in Internet and Technology Addicts Anonymous, a 12-step group

that's been, that people have started to help with this very thing, addiction to the Internet and all its guises. But that's kind of their bottom line. Like they will do things like, I'll listen to the radio, or I'll listen to an old-fashioned record player, or I'll watch movies, but only with friends and only it's so that the tool doesn't become the way I self-send. or the way I entertain myself. I find other ways to do that. And so it's just a tool to get the work done, you know, whether it's maps or calls or whatever. You know, you think about it in a different kind of way. And I do think it's really important at the end of the day having a cutoff time. And this is really, really hard. Because, of course, at the end of the day, we have no more willpower,

we're tired, but really having like a cutoff time, just about two weeks ago, I along with a patient, because she was really struggling with watching YouTube videos late in the night. I said, I said, you know what? I'm struggling with that too. Why don't we both make a pledge no videos after 6 p.m. And this was like in the midst of all the election stuff and I'd been watching a lot of podcasts and videos about that. So that was a hard pledge to make. I still was watching videos, but come 6 p.m., I knew I had to turn it off, which turned out to be a really good thing for me because I would usually start at 5.30, you know, when I had time in the evening. And by 6, normally I would have just kept going, but since I had made that pledge, so now that's nice

because now it's just 30 minutes. There's a study that showed that if people reduce their use of entertaining digital media down to 30 minutes a day and increase their exercise by 30 minutes a day, right, to those things simultaneously, they have markedly decreased anxiety, depression, real significant improvements in overall well-being. So we can be. make these little changes with these kinds of guardrails or self-biting strategies that can have a big impact on our lives. It's so important to have those guardrails and just be mindful of the effortless way in which the technology and tools around us can hijack our consciousness. You know, there's innumerable ways in which it can happen. And those systems are so important.

I love how you mentioned earlier too of just finding the healthy things to regulate your nervous system after long working where you want to go seek for that. You know, for me, like a quick breathwork practice. Like, there's great apps for that. How quick is how long for you? Five minutes, ten minutes? Sometimes I use the app other ship. They have like four to seven minute ones, which are really short.

Sometimes it'd be 15 to 30 minutes if I need it. Or if I'll just do my own guided one. Yeah. But usually that's enough. Like, I feel like our breath is just the most powerful tool so often overlooked. Yes. Yeah. Yeah, I had, uh, I had,

someone reach out to me who had read dopamine and he had tried everything to get into recovery from a severe addiction and nothing really helped all that much until he said he discovered breathwork. Now he's a huge proponent of it. So that's very cool. Yeah. Amazing. Yeah, I love all those other protocols and practices that you gave and I think to kind of wrap up here, you know,

all of this, the whole conversation is pointing to what's available to us. Like the possibility of how great this life can be if we come into right relationship with our mind and body and nature around us and the society in which we live, which is amazing and can undermine many aspects of our lives. And so what do you feel as we come into right relationship and come back into nature with our own nature? Like what's available here in terms of quality of life and these things that we can cultivate? Well, I mean, I think that when we are in right relationship, as you say, with ourselves.

I do think that we're putting something very positive in the world. I mean, it's just all we can change, really, with any kind of exactitude is ourselves, right? But once we've done that, there's an enormous ripple effect, I think, and it changes, you know, the energy around us. And it helps other people. I think it can. you know, in a way that just can improve not just our lives, but other people's lives as well. And I think that's really important. Because for me, at the end of the day, it really is about relationships with other people.

Yeah, and being there for them, right? Yeah, right. Actually allowing yourself to be present for them. Yeah, and feeling like you matter, right? I mean, so I think so often we can feel like we don't matter. but again getting back in touch with ourselves and being in balance we can reconnect with the ways that just being present you know we don't really have to bring anything else right yeah yeah i feel like so many of us often make decisions from a like lethargic state of consciousness

you know and none of us make optimal decisions when we're coming from pessimism and just like not feeling well internally you know and so much of the this conversation, I think, has been reminders to empowering us to come back into like a balanced state of consciousness to be able to serve and show up and, you know, come into those relationships and community and engage in things that are really meaningful to us. Yeah. To see beauty and appreciate it. Yeah.

Yeah. The last thing that just is coming to me right now is have you seen beauty and the pain and the addiction. And a lot of the patients that you've worked with, I feel like, and I would just love to get your perspective on being able to see the beauty of what's emerging through the pain and suffering often of people. And like there is a gift. There is something really amazing that kind of emerges through pain and suffering oftentimes. Oh yeah. I mean, what I love about working with people, you know, in recovery from severe addiction is inevitably, it's an incredibly humbling process, right? They get to a place where they've really been broken by life, but somehow they manage to sort of pick

themselves up and put the pieces back together and keep going. And I just love that because as they get into recovery and their lives get better and better and better and the lives of the people around them get better and better. There's this real gratitude, ironically, for their disease, right? And people talking about how they actually are glad that they were afflicted with alcoholism or drug addiction or whatever it is because it forced them to live their lives at a deeper, more interconnected level, to work on spiritual practices and be, you know, alive and present. way that if they had just kind of skated through and never had those kinds of hardships, they probably wouldn't have made the effort. That's amazing. Life doing life's thing,

getting us back home. Yeah. What do you think is the overarching goal of your work and your life's mission, what you've been so dedicated over the past many, many years, educating people around, I suppose, what is your overarching desire to how you're supporting, serving humanity. Oh, I mean, I, you know, I just feel so lucky that I'm in a job where I get to talk to people about their sort of deepest, most innermost struggles and thoughts and feel. I mean, it's a great privilege and an honor to be let into people's lives in that way. And I really feel like more than anything, I'm really just a witness to their journey and it's an enormous privilege. in some ways, I don't even actually know what I do.

I mean, it's like, it's a bit weird, right? It's like, okay, I listen to people for a living. I mean, it's a little strange, right? But it is just amazing what people, you know, can do when they decide to pursue recovery from whatever it is. And the meaning and purpose and joy that they can find. And it's not all the time, like, you know, it's fluctuating. but and I think, you know, importantly, getting in touch also with their ethics and their values and trying to be good people and live a good life and be of service.

These are all kinds of, they all go together. Just, I just know how powerful and transforming a non-judgmental accepting presence and witness can be for people. And so thank you for being that for people. I try. I don't always. seed, but I'm going to keep trying. Striving. But yeah, I just really enjoy getting to connect with you and drop on this on the show. Thanks.

This has been super fun. Yeah, likewise. And thanks for, you know, educating me and sharing with me some of your practices. It's been really interesting. Thanks for your curiosity. Yeah, I appreciate it. And before we wrap up, just any, you know, you have the new workbook that's tagging along dopamine nation and any other last things.

You want to point people towards before we head out? No. sweet all right we'll link things down below everybody who's tuned into this episode of the know they self podcast thanks as always for coming on this journey and let us know um where this episode has been uniquely impactful for you um on your own path and until next time be well