Muscle for Life with Mike Matthews - Anna Lembke on the Truth About “Dopamine Detoxing”

Starting point is 00:00:00 Hello, and welcome to Muscle for Life. I am your host, Mike Matthews. Thank you for joining me today to learn about dopamine, a chemical that many people are hearing a lot of things about these days. And many people are wondering, are we drowning in this chemical? Are we experiencing many negative effects associated with being bombarded with dopamine because of so many elements of our modern lifestyle that are engineered to trigger as much dopamine as possible. And if there is a situation worth addressing, what can we do about it? Well, those are a couple of the questions that are going to be answered in today's episode. And my guest is Dr. Anna Lembke, and she is a Stanford professor and expert in the neuroscience of addiction.

Starting point is 00:00:56 And the primary question I had for Anna that led to this interview was regarding dopamine detoxing. Is that really a thing? Is that a legitimate form of therapy? Or is it like so many other forms of detoxing that are promoted on social media that are complete nonsense, that are pseudoscientific piffle? And I thought Anna would be a great guest to talk about this because not only is she the chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and the medical director of addiction medicine at Stanford, she's also a best-selling author of several books, including her latest, Dopamine Nation, which is a New York Times

Starting point is 00:01:37 bestseller, and it is a deep dive into the science behind dopamine and impulsive overconsumption. And if I have almost lost you because you're thinking this topic doesn't really apply to you, you don't have a problem with addiction, when's the last time you tried to put down your phone for 24 hours or maybe longer? And if you have tried that, how did it go? Well, my point is, in our discussion, Anna explains that addiction applies to more than just classic substance addiction, to more than just alcohol and opioids. She explains that it also applies to behaviors that we can develop complicated relationships with, like watching Netflix, watching porn, playing video games, eating too much junk food, and more.

Starting point is 00:02:32 And so if there is any behavior that you engage in regularly that you would prefer to not engage in regularly, or maybe not at all, or if there is any behavior that you over-engage in and you would like to just do less of it, not necessarily eliminate it, you're going to like this interview. Before we begin, did you know that you don't need supplements to build muscle, lose fat, and get healthy? That you don't need any pills, powders, and potions whatsoever

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Starting point is 00:05:45 or we will send you something else if you'd rather try something else. So you really have nothing to lose. Go to buylegion.com now, use the coupon code MUSCLE at checkout to save 20% or get double reward points if it is not your first order and try my supplements risk-free. order and try my supplements risk-free. Hey, Anna. Hi. Hey, it's nice to meet you, and I appreciate you taking the time to come on my podcast. Thank you. I'm happy to be here. Thanks for inviting me. Absolutely. So we're here to talk about the dopamine detox, something that people are still talking about. I came across it a few months ago. I saw articles going up and people posting around on social media, and there's certainly still buzz around this. And I haven't spoken about this topic much. I haven't written about it much. So I wanted to get somebody on the show who knows more than I do about this stuff to share

Starting point is 00:06:50 your thoughts on probably we could just start with what is the dopamine detox, at least what is the idea behind it? Yeah. And then maybe talk a little bit about get into the weeds on it. Like, okay, does this have scientific validity? If not, does it have general utility regardless? Or is there something else people should be thinking about or some other way that they can attack the same problem? Okay. Well, I mean, I guess we should start by defining what dopamine is. Dopamine is a neurotransmitter, which is a chemical in the brain that allows two neurons to communicate

Starting point is 00:07:34 because neurons are the long spindly workhorse cells of the brain, but they don't actually connect end to end. So in order to conduct the electrical circuits, which essentially make the thoughts, emotions, and other cognitive processes that make us who we are, there are these little chemicals called neurotransmitters that bridge that gap between that open space between neurons, which is called the synapse or the synaptic gap. So dopamine is one of the molecules that does that. We make dopamine in our brains. Dopamine is essential to substantia nigra. And when that happens, people end up with this rigidity and tremor and gait that's characteristic of Parkinson's disease. So dopamine is probably the most important neurotransmitter when we think about motivation, reward, and pleasure. It's not the only neurotransmitter, but it's the most important one. And it's also the neurotransmitter that kind of goes haywire when people become

Starting point is 00:08:51 addicted. And we do think of addiction as a brain disease. And the bottom line is that when we do something pleasurable, we release dopamine in that part of our brain called the reward pathway. And the more dopamine we release and the faster we release it, the more addictive that substance or behavior is. The problem is that we now have a kind of a mismatch between our primitive wiring and our modern environment. Namely that our primitive wiring has evolved for a world of scarcity and ever-present danger, where it's really hard to find rewards. You have to walk tens of kilometers to find a drink of water. And so, our pleasure-pain pathway, our reward system has really evolved for this world of scarcity, where we have to work really hard to find anything,

Starting point is 00:09:45 you know, rewarding at all that keeps us alive, food, clothing, shelter, finding a mate. But we now live in this environment where we have access to an infinite quantity and variety of highly reinforcing drugs and behaviors, including drugs that didn't exist before, like video games, like social media, like online pornography. And the traditional drugs like alcohol and cannabis and opioids now exist. They're also very accessible and in highly potent forms. So, for example, fentanyl is a very, very potent opioid, 50 to 100 times more potent than heroin and morphine. And it was like invented, you know, in the last hundred years or so. So what's happened, the theory behind the dopamine detox and what I hypothesize in my book, Dopamine Nation, is that we've all become more vulnerable to the problem

Starting point is 00:10:42 of addiction because we are surrounded by all of these feel-good drugs and behaviors. And it's kind of like a fire hose of dopamine to our reward pathway. And our brains are reeling in response. And the only way that they can compensate or cope is by down-regulating our own endogenous dopamine production and down-regulating our dopamine receptors, which are those little catcher's mitts on the postsynaptic neuron that catches the dopamine that allows for the transmission in that neural circuit. What's happened is that we're all kind of in this chronic dopamine deficit state. And that's, by the way, just to compensate for too much dopamine coming in.

Starting point is 00:11:24 And once we're in that state, that looks very much like depression, right? The universal symptoms of withdrawal from any addictive substance are anxiety, irritability, insomnia, depression, and craving. So that one of the ways that we can get ourselves out of this dopamine deficit state and sort of restore baseline normal levels of dopamine is to take a break from whatever substance or behavior we are ingesting compulsively, over-consuming, using too much of to tell our bodies, okay, wait a minute, you know, you now need to start to upregulate dopamine in order to like get back to those, that level

Starting point is 00:12:08 baseline. So that's essentially what the dopamine fast is. It's at least in, as I write about it in Dopamine Nation and as I, as the science supports and as my clinical experience supports, it's not like you abstain from everything that's pleasurable. That's sometimes how it's talked about on YouTube videos. It's really that you identify that substance or behavior that you have a complicated relationship with, let's say a compulsive or addictive relationship with that. Once you start, you have a hard time stopping that it's starting to interfere with your goals and values. You take that substance or that behavior and you eliminate it for 30 days. Why 30 days? Because the science shows that 30 days is usually the average amount of time it takes to restore normal dopamine pathways. And that's

Starting point is 00:13:00 also consistent with my clinical experience that on average, you need to abstain from that online digital product lens widens, you're able to notice more things in your environment, be more present, you're able to enjoy more modest rewards. And if you go back to using your drug of choice, you can use it much less and get more reward from it. Because of course, what happens over time is we develop tolerance to our drug needing more and more to get the same effect as we go deeper and deeper into this dopamine deficit state. What are your thoughts on this term addiction? And this is, at least as far as I understand, there's an ongoing debate about how biologically valid is saying, well, this person's addicted to food or porn or Netflix or video games versus fentanyl or a very addictive drug in the traditional sense. Yeah. Well, you're absolutely right. There is disagreement and controversy about this. Not everybody believes that you can be addicted

Starting point is 00:14:32 to a behavior like pornography or video games or gambling. Or exercise. Right. Or exercise or sugar or whatever it is. Clean eating even. I mean, we see a lot of different in the fitness space. Those are things that are talked about. Right, right. Or workaholism, being addicted to work, right? Yeah. And if we're looking at the Diagnostic and Statistical Manual of Mental Disorders, the only process or behavioral addiction, which is a way of talking about addictions that don't involve ingesting a substance but involve a behavior, the only behavioral addiction that's currently included in the Diagnostic and Statistical Manual of Mental Disorders, which is sort of our dictionary for diagnosing, is in fact gambling addiction.

Starting point is 00:15:21 So pornography addiction is not in there. Sex addiction is not in there. There's no shopping addiction. There's no sugar addiction. There's no video game addiction. If you look at the International Code of Diseases, however, which is on a world stage, in fact, gaming disorder is included. So video game addiction. And China really pushed for that because they have a huge problem with that. I don't know that their problem is any worse than the problem here in the United States, but their leadership, their governmental leadership is much more concerned about it than we seem to be here. So on that stage, the international code of diseases stage, you can code for gaming disorder. But besides gaming disorder and gambling disorder, there's no official

Starting point is 00:16:06 recognition of other processes of addictions. But I can tell you that I believe very strongly that these are diseases of the brain just like any other. And the reason that I think so is because if you look at the natural history of the disease of addiction, it follows the exact same trajectory, whether your drug is cannabis, alcohol, nicotine, cocaine, or gambling, pornography, video games, social media. People usually start out for one of two reasons, to have fun or to solve a problem. That problem can be very wide ranging from anxiety, depression, inability to concentrate, insomnia, to boredom, loneliness, despair, lots of different reasons why people use. If their use of that substance or behavior

Starting point is 00:16:54 effectively works short-term to solve the problem or it's fun, people will typically do it again. If they continue to do it repeatedly over longer periods of time, the brain adapts such that they start to down-regulate their dopamine production. They need more of their drug in more potent forms over time to get the same effect. Pretty soon, they're putting lots of their creativity, time, and energy into finding the drug, making money to get more of the drug, hide their drug use, start over again the next day. And ultimately, the sine qua non of addiction is the continued compulsive use of that drug or behavior despite harm to self or others. So that even when it's interfering with their lives,

Starting point is 00:17:39 they continue to use despite health problems, relationship problems, work problems. And that's exactly the saying, whether your drug is pornography or whether your drug is alcohol. And also when people stop, they go into real withdrawal, even including physical symptoms from things like sex and pornography addiction or video game addiction. I mean, there's subtle physical symptoms. It's not as profound as like an alcohol withdrawal that you can actually die from or an opioid withdrawal, which people describe as a curse worse than death. Yeah. Crawling up the walls like exorcism. of physical agitation, anxiety, inability to sleep, ruminations, cravings. So because of that, because the way that it manifests phenomenologically in people's lives is so similar,

Starting point is 00:18:34 I've just become convinced that those are the same brain disease. Also, when you look at interventions, so I do the same interventions with my patients who have drug and alcohol addiction as have process addictions, and they get better at the same rate. So if the intervention or the solution or treatment, when applied in the same way to those behavioral addictions, works similarly, I can only conclude from that that we're dealing with the same brain process. And then practically speaking, in some ways, what works is what's true, right? So if you can help people, then academic arguments are just

Starting point is 00:19:17 less important than what you can do with it. What do those interventions look like? Well, it really starts with the abstinence sampling, which is sometimes referred to as the dopamine fast. So, for example, if a patient comes in and they're addicted to sex pornography, mostly compulsive masturbation, the intervention is no orgasms with yourself or anybody else for one month. And that is really, really hard. Once this behavior has become like a regular coping strategy or just like part of the way that people organize their day and their daily

Starting point is 00:19:55 rhythms, really, really hard to let that go. But that's essentially the initial intervention. Why is that important? Because you need to abstain for long enough to signal to the body, oh, I got to start making more dopamine in order to bring those levels back up to get out of that dopamine. It's not so easy to trick with just a day or two. Well, yeah. And in fact, what I tell patients, again, whether it's pornography or nicotine, the first two weeks, you're going to be miserable because you're going to be in that dopamine two weeks, you're going to be miserable because you're going to be in that dopamine deficit state. You're going to be craving the universal symptoms of withdrawal from any addictive substance, again, anxiety, irritability, insomnia, dysphoria, and craving.

Starting point is 00:20:35 But if you could just make it to those two weeks, it's time limited by weeks three and four, the light starts to come out. People start to feel better. Again, that lens widens. They're not so focused. Other things become enjoyable. And so that's really critical. And then patients will come back a month later. If they were able to abstain, great. We talk about, okay, well, what were the pros and cons? Pros, people talk about feeling physically better, emotionally better, and just so much more able to be present for their lives, right? To be awake and paying attention and to experience the spontaneous and natural unfolding of their life instead of, you know, constantly being preoccupied by, you know, finding a time and a place to use, using, and then coming out of it. The downsides about abstaining for that month, because I ask

Starting point is 00:21:27 pros and cons, people say, well, I had a ton of time and I didn't know what to do with it. So kind of boring, right? And scary. Boredom can be really scary. You kind of think, well, gee, what am I doing with my life? And then also people say I couldn't be with my friends because some people use in isolation, but other people use together. And then they say I couldn't be with my friends because some people use an isolation, but other people use together. And then they say I had to isolate from my friends, which is, you know, of course, we don't want people to be, you know, isolated from the people they care about. So those are the two really hard things. If folks describe that they weren't able to abstain for the three days, I just say, hey, that's really important information, right? That tells us this may

Starting point is 00:22:03 not actually be within your willful control. Maybe you need a more aggressive intervention. If people were able to abstain, but in fact, don't feel better after 30 days, that says, hey, that's useful information too. There's probably something else going on. Maybe you have depression and this isn't just a dopamine deficit state caused by your addictive behaviors. This is something else going on. So I just think that it really has to start, has to start with that dopamine fast. Many times people will come back in and for the first time, be able to see true cause and effect between their use and the impact it has on their lives. When we're in our addiction, we really don't see

Starting point is 00:22:45 it clearly. When we get some space, people often say, I don't even recognize that person. You know, it's sort of surreal. Like who is that person who was putting every waking amount of energy into getting that drug and using that drug? So it can be a super powerful experience. And then of course, if the patient was able to do it and they feel better, then we say, okay, well, what's next? Do you want to go back to using? If they do, then they almost always want to use less. And then we talk about what will moderation look like.

Starting point is 00:23:15 It has to be really granular. What days of the week? How much? Who are you going to use with? What are the circumstances you won't use? Really being really specific about that. Or they might want to abstain, a condition to abstain. Whether the goal is ongoing abstinence or moderation, we talk about

Starting point is 00:23:31 what I call self-binding strategies. And this is really important because this is basically putting barriers, both literal physical barriers and metacognitive barriers, barriers in our minds between ourselves and our drug of choice that either helps us abstain or helps us moderate whatever our goal may be. And those barriers take many forms. They can be time barriers. They can be literal physical barriers. They can be barriers related to category. I'm going to use, I'm going to watch this type of YouTube video, but not that type of YouTube video and on and on. And what are some of you mentioned education helps with? Because so I'm thinking of where I have gotten asked about this is with pornography, something that I haven't looked at pornography in many years. I was never, I never got to the point of addiction, but when I was younger, I was probably into it as much as,

Starting point is 00:24:32 I guess, your average younger dude. And eventually I stopped because it was more ideological. I mean, one, my wife, who was my girlfriend first for a while, and we started dating when I was like 17, she didn't like it, which was one thing. And then also it's a pretty, it's a pretty grubby industry. And it's something that I just don't agree with. I don't agree with anything. Like I think society would be better if it were just gone altogether, period. And, and so it was more of a values thing, right? So eventually I was just like, I can't, I just, there's too much cognitive dissonance here. I can't be the kind of person I want to be and still put any time or, or support any of this with even a click. Right. And so then I just stopped one day and that was kind of the end of it. And so people would ask me, I shared that on, on my podcast, maybe a year and a half ago or something like

Starting point is 00:25:19 that. And I, but, um, I didn't, I didn't have much practice. Like that's not a very, that's one of those things where people say, oh, that's cool. Good for you. But, but then people started reaching out to me asking like, so how did you do it? How did you actually do it? And, and I felt kind of bad because I didn't have great advice. I was like, I literally just stopped because one day I just had enough of it and that was it. That's why. And that's all I did.

Starting point is 00:25:45 But that's not very helpful, you know? Yeah. Yeah. In fact, you know, the truth is you're not in a good position to advise people how to quit using pornography because you never really got addicted to it. Probably because it's not your drug of choice. It's not, you know, people are different in terms of their drug of choice. What releases a lot of dopamine in one person's brain might not release all that much dopamine

Starting point is 00:26:05 in another person's brain. You might have other drugs out there that kind of grab you and potentially hijack your motivational circuits. It's clear pornography is not one of them if you were able to stop that easily once you decided that it was orthogonal or contrary to your values. But the hallmark of pornography addiction for people for whom it really is their drug of choice is that they can recognize that it's a grubby industry and that it's not consistent with their values. And even then, it's very difficult to stop.

Starting point is 00:26:37 So that's why a framework for both understanding what's going on in the brain and for doing something about it is really important. And that's essentially what I'm offering in Dopamine Nation. And it does, yes, require just stopping, but the just stopping comes with a deep understanding, at least I hope that's what it comes with, of what's happening in the brain. I also don't ask people to stop forever. Importantly, I ask them for 30 days and most people can wrap their head around 30 days of anything. If I ask people to stop for a lifetime, trust me, nobody would come back. But by asking for 30 days, you know, what I'm asking is like a hard weightlifting set, right? You just kind of

Starting point is 00:27:20 wrap your head around it. Or maybe, maybe, maybe it's like a workout, a hard work. Okay. A hard workout. I don't know anything about weightlifting. The danger of using a metaphor when you don't know what you're metaphoring to. My joke is a set is like 15 seconds and you take a rest. For some people, they'd be like, well, this is a little bit more than a set. Yeah. And it's admittedly super, super hard.

Starting point is 00:27:43 But of course, it doesn't even occur to some people that that would be the place to set. Yeah. And it's admittedly super, super hard, but of course it doesn't even, you know, occur to some people that that would be the place to start. And importantly that, you know, especially for pornography addiction, that it, it means no orgasms. So it's not just not looking at pornography and be like, you can't, you cannot touch yourself. Um, you know, in that you cannot, you cannot have an orgasm because the whole idea is that you need to reset the brain. This is brain physiology. You need to abstain for long enough that you trick your brain into saying, oh, we got something different going on here. I need to upregulate dopamine. And that's the key piece because it's not until you get back to what we call homeostasis

Starting point is 00:28:22 or those baseline levels that your brain is freed, that you're freed from the... You're not completely freed. It's like you're home free for people with severe addiction. But the fog has at least lifted. Right. The immediate chains have fallen off, right? And you can get some clarity and you feel better. You start to feel better. And then that turns it into its own motivation. Because again, when we're in it, we can't imagine that there's another way. When we get that little bit of 30-day distance, we feel enough better that it lights a fire, you know, go, oh, well, wait a minute, this might really be something here.

Starting point is 00:29:01 The other thing that's very interesting to me, specifically with pornography addiction and my work with people with severe sex pornography and compulsive masturbation, is that the abstinence must not just be from pornography and sex and masturbation and orgasm, but actually even including fantasies. Because of course, what happens with euphoric recall is that we get a little spike of dopamine just in being triggered and remembering. And that little spike of dopamine is followed by a dopamine deficit state, which is that state of craving. So you get yourself in that cycle, which takes up so much energy and actually causes a stress reaction. Cortisol is released when that happens. And so to really get out of that cycle, not even-

Starting point is 00:29:51 You can't even fantasize. No, can't even fantasize at least for those 30 days. And maybe- I can relate to that in my own experiences. Again, maybe it didn't get as far as some of the people, but that makes sense to me. It does. Yeah. And it really has really interesting, you know, cognitive changes. actually requires lifelong absence from fantasy, pornography, and masturbation, such that their sexual life is only characterized by sex with their intimate partner, whoever that may be. I mean, that's what you might consider an extreme version, but for many, many people with this devastating addiction, that's ultimately the best path.

Starting point is 00:31:07 devastating addiction, that's ultimately the best path. sharing it with a friend or a loved one or a not so loved one, even who might want to learn something new. Word of mouth helps really bigly in growing the show. So if you think of someone who might like this episode or another one, please do tell them about it. Are there any drugs to use the term that, that would include not just chemical drugs that you ingest? Any of the things that you've talked about that, in, just, just any of the, the, the modern, uh, drugs that people turn to. Are there any, I'm just curious that you would say in your experience, again, like I said, I think we'd be better off if porn were just gone. That's my, my opinion. But you know, if there are things where it, for people listening, um, where you'd recommend, if you haven't gotten into this one, it's probably better if you just stay away.

Starting point is 00:32:09 Yeah. Some of these are really insidious. So it's an interesting question, and I can't answer it simply because really addiction is a biopsychosocial disease, and it's the intersection between that individual's vulnerability and access to that drug. If you look from a prevalence perspective, what is the drug that most commonly causes addiction and other health outcomes? It's alcohol, tobacco, and opioids and cannabis. Why? Because those are more accessible than any

Starting point is 00:32:47 other drugs. Alcohol and tobacco are legal, right? So they're more accessible. And cannabis is quasi legal in most states now. And opioids are very, very accessible because we're in the middle of an opioid epidemic and an epidemic of overprescribing, which has now led to a heroin and fentanyl epidemic. So what I'm trying to say is that drug of choice matters. So what's really addictive to one person may not be addictive to another. And when you have the propensity for a certain drug and you marry that with easy access to that drug, you get that perfect storm of, you know, almost inevitable addiction without some sort of intentional, again, sort of self-binding strategies to ward against it. I thought, I used to think that I was sort of impervious to the problem of addiction because drugs and alcohol don't really do much for me.

Starting point is 00:33:48 But then, you know, there was the internet and then there was, you know, digital romance novels, and then there was YouTube and then there was social media. And those are definitely my drugs of choice, right? Once I start down those roads, I have a very hard time. I mean, literally the other day, my husband and I were watching a Netflix episode and the episode came to an end and he had no problem just stopping. And I was like fighting him for the computer because I literally, I had to press next episode. My point is just people always want to know, well, what's the most addictive drug? It's not like there's not like one drug is the most. For one person, one thing is the most addictive drug.

Starting point is 00:34:30 For another person, another thing is the most addictive drug. And access creates the phenomenon of addiction. So one of the biggest risk factors for addiction is simple access. If you have more access to more of the drug, you're more likely to try it. You're more likely to get addicted to it, especially if it is your drug of choice. But they are concerned about any of the things that we've talked about and that it seems to be going in the wrong direction. But then at the same time, they don't want to live like a medieval monk, you know, where there's these extremes. extremes of, and, and, and so do you have any, any advice to share on how somebody can kind of audit their own behaviors and, and try to maintain a, a balance where you get to have fun and you get to do things that are pleasurable, but you also get to remain centered and, you know, you don't

Starting point is 00:35:43 let it get out of control. Yeah. So, um So the things to look for are the four Cs, out of control use, that's using more of the drug than you intended or for a longer period of time. There's compulsive use, which means that you planned not to initiate use, but then you found yourself using even when you had planned that you weren't going to use on a given day. So there's a level of automaticity outside of conscious awareness. Cravings means that you find yourself thinking about using and even having some physical urges to use. For some people, this is they can even break out in a sweat or have stomach cramps. For others, it's just intrusive thoughts of wanting to use. And then the final one is consequences that you

Starting point is 00:36:29 find. It's starting to interfere with your values, with your health, with your relationships, with your work. The other thing to look for are signs and symptoms of going into this dopamine deficit state, which is a physiologic symbol of dependence. And that's essentially tolerance. That's finding that your drug isn't working anymore at the same dose and you need more of the drug or more potent forms of the drug to get the same effect. And finding that when you don't have access that you experience some kind of withdrawal. And it's usually a psychological withdrawal. And for people out there who sort of don't think they can relate to the addiction problem, I would suggest that you consider just putting your smartphone away

Starting point is 00:37:12 for 24 hours and just self-observing that you will likely go into withdrawal for the first 12 hours where you'll be mentally preoccupied, restless, worried about what you're missing. Your brain will make up all kinds of reasons why you really should check it, even though really there's no need. But if you can get past sort of that initial hump, people then will get to that place where they kind of, again, feel free, feel liberated. And then they don't even want to go back and check it because it's kind of nice to not have it be weighing you down.

Starting point is 00:37:42 That's a good segue to my next question, which is if you think there's value in doing mini detoxes. So you talked about the all in and that could be for somebody who has a real problem or for somebody maybe who doesn't necessarily just wants to challenge themselves. Okay. I don't think there's anything probably wrong with that. But is there value in doing like what you just said, maybe committing a certain period of time, I'm not going to be checking my phone or I'm going to take a few nights off of Netflix or I'm going to take a few nights off of the digital romance novels or whatever. Yeah. Yeah. No, this kind of intermittent fasting or these pulses or a digital detox or a digital Sabbath. So trying to one day a week, and this is really what I call self-binding strategies, which is a way to moderate. And what self-binding strategies are is again, a way to put barriers between ourselves and our drug of choice to change our micro environment so that when we have the desire to use, we can't immediately access our drug.

Starting point is 00:38:49 We're able to press the pause button and get a little bit of distance. So yeah, so setting time barriers where you say, I'm only going to use these hours in the day, or I'm only going to use this day of the week or this month of the day of the month, or you can do categorical barriers where you say, I'm not going to play that video game, but I'm going to let myself play this video game. Or I'm going to eat this food, but I'm not going to eat that category of food. Or even like literal barriers, like just like not having it in the house, right? Or not bringing it into the bedroom or something like that. Those are all really important and really useful even if the goal is moderation. So are there any things that we can do?

Starting point is 00:39:34 So we have the abstinence, whether it's a longer term or a shorter term, and that makes a lot of But is there anything we can do to get even more pleasure out of our moderation of our drugs of choice? Can we do things that make the pleasurable moments even more pleasurable that are not destructive, obviously, like positive things we can do to even heighten our sensitivity to pleasure, I guess. Yeah. I think, I think it's not, I think the idea is not, it's not that the way to get, make the pleasurable moments more pleasurable. It's really what you're asking is what's an alternative healthier, healthy source of dopamine and, and a, and a healthy source of dopamine is actually to get your dopamine indirectly by first doing something that is painful, either physically or emotionally painful. Because when we do that, whether it's by exercising or ice cold water baths or intermittent fasting

Starting point is 00:40:32 or reading a difficult book or engaging in a psychologically challenging encounter, what we're doing essentially is tricking our bodies into upregulating our own feel-good hormones and neurotransmitters because we're saying, oh, there's an injury here. I need to protect the body from injury and our bodies then really start to make more dopamine, serotonin, norepinephrine. It kicks into action in our endo-opioid and endocannabinoid systems. And there's a whole literature and a whole science around this called hormesis, which is Greek for to set in motion. So essentially by intentionally inviting pain into our lives, we will set into motion our body's own healing capacity, which will then upregulate dopamine.

Starting point is 00:41:16 And this has been well studied. So, for example, with exercise, what happens is over the course of exercising, we slowly increase dopamine levels and those dopamine levels remain elevated for hours afterwards before going back down to baseline. So this is the runner's high that you get afterwards or in the latter part of exercise. And it's a really great and healthy and adaptive way to get the dopamine because you're getting it indirectly. You're not getting it immediately from the stimulus. You're getting it in response to the stimulus. Having said that, it is possible to get addicted to pain. I have seen patients who are addicted to exercise, who have started to get

Starting point is 00:41:55 addicted to ice cold water, baths, who are addicted to things like cutting or other extreme sports. So it's like anything, when it comes to dopamine, if we do too much for too long or too potent a dose, we're at risk for going into this kind of compensatory dopamine deficit state. So you don't want to do that. You want to do it in measured doses and not too much, but doing things that are hard is actually a great way to upregulate dopamine. That is then what I was thinking is like, okay, well then if we have, let's say we spend most of our waking hours alternating between doing things that are hard, which could be exercise. It could be working, trying to work, especially something

Starting point is 00:42:46 that's difficult. It could be like you said, reading a difficult book or having maybe a difficult conversation, whatever. So we're doing these difficult things. Being fully present, not unplugging, not being distracted, being fully present. Putting the phone away for 15 minutes. Yeah, putting the phone away. I mean, getting off the couch, right? Being fully present for our children, for our spouses, really listening when our spouses talk as opposed to having our own. These are all little mini challenges, telling the truth.

Starting point is 00:43:13 So I talk about radical honesty, the importance of telling the truth and how hard that can be, experiencing the shame that comes with telling the truth about things we're ashamed of. All of that is part of this. So we're ashamed of. All of that is part of this. So we're doing that. And then we also have the dopamine spikes, our drugs, and we have some of that too. But it sounds like that scenario where it would seem like we are always under the influence of dopamine one way or another.

Starting point is 00:43:47 That doesn't lead necessarily to the same issues that if you were to just turn to just your drugs, like that's where you get your dopamine from is just your drugs. But if you balance it with difficult... Because if you're going to get in shape, if you're going to make a life for yourself, you're going to have to do a lot of difficult stuff all of the time. But I guess there's just a different physiological effect. And you mentioned, is it this point that it doesn't spike dopamine in the same way or it doesn't? Well, here's the key. We were really wired for a world of scarcity and ever present danger. So our natural state is to have access to very few intoxicants and instant pleasures and to essentially be working all the time to survive. So it's almost like the natural balance

Starting point is 00:44:40 there. Like if you're going to get the jolt of joy, you're going to have to work for it. You're going to have to sacrifice. That's really the best way to go. But now, now one thing to be aware of, because sometimes this happens, people will get into this like work hard, play hard thing where they work really hard, you know, so they, they do the hard thing. And then instead of letting that be its own reward, they then reward themselves with an intoxicant. And now you got a terrible dynamic because now you're going, that seesaw pleasure and pain is wildly fluctuating from one end to the other. You're releasing cortisol to compensate as the brain tries to restore homeostasis. That is no good. You do not want that. And that happens a lot. So for example,

Starting point is 00:45:25 a lot of patients with addiction who try to get in recovery and they're still trying to work as hard as ever. And I say, you know, you're not going to be able to get in recovery from your addiction until you stop working this hard. You need to have a more relaxed, less stressful lifestyle in order to be able to have the energy to focus on, you know, recovery and abstinence and just kind of getting to know yourself again. That brings me to my last question is, do you think there's value in setting some time aside for just relaxing and just maybe even being bored? Yes, very important.

Starting point is 00:46:05 Yeah. You know, Benjamin Franklin used to recommend outdoor air baths. He believed that it was really important for people to just go outside and be in the fresh air. And I think things like that are important. Just schedule some time every day where you're just sort of outside doing nothing. You don't have a device. You know, you're just in the fresh air. You're looking at the sky. You're looking around you. Maybe you're with your kids. You're at a park. You're not on

Starting point is 00:46:31 your phone. I mean, just really slow. That's the kind of stuff that's hard for me. I always like to be doing something. I like working on the next thing. That's terrible. That's terrible. We have to get away. That's so ingrained in our culture, but we have to get away from that. We have to intentionally slow it way, way down in our lives, in our minds. And we have to see that that is a worthy and valuable thing to do, right? That's really important, right? To leave the devices behind, go outside. Be present for your children. Be present for your spouse or your friend or whoever it is. Let your thoughts kind of unroll. Don't be afraid.

Starting point is 00:47:14 Don't be afraid of that. Great. That's great advice. It's advice that I should take myself, which I... You will. You're going to... This weekend, you're going to do it. You're going to take, Hey, I did it. I did it last weekend. You did. What did you do?

Starting point is 00:47:29 Now we're going to get down to it. I, on, on Sunday, I took my kids to a golf lesson. They wanted to do that. And then, and then from there I took them to, uh, they wanted to go swimming. So I took them to the pool and, and I will say though, yeah, you took your phone this is your question yeah but what you'll never guess what i was doing on my phone though it's not what most people are doing it doesn't matter what were you i know i know i know i was i was doing uh vocabulary flashcards is what i was doing doesn't doesn't count no doesn't count you need to let yourself be bored so do the same thing this weekend but leave your phone at home. I'll do it.

Starting point is 00:48:07 I'll do it. I'll do it. I'll agree. I'll agree to that. Because you will be present for your kids in a really different way. And that's important. Yeah. No, I do agree.

Starting point is 00:48:15 I do agree. And it's something that I can, I can be better with. I'm probably not horrible about it, but I can be better about it. I can, I tend to get lost in not just my work, but I have all these things and goals and, you know, even my vocabulary and that, that ties into my writing. I'm always wanting to work on the next thing. And so it can be hard for me to feel like I'm moving. I'm making enough progress on all the fronts that I want to make progress on. Well, and I, you know and thank you for sharing that.

Starting point is 00:48:45 You're certainly not alone in that. But I think one way to look at that is that sort of like a defense mechanism against the existential angst that we all feel in being alive. We try to really make our worlds a very small place so that we feel safe. And we do that with all these little goals

Starting point is 00:49:03 and this and that and trying to rearrange it all. You just let it all go. This would be an interesting discussion to carry on, actually, I'd be curious. Because I feel like that probably doesn't characterize my personality. I'm sure I'm just another kind of archetype of a person, but it doesn't probably come from a place of fear or worry. I'm just not that kind of person.

Starting point is 00:49:35 I don't believe that. I think behind all those layers of ambition for all of us is really some kind of deep existential fear. i'm not gonna i'm not gonna say it's not possible i'm not aware of what it is if that's the case then i'm not aware of it i'll say that because because you wouldn't let yourself be still long enough well maybe i mean we can follow this up with another another discussion i don't think i mean hey i'm i'm i'm interested in in first and foremost learning more about myself. And I've put a lot of time into it and work into it, but there is no end point. There is no, okay, I finally completely understand everything about myself.

Starting point is 00:50:16 And so I'm always trying to get better. At least there's that. But this was a great discussion. I really appreciate the time. Yeah, likewise. Thanks for being open. Yeah, absolutely. And the book is Dopamine Nation. And if if people listening liked this discussion, then they will certainly like the book. All right. Thanks so much. I hope you liked this episode. I hope you found it helpful. And if you did subscribe to the show,

Starting point is 00:50:44 because it makes sure that you don't miss new episodes. And it also helps me because it increases the rankings of the show a little bit, which of course then makes it a little bit more easily found by other people who may like it just as much as you. And if you didn't like something about this episode or about the show in general, or if you have ideas or suggestions or just feedback to share, shoot me an email, mike at muscleforlife.com, muscleforlife.com, and let me know what I could do better or just what your thoughts are about maybe what you'd like to see me do in the future. I read everything myself. I'm always looking for new ideas and

Starting point is 00:51:25 constructive feedback. So thanks again for listening to this episode and I hope to hear from you soon.

Muscle for Life with Mike Matthews - Anna Lembke on the Truth About “Dopamine Detoxing”

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