Offline with Jon Favreau - Sex, Drugs, and Phone Addictions with Dr. Anna Lembke

Episode Date: May 15, 2022

For a closed-captioned version of this episode, click here. For a transcript of this episode, please email [e-mail] and include the name of the podcast. 

I find myself, I think, on my phone to avoid the times where I'm sitting at bed at night thinking about, you know, bigger questions of meaning and purpose and existence that sort of flood into your head when you're just by yourself. And you tell yourself like, well, I'll distract more difficult now because you have phones and internet and other digital distractions to distract you. I think you're not alone. I think what you described, what you do is kind of constantly distracting yourself so that you don't look at those deeper questions is what all of us are doing to some degree or another. And in a way, it's so tragic because, you know, we've engineered this world that actually allows us to have leisure time to reflect on these deep moral questions. And instead of doing that, you know, we're playing League of Legends, right? I mean, it's just so ironic, you know, that given the opportunity to actually think about, you know, again, you know, what is our meaning and purpose? How should we be living in the world? You know, how should we be engaging with one another? We're terrified of those questions and we're, you know, just wanting to sort of titillate ourselves out of having to think about them.

I'm Jon Favreau. Welcome to Offline. Hey, everyone. My guest today is Dr. Anna Lemke, professor of psychiatry at Stanford University and author of the New York Times bestseller, Dopamine Nation. As most of you know by now, one of the reasons I started the show is because I'm hopelessly addicted to my phone. But until I picked up Dr. Lemke's book, I wasn't using the word addiction literally. Now I'm rethinking that. In Dopamine Nation, Lemke argues that the internet, social media, and our phones are addictive in ways that are quite similar to drugs, alcohol, or tobacco. She even calls the smartphone the modern hypodermic needle and makes the case that constant access to things that flood our brains with dopamine,

like shopping on the internet, watching YouTube, or scrolling through Twitter, are actually changing the way our brains process pleasure. Basically, we're getting too much of a good thing. We're becoming addicted to that feeling. And when we can't get enough of it, the withdrawal leads to an increase in pleasure's most related and most opposite reaction, pain. Dr. Lemke cites skyrocketing rates of anxiety and depression as one consequence of our collective dopamine addiction, especially in wealthier nations where all this access to overabundance is actually causing us harm. What's also interesting is how Dr. Lemke pulls lessons from her own patients, people struggling with addiction, to help us identify and overcome addictions in our own lives that we might not

otherwise recognize. I invited Dr. Lemke on to help us better understand this relationship between pleasure, pain, and our extremely online existence. What followed was an instructive conversation about the way dopamine works in our brains, how the internet, smartphones, and social media are particularly addictive, and how we can reset our brains to have a healthier relationship with technology and the world around us. I certainly found it helpful, and I didn't even have to pay a therapist. As always, if you have any questions, comments, or complaints, feel free to email us at offline at crooked.com, and do please rate, review, and share the show.

Here's Dr. Anna Lemke. Dr. Anna Lemke, thank you for joining Offline. You're very welcome. Thank you for having me. So this is a show about all the ways the internet is breaking our brains and what we can do about that. You've written an outstanding New York Times bestseller called Dopamine Nation that argues the internet and social media are addictive in ways that are similar to things like alcohol, drugs, nicotine, sugar, because they're all screwing with our dopamine levels. For people who might not be familiar with dopamine, can you start by explaining what it is and how it works?

Sure. So dopamine is one of many neurotransmitters in our brain, and neurotransmitters are the molecules that communicate across the synapse. The synapse is the space between neurons, and neurons are the workhorse cell of our brain that conduct the electrical signals that create our thoughts, emotions, and everything. Dopamine is essential for the experience of reward, pleasure, and motivation. It's not the only neurotransmitter involved in that process, but it's probably the final common pathway for all reinforcing drugs and behaviors. Dopamine may be actually even more important for motivation than for the experience of pleasure itself, although it's involved in both of those processes.

And there's a very famous experiment showing that if you engineer a rat to have no dopamine receptors in the reward circuit of the brain, if you put food in that rat's mouth, it will eat the food and get pleasure from the food. But if you put the food even a body length away, the rat will starve to death because it won't be motivated to get up and go get the food. Hence, dopamine is essential for not just the feeling of pleasure, but also the desire to go get the reward. Well, so you're a psychiatrist. What were you hearing from patients that were addicted to drugs and alcohol, they were also almost uniformly very depressed and anxious. And when they were able to stop using drugs and alcohol for a long enough period of time,

which on average was about a month, then they felt better in many different ways. But importantly, their mood improved and their anxiety went down without my having to do any other intervention in terms of like an antidepressant or an anxiolytic or some kind of psychotherapy. So that was very powerful for me because it demonstrated that just stopping the addictive substance alone could have this profound effect on a patient's mood and well-being. The corollary to that was through my career, I've also seen many patients with pain, physical pain, who have gotten addicted to opioids as a result of a doctor's prescription. And what I saw in those patients, for many of them, was that when they got

off of opioids, their pain actually got better. So again, a profound corollary to this idea that when we repeatedly ingest highly reinforcing, that is to say, addictive substances, in the moment, they seem to relieve our pain, whether it's psychological pain or physical pain. But the cumulative effect over time is that they actually make pain worse. And that we don't see that because it's an insidious step-by-step process. But then we find ourselves in this place where we have more physical pain for patients with chronic pain on long-term opioids, have more psychological pain for patients who are using any of those substances. So that's essentially what I've seen. Can you explain a little about this link between pleasure and pain and the role that dopamine plays in that?

Sure. So one of the most important findings in neuroscience in the last hundred years or so is that pleasure and pain are 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 if you imagine that you have a beam on a central fulcrum, when we experience pleasure, it tips one way. When we experience pain, it tips the opposite way. And there are several rules governing this balance. And the first is that it wants to remain level. It doesn't want to be tipped for very long to pleasure or pain. And so with any deviation from that neutral position, our brains will work very hard to restore a level balance or what neuroscientists call homeostasis. And they do that through a process called neuroadaptation. So for example, when we ingest an intoxicant, we get a release

of dopamine in the brain's reward pathway and our balance tilts to the side of pleasure. But no sooner has that happened than our brains will work to restore homeostasis by adapting to the increased level of dopamine by down-regulating our own dopamine production and transmission. I like to imagine that as these little neuro adaptation gremlins hopping on the pain side of the balance to bring it level again. But the gremlins like it on the balance, so they don't get off as soon as we're level. They stay on until we're tilted an equal and opposite amount to the side of pain. And that's very important. We experience that subjectively as the come down, the after effect, the hangover. If it's subtle,

we might not even notice it. It might be outside of our conscious awareness, but for every pleasure, we pay a price. The price is the equal and opposite of whatever the initial stimulus was. And that is how our brains ultimately then restore homeostasis. Now, what happens with addiction is that as we repeatedly expose our brains to the same or similar stimulus, we accumulate more and more neuroadaptation gremlins on the pain side of the balance until we've effectively changed our hedonic set point. Now we are walking around chronically with a balance tilted to the side of pain. Those gremlins are camped out there,

and it takes a long time to reverse that process. So when we don't have our drug, we are in withdrawal, the universal symptoms of withdrawal from any addictive substance or anxiety, irritability, insomnia, dysphoria, and intrusive thoughts of our drug. Now we're needing to use our drug in greater and greater amounts, not to get high, but just to level the balance and feel normal. And when we try to stop using, we go into immediate withdrawal and that can last a very long time, which is why people with addiction will relapse even when by every objective measure, they and others can see that their lives are better when they're not using, but subjectively they are in pain. And that physiologic urge to restore

the balance kind of supersedes everything else. So what you're talking about addiction is something that humans have grappled with for centuries. But the argument in your book is interesting because basically you're saying that this is now a sort of societal issue because there are just so many more sources of addiction out there and there's such easier access. And you say that our brains are not evolved for this world of plenty. Why not? And what are they wired for? Yeah. So this system of the pleasure pain balance, where we have to feel the opposite of whatever the pleasure is before going back to level, is a genius type of wiring for a world of scarcity and ever-present danger. Because it means whatever

pleasure we find, it is fleeting. And in fact, we pay a price for it. And that pain is then driving us to continue to seek more of whatever we need to survive food, clothing, shelter, which is exactly why we've been able to survive through millions of years of evolution, because the world has primarily been a world of scarcity. Over the last 200 years or so, we have completely transformed our world. Technology has created an incredible abundance, not just of our basic material things that we need to survive, but above and beyond that. Now everything is drugified in some way, whether it's food, human relationships, sex, shopping, you name it. We have not just our basic needs met, but we have increased potency, variety, quantity, and access to all kinds of reinforcing drugs and behaviors, which has made us all

vulnerable to the problem of addiction. And furthermore, vulnerable to this problem of the pleasure-pain balance being reset to the side of pain, which I argue is the reason that we're seeing increased rates of mental illness and suicide, especially depression and anxiety. And what's interesting about those increased rates of depression and anxiety is you point out that they're increasing even faster in the wealthiest nations. And you think there's a dopamine connection there. Can you explain what that is? Yeah. So if you look at the epidemiologic data, it's very clear that the rates of depression,

anxiety, suicide are going up and they're going up fastest in rich nations. If you do measures or surveys, happiness surveys, the least happy people live in the richest countries in the world. And those trends are just continuing, which is paradoxical, right? You would think that as we have more and more material goods, more access to state-of-the-art health treatment, including mental health treatment, that we would all be more and more

mentally well. And yet we're seeing the exact opposite. We've clearly reached some kind of tipping point where the overabundance is in fact causing us harm. And I argue that it's because of this sort of ancient wiring in the reward circuitry that I just described. So it's basically because people in wealthy nations and wealthy people just have a lot more access and exposure to addictive substances, whether they be drugs, alcohol, sugar and foods, even just like that we have more access to addictive substances or things that you would clearly identify as addictive substances. It's that we also don't need to strive for anything. All of our survival needs are met. There's nothing that we need to work for. And we're also incredibly insulated from painful experiences. So, I mean, if you think about like how humans evolved,

they lived in their bodies. They had to rely on their bodies to survive. They had to tolerate a great deal of pain, right? Whether that was the pain of exertion to get food or the pain of living, you know, against the natural forces or whatever it was. But we are completely disassociated from our bodies where we spend all of our times in our head. We don't even have to, you know, talk about exerting ourselves. We don't even really have to get up off the couch. If we have any kind of physical pain, we can take a pill to eliminate it. In fact, we expect that we should not have pain and that pain is dangerous and that any type of pain is a mark of psychopathology and that we need to medicate it or do something about it.

So it's both this, the way in which we're insulated from pain and the way in which we don't need to strive for any of our, you know, survival needs. And on top of all that, we are, you know, we have this smorgasbord of highly drugified substances and behaviors, including things that didn't even exist before, like social media and video games and online pornography. Plus, we have a lot more leisure time. We're living longer. We have more leisure time on any given day, as well as having more days in our lives. We have more disposable income, even among the poorest of the poor. So we talk a lot about the income gap.

And of course, there's a terrible income gap and it's a tragedy. But even among the poorest of the poor, people have more disposable income for luxury goods than ever before in the history of humanity. And so because we are chasing pleasure at all costs and trying to avoid pain at all costs, paradoxically, we're causing ourselves more pain, more anxiety, more depression because of this imbalance. Yes, that's exactly right. Yeah. So I'd like to focus in on the digital aspect of our dopamine addiction, because that's what

this show is all about. You've called the smartphone the modern day hypodermic needle. Is it really that bad? I mean, I think so. So if you, the actual hypodermic syringe was invented in the 1850s. And when it was first invented, it was going to be the solution to the growing problem of morphine addiction in the United States. The idea was that if you took the morphine and you injected it directly into the venous system, people wouldn't get addicted. Of course, that turned out to be the opposite of true. And there are many, many anecdotes like that in the history of technology. And I do think that the smartphone has accelerated the growing problem of addiction because of the 24-7 access. One of the big factors

of what makes something addictive is quantity and frequency of how often we use it. If again, you think about that pleasure pain balance, it's probably okay if we indulge in intoxicants on occasion, as long as we leave enough time in between for the neuroadaptation gremlins to hop off and for homeostasis or baseline dopamine firing to be restored. But if as soon as our balance is tipped to the side of pain, we instinctively want to get out of that place, we reach for more of our drug and there it is, then naturally we're going to find ourselves much more quickly circling the drain that is, you know, the problem of addiction. And in my own clinical practice,

I saw an explosion in the early years of the 2000s, more and more people coming in with severe addiction to gambling, pornography. And really, you know, the story was very common. It was like, well, I always kind of gambled or I always kind of used a little bit of pornography, but it wasn't until I got this smartphone that things really got out of control. Yeah, I thought it was so interesting that you made the point that the internet promotes compulsive overconsumption, not merely by providing increased access to drugs old and new, but also by suggesting behaviors that otherwise may never have occurred to us. So are you saying that just being exposed to addictive substances and behaviors can actually make us more addictive? Oh, absolutely. I mean, access is one of the

biggest and underappreciated risk factors for addiction. So the risk factors basically can be grouped into three buckets, nature, nurture, and neighborhood. There's clearly an inherited component or vulnerability. You know, the way we're raised matters. If we have parents who explicitly or implicitly condone substance use, that's going to affect our addiction risk. But neighborhood is huge. And neighborhood refers to this idea of, do you have access to this drug? Is it readily available? Can you get it easily? When you run out, can you get more? I mean, just think of a world in which you had the same access to cocaine as you do to TikTok. There would be a whole lot of people who would be severely addicted. And we already have a cocaine problem, but I mean, just analogizing that to TikTok, it's crazy. I mean, it's infinite, right? And the other part of that too is the suggestibility part. I mean, humans are very, very suggestible. There are certain temperaments that are less suggestible than

others. Teenagers though are particularly that time of life is one of high suggestibility, meaning that peer pressure has a larger effect, but we're all vulnerable to that. And when we see somebody else doing something, it suggests the idea to us, and then we want to do it. That's just human nature. And that's where social media, even separate from social media addiction or addiction to social media, but social media intersecting with addiction to traditional drugs is really, really pernicious. Like, you know, people making videos of themselves using a particular drug and then other teenagers seeing that or people seeing that and then thinking, well, I want to try that. So stuff like that. So I'm sure there's some listeners right now thinking like, well, I'm not that addicted to my phone.

You point out, though, that addiction is a spectrum disorder. Can you talk a bit about that? Yeah. So it's clearly, you know, it's clearly on a spectrum. The Diagnostic and Statistical Manual, the fifth edition actually made a big change to acknowledge that it's a spectrum disorder. You know, not everybody is equally addicted to whatever the drug is. Some people are a little bit addicted. Some people are a lot addicted where they've lost everything as a result of their addiction. And then there's kind of this pre addiction state where people are kind of engaging in compulsive over consumption, but not necessarily meeting our threshold criteria for addiction. I will say that it's important to note that there's no blood test or brain scan to diagnose addiction. We based it on what we call phenomenology or patterns of behavior.

But I can tell you that the pattern of addiction to things like social media, video games, online pornography, et cetera, is identical to when people get addicted to drugs and alcohol. And it's kind of a progressive disease. So, you know, we all start out a little bit addicted and then some of us are able to kind of recognize it and self-correct. Those people probably don't have the disease of addiction or the innate extreme vulnerability, whereas others, once they get going on their drug of choice, will have a very, very difficult time of both seeing it and stopping it even once they do see it. And I think that's a core piece of addiction is the loss of agency. Of course, ultimately, we all retain some agency or most of

us retain some agency. I can think of circumstances where all agency is lost, but agency is greatly diminished in the disease of addiction. Agency is diminished. I think another issue is not knowing that you're addicted right like and i think that's particularly probably the case with you know internet consumption and social media like i remember when the iphone first came out one of my friends got it first and the way he explained it to me was um you'll never be bored again and at the time i thought that sounded great that we'll never be bored again and that's sort of how I used it is like I'm passing the time. I'm using my phone all the time.

I'm not going to be bored. What do you think our inability to just be bored has done to us? What are the consequences of that? Well, let me just first reflect on your friend's comment because it's fascinating. And I think that the truth is that these devices have made us more bored than ever. And again, because what's happened is now we've so overstimulated ourselves with these high dopamine stimuli that natural pleasures and natural rewards are no longer interesting to us. In fact, less and less becomes interesting. And that's what happens in addiction. Our focus slowly narrows down to that drug of choice. Other things lose their salience and we become obsessively preoccupied with obtaining ever more potent

forms of that particular drug. And so we get caught in this vortex. And when we don't have that particular feeling, we're beyond bored, we're devastated. So part of getting out of this vortex of compulsive overconsumption is, first of all, being able to tolerate the intense boredom that comes with the comedown. Because boredom is actually a very uncomfortable emotion. It's uncomfortable in a superficial sense. It's like, oh, this is boring. I don't have anything to do. But it also opens up all kinds of deep existential questions like, what do I do with my time? Like, what is my life for? You know,

why am I here? Why do I do this thing and not that thing? I mean, in interesting ways, COVID and sheltering in place, I think kind of raised some of those questions for people as well, sort of like, wait, why was I doing that thing? But to get out of our cyclical kind of compulsive use of these drugs, we have to be able to sit with that intense kind of boredom until those neuro adaptation gremlins hop off, homeostasis is restored, baseline dopamine firing goes back to original levels, and then we're able to take joy in more modest rewards. Because really, the truth is that anything can be interesting if you focus on it and immerse yourself in it and pay attention to it, even the most mundane task. And this is part of what we need to learn in recovery, not just people with severe addiction, but frankly, I think all of us

who are in a way addicted to this crazy dopamine oversupply that we live in, we have to be able to recapture our joy in simple, modest pleasures. I find myself, I think, on my phone to avoid the times where I'm sitting at bed at night thinking about, you know, bigger questions of meaning and purpose and existence that sort of flood into your head when you're just by yourself. And it's like, OK, well, now I need to I need to take something to fall asleep because I can't sit in bed like this. When I wake up, I don't want to think about these things. I'm just going to scroll through Twitter because that's going to be distracting. And you tell yourself like, well, I'll distract myself with the news of the world and everything else. And I don't have to worry about this. I'll just keep going through. But it is that the boredom thing is a real is a real issue. And I feel like that's probably always been a struggle of humanity. But but it might just be more difficult now because you have phones and internet and

other digital distractions to distract you. Yeah. I mean, thank you for sharing that. I think you're not alone. I think that, I think what you described, what you do is kind of constantly distracting yourself so that you don't look at those deeper questions is what, you know, all of us are doing to some degree or another. And in a way it's so tragic because, you know, we've engineered this world that actually allows us to have leisure time to reflect on these deep moral questions. And instead of doing that, you know, we're playing League of Legends, right? I mean, it's just so ironic, you know, that given the opportunity to actually think about, you know, again, you know, what is our meaning and purpose? How should we be living in the world? You know, how should we be engaging with one another?

We those we're terrified of those questions and we're, you know, just wanting to sort of titillate ourselves out of having to think about them. I want to focus specifically on social media here, which seems to have even more addictive qualities than using your phone for something like texting. Why do you think social media specifically is so addictive? Well, I mean, first of all, we are wired to make human connections. We're social creatures. You know, we release dopamine when we make connections with other people. Being part of a tribe has helped us through evolution, helped us protect ourselves from predators, find mates, conserve scarce resources. So it's, again, it's deeply baked into our DNA to want to make these connections.

And we, you know, we know that oxytocin, which is a love hormone is released and binds to dopamine releasing hormones specifically in this reward pathway. So we get a little hit of dopamine when we make a human connection. So I think what social media has done was, is that it has removed the work that it has taken to make those human connections and distilled human connection down to just the reinforcing parts of it and then made that very, very potent. So essentially turned human connection, which is healthy and adaptive, into a potential drug. And the features of that are, well, first of all, you don't have to go anywhere to meet people. So it's effortless. You know, if it's boring, you don't have to tolerate like a less than interesting or let's say even challenging or distressing interaction. You can just swipe right or

swipe left and find somebody else. You know, these are often curated profiles and beautiful faces and flashing lights and images. We're rewarded for engaging and interacting with likes, with rankings, with confetti, with happy noises. So, you know, the people who made these social media platforms have carefully studied it and quantified it and seen, you know, engineered what keeps people on and then amplified those aspects of it. The alerts too are really interesting. So these are the teasers or the reminders or like the intrusive little thing that comes in and says, oh, you should check this out. You should check that out. We know from animal studies that if you train a rat to know that it will get cocaine once or shortly after it, you know, hears a bell or sees a light, if you measure dopamine levels in that

rat's brain, what you find is that dopamine levels go up just with seeing the light or just with hearing the bell. In other words, the conditioned cue itself is rewarding. But following that brief hit of dopamine with the light or the bell, there's actually a decrease in dopamine, not to baseline levels, but below baseline levels. That's the dopamine deficit state, the gremlins on the pain side of balance. So then we're in craving, right? And once we're in the craving state, once our balance is tipped to the side of pain, we are very, very motivated to do whatever work is required to get the reward. And my colleague, Rob Malenka, who's a neuroscientist says that in his animal studies, the way that he defines whether or not an animal is addicted is how hard that animal is willing to

work to get the reward. So what happens is we get a little alert, oh, you should check out, you know, this, this video. And we get a little burst of dopamine and we get a dopamine deficit state. And then it's like, you know, we could be, a train could be coming, but it's like, I'm going to take the time here to go check out, that video i must do that now because it's just like it's hardwired physiology i mean i i your point about doing the work to make these social connections is so well taken because i think one of the things i tell myself to justify all my time on twitter is you know i'm in politics and And so I'm like, well, these larger questions of meaning and purpose that we were just talking about, I'm trying to engage other

people in those questions. And we're trying to have this debate about our purpose here and how we all live together and all that kind of stuff. But that's not really what's happening on social media, because it's not like we're all sitting together having these deep conversations that you would with people in real life where you're arguing with each other and you're doing the work to build connections and figure out politics and all that kind of stuff. Because you're just trying to make a statement, get the retweet, hit the like, and get those quick dopamine bursts. Right. Exactly right. What it becomes is really just a chase for dopamine. And the actual content that we are using to justify why we're there is really relegated to a corner because we can tell ourselves that's why we're there because of the argument

or the debate or the pros and cons of X, Y, or Z. But really, it's about the hits. And one of the ways that we create intimacy with other people is to feel the same emotion at the same time that they're feeling it. Now imagine, you know, including negative emotions like outrage, right? And now on social media, you can have that experience not just with one other human being or even a small handful. Now you're having it with millions of human beings.

So the potency of that experience is very, very intense, which is also a way in which it becomes drugified. How has this explosion in the use of smartphones and social media changed how you treat patients? It's really changed how I treat patients. 20 years ago, a patient would come in and say, I'm depressed, I'm anxious. I'd say, try this pill, try that pill, try some psychotherapy. I didn't even ask really about drug and alcohol use. And it didn't even occur to me that our engagement with these devices necessarily, although I think I really early on had kind of an intuitive sense that these devices were highly habit forming and addictive. And now when a patient comes in wanting help for

depression, anxiety, insomnia, poor concentration, whatever it is, one of the very first things I'll do is I'll screen for compulsive overuse of drugs, alcohol, and all kinds of digital devices. And if I find that that's a part of that person's daily practice, then the first thing that I will suggest is a dopamine fast to try to reset reward pathways. Because in the majority of my patients, when I do that, that intervention alone essentially alleviates most of the depression and anxiety that they came in for in the first place. So I'm not a patient of yours, but I've already tried to use this interview to get some free counseling. So what is a dopamine fast like if I'm addicted to my phone all the time? And of course, again, I tell myself, and this is somewhat justified, that I need to be on my phone

because I need to keep up with the news because I do two podcasts about the news. So I need to keep up with the news. I need to be on my phone. But it does feel, you know, it definitely got worse during the pandemic. It's one of the reasons I started this show. I'm just on my phone too much. What does a dopamine fast look like for someone like me? Well, for someone like you, you know, who sounds like you're kind of the average consumer at this point and not

somebody with a full-blown addiction. I want to really emphasize that when I use that word addiction, it's somebody who's had serious life consequences as a result of their use. And so that can look things like profound depression, profound anxiety, inability to function in their major societal role, thoughts of suicide. In that context, severe addiction, and I see that. So let me just emphasize, I see people with, they're suicidal because of their online gaming disorder, because of their pornography addiction, because of social media engagement. And for those individuals, what it really takes is putting all screens away for a month. And why a month? Because a month is usually the average amount of time it takes to

reset reward pathways. I always warn patients they're going to feel worse before they feel better. Those first two weeks are especially horrible as they go into withdrawal. But as the gremlins start to hop off and homeostasis is restored by weeks three and four, you know, the sun comes out for people and people will say, I feel so much less anxious, you know, and then it becomes, how are we going to reintegrate this device if we are, you know, back into your life and very specific what that will look like. Now, what I've learned, you know, since the publication of the book is that many people either can't or are unwilling to do that because they need to be engaged with these devices for their jobs. So then what I suggest is that you find the category

of online behavior that you feel is unhealthy for you. The online behavior that once you start, it's difficult for you to stop. And or you find that you feel worse after doing it. So it somehow changes your subjective dopamine state so that you're more depressed and anxious as a result. And then you take that thing, whether it's maybe it's Twitter, maybe it's Facebook, maybe it's Instagram, maybe it's Snapchat, who knows? And you eliminate that for a month. I think that's probably the recommendation that I would have for someone like you. And that you can plan that in advance, right? You can let people know, I'm not going to be on Twitter for this amount of time. You can communicate to me in this other way. You can plan for other ways that you'll get your news by reading maybe long form journalism, which will give the opportunity

to compare and contrast how much knowledge you actually acquire from Twitter versus other forms of getting your news. And my experience has been, I feel like I'm ultimately a lot more, a lot better informed than many people who are getting their news from social media, because it's not really the best, the best source ultimately. And, you know, that's kind of what I recommend. There's also a mini fast that people can try where they literally put all devices and screens away for 24 hours. It's amazing how anxious that makes people just the thought of like, it's almost like being like, they're going to be blind and unable to like grope their way through a 24 hour period without their phone. But I think that can be an instructive experience. It's not enough time to reset reward pathways, but it's enough time to recognize how addicted we've all become. You talk a lot about balance as a solution.

Do you think a healthy use of social media is possible? I think it is possible, but I do think that it must start with a dopamine fast to reset reward pathways. A lot of times patients will ask me, well, can't I just slowly decrease? The problem with that is that then you never reset reward pathways. So you never regain the salience in other more modest rewards. And you also don't get the opportunity to see true cause and effect. It's not until we get some distance from our drug that we're able to really look back and say, wow, that's crazy that I put that much time and effort into using, you know, that substance or doing that behavior online. Like I don't even really recognize myself. So I think it starts with a fast and then a very

detailed plan of, okay, how am I going to reintegrate this into my life? I'm going to make sure that when I wake up in the morning, I first exercise, get ready, you know, do my, my, my called chaos at us because my kids are in Spanish immersion, but the things I need to do, my to-do list, you know, eat a healthy breakfast, clean up, make my bed, whatever my morning, you know, sort of practice wellness practices are. And only then am I going to go to my device and turn it on. And before I turn it on, I'm going to actually make a list of the things that I'm going to do on my device. Now that list might actually include some YouTube surfing, but I'm going to be aware that when I'm doing that, I'm doing that. I'm not going to sneak it in between. And then when I'm not using the device, I'm gonna power it down i'm gonna turn

it off and put it in my bag right there's this almost this sense of once we've sent a missive out there's a part of our brain that's mentally preoccupied with it coming back in and it's just really amazing to me how like we're always a little bit disengaged from what we're doing because we're thinking about our phones. But if you turn the thing off, you don't send anything out. So you're not expecting a return and you turn it off. You can put it away for a while. And that's very, very liberating. So just a lot of little tricks like that. I mean, my patients have come up with a million amazing, you know, ways that they've learned to kind of interact with these devices, but in a way

that preserves their agency and allows them to balance or moderate their use. The last lesson you had in the book was my favorite. You said, instead of running away from the world, we can find escape by immersing ourselves in it. Why does that work? Can you talk about that? Well, I mean, I've spent a lot of my life, you know, running away from painful things only to find out that they always outrun me. So no matter, you know, no matter how hard we try to pretend like those things are not there, tell ourselves stories that, you know, rework a narrative, at the end of the day, you know, the truth will find us. So ultimately, it's better just to

stop trying to distract ourselves, turn and face it and just tolerate it, examine it, dive deep into it, wonder about it, sit with it, and recognize too that we're not alone in our suffering, that life is hard, that no matter who you are, I mean, I think people can look at other people's lives and think, oh, they have it all, or that person's got it all together. Everybody suffers. Everybody suffers. Everybody questions. Everybody struggles. You know, we're not alone in our suffering. So I think that's important to recognize that and take comfort in that and normalize sadness and, and even some degree of despair and just, you know, remember that those feelings will pass. You know,

we won't, when we're in those States, we feel as if they're going to last forever, but in fact, they never do. Nothing lasts forever, not even our misery. And it sounds like that's also a way to give ourselves more lasting, deeper pleasure than just sort of chasing the quick dopamine hits. Right. So one of the, you know, one of the recommendations in my book is basically instead of constantly pressing on the pleasure side and getting those gremlins on the pain side, if we intentionally press on the pain side by doing things that are mentally and physically challenging, the gremlins will actually hop on the pleasure side. This is the science of hormesis, which is Greek for to set in motion. And it turns out that mild to moderate noxious stimuli actually

upregulate dopamine production and other feel-good neurotransmitters. So by kind of simulating a world that doesn't exist anymore, that is to say simulating hardship, we can reset our dopamine reward pathway to the side of pleasure. Last two questions I'm asking all of our guests. What were you doing the last time you realized you needed to put your phone down? And what is your favorite way to unplug? Oh, gosh. Well, you know, I actually don't really use a smartphone.

Wow. Yeah. I had to get one a couple years ago so that I could prescribe medicines. But other than that, I don't use my phone. But I'm vulnerable to YouTube surfing. And probably the last time I can remember, you know, I'll get on YouTube and I'll just like be watching inane videos. And I, what I'll do is I'll refresh the YouTube button because I want to see what YouTube offers me. It's like almost like an old friend, like what, what my friend, what is my friend YouTube thinking that I should

watch today? I mean, I actually, I'm drawn in by that. You know, the way that someone might suggest a book because they know you. I mean, I know it's terrible, but, and I have to say, I've been watching the Johnny Depp, Amber Heard trial and think to myself, why am I about that. Why am I watching this? Why am I watching this? But there it is. And how do I get off? I often will call out to a family member, can you please come help me turn this off?

I cannot get off. Come and help me shut down the computer. I love that. That's a great way to unplug, asking someone for help doing it. Dr. Anna Lemke, thank you so much for joining Offline and for all the wonderful advice. Really appreciate it. You're very welcome. Thanks for having me and thanks for a great conversation. Offline is a Crooked Media production. It's written and hosted by me, Jon Favreau.

It's produced by Austin Fisher. Andrew Chadwick is our audio editor. Kyle Seglin and Charlotte Landis, sound engineer of the show. Jordan Katz and Kenny Siegel take care of our music. Thanks to Tanya Sominator, Michael Martinez, Andy Gardner-Bernstein, Ari Schwartz, Andy Taft, and Sandy Gerard for production support. And to our digital team, Elijah Cohn, Nar Melkonian, and Amelia Montooth, who film and share our episodes as videos every week.