The Liz Moody Podcast - How To Hack Your Dopamine To Stop Reaching For Your Phone And Experience More Pleasure In Everyday Life With Dr. Anna Lembke

Episode Date: February 2, 2022

My guest today is Dr. Anna Lembke, professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of the instant New York Times best seller Dopamine Nation: Finding Balance in the Age of Indulgence.On this episode, we talk about: what dopamine is and what it does in your body why you don’t necessarily want to raise your dopamine levels (despite what pop science leads you to believe) how the way our brain is wired is mismatched with the modern world (and how to fix it) why you can’t stop reaching for your phone (even when you’re supposedly doing something you like more) an easy hack to experience more pleasure in all of your daily experiences the surprising reason why rates of chronic pain, fibromyalgia, anxiety, depression are going up a science-backed way to overcome the initial hurdles of doing hard things that we know are good for us examples of high dopamine activities we want to lean away from and low dopamine activities we want to lean into more the neuro-scientific reason wealthier people are often MORE unhappy what a dopamine fast is and how to do it Tag @lizmoody with any thoughts, feelings, or reactions as you’re listening, and show me changes you make based on the episode! I would also SO appreciate it if you shared this episode or any favorite episodes with someone you love in your life! PS: My Patreon is live! You can join Green Smoothie Society and get access to ALL of my green smoothie recipes and advice! Get all the deets at patreon.com/lizmoody. This episode is sponsored by the Healthier Together Deck, which has 150 conversation starters in 6 categories! Find out more at htdeck.com—if you order today, you can get it in time for Valentine’s Day! This episode is sponsored by AG1 by Athletic Greens. Visit athleticgreens.com/healthiertogether and get your FREE year supply of Vitamin D and 5 free travel packs today. This episode is sponsored by Seed. You can get 15% off your first month’s supply of Seed’s DS-01™ Daily Synbiotic by going to https://seed.com/daily-synbiotic and using the code LIZMOODY. This episode is sponsored by Paleovalley. Head over to paleovalley.com and use the code LIZM for 15% off. This episode is sponsored by Dame. Head over to dameproducts.com and use code HEALTHIERTOGETHER at checkout for 20% off your purchase through January 31, and 15% off from then on. Healthier Together cover art by Zack. Healthier Together music by Alex Ruimy. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends, and welcome back to the Healthier Together podcast. I'm your host, Liz Moody, and I'm a cookbook author and long-time journalist. The Healthier Together podcast is all about helping you live your healthiest, happiest life, whether we're doing a chatty, girlfriendy episode about sex or dressing cute or deeper dives into hacking our hormones or glucose levels or gut health. My guest today is Dr. Anna Lemke. Dr. Lemke is, who, she is an impressive woman. She is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.

She's published more than a hundred peer-reviewed papers, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar and maintains a thriving clinical practice. You might also have seen her on the Netflix documentary, The Social Dilemma. Her new book, Dopamine Nation, Finding Balance in the Age of Indulgence was an instant New York. bestseller and can be found wherever books are sold. This episode is all about dopamine, which based on my TikTok for you page is incredibly misunderstood. We talk about what dopamine actually is and what it does in your body, while you don't necessarily want to just raise your dopamine levels despite what pop science leads you to believe, why you can't stop reaching for your phone even when you're doing something that you supposedly like more like hanging out with your friends or watching a good TV show,

an easy hack to experience more pleasure in all of your daily experiences, the surprising reason why rates of chronic pain, fibromyalgia, depression, and anxiety are going up, a science-backed way to overcome the initial hurdles of doing those hard things that we know are good for us. The neuroscientific reason wealthier people are often more unhappy, what a dopamine fast is, and how to do it, and so much more. There's a ton of incredible scientific knowledge in this episode, but Dr. Lumkey is so good at explaining this stuff. And I tried to always bring it back to the pragmatic and actionable things that you can do to feel better in your life today. If you feel like you're always reaching for your phone and you don't want to be, if you wish that you had a better relationship with alcohol or

sugar, if you don't know why you can't find the motivation to work out or to meditate, if you find yourself easily bored or find it hard to take pleasure in simple life activities. This episode is for you. The good news is there are really small changes that we can all make that will yield huge results. I personally had a few game-changing takeaways from this episode that I feel like really transformed how I live my life day to day. So stay tuned after the episode. I will walk you through everything that I am thinking and doing differently. And of course, I would love to hear your thought. So please share them by taking a screenshot and tagging me on Instagram. I am at Liz Moody. I would also so appreciate if you would share the episode with anyone in your life who you think would

benefit. Maybe somebody who is struggling with any of that stuff that I just mentioned with the alcohol or the sugar or the working out or the phone. I feel like I know a million people. Like everybody in my life is struggling with at least one of those things. So please share Dr. Lemke's wisdom. Okay. Let's talk dopamine. You're listening to the Healthier Together podcast. Dr. Lemke, thank you so much for taking the time to join me today. I'm so excited to talk all about dopamine. Well, I'm excited too. Thank you for inviting me. Can we start off? Can you just explain to me what dopamine is and what it does in your body like you were talking to a five-year-old, like a really smart five-year-old, but a five-year-old? Sure. So dopamine is a chemical that we make in the brain and it is technically a neurotransmitter. So neurotransmitter. are the molecules that go back and forth between neurons in that gap between neurons called

the synapse. It's not really that important to understand exactly how that works. But the bottom line is that dopamine is essential to the experience of pleasure, reward, and motivation. It's also really important for movement, and it's no coincidence that motivation and reward are linked to movement because typically we would have to get up and move to go get the reward that we want. So when the internet, when I feel like when I hear about dopamine on the internet, everybody's like raise your dopamine, how to raise your dopamine, how to hack your dopamine to make it higher, do you view it as always a good thing to be trying to get your dopamine levels higher and higher? Is that the goal? Do we have low dopamine and we need to raise them?

Yeah, it's a great question. And it's a little bit. difficult to understand without understanding the concept of homeostasis. And in simple terms, homeostasis really just means balance or being in balance. So we, all of us are constantly firing dopamine in our brain. It's being produced. It's being released in the synapse. It's going back and forth between neurons at a low constant baseline level. And the things that we do, do and the things that we ingest can change that baseline level. So when we talk about, you know, being sort of in a healthy dopamine place, you know, it's not really about raising dopamine necessarily or lowering dopamine.

It's really about how to keep things in balance, which is why in my book I do use actually a balance, like a teeter-totter in a kid's playground, as an extended metaphor to explain the neuroscience. Do you think that modern life tends to put most of us in a certain place on that balanced scale, though? So is it like a lot of the hacks and whatever are about raising dopamine because most of the way we live now lowers dopamine? Or how does that work? Yeah, so it's tricky. But basically, we are wired over millions of years of evolution to approach pleasure and avoid pain. It's what's kept us alive in a world of scarcity and ever-presenting. in danger. And the way that our brain signals to us that something is pleasurable and that we should

try to do it again and again and again is that it releases dopamine in a part of our brain called the reward pathway, and that feels good, right? That's associated with euphoria. That's associated with all of the pleasing kind of states of arousal, but also the cessation of certain states of pain. So, you know, we're wired to pay attention. to dopamine as a signal to tell us what we should try to do again and again. But the problem is that this primitive wiring is mismatched for the modern world, where we have access to an almost infinite supply of highly reinforcing drugs and behaviors. And the essential difference between things that are reinforcing and even addictive and things

that are not is that things that are addictive release a whole lot of dopamine all at once. And in essence, they release a lot more dopamine than our primitive brains were evolved to tolerate. And so in response, what our brain does is says, oh, whoa, way too much dopamine going on here. I need to downregulate or lower my own production of dopamine. I need to take my little dopamine receptors that are like catchers mitt and catch the dopamine on the outside of the neuron. And I need to, you know, collect those receptors and bring them inside. because I've got too much dopamine going on here. And essentially what the brain then does is it down regulates dopamine,

not just to baseline tonic levels of firing, but actually below baseline. We go into a dopamine deficit state. And that dopamine deficit state is akin to clinical depression. The universal symptoms of withdrawal from any addictive substance or behavior are anxiety, irritability, insomnia, dysphoria, and craving. So the bottom line is that when we do something that is highly and immediately pleasurable or reinforcing, we pay a price for that. And the price is that our body shuts down a dopamine production and we go into this dopamine deficit state so that the aftermath of that pleasurable experience is a painful experience. And it might be very subtle and it might be just outside of conscious awareness.

for example, just when that, you know, fun YouTube video ends, we have this fleeting moment of wanting to watch another one, right? That's our brain sort of saying, ooh, that was so much fun that I've now had to like compensate and sort of put you in this kind of semi-iritable craving state. So, and that's what drives, you know, like click next video, click next video, click next episode, right? But the problem, the problem is that with repeat, exposure to highly reinforcing substances and behaviors, that initial response gets weaker and shorter, but that after response, that dopamine deficit state gets stronger and longer so that ultimately we end up feeling very bad because we've spent so much time feeling very good.

I'm picturing two scenarios that immediately come to my mind with that. One is when you're out at a restaurant with friends and everybody's reaching for their phone, even though you're ostensibly doing the fun thing, you're hanging out with the people that you love and having the conversations. But there's something like addictive or easier about, I don't know, picking up your phone and scrolling through it. Is that dopamine related? Yeah. So, and that's exactly a wonderful example of why our phones do essentially represent a potentially addictive drug. They're not neutral. And what I mean by that is that anything that we do, that as soon as we're done doing it, we immediately have an urge to do it more and do it again.

That's a signal we need to pay attention to in our modern ecosystem because that says that, hey, that's something that's potentially addictive. That's something that releases a lot of dopamine all at once, that then your brain compensates by going into this dopamine deficit state, which then drives. the urge to want to use again, creating this kind of death spiral, where you get to a point where that's the only thing that's enjoyable and other things, more natural words like sitting around chatting with friends, is no longer pleasurable. And when we're not doing, you know, that, that behavior or that substance, we're in this dopamine deficit state where we're unhappy. So it's

very paradoxical because it feels like we're in control of choosing that experience. But with repeated exposure, that experience really controls us and narrows our focus, makes it hard to enjoy other things, and sort of constantly sucks us back in. And that's essentially what's happening, you know, in the scenario you describe. Well, and to that point, the second thing that I pictured was a conversation that I had with my therapist recently, where we were talking about how these things that bring us more pleasure ultimately, I'm thinking like getting, like, getting into a really good book or taking a walk, they feel boring at first. I was trying to think about adding pleasure and joy and play into my life. And I was having a conversation and therapy

about that. And I was like, the hurdle that I'm trying to overcome is that these things really do feel boring compared to this immediate hit of, I don't even know if it's satisfaction, just like pleasure on a very base but not very satisfying level that you get from being on your phone or eating sugar or things like that. Yes, exactly. So what's happened in our modern ecosystem is that we're all constantly bombarding our reward pathway with these highly reinforcing very potent drugs that come in almost any form in our food on the internet, in actual drugs that we take, both prescribed and otherwise, such that we've effectively changed our set point for experiencing pleasure and pain to a place where it's that much easier to experience pain, and we need a whole

lot more pleasure to experience pleasure. And in the book, I do use this extended metaphor of a balance, which I think is a helpful way to understand this. And if you'd like, I could quickly like describe it. Yeah, I would love that. That's sort of that pleasure pain, teeter-totter that you have in the book. Okay, yeah, talk about that. So imagine that in your brain there's a balance like a teeter-totter, it's like a board on a central fulcrum. And that balance represents how we process pleasure and pain. When we experience pleasure, it tips to one side. And when we experience pain, it tips to the opposite side. But there are opposite side. But there are three rules governing this balance. The first is that the balance wants to remain level. and our brains will work very hard to restore a level balance or what neuroscientists call

homeostasis after any deviation from neutrality. And the way that the brain does that is by tipping an equal and opposite amount to whatever the initial stimulus was before returning to neutrality. So, for example, if I have a piece of chocolate, I get a little release of dopamine and the reward pathway, my balance tips to the side of pleasure. But no sooner has that happened. Then my brain adapts by down-regulating, dopamine and dopamine receptors. I imagine that is these neuroadaptation gremlins hopping on the pain

side of the balance to bring it level again. But the gremlins like it on the balance so they stay on until it's tipped an equal and opposite amount to the side of pain and that's wanting that second piece of chocolate. If I wait long enough, that feeling passes, the gremlins hop off and neutrality is restored. But again, the first rule of the balance is that for every pleasure we pay a price because the way that the balance goes back to the neutral position is by first tipping an equal and opposite amount to the side of the opposite of whatever the initial stimulus was, and that's called the opponent process mechanism. Now, here's the second rule of the balance, and it's probably the most important one for understanding how we get addicted. With repeated exposure to the same or similar stimulus, that initial response, the tilt to the side of pleasure, gets weaker and shorter, but that after response gets stronger and longer. words, the gremlins get bigger, more muscular, more numerous. And eventually, you know, we get to a

point where that piece of chocolate does absolutely nothing for us, but we pay a very big price with all those gremlins camped out on the pain side of the balance, tents and barbecues and tow. And this is essentially what happens as people become addicted. They get to a point where they've changed their pleasure pain set point. Now they need their drug of choice not to feel good, but just to restore a level balance and feel normal. And when they're not using it, their balances tip to the side of pain. You know, gremlins camping out there and they're in a dopamine deficit state. So they're irritable, anxious, craving, narrowly focused on their drug. And this is why people with addiction will relapse, even months and years after they've stopped using their drug.

It's because it takes a long time for the brain to readapt to the absence of that drug. And so people are walking around in this dopamine deficit state. Now, the third rule of this balance is that the balance remembers. We have an incredibly keen memory for that initial stimulus of either pleasure or pain. And you can imagine from an evolutionary perspective why that would be, because we have to remember where we found that oasis, right, in order to be able to find it again. And we have to also remember, you know, where the lion's den is and the last time the lion mauled us and nearly killed us so that we don't go in that direction again. But we're incredibly amnestic or the after effect or the gremlins, the opponent process effect. So, for example, many times

my patients in recovery from addiction will talk about euphoric recall and how they always remember that those early times of using their drug and how good it felt. And the same thing with me, like, I love chocolate. And when I think about chocolate, I only associate it with the delicious flavor of chocolate. And I don't remember the constipation and tummy ache that I got, you know, after I ate the whole box, just as an example. Likewise, on the pain side, you know, we really remember getting burned on the stove, and we really remember how hard it is to jog, but we don't remember how good it feels after we exercise. We're incredibly amnestic for that opponent process mechanism because just as the gremlins hop on the pain side after a pleasurable stimulus,

they will also hop on the pleasure side after a pain stimulus, which is one of the secrets actually for resetting the balance and getting dopamine in a more enduring way. The number one rule of habits is to make the things that you want easier and the things that you don't want harder. Yet so many of us want to eat healthier, but so few of us actually take the steps to make eating healthier easier. That's where Marley Spoon comes in. What I love about this company and what's different than all of the other companies out there that are doing like stuff in the same arena, is that you can customize your choices based on the effort that you want to put in. So if you want them to send you ingredients, so you can make your own 20-minute meal in,

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and things like that that you're talking about in the book? Yeah. So, you know, the book is quite prescriptive. I talk about the neuroscience. And then I say, you know, Here's what you can do to restore a healthier balance. First, you need to avoid intoxicating, highly reinforcing substances and behaviors long enough to reset healthy reward pathways. And if you go back to using, you want to use in moderation, right? You want to use your intoxicants not too frequently because you don't want those gremlins to collect on the pleasure side. And you don't want to use too much and you want to avoid certain highly potent stimuli that you know you can't regulate. But in addition to like avoiding abstaining from and then ultimately in some cases trying to moderate your drug of choice, you also want to intentionally invite painful experiences into your life.

Why? Because by pressing on the pain side of the balance as the initial stimulus, you induce those gremlins to hop on the pleasure side. This is the science of choramesis, which is Greek for to set in motion. And essentially what it means is that by using mild to mind, moderate, noxious stimuli. What we do is we signal to the brain and the body that there's an injury, which causes our brain and body then to upregulate production of our own endogenous feel-good neurotransmitters and hormones like dopamine, serotonin, norpenerfarin, or endocannabinoid system, or endo-opioid system. So it's things like exercise, cold showers, doing something that's cognitively challenging, that requires frustration tolerance, doing something that's emotionally

challenging, or even in this day and age, just unplugging for a while and tolerating boredom and tolerating silence, which can be plenty distressing because we're so used to the constant stimulation. So that would be an extra. There's all the benefits of meditation that we talk about with focus and bringing your attention back. But even if you're not successfully meditating and you're just sitting there being bored, would that be a beneficial activity in terms of like the pain of dopamine? Well, you know, meditation, it's funny. I think when most, I mean, for a practitioner, for people who are not regular practitioners

of meditation, I think it's important to emphasize that, you know, meditation isn't just like sitting, you know, in a certain position, engaging, you know, in a certain type of mind, body work. You know, we can be mindful and sort of access our meditative states all throughout our conscious waking lives. So it's not just a matter of like being bored and be like, this is horrible. You know, I'm so bored. Why am I doing this? It's more a matter of like going, oh, this is interesting. Like I'm quite anxious in the face of sitting here doing nothing. I wonder what that's about for me. I wonder, you know, why it's so hard to tolerate things like this. You speak about

removing the source, you know, sort of doing a dopamine fast, something like social media, for instance, I can't remove social media. I have to be on it for my job. I'm curious if you can't fully remove the source of the dopamine and then bring it back in a moderate way, if there's any way to bring yourself back into that balance. Can you just skip to the moderate part or does that not work? Yeah. So in my clinical experience, that doesn't work. It turns out, it's much harder to go from using a lot to using in moderation than it is to go from using a lot to using none to trying to return to moderation. And I think the neuroscience explains that well, which is to say by abstaining what happens

is you allow enough time for those neurodaptation gremlins to hop off the pain side of the balance and restore a level balance, that is to say, baseline, healthy dopamine firing, such that number one, you can then actually gain access to the pleasure of more modest rewards. And number two, you can look back and see true cause and effect because something very tricky happens and something very distorted actually when we're chasing dopamine is that we can't really see true cause and effect. And we tend to minimize the problematic aspects of that drug on our lives, as well as rationalize all the reasons why we couldn't possibly stop using it. But when we get some distance from it, we're able to go, oh, yeah, that was just a rationalization.

And I see that now. And one of the most common rationalization is I can't stop this behavior because I need it for my work. And although I fully acknowledge that, you know, this technology and the, you know, the metaverse is deeply embedded now into our lives and even our DNA. And we have to learn, you know, learn to live in a companionable way with it. I do not accept at face value that people can't turn it off for a period of time, even people for whom it's an integral to their work. There are things called vacations. And surely somebody can take at least a week of vacation.

And in that time, you know, lay the groundwork for other people covering whatever it is they do such that they can get away for a week. Now, I usually say in my book that typically I think it takes about a month of absence from a particular drug to reset reward pathways. But I base that on data having to do with highly addictive drugs like alcohol and cocaine. We really don't know when it comes to behavioral addictions or digital products. In my clinical experience, a month is about what it takes. But, you know, I've seen people for whom sort of restoring dopamine levels can happen much sooner. But what I say is, you know, if you can't do a month, do a week. If you can't do a week,

do one 24-hour period where you do not look at a single screen, touch a single device, check a single text message or social media app, and just observe what happens because it is a really interesting experiment where people will go into withdrawal. And in a way we had sort of an artificial, enforced example of that when Facebook shut down some time ago. I don't even remember the date. I think it was last year. There was some like massive outage of like Facebook and Instagram. And people seriously freaked. And I think it's because they went into withdrawal.

But it's really good to observe that and then go, okay, wait, you know, this thing is really kind of controlling me. And, you know, how can I get some distance so that I can use it in a way that's more consistent with my goals and my values and elevates my autonomy and choice? The other thing that I thought was really interesting about the pleasure pain scale was when you talked about how much people reporting being in mental or physical pain has gone up, whether it's like, I think you mentioned fibromyalgia, depression, pelvic pain syndrome, anxiety. And I think from what I understand reading your book, it's because our access to pleasure has increased.

Is that right? Is that part of the pleasure pain balance? Yes, that's correct. So I hypothesize that this is happening on an individual level on a very mass scale and may in part explain why rates of anxiety, depression, suicide across different nations, what you will find paradoxically is that the richest nations with access to the best health care and all of the privilege that comes with wealth are the nations that have the highest rates of these kinds of mental and physical health problems, including, you know, unexplained pain syndromes, physical pain syndromes. And, you know, I postulate that that's because we are constantly bombarding our pleasure pain balance with these highly reinforcing drugs and

behaviors and that our brains are madly trying to compensate by downregulating our feel-good hormones and putting us in this dopamine deficit state such that the antidote to this problem is not more feel-good pills and feel-good behaviors and trying to insulate ourselves from pain and all of the things that, you know, we do, you know, the antidote is, believe it or not, to eschew or avoid these pleasures and do things that are hard. Yeah, it's so interesting when you put it into the context of like self-care. It's like, do I actually need a warm bubble bath and to, you know, hang out and watch a stupid housewife show or something? Or should I be going for a hard run and taking a cold shower afterward, you know? Yeah. And, you know, all good things in moderation, right? Like,

this is not about like never enjoying that cup of coffee or never, you know, watching your favorite Netflix show. But it's about observing that if you have coffee and chocolate in the morning and, you know, you take your stimulant at noon and you're on your phone all day and you binge on Netflix tonight, it's the cumulative effect of all of that that resets our balance to the side of pain, such that we really have to, you know, you know, I do believe we need to consciously pursue a new form of a and then introduce these pleasures knowingly in extreme moderation. And also they'll be more pleasurable then. I mean, that's the irony.

Like we can't almost even enjoy all this stuff that we do. And then I do believe that in that moment of feeling bad where we do want to reach for a piece of chocolate or, you know, an escape movie or, you know, a hit on a bong, whatever it is, that it is good to experiment within that moment, not doing the thing that it's, feels instantly good, but actually doing something that's challenging and difficult. And noticing how in its aftermath, you know, we actually feel better in many instances than we would with, you know, after that show or, or, you know, that hit or or that extra piece of chocolate cake. Do you have any tips for those first moments of doing the harder thing?

Like, I'm thinking about the first five minutes of reading a literary fiction book where your mind sort of wandering and you're just like, my God, I just want to like, this is hard work, you know, those overcoming that initial hurdle. Yeah. So I think, you know, when you understand the neuroscience and you realize that in that moment of doing the hard thing, you're basically like producing dopamine, like you're your dopamine factories. They're like they're chugging along. then it reframes that experience as like, oh gosh, I'm doing this thing that's hard and pour me into a thing that's like, wow, this is really good for me. And this is going to pay off dividends like going forward so that it becomes like a project you want to do. And for me, this reframe works. Like for me, I, you know, exercise is sort of my go-to for, you know, resetting my balance and creating resilience. resiliency in that regard. And I'll be, you know, and I'm by the way, you know, really slow and everybody

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I have a weird question. It's a kind of habit rule that people talk about, which is that you can overcome your procrastination at doing hard things. by making those hard things fun, like listening to an interesting podcast while you're working out or folding the laundry, just kind of trying to do these little tweaks to make those harder things fun. Would that take something that would have been on the pain side of the pleasure pain balance and good for your dopamine in that way and turn it into something that's just back on the pleasure side and a high dopamine activity?

Yeah, that's an interesting question. You know, this is all sort of inferential. We don't really have science around these. sort of behaviors and how their, you know, our brains are affected if, for example, we're listening to music while we're exercising or a podcast or whatever it is. But, and you know, and I would much rather that somebody, you know, exercise and listen to a podcast than not exercise at all. But I do worry a little bit about the ways in which we are always somehow distracting ourselves, you know. And I do think that there's something to be said for, you know, being fully present in that moment.

And I just want to qualify that, you know, when I was a young woman and I, you know, encountered this concept of like, be here now. I didn't really get it because I kept thinking, I must not be doing this right. Because if I were doing this right, like I would be here now and experience the bliss of the Buddha or something like that. But it took me, you know, well into middle age to realize now, oh, no, no, be here now means, okay, this hurts. Like, this is actually not fun, you know, but I'm fully present in the moment. Yes, indeed, I'm here. So I think that there is something to be said for just letting ourselves kind of rest there.

And by the way, in my experience, when we do that, it does open things up. And I don't, you know, have the best words to describe it. But, you know, what I find, for example, when I go for a walk and I almost, I never walk listening to anything, I just walk along. And, you know, initially, my head is full of really annoying ruminations about the things I haven't done, the things I have to. to do, how boring this walk is, I wish it were over. I mean, you know, a million, you know, there's, I love that book Wild by Cheryl Strait. It's wild, right? Isn't that her book? And I love it because, you know, she starts walking, you know, the, I think it's the Appalachian Trail. And she just talks about how like these really annoying commercial vignettes, like jingles keep popping in her

head. You know, it's, it's annoying. Like our, we're just like broken records and blah, blah, blah, but it's instructive. It's instructive be like, oh, look at that, that weird little thought or why do I keep thinking this over and over again? The other thing, too, that I find is that what can often flood in in those moments of, you know, just letting our ruminations carry along is our, what Freud would call our super ego or what's more commonly known as our conscience, where what often gets generated is like really all the things that we should do and that we're neglecting. And I think it's important from a moral

perspective to spend time in that place. Because the only way to alleviate those types of ruminations is to actually go do the shoulds, right? Go and take care of them instead of ignoring them. So anyway, those are just some random thoughts for you today. Are there, we've talked about phones and sugar and these things kind of being negative for our overall dopamine balance. Just to put like a very clear perspective on it, what would be other examples of high dopamine? And then on the flip side, what are those sort of lower dopamine things that we can do to restore our dopamine? Not the hacks that bring it back, but just like the inherently low dopamine activity is like taking a walk. Okay, so first of all, on the high dopamine side, let me just say that there's enormous inter-individual

variability in what, you know, tips one person's balance hard and fast to the side of pleasure may not tip another's. So there's this concept of drug of choice. For example, alcohol does nothing for me. Caffeine doesn't wake me up, but, you know, 10 years ago, if you were to give me a romance novel, I would not have been able to stop reading unless you physically yanked me out of that place. I know. I read about your twilight. I know. Twilight. Twilight. Twilight was my gateway drug. I just think it's so funny, this, like, brilliant Stanford professor and just sitting there being addicted to Twilight. It's amazing.

It's very relatable. Yeah. Yeah. Super embarrassing, right? But anyway, but Twilight's really a good book. Written for teenagers. All right. Yeah.

So, wait, wait, I lost the thread. So individual variability aside. Yeah. So, so obviously. know, we have the intoxicants that sort of everybody knows about. These are drugs and alcohol and things like that. But it's also important to recognize that food has been drugified, adulterated with, you know, chemicals that have been made up in a laboratory and sugar and salt and fat. So, you know, food can be, you know, an intoxicant drug. And also almost, you know, just many,

many things on the internet, whether your drug is video games or social media or pornography or gambling sites or shopping sites. You know, it's all potentially highly addictive. So I think that's important for people to recognize. On the pain side, the things that you can do to kind of press gently on the pain side of balance is really almost any form of exercise as tolerated without injury. You know, ice cold water showers are now sort of very popular and there's science behind it as I talk about in my book.

The neat thing about, you know, these kinds of activities is that there's not this dopamine spike followed by a dopamine plunge, but rather a gradual slow increase of dopamine as we progress in the exercise, which then remains elevated for hours afterwards. But also really just, again, unplugging, doing things that are inconvenient, walking instead of driving, going out in the rain, exposing ourselves to, you know, cold-ish temperatures just on a weather basis, being outside, you know, doing things that are anxiety, provoking, doing things that are cognitively challenging, that also include not constantly interrupting ourselves with our phones and our email and texts, but like tolerating kind of

that moment of frustration when we're not sure what the next idea or a solution will be and kind of waiting for it or, you know, thinking about it. You know, there are a million others. I mean, people can, you know, you can come up with these things, you know, as we go along. so many opportunities to sort of make things just a little bit hard and inconvenient, you know, in the pursuit of really I'm having a better life. It occurs to me, and I guess this would be an extension, like an exaggeration of the first world country, depression, anxiety, suicide rates that we were talking about earlier,

but that very wealthy people never have to have those like little inconveniences. And when you hear about these incredibly wealthy people being dissatisfied, depressed, malcontent, you're kind of like, well, but you have this really nice bath hub that you, for me, a fixation is the separate bath and shower. And I'm like, if you have a bathub that's separate from your shower, how can you be unhappy? Like, I just don't understand that. But it is interesting that, you know, if having to walk to the grocery store and the rain to get your groceries gently presses on that pain side, that if you have,

have a certain amount of wealth, you never have to gently press on the pain side, which could lead, like, ironically, to feeling malcontent unhappy. Yeah, precisely. You know, when I live here in Silicon Valley, and I see that all the time in my practice where people are, have everything, and yet are really unhappy. And then also feel guilty about it, you know, genuinely guilty because it's like, I have everything. I should be, you know, so happy. And yet I'm not. So yeah, you're, you're, absolutely right. Well, and just extrapolate a little bit further, it's like you can, as a not incredibly wealthy person who I'm, I sometimes, I get jealous of people where I'm like, oh, like, I know some very wealthy people and I'm like, oh, their lives are so easy, but it almost makes it

easier to be like, well, I'm actually helping my brain when I'm having these moments of struggle in some ways. And it makes it feel easier to, I guess, move through those and not be jealous of people who appear to quote unquote have it easier? Oh, yeah, I think it's, you know, as a psychiatrist, I get to look under the hood all the time. And I really think that having vast amounts of wealth is a curse and not a blessing. Of course, living in abject poverty is also, you know,

very, very difficult. So, you know, but I really do think that this kind of vast wealth kind of distorts perspective. I mean, imagine growing up, knowing, you know, that you never really had to work a day in your life, it would be really strange. I mean, it would sort of distort everything that you did. So, so I think that, you know, when we assume that other people have it so much better, we're really making a false assumption because everybody struggles. Is there a time of day that you want your dopamine to be higher or lower? I'm thinking about,

I saw this TikTok that was like, in the morning you don't want to flood your body with dopamine by reaching for your phone first thing because it teaches your body that its baseline is an extremely high level because we're getting that huge flood from social media, which makes the rest of your day feel really depressing. So is a low dopamine more, I mean, also I feel as silly as I should, quoting a TikTok too, like a Stanford professor. But is there any truth to that? Well, it's an interesting idea, you know, this idea that's sort of like if you start out with ice cream, like, what else do you have to look forward to? You know, there's no science that I know behind that,

but I think we can infer, you know, some wisdom from that. One thing that is really true is that when it comes to dopamine and reinforcing behaviors, our brains are like little alarm clocks and they're used to seeing it when they're used to seeing it. So if you're used to having, you know, your cup of Java, you know, at 8 a.m. in the morning, if you suddenly switch that up and have it at another time, at 8 a.m. the morning, your brain's going to be going, where is my coffee? So that when we do make changes in our lives, you know, where we try to remove those reinforcing substances and behaviors, we need to be aware that at the time when we usually had our drug

of choice, which for many people is actually the evenings, is going to be a time when we're going to have the most craving. The other thing is that willpower is not an infinite resource. It's a muscular activity of the brain that wanes through the course of the day. So in some ways, if you're going to have your dopamine in moderation, you maybe should do it toward the earlier part of the day when you have a more willpower to exercise around what you use and how much. Because if you wait until the end of the day, that's when we're all tired. and that's when that, you know, that first drink can really more easily turn into three or four. Not that you would want to start drinking in the morning, but it's just important to acknowledge that willpower wanes.

So if you maybe want to do the hard workout or the cold shower or stay off your phone, front loading kind of those gentle pains at the beginning of the day when you still have the mental reserves, to actually do so and you don't have so much decision fatigue that you just can't do anything, will tip the skills in your favor, even if you're tired at the end of the day and you're not doing as well? Well, it's true. I mean, it's tricky. I mean, I think you could come at that again from two angles. You could say that, you know, you should really actually avoid your drug of choice in the evening when you have less willpower to manage it and use it, you know, in planned ways at other times in the day when you have more willpower. So I'm not really sure, you know, what the answer is there.

But that's kind of what my experience tells me. I think that the TikTok really resonated with me because I do find that on days that I start the day with social media, I don't feel depressed for the rest of the day, but I just feel like scattered, distracted, just kind of off. And like I'm not finding joy in other things. And I do think that there is an interesting notion with, of course, the harder but more satisfying and ultimately better thing will be even harder and less enjoyable if you're front-loading

with this like flood of feel-good, immediate pleasure. Yeah. I mean, I think the whenever you do your drug of choice, the key to remember is, again, that there's a cost. There's a price that you pay when you flood your brain with that. dopamine, you're going to go into a dopamine deficit state and experience those universal symptoms of withdrawal, anxiety, irritability, you know, dysphoria, craving so that if you want to have a more productive day, it totally makes sense to not start your day with your drug, right?

Like do all your, you know, what we call in our family, chaos, caes arsera, which is our Spanish term for the things you need to do. You know, get through your to do list, feel a sense of accomplishment. And then maybe it's not unreasonable at the end of that process to give yourself, you know, an hour of social media that you schedule or, you know, have a small glass of wine or whatever it is. But also just, just be aware that that, that, that doesn't then turn into a binge at a point in the day when you are more tired. I very rarely get genuinely excited about skincare, but this is one of the most innovative products that I have come across in years. And I am so obsessed with.

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Yeah. Yeah. I mean, you know, it's not that all pleasurable experiences are bad. And I would say especially if you are engaging in what we call natural rewards, food, clothing, shelter, finding a mate, especially if you are, you have worked for those things. So if you think about that pleasure, pain, balance again, if you are hungry, you know, then your balance is naturally tipping to the side of pain, right? That's a state of wanting and a state of some, you know, mild pain. and then if you eat in response to genuine hunger, that will then level your balance, right? So you've got a signal from your body and your brain, oh, you know, you actually need to eat

some food to survive and then you eat food and then you're back to homeostasis. That's a, I think that's a kind of a pleasure that's healthy and good, you know, when thirsty drink, when hungry eat. I think the Buddha said that. And then I also think it's important to our. on the flip side, the things that we will find more pleasure, right? By doing these dopamine balancing techniques in our lives and incorporating them into our daily lives, the things that we now find boring, we will find more pleasurable, right? That's part of it. Oh, absolutely. So,

you know, in my book, I talk about how I literally did get addicted to romance novels and I was reading them instead of paying attention to my kids, instead of paying attention to my husband. He even brought romance novels at one point to work and was reading and being patience. I know. And basically, I began to experience less pleasure in my work, in my role as mother, the wife. And it was only when I gave them up, which initially was horrible and painful and like really anxiety provoking, that I could then be more present and found more joy in my children and my husband and my work again. I mean, and the same thing with all of these pleasures that when we eliminate them from for a period of time, we do reset our pleasure pain balance. For example,

if you cut out sugar for long enough, I mean, you eat a slice of an orange that will just burst in your mouth, right, with its sweetness. But if you're eating chocolate every day, you know, an orange isn't that exciting. That's interesting. It is, it's a, it's a nice carrot that when you're doing these things that feel really hard, you actually will be bringing. And it feels like a realer, I don't know, it just feels like a more satisfying, fuller, whaler pleasure to the pleasures that you get from, you know, a great hike

or, yeah, a beautiful piece of citrus. Our stone fruit in the summer is my, I just, I think it's the most wonderful thing on the planet. It feels like just a more whole or realer pleasure than when you're kind of mindlessly shoving chocolate into your mouth and you're like, I love this, right? Right. Well, see, I love chocolate. I absolutely love chocolate. And I really don't care for fruit unless I'm not eating chocolate. So, so, you know, again, this, you know, the pleasure pain balance is obviously, it's not quite that simple and, you know, everybody's a little bit different and, and it's possibly even to experience pleasure in pain simultaneously, for example, when we're eating spicy foods.

But, but, yeah, I mean, the general point is just such that it's very hard to believe that we would be attracted to certain things that we're not currently attracted to just by giving up something else that we really like. But, you know, it's, it really works. So I think that we've sort of talked around the idea of a dopamine fast, but I just want to mention it by name because it has. become very trendy. It's, you know, people are like, oh, I'm doing a dopamine fast day. And that literally is just the concept that we've talked about, right, which is abstaining from these

high dopamine flooding things for a set period of time, whether that's a day, a week, a month. Yeah, I mean, I think there are a couple different approaches. One is to choose one thing that we have a conflicted relationship with that we've noticed is kind of taking over our lives to the exclusion of other things and to eliminate that thing for a period of time. The other thinking about a dopamine fast is that you kind of eliminate all pleasurable things, you know, for a certain period of time. That's not generally what I do in my practice with patients, although naturally some patients will say, well, you know, now that I've eliminated this, I think I'm going to try to eliminate

something else. Or some patients will know, you know, if there's no way I'm going to be able to give up smoking, unless I also give up caffeine because whenever I have a cup of coffee, I want a cigarette. So some of those things then are twinned or paired, and it's best to give them both up at the same time in order to be able to abstain from the other. But I generally recommend, I also think it's just like mentally more digestible to think about one thing. You know, one, okay, that one, like, okay, I'm going to, I'm going to get off Facebook or I'm going to get off Instagram or I'm going to, you know, not eat sugar this month. You know, kind of it's more, it's more doable in a lot of ways. And if the drug or behavior is potent enough and people do it

for long enough, they really will notice a difference. And then, as you said before, you know, it becomes its own carrot, right? It's, it's not me telling you. It's you experiencing, wow, I feel better. You know, like, that's so weird. I actually feel better. And then being able to really decide in that feel better place in a clear censorium how you want to interact with that, with that substance or behavior going forward. Do you have any advice to when we are bringing things back into our lives, what healthy moderation looks like? Obviously, it differs from substance to substance. Like chocolate recommendations would be different than Instagram recommendations.

But I do, you know, you hear a lot of people doing sober January and then they start drinking again in February and they're like, oh, I only need, you know, a glass. class of wine once a week, but then it goes up to every other day and then it goes up to every night. So how do we achieve that moderation after the dopamine fast? Well, it's a challenge and it requires a lot of planning and a lot of effort. But I talk in my book at length about self-binding strategies and basically how before going back to moderation, it's really necessary to set up a lot of barriers between ourselves and our drug of choice based on time, based on literal geographic.

barriers and physical barriers based on categorizations. I'm going to have beer, but I'm not going to have hard liquor, you know, or whatever it is, I'm going to, I can go on Facebook, but I can't go on Instagram. And then just basically experimenting, but doing it in a way that's very honest by like actually keeping track. I'm talking with somebody else, doing it with a buddy, noticing when you're slipping, I'm trying to avoid daily use to give enough time in between for gremlins to hop off. So, you know, people then need to do their own honest, ongoing experiments. Some people are able to achieve moderation. Others find ultimately it's not worth the effort and that abstinence is actually easier for them. But these are all sort of life

experiments. The point is really that they're life experiments that are worth doing. Can you leave us with one homework assignment for bringing our dopamine levels into balance something like super simple and pragmatic that we can start doing today? I suggest that each of us takes 24 hours, 24 to 48 hours, not touching or looking at a single screen or digital device. And, you know, we can prepare for that by letting people know, I'll be out of touch, I'll be out of reach, doing it with a buddy, planning an in real life activity to, you know, sort of engage ourselves during that time period.

But it is very instructive and informative to do that and also incredibly hard. And that would be my, you know, even if it's just 24 hours, see if you can go 24 hours and don't look at your phone or your computer, don't touch it, and just observe, like, what you're experiencing in that time. I'm like, what am I going to do for the time? I know, right? I almost my immediate instinct is to like go camping or something where I'm fully removing it. Or you know what?

You might be cleaning out your closet, scrubbing your toilets, you know, taking on that hobby that you've been wanting to do for the last five years that you never really started. Which again might sound boring at first and feel hard at first, but it will get more satisfying and get more fun as you get your dopamine levels back into balance. There you go. All right. All right. I think we can all do that. I am obviously going to talk a lot about your book at the beginning of the episode, but is there anything else that you would like to share about your work and your own words or where people can find you? No. Thanks for having me. Very grateful to be on. It was

great conversation. And I'm just grateful for a platform to spread these ideas, which I do really believe in as a way to help people. Thank you so much, Dr. Lemke. There was so many informative, useful takeaways, and it was lovely talking to you too. You're listening to the Healthier Together podcast. So interesting, right? Okay, so there are two main things that I wanted to share that I've been thinking about since I recorded the episode and that have really fundamentally changed the way that I moved through the world. The first is, and this might sound dramatic, but it's really true, literally just doing this

interview changed my notion of wealth and my desire to be wealthy. Like, I want to have money and take vacations and all of that, but I have spent years thinking of the advantage of accumulating wealth as eliminating the discomfort in my life. And I think that that's been so appealing for so long because I associate my anxiety with being so uncomfortable all the time. And I know that there's that stat about after like a certain level of income, I think it's like 70K, people aren't any happier. But I was always like, okay, that is truly bullshit. Because if you have more money, you can get a therapist, you can have someone shot for your groceries, you can have someone clean your house, you can just eliminate everything bad from your life and fill it with all

of the good stuff. And then this interview with Dr. Lemke fully flipped that on its head because it reframe discomfort as a good thing. Like getting your own groceries in the rain is good for your dopamine, doing your dishes, the discomforts of living life, it's good for your dopamine. So the really wealthy people who can eliminate all of that discomfort actually feel worse on a day-to-day basis because they don't have the little pleasure gremlins hopping on the seesaw to balance the pain gremlins, as Dr. Lemke would say. It made this statistic make so much more sense to me, and it also made all of the incredibly wealthy people and celebrities who are really, and happy make more sense too. And all of that just totally recalibrated my goals.

And the second thing is, the interview made doing hard things so much easier for me. Like every day I stand in the shower and I'm like, I don't want to make it cold. I don't want to make it cold. But then I'm like, it's going to make the rest of my life feel better. So I do it. Same with workouts or putting down TikTok or slugging through a boring work problem or doing an annoying chore. I have so much more motivation to do these types of things because I now know that they're balancing my dopamine and they're making it that much easier for my pleasure gremlin to hop on the seesaw. I've honestly probably had more luck doing the hard things in my life since I interviewed Dr. Lemke. Like I've done more hard things since that interview than I've done

cumulatively for the six months before. And I felt better about doing them and I've procrastinated less, and it's just been so helpful for my motivation. Beyond that, well, I am probably not going to do a month or even a week of no screens. I am going to try a screen-free day once a week. And I also love the idea of sometimes just doing nothing, like not reaching for my phone in every little minute, taking walks without it. Like, I know this is gross, but I'm one of those people who will bring my phone to the bathroom. And I like the idea of not having my phone in the bathroom just sitting there and doing my business and then leaving the bathroom. Things like that, just like these little pockets of time to sit and just be and just do nothing. I do think that every

little bit matters and I am excited to see how it all benefits my ability to take pleasure in simple things and enjoy things that I might be bored by now. Anyway, I am so eager to know your thought. So please let me know. And if there's anyone in your life that you think would benefit from this episode, please send them the link. Then you could have someone in real life to talk through it all with because I know there is a lot to unpack here. And if you're new here, if you were sent this episode by someone else, first of all, welcome. I am so glad that you're here. Do not forget to subscribe on whatever platform that you're on so you don't miss out on any future episodes. We have so much good stuff coming up. And we also have almost 100 episodes.

of amazing content to go back and listen to if you would like. All right, that's it for me. I love you guys and I will see you on the next episode of the Healthy Together podcast.